A recent Japanese study (1) reasserts the correlation between ABO blood group and secretor status and intestinal alkaline phosphatase (IAP), an enzyme that aids digestion of fat in the diet. The study also concludes that evaluation of metabolic syndrome would be better if ABO blood group and secretor status are taken into account.

The abstact of the study, to be published in the journal Biochemical and Biophysical Research Communications, starts:

"Serum levels of intestinal alkaline phosphatase (IAP), a protein implicated in transcellular transport of chylomicrons, vary among ABO blood groups."

Background: the body produces proteins which bind with lipids (fats) and are transported around the bloodstream together as lipoproteins, where the fats are needed or stored. One way of measuring the amount of lipids transported in the blood is by measuring the proteins associated with lipid transport. An apolipoprotein is the protein component that combines with a lipid to form a lipoprotein. Chylomicrons are lipoprotein particles that are created by cells in the small intestine. Chylomicrons transport lipids to adipose tissue.

Variation in IAP according to blood group has been known for decades from previous studies, and is one of the reasons why individuals of different blood groups vary in their tolerance and metabolism of dietary fats.

To determine whether IAP is associated with chylomicron secretion in humans as well as rats, the researchers used the following method:

"Serum samples from 40 healthy subjects were obtained after overnight fast and 3h after a high-fat meal, and assayed for IAP and apolipoprotein B-48 (apoB-48), both proteins exclusive to intestine, although only apoB-48 is found in chylomicrons.

"The two proteins were greater in subjects without blood antigen A (B and O) than in those with this antigen (A and A; 2.4- and 4.7-fold for IAP and 1.5- and 2.0-fold for apoB-48 before and after the meal, respectively."

This is a significant difference between IAP and apoB-48 levels even when fasting.

The study concludes:

"Moreover, IAP and apoB-48 levels were strongly correlated in the subjects with the secretor phenotype (r>0.81). These results indicate that IAP is strongly involved in chylomicron formation and fatty acid metabolism might change among ABO blood type."

"In addition, ABO blood type classification in apoB-48 measurement would improve the diagnostic value in the evaluation of metabolic syndrome."

In other words, this is a mechanism by which non-secretors are more likely to get syndrome X than are secretors, and can be monitored with blood tests for IAP and apoB-48.

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Reference:

Involvement of intestinal alkaline phosphatase in serum apolipoprotein B-48 level and its association with ABO and secretor blood group types.

Nakano T, Shimanuki T, Matsushita M, et. al.

Biochem Biophys Res Commun, January 5, 2006.

Pubmed [16412386 ]

Are there diet options that will assist in quit smoking? Most difficult hurdle to quit. Am 53 years of age and have smoked since 9 years of age. Tried every marketed product. What's the crazy 'noose' that holds this habit inside my life so strongly? Better, what is the solution to ridding of this nasty and lethal habit? Thanks for your advice.

Antoinette

The World Health Organization estimates that tobacco kills around 4.9 million people a year, and that this will rise to 10 million by 2030 (1).

Smoking predisposes and contributes to cell-damaging changes throughout the body. Smokers have a greater incidence of coronary heart disease, myocardial infarction, peripheral vascular disease and reduced healing rates. People with diabetes and women who use oral contraceptives are at higher risk of circulatory problems, and respiratory disease is higher among smokers. Smoking increases the risk and severity of oral cancer, periodontal disease, and premalignancy in the oral cavity (see previous article on smoking).

A study on how dentists can play a part in helping their patients to give up smoking using a point of care test for measuring salivary nicotine metabolites (2) improved smoking quit rates by 17% at eight weeks.

A saliva test carried out during the visit to the dentist gave patients a visual scale of the level of toxic substances in the blood. Patients were given verbal counselling on smoking cessation, information about the effects of smoking on oral health (including photographs of smoking related disease), and literature packs. They were then asked to attend the dental clinic eight weeks later, with the objective of smoking cessation as measured by self report and confirmed by a salivary nicotine metabolite value of zero.

At eight weeks the saliva test showed that quit rates had improved significantly, with 23% of cases quitting compared with 6% of controls (based on the number of patients who attended the follow-up).

The authors recommend: "The identification, documentation, screening, and treatment of every tobacco user should become standard practice in all healthcare environments."

It appears that personalised feedback on exposure to tobacco derived toxins can improve motivation to quit smoking. Immediate and personalised biofeedback from the test reinforced counselling and placed potential quitters in a more supportive environment.

You may wish to consult your dentist on stopping smoking, however your naturopath may be able to offer further assistance:

In natural medicine the herb Lobelia inflata has been used to help people stop smoking. An active ingredient in the lobelia plant, lobeline, is similar to nicotine in its effect on the body. Like nicotine, it stimulates nerves in the central nervous system. In fact, lobeline has been used as a nicotine substitute in many anti-smoking products and preparations designed to break the smoking habit. In 1993, however, the U.S. Food and Drug Administration (FDA) prohibited the sale of lobeline-containing smoking products because, according to the FDA report, they lacked effectiveness in helping people quit or reduce smoking.

It is important to note that lobelia is a potentially toxic herb. Lobelia can be safely used in very small doses (particularly homeopathic doses), but moderate to large doses can cause serious adverse effects ranging from dry mouth and nausea to convulsions and even coma. Under the guidance of a qualified healthcare practitioner, however, lobelia, in combination with other herbs that affect the respiratory system, is considered relatively safe.

In homoeopathy there are various other remedies that may be used to help individuals stop smoking, including Caladium Seguinum, Natrum Carbonicum and Sepia, depending on the clinical picture.

References:

(1) World Health Organization. Annual report from WHO's tobacco free initiative. Geneva: WHO, 1999.

(2) Effect of incorporating a 10 minute point of care test for salivary nicotine metabolites into a general practice based smoking cessation programme: randomised controlled trial.

Barnfather KD, Cope GF, Chapple IL.

BMJ. 2005 Oct 29;331(7523):999.

PMID: [16210250]

Cœliac disease is believed to affect 0.3-1% of the population in almost all countries and ethnic groups where it has been investigated. Previously regarded largely as a childhood problem it is now recognised to affect mostly adults, with about 25% of diagnoses being made in people over 60 years of age. Typically the presenting features of malabsorption (diarrhoea and weight loss) are suggestive of cœliac disease, but case presentations in the BMJ indicate that often few or no gastrointestinal symptoms are present, and some people with the condition can even be obese. The condition may also present insidiously, for example, with iron deficiency anaemia, osteoporosis or neurological symptoms

Historically diagnosis is based on atrophy of the lining of the small intestine, which recovers on a gluten-free diet. An endoscopic examination is needed to see this. Since antibody testing has become available, anti-endomysial and anti-transglutaminase antibodies are often used as a preliminary and less invasive method of screening.

Where both intestinal atrophy and blood antibodies are found the diagnosis of cœliac disease is straightforward. Difficulties arise when one or other of these is not found, and the diagnosis is particularly difficult when both are negative. The objective of orthodox medical diagnosis of cœliac disease is to determine treatment, i.e. a gluten-free diet. Some individuals with cœliac disease have no symptoms and find a gluten-free diet very limiting. When the diagnosis is in doubt and individuals have few or no classical symptoms of cœliac disease, treatment approach is more problematic.

Intestinal biopsy needs expertise: the disease may be patchy, so biopsies from several sites in the upper intestine should be carried out, and although cœliac disease is regarded as an upper small intestinal disorder, it is possible for atrophy to be present at the far end of the small intestine. If endoscopy is carried out following a positive antibody test, the individual may have already started a gluten-free diet, and the results of endoscopy can then be negative.

The results of antibody testing in any area depend on the population used to standardise the test, the particular test used, and the laboratory expertise. A combination of anti-endomysial and anti-transglutaminase antibodies is often used, and can be highly predictive of the condition. Antibody negative cases of cœliac disease do occur, a possible reason for this is IgA deficiency. This is more common in cœliac disease and since anti-endomysial and anti-transglutaminase antibodies are normally measured as immunoglobulin A antibodies they will be absent in individuals with IgA deficiency. Therefore in patients with IgA deficiency, IgG anti-endomysial and anti-transglutaminase antibodies need to be checked.

There is a strong association between being an ABH non-secretor and having overt cœliac disease. Non secretors being about 200% more likely to be cœliacs than secretors. Non-secretors also have lower levels of IgA than secretors. One study reported that up to 48% of patients with cœliac disease were reported to be ABH non-secretors. This appears to be especially true for the Lewis negative (a-b-) phenotype. Evidence suggests an increased prevalence of complications and cœliac-associated abnormalities is also found in non-secreting and Lewis negative individuals with cœliac disease.

This may go some way to explaining the 'atypical' cases of cœliac disease reported in the BMJ. Gluten-free diets are usually heavily reliant on corn/maize-based substitutes. Using corn as a staple is likely to increase weight due to the inhibiting effect it has on insulin production, which may cause weight gain, particularly in non-secretors, who are more prone to syndrome X.

The possibility of cœliac disease should be borne in mind even with 'atypical' presentations and negative diagnostic results. It would appear that eating according to reccomendations of blood group and secretor status would still be of benefit when diagnosed as cœliac or not, although with a positive diagnosis of cœliac disease gluten should also be avoided.

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References

Saunders DS, Hurlstone DP, McAlindon ME, Hadjivassiliou M, Cross SS, Wild G, et al.

Antibody negative coeliac disease presenting with coeliac crisis in the elderly people—an easily missed diagnosis.

BMJ 2005;330: 775-6.

PMID 15802721



Furse RM, Mee AS.

Atypical presentation of coeliac disease.

BMJ 2005;330: 773-4.

PMID 15802720

Pathbase 3.0 - Celiac disease

A study at the Hamad General Hospital in the State of Qatar on hearing loss in children (1) found a significant correlation between hearing loss (HL) and Rhesus blood groups. The study was intended to look at consanguinity (where the child's parents are related by blood or descended from a common ancestor) and other parental factors, and consanguinity was also found to have an association with HL, as well as high blood pressure in the father and illiteracy or family history of HL of either parent.

The finding in this study that if the mother's Rhesus blood group was Rh positive the child had a higher risk of HL is not the first connection to be found between blood groups and HL, as a previous study found blood group O to be at highest risk of noise-induced HL.

Further research combining the effects of these two common blood group factors could be useful in screening for and preventing HL in individuals at higher risk.

References:

1. Bener A, Eihakeem AA,Abdulhadi K

Is there any association between consanguinity and hearing loss.

Int J Pediatr Otorhinolaryngol, March 1, 2005; 69(3): 327-33.

Pubmed 15733591

2. Dogru H, Tuz M, Uygur K

Acta Otolaryngol. 2003 Oct;123(8):941-2.

Correlation between blood group and noise-induced hearing loss.

Pubmed 14606597

The idea of the 'Polypill' was first mooted in 2003 by Professors Nick Wald and Malcolm Law of London’s Wolfson Institute of Preventive Medicine (1), suggesting that if everyone over age 55 and anyone with existing cardiovascular disease took a single pill per day without screening, ischaemic heart disease events would be reduced by 88% and stroke by 80%. Side effects would be “minimal” (only 15% of those taking the pill).

The polypill proposed by Wald and Law would have six ingredients: a statin, aspirin, folic acid, and three antihypertensives (a thiazide, a ß blocker, and an angiotensin converting enzyme inhibitor), all at half dose. The combination, the authors said, would prevent heart disease and stroke by reducing four different risk factors—blood pressure, lipid concentration, homocysteine concentration, and platelet function. Financial considerations reduce the cost-benefit ratio: if the Polypill included the three classes of blood pressure lowering drugs with the lowest prevalence of adverse effects (thiazide, angiotensin II receptor antagonist, and calcium channel blocker) instead of the three with the cheapest ingredients (thiazide, ß blocker and ACE inhibitor) only 8% of those taking the pill would suffer adverse symptoms.

At a recent meeting of experts organised by the US Centers for Disease Control in Atlanta it was suggested that three powerful groups are threatened by the Polypill idea: the drug industry, doctors, and the public health lobby, which “generally favours lifestyle change over mass drug treatment”. The drug industry and doctors obviously stand to lose income and clientele from removing individualised diagnosis, treatment and prescription, as the Polypill will no longer need consultations and can use generic components that are not subject to patent protection. The public health lobby however could lose the option of personalised healthcare, and the right to take control of their own health and prevent disease through the natural self-healing ability of the body when using appropriate diet and natural medicine according to individual need without any side effects.

The fact that while statins can perform the dubious task of lowering cholesterol levels in healthy individuals, it can also cause cardiomyopathy by depletion of coenzyme Q-10, is one of the ironies of both statins and the Polypill concept, apart from the rarer side-effects of rhabdomolysis, memory loss and hepatitis, however statins are now available over the counter in the UK without prescription, with no inclusion of or recommendation to take co Q-10. Beta-blockers are well known for their mind-numbing effects as well as their unsuitability for those with asthma. Hypokalaemia (potassium deficiency) may occur with thiazide diuretics. ACE inhibitors can cause acute renal failure, more common in the older population. Aspirin is unsuitable for those with salicylate intolerance, and causes internal bleeding, particularly in individuals of blood group O, however the authors say that the risk of increase in haemorrhagic stroke (from bleeding) would be exceeded by the reduction in thrombotic strokes (from a blood clot), giving the all-important cost-benefit ratio. The authors failed to mention natural medicines that prevent strokes from bleeding without any side-effects. The authors say about a third of people taking the Polypill would ‘benefit’ overall (at the expense of half of this number of people having side-effects).

The only useful thing about this concept is that it raises the profile of the significance of homocysteinaemia in cardiovascular disease. [The role of folic acid for reduction of homocysteine is well documented, however research suggests that synthetic folate supplementation (pteroyl-L-monoglutamic acid, a product of the pharmaceutical industry which rarely occurs in nature) could cause an increase in the incidence of breast cancer (2). The authors of this paper would wish that it be considered as nothing more than a 'research pointer', as the number of deaths in the study was small (31 actual deaths), and the findings were balanced with commentary and several notes of caution, although the article has already caused front page headline reactions in the tabloid press. Although we are told in the research that the "tablets were supplied in six colours, two of which contained folate in 0.2 mg and 5 mg daily doses”, what is not reported is which colouring agents were used, and whether carcinogenic azo dyes had an influence on the results].

Interestingly a version of the polypill is likely to appear on the market in India by the end of 2005, as the authors stated “widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention”. Is it that resistance would be less from the three major groups who could influence the acceptability of the Polypill idea would have less influence in India? The recipients of the pill are unlikely to be monitored for side-effects due to the fact that “the tests lack specificity, so the increased risk of cardiovascular disease after stopping the drug in people positive on monitoring may outweigh any benefit” – the cost-benefit ratio again.

Based on the potential costs and adverse effects of the Polypill, the concept of the Polymeal was raised in 2004 (3) with the objective of identifying “an effective, non-pharmacological, safe, cheap, and tasty alternative to reduce cardiovascular morbidity and increase life expectancy in the general population”. The ironic tone of this article suggests that an “evidence based recipe” includes wine, fish, dark chocolate, fruits, vegetables, garlic, and almonds. Using similar analysis to that of the Polypill study, the authors state that “combining all the ingredients of the Polymeal resulted in cardiovascular disease being reduced by 76%. Whether increasing the amount of each ingredient would increase the effect of the Polymeal is uncertain”.

The article was published just before Christmas and makes amusing reading: if the Polypill ingredients were used to fortify flour used in Polymeals, “redundant cardiologists could be retrained as Polymeal chefs and wine advisers”. There are however some serious conclusions: “Pharmacological interventions are not the only option for preventing heart disease; a healthy diet and an active lifestyle reduce cardiovascular disease as well”. It is unfortunate that the idea of a healthy diet is not taken seriously by the medical community at large, and the article had to be presented as a joke.

The concept behind the Polymeal article could also be applied to the idea of the Polypill: “The preventive strategy outlined here is radical. But the ‘healthy person’ is an outdated concept from the era before scientific prevention. We should recognise that in Western society we all have cardiovascular risk factors, so everyone is at risk, and the diseases they cause are common and often fatal.”

What the authors of both Poly- studies fail to appreciate (or admit) is that some individuals are at greater risk of heart disease than others, and the cost-benefit ratio of many foods are different according to some easily-measured factors, not least ABO blood group and salivary secretor status. If individuals were given access to the information about simple food choices on a large scale they could take control of their own health.

References:

1. A strategy to reduce cardiovascular disease by more than 80%.

Wald N J and Law M R, BMJ 2003 326: 1419.

2. Taking folate in pregnancy and risk of maternal breast cancer.

Charles D, Ness AR, Campbell D et. al., BMJ 2004;329:1375-1376.

3. The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%.

Franco OH, Bonneux L, de Laet C et. al., BMJ 2004;329:1447-1450