A news article from the BBC suggests that the UK government may be overlooking research that contradicts the link between childhood obesity and exercise.
The government supports exercise for children, while apparently not acknowledging that other factors such as genetics, diet and socioeconomic status could be more significant in preventing childhood obesity. A long-term research programme, the EarlyBird Study was established to explore a possible causal link between the rising incidence of type 1 diabetes and insulin resistance. Type II diabetes, formerly known as "late onset", was renamed due to the increasing prevalence in children. Results from the EarlyBird Study assert that Type I and type II diabetes are the same disorder of insulin resistance, set against different genetic backgrounds.
The EarlyBird study has looked at many variables in 307 children from age 5 over an extended period of time, including anthropometrics, birth weight, body composition, fat distribution, dietary habits, energy expenditure, genetics, demography, heart rate variation and physical activity on insulin resistance and its metabolic correlates (including haematology profile, glucose, cholesterol, HDL cholesterol, triglycerides, uric acid, HbA1C, FSH, LH, serum IGF1, adiponectin, leptin, IGF-1, gonadotrophins and SHBG, C-reactive peptide hcCRP - a marker of inflammation, as insulin resistance is "fundamentally a state of low grade inflammation").
The findings of the study cast doubts on the government's strategy to halt the increase in childhood obesity by the end of the decade, largely by encouraging physical activity. Results from the programme so far have produced several published papers, some concluding that increasing exercise is not necessarily the best way to prevent obesity:
The programme director, Professor Terence Wilkin, said "children's activity levels had no bearing on their body mass index" (a measure of obesity risk in the growing child). His team has been unsuccessful in their appeal to government ministers for funding to continue the study. The BBC also quotes Professor Philip James, from the International Obesity Task Force, who said it was much easier for the government to concentrate on promoting sport rather than taking on the food industry, which has "enormous political and strategic power".
The EarlyBird Study is another example of the kind of research that should be promoted, as it is holistic in outlook, starting early in life, before diseases have become irreversible, it measures many variables and challenges the status quo, which is often maintained by vested financial and political interests. The following are some examples of other conclusions reached from the study:
Meanwhile, Canadian genetics research at Montréal's McGill University have found four additional SNPs implicated in type II diabetes. As well as the known TCF7L2 gene (transcription factor 7-like 2, on chromosome 10), the presence of multiple gene associations "constitute proof of principle for the genome-wide approach to the elucidation of complex genetic traits."
Q: I am interested in trying a fast regime since I found out accidentally that fasting relieved my pain. The couple of times I just didn't eat all day for some reason I felt good then I asked my doctor only to be scolded. But I asked my acupuncturist and she said that she believed it could work but to be very careful. I am not overweight. How often would you suggest one to do these 8 day fasts? I have suffered from Rheumatoid arthritis for 20 years and am on humira and herbs. I do yoga and walk and eat pretty healthy. Thank you, peace. Michelle
Humira is an injectable protein that blocks the inflammatory effects of tumor necrosis factor alpha (TNF a), an inflammatory cytokine. The medication has potentially serious side-effects, and the extent to which these are currently present, combined with the risk of getting further side-effects are compared with the symptom relief gained from using it form part of the decision process (cost-benefit ratio) when choosing this therapy. Easily obtainable alternatives to pharmaceutical medication with few side-effects that have a long history in the treatment of inflammatory arthritis and have incidentally been shown in studies to decrease TNF a include the spice turmeric and the rhizome of ginger.
The reason fasting can relieve the pain of rheumatoid arthritis may be related to reduced lectin intake and the possibility that some lectins (such as wheat and lentil) may promote inflammation in joint cartilage.
Strict fasting, or the abstention from all food while drinking only water, also has a long history in natural medicine, and is safe when carried out in proportion to your constitution and vitality, although any fast longer than two days should be supervised. Sometimes it may be better to start with a modified fast (e.g. vegetable juice only). Fasting is a good way of finding out exactly which foods are causing the pain: by gradually introducing foods one at a time after a period of abstention until the pain returns. The best way to do this is with the support of a naturopathic physician who will carry out tests for blood group and secretor status, and help with the introduction of foods which are most likely to be of benefit to individuals of a particular type while monitoring nutritional status.
Although some published research and much anecdotal evidence exists to show the benefits of yoga for patients with osteoarthritis, there is little published evidence for a therapeutic effect on those with rheumatoid arthritis, although yoga is often cited as a suitable low impact mobility exercise. In the Western world, yoga is seen as simply a collection of physical postures. The word originates however from one of the six schools of Hindu philosophy, focusing on meditation as a path to self-knowledge and liberation, a means to both physiological and spiritual mastery. Another form of spiritual self-discipline which has been used in scientific studies is Falun Gong, an ancient Chinese Qigong. This has been shown to alter gene expression of practitioners in favour of enhanced immunity, downregulation of cellular metabolism, and alteration of apoptotic genes in favor of a rapid resolution of inflammation. The cost-benefit ratio may be good, as the therapy involves the low-risk activities of daily reading of Falun Gong books and daily practice of exercises lasting 1-2 hours, although participants in the study had been practitioners for between 1-5 years.
Many pharmaceutical companies provide Continuing Medical Education (CME) for prescribing physicians. Although these programmes run by drug companies do not overtly market their drugs, physicians may get the impression that a disease or condition is underdiagnosed and best treated with a prescription. Following on from the previous column about the influence of pharmaceutical companies on medical research there is now a resource listing ways for physicians to complete their CME credits without being influenced by the bias of drug companies.
The online resource, PharmedOut is an independent project run by Georgetown University School of Medicine staff members for physicians and other prescribers:
PharmedOut is one of more than 20 programmes funded by a $21 million grant from the Attorney General Consumer and Prescriber Grant Program that are intended to teach physicians and nurses to more critically evaluate information from pharmaceutical companies about prescription drugs. Ironically the funding for the grant comes from a drug company, a settlement from a court case about unlawful marketing of a drug:
The grant will fund programs designed to provide health care professionals and consumers information relating to prescription drugs, including the way in which drugs are marketed.
Mini syllabi available on PharmedOut include:
* Your Friendly Drug Rep
* Why You Get Samples
* Industry Sponsored Research
* Disease Mongering
* Direct to Consumer (DTC) Promotion
Resources also include many links to other websites of similar organisations. The CME suggestions include the National Center for Complementary and Alternative Medicine (NCCAM) video lecture series, along with many other options.
Pharmaceutical companies may be biasing the design of many large clinical trials to simply satisfy their own marketing needs rather than answering important clinical questions that may have a major influence on public health. According to an article in the New England Journal of Medicine (NEJM), both outcomes would be desirable in an ideal world, and are not mutually exclusive.
The NEJM article comments on a study published in The Lancet, the MEDAL programme, which compares the side-effects of two Cyclo-oxygenase-2 (COX-2) inhibitor non-steroidal anti-inflammatory drugs (NSAIDs): etoricoxib (Merck), and diclofenac (a 'well-tolerated' generic drug in use for over 30 years). This column has previously reported on the widely known association between COX-2 selective inhibitors and an increased risk of thrombotic cardiovascular events in placebo-controlled trials. The Lancet study also compared the risk of gastro-intestinal complications (Inhibition of COX reduces prostaglandins in the lining of the stomach, making it more sensitive to corrosion by gastric secretions).
The Lancet study states:
The conclusion of the study is:
At first glance it may appear that the study usefully demonstrates the comparative cardiovascular risks of the traditional NSAID diclofenac, previously held to be well tolerated (but also a drug that is poisoning vultures in India ), while etoricoxib had a lower risk of gastrointestinal side-effects. The NEJM article however points out that the relative COX-2 selectivity of diclofenac is similar to that of celecoxib, and that the potential for increased cardiovascular risk with celecoxib may actually be higher than that of naproxen by 70% (naproxen is also a COX-2 inhibitor). In addition, the Arthritis and Drug Safety and Risk Management Advisory Committees of the Food and Drug Administration recommended naproxen, not diclofenac, as the "preferred comparator" for large trials of COX-2 inhibitors. So why was diclofenac the drug chosen for comparison? In an interview with the NEJM, Dr. Robert Califf, vice chancellor for clinical research at Duke University said:
Dr. Califf suggests that if the study had been designed in a public forum it would "almost certainly" have used naproxen, and possibly a placebo, in which case it is unlikely that the company would spend hundreds of millions of dollars funding a study that would be likely to have adverse outcomes for their drug, but this is "probably about as good as it gets in the current system".
The NEJM article concludes:
The incentive to attract pharmaceutical companies to invest in clinical trials designed by an independent unbiased process could be the perceived impartiality of such a process, which would encourage sponsors to evaluate their drugs in a manner that highlights their potential clinical value and not their anticipated marketing potential. If a non-commercially funded body were designing clinical trials such as the MEDAL programme, there are many natural medicines without severe adverse side-effects which could also have the chance of being compared with pharmaceutical medicines in addition to using a placebo, and the results would probably be universally accepted rather than seen as simply adding to the plethora of biased pharmaceutical-funded drug trials.
The enzyme transglutaminase, which is added to some breads and croissants to make the dough more pliable, may act upon gliadin (a glycoprotein present in glutenous cereals) to generate the epitope associated with the coeliac response and with anaphylaxis to wheat.
A letter by two researchers in New Zealand published in the journal Trends in Food Science & Technology suggests that transglutaminase (TG) should not be added to cereal products containing wheat, barley, rye or oats until safety checks have been carried out.
A researcher from the biochemistry laboratory in the Centre Hospitalier Chubert , Vannes in France later published an article in the journal Allergie et immunologie about the rôle of TG in both coeliac disease and wheat-dependent exercise-induced anaphylaxis (multi-system allergic reaction on exposure to wheat and during subsequent exercise). The latter condition is not necessarily linked to gluten intolerance, but involves an IgE response.
Transglutaminases transform proteins by deamidation and/or transamidation, the latter cross-links proteins together. New epitopes have been suspected in cases of anaphylaxis to wheat isolates (a food ingredient consisting mainly of deamidated gluten proteins). As a microbial TG is included in many food technological processes, the author concludes: "its safe use should be checked. This assessment must cover not only the safety of the TG itself but also that of the deamidated/cross-linked proteins generated by this enzyme."
Diagnosis of wheat intolerance using skin prick testing and sensitization against wheat proteins is not very accurate. As a result of this, the number of individuals diagnosed with irritable bowel syndrome (IBS) patients who have "food allergy" may be larger than believed. If the interaction with the lectins in wheat germ agglutinin and blood group antigens is taken into account, a lot of the dietary intolerances to eating grain-based foods can be explained. Additives in factory-made baked goods is another reason to eat organically produced bread, with ingredients according to blood group.