A review in the British Medical Journal found that anti-inflammatory drugs cause heart disease. The use of selective cyclooxygenase-2 inhibitors (a type of anti-inflammatory) is associated with a 1.4-fold increase in the risk of heart attack, stroke, or death from vascular disease compared with placebo. Further, large doses of diclofenac and ibuprofen are also associated with an increased risk. In a meta-analysis of 138 randomised trials and almost 150 000 participants, Kearney et. al. (1) found that the hazard was not confined to long term use only.

Cyclooxygenase-2 (COX 2) inhibitors were regarded as a preferable alternative to conventional non-steroidal anti-inflammatories (NSAIDS) for some conditions, particularly arthritis. The inhibition of cyclooxygenase-2 has been more directly implicated in ameliorating inflammation, whereas the inhibition of cyclooxygenase-1 (older NSAIDS like diclofenac and ibuprofen inhibit COX 1 along with COX 2) has been related to adverse effects in the gastrointestinal tract (indigestion, abdominal pain, gastric or duodenal perforation or bleeding). Therefore, it was hoped that coxibs would be better tolerated than nonselective NSAIDs but equally effective.

The suspicion that COX 2 inhibitors could cause heart problems was raised by a 2001 review in the New England Journal of Medicine (2).

We must gather additional information on the pharmacology of the coxibs. Given the cardiovascular findings in the VIGOR (Vioxx Gastrointestinal Outcomes Research) trial and the association of both rofecoxib and celecoxib with small, but potentially clinically relevant, changes in blood pressure, elucidation of the cardiovascular and renal effects of these drugs and their interactions with potential adjuvant therapies, such as low-dose aspirin, is imperative.

A risk analysis was therefore required as to which was worse in individuals who could not tolerate conventional NSAIDs: increased risk of heart disease vs. pain from arthritis.

Add this average increased global risk of adverse myocardial and vascular events for people taking NSAIDS to the already elevated risk of individuals with blood group A, AB and non-secretors or Lewis negative, and you may feel your heart miss a beat.

The choice between different anti-inflammatory regimens requires assessment of the individual expected absolute attributable risks of cardiovascular and serious gastrointestinal events.

This sounds like wise advice from the BMJ, but how much can orthodox medicine judge "individual expected absolute attributable risks" without knowing the individual patient in depth?

In naturopathic medicine simply blocking the pain and saying a person is cured is like opening the windows to let the smoke out while the fire rages below. There are numerous anti-inflammatory herbs and natural medicines (ignored in mainstream studies) with far fewer side effects than pharmaceuticals, but a naturopathic physician will also address the cause of the problem in the individual.

Kidney disease is a side effect of high-dose analgesic paracetamol (acetaminophen), but remains widely available. Rofecoxib (a COX 2 inhibitor) was withdrawn from the market on September 30th 2004 because of concerns over myocardial infarction. Let's hope the other pharmaceutical NSAIDs follow soon, people will have to look into dietary and lifestyle changes to prevent inflammation, and natural medicines will get the attention they deserve.

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A large proportion of biomedical research is funded by the pharmaceutical industry. The extent to which this affects the outcome of academic research was investigated by Patsopoulos et. al. in the British Medical Journal.[1] The authors conclude that industry funding of randomised controlled trials are a form of advertising for the products that are the subject of the study. This is due to weight of numbers: there are more studies on drugs than on lifestyle interventions or non-patentable medicines (such as herbal medicine for example), which results in the drug studies being cited more often in academic papers.

The research found that:

"Since 1994, biotechnology and drug companies have provided funding to an increasing proportion of frequently cited studies", and

"Industry funding has become ubiquitous for frequently cited randomised controlled trials, and most of these influential trials have no other sources of funding".

"Since 1994, biotechnology and drug companies have provided funding to an increasing proportion of frequently cited studies", and

"Industry funding has become ubiquitous for frequently cited randomised controlled trials, and most of these influential trials have no other sources of funding".

The authors conclude that many important questions in clinical research have no connections with specific products and thus would not be supported by industry. Such questions may never be funded or may not be cited frequently once published. They forsee the scenario of "Academic Inc," with academic medicine evolving into an efficient enterprise that is directed by profit and has strong ties to other profit making corporate structures.

One effect of the huge amount of industry-funded research is that national guidelines may be biased towards the better quality studies.[2]

For example, most of the evidence on which the 2004 NICE (National Institute for Health and Clinical Excellence) guidelines on dyspepsia are based came from randomised controlled trials funded by industry. This created several distortions in the evidence base:

Firstly, evidence from trials of proton pump inhibitors was abundant compared with data for off-patent treatments such as metoclopramide or lifestyle interventions.

Secondly, placebo was chosen as a comparator when "current" treatment would have been better.

Thirdly, in one instance (cisapride in non-ulcer dyspepsia) a large number of poor quality studies funded by industry led to a result that was later discounted as potentially biased.

Another effect of the disparity between research into pharmaceutical drugs and alternative medicine is that doctors now expect that all therapies should be clinically validated, even though much more funding for research is channelled into pharmaceuticals. There has been a backlash against Prince Charles' pro-integrative medicine address to the World Health Assembly in Geneva.[3] Thirteen high-profile doctors wrote an open letter saying that alternative medicine was being promoted within the UK National Health Service despite a lack of evidence.

The UK government had previously stated an intention to commission research focused on improving health and social care.[4] In their goals for research and development over the next five years, the government has made a commitment to "creating a vibrant research environment that contributes to the health and wealth of England". This could well be a way of getting funding for important research, particularly in the light of recent criticism.

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The British Society for Ecological Medicine has commissioned two speakers on blood groups in a one-day conference on individuality.

Entitled: One Man's Meat (or, Why me?), the day has been organised by Dr. D Freed, allergist and author of several papers on lectins and their connection to health and disease.

The principal aim of the Society is to promote the study and good practice of allergy, environmental and nutritional medicine, for the benefit of the public.

The topics and speakers are as follows:

Why asthma and allergy? Nutrition and environment in causation and treatment.

Prof Ross Watson PhD, University of Arizona

Alcohol toxicity not every drinker, and not just the liver and brain

Prof Victor R Preedy DSc FRCPath, Genomics Centre, Kings College, London

Individual responses to foods in inflammatory and neoplastic bowel diseases

Prof Jonathan Rhodes MD FRCP, Dept of Medicine, Liverpool University

. . . and in rheumatoid and other diseases

Dr Azita Alavi PhD, St Georges Hospital, London

Why are some patients harmed by a medicine when others are not?

Prof Munir Pirmohamed PhD FRCP, Dept of Pharmacology, Liverpool University

Diet and individuality in detoxification

Dr Rosemary Waring PhD, Dept of Biochemistry, Birmingham University

Blood group diets

Dr tom Greenfield, Kent

Biotype diets: blood types as predictors of food allergies

Dr Laura Power PhD, Virginia, USA

Group discussion

The BSEM 2006 Summer Meeting is scheduled for 16 June 2006 at The Royal College of General Practitioners, London.

To book a place, use the following form: http://www.ecomed.org.uk/meet_regform.html

An debate in the International Breastfeeding Journal [1] has revealed how a US government agency designed to safeguard the health of low-income women, infants and children could be putting the lives of over 700 babies per year at risk, exploits the government-funded distribution network as a promotional and brand loyalty tool, encourages inflated retail prices and may even contravene human rights.

The article focuses on the WIC program (The United States' Special Supplemental Nutrition Program for Women, Infants and Children), launched in 1974 and administered by the Food and Nutrition Service of the US Department of Agriculture. The WIC program “serves to safeguard the health of low-income women, infants, & children up to age 5 who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care”.

The WIC provides free formula milk to the needy if: 1) they are individually determined by a competent professional to be in need of the special supplemental foods supplied by the program because of nutritional risk; and 2) meet an income standard, or receive or have certain family members that receive benefits under the Food Stamp, Medicaid or Temporary Assistance for Needy Families Program. The total cost of the WIC program in the 2004 financial year was US$4,890,200,000 for 7,904,000 participants.

The cost of the formula milk was rebated to the WIC at between 85 to 98 percent of the wholesale price in 2000 financial year, and for the US as a whole, net prices averaged 18 cents per can of milk-based liquid concentrate that year. The manufacturers of the formula are paying most of the cost of the actual product, the author suggests, for the following reasons: low product cost, inflated retail prices, brand loyalty, and expanded reach. This is corroborated by the following facts: during the 1970's, one company paid a million dollars to the City of New York for the privilege of donating free formula to all of the City hospitals; In 1989, Abbott Laboratories and Bristol Myers got into a bidding war in Canada over the exclusive right to supply free formula to Canada’s largest maternity hospital.

It is universally accepted that breastfeeding is preferable to formula feeding in most cases. The infant mortality associated with not breastfeeding is relatively small in richer countries, but it is not negligible. Recent studies indicate that formula feeding in the US causes substantial numbers of excess infant deaths. The risk of post-neonatal (29-365 days of age) mortality is about 27% higher among infants who are never breastfed compared to infants who are ever breastfed. On this basis, about 720 infant deaths in the US would be averted each year if all infants were breastfed. WIC has a vigorous and effective program for promoting breastfeeding, resulting in steadily increasing breastfeeding rates among clients. However, a USDA report acknowledges: Although breastfeeding rates are increasing among women participating in WIC—both while in the hospital immediately after giving birth, and 6 months after giving birth—the rates continue to be lower than those of non-WIC women. Although some have questioned whether WIC provides a disincentive to breastfeeding by supplying free infant formula, the women most likely to participate in WIC, including mothers who are poor and have low education levels, are less likely to breastfeed their children in general. WIC has a breastfeeding promotion program, but its positive impact is diluted by WIC’s infant formula program. It is difficult to see how offering free formula could fail to be an incentive to use formula. The inducement is not simply that something of value is being offered at no cost. Even if it is unspoken, there is the implicit message of endorsement: if a government agency is handing out this product, it must be good.

It is also suggested that the WIC program may contravene human rights law: The most directly applicable international human rights agreement is the Convention on the Rights of the Child, an international human rights agreement that came into force in 1990, which states, “States Parties recognize the right of the child to the highest attainable standard of health” and they shall take appropriate measures “to combat disease and

malnutrition . . . through the provision of adequate nutritious foods, clean drinking water, and health care.” It also says States Parties shall take appropriate measures “To ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition [and] the advantages of breastfeeding . . .” and that States Parties shall "take appropriate measures to diminish infant and child mortality.”

The author concludes:

"If infant formula could be demonstrated to produce better infant health, there might be a reason to distribute it without cost to those who could not otherwise afford it. However, there is no evidence to support the generalization that the use of infant formula results in better infant health than breastfeeding. On the contrary, the evidence clearly and consistently shows that the use of infant formula increases the risks of morbidity and mortality throughout the life cycle. The use of infant formula has been shown to be harmful to the health of mothers as well. The inescapable conclusion is that the government should not be distributing free infant formula... WIC could reasonably provide infant formula, but only in exceptional cases, if that is recommended for a specific reason by a physician or a lactation counselor. An initial list of acceptable reasons could be drawn from the Lawrence study of contraindications to breastfeeding. The rebate program should be ended. The WIC program should stop providing free infant formula to the majority of its clients, and should be limited to providing infant formula to no more than a small percentage of its clients... Currently, WIC acts in a way that benefits commercial enterprises at the expense of infants. The government should not risk infants’ health in order to support commercial enterprises."

The book Eat Right 4 Your Baby [2] gives suggestions on how to encourage and promote a good flow of breast milk, and where necessary, the use of soya-based formula milk is gaining popularity due to colic and digestive problems from cows' milk. Predigested protein is also available. The best formula for your baby should be decided in conjunction with your paediatrician.

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Report of the UK and Eire IfHI Members Symposium, 7th April 2006

Part II

After lunch I gave a presentation of lab testing facilities for blood type practitioners. This included a basic review of blood groups, UK distribution, disease and dietary significance of Rhesus, Lewis negative and minor blood groups A2 and A3, MN, and postal serology services offered by nature-cure lab services. Other useful laboratory tests were discussed: salivary secretor status test; the indican test; oxidative stress urine test; secretory IgA; anti-A and anti-B agglutinin titre; various stool markers; blood group specific markers in the standard biochemistry assay such as ALP (alkaline phosphatase) and BUN (blood urea nitrogen). There is a choice of labs for most of these tests for UK practitioners.

New information on subgroups of A was presented: As discussed in part I, many individuals of blood group A phenotype may have the genotype AO (it may be as high as 90%). Of these individuals, AO secretors are therefore capable of secreting the H antigen (of blood group O) into their stomach as well as the A antigen, allowing bacterial infestation, i.e. H. pylori (1). Low stomach acid, common in individuals with group A blood, additionally increases the potential for bacterial growth.

It has been known since the 1950’s (2) that individuals of blood group O are more prone to gastric ulcers, and it has been hypothesised that the connection relates to secretion of the H antigen and H. pylori cellular adhesion. Also those with blood group O tend to be hospitalised as a result of gastric ulceration more frequently than individuals with other blood groups due to the thinner O blood. Non-secretors of all types are also more prone to H. pylori, due to the similarity of Lewis a (Le a) to H antigen, although it has been found that some strains of H. pylori prefer Lewis b (Le b). A recent study (3) suggests that due to the diversity of H. pylori strains, their varying preferences for cell membrane antigens and the possibility of several mechanisms of attachment to the cell surface may make this type of study of H. pylori inappropriate for epidemiological research.

The question may arise “how do you know if you are AO or AA?” Mendelian genetics can be applied in certain cases to give an answer: if one parent is O the child typed blood group A1 must be A1O, (who may be more prone to bacterial overgrowth than AA). Similarly if two parents of blood group A have a child who is typed as blood group O, both parents must be AO.

If an individual is typed as A2, which can only be A2O or A2A2, they may have susceptibility to H. pylori beyond that of A1O: a recent study found that individuals with the A2 phenotype, as well as individuals of blood group O, are also more prone to gastric ulcers (4).

The A2 blood group may have some structural differences when compared with A1 – there are several similar A antigens on the surface of red blood cells of individuals with blood group A, individuals with the A2 phenotype express only one of these.

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The afternoon coffee and green tea break also included a selection of NAP Unibars and Elspeth Semple’s amazingly tasty wheat-free fruit cake and chocolate cake, as well as fresh and dried fruit and nuts.

Then followed a presentation on herbs by Carole Symons MIfHI, medical herbalist. Carole listed selected herbs and their suitability for individuals of particular blood groups, including some used in NAP formulations. Where a particular herb might not be suitable for a specific patient, alternatives were given with similar actions. It was noted that Echinacea is not suitable for prevention of bird flu, as it is likely to overstimulate the cytokine burst. This was a topical subject, as the previous day a dead swan had been found to have the H5N1 strain of bird flu in Scotland. Elderberry products may be a better approach, than Echinacea, in combination with selenium, zinc and olive leaf. For someone with flu, the recommended dosage for an elderberry product such as Proberry liquid is 4 tablespoons (15 ml) 3 times per day.

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Dr. Stuart Semple MBChB, FFHom, MIfHI presented a discourse on homoeopathy and the BTD. After 40 years of involvement in homoeopathy, he now uses blood grouping as a first line approach. He described how initially changing a client’s diet at the first appointment before deciding on a constitutional remedy at the second consultation tends to clarify the remedy picture in that individual and allows for more accurate prescribing. A former student of Marjorie Blackie, Dr. Semple explained that there are only 20 constitutional remedies, and that 60 % of the population have personalities that fit these remedy pictures. It would be an area ripe for research in the homoeopathic world to explore the correlation between the 8 basic blood groups and their subcategories, and these constitutional remedies, in the same way that the link was drawn earlier with the dosha/haplotype connection. This would also raise the question as to whether certain blood groups might react better or worse to a particular constitutional remedy.

Another area of interest to Dr. semple is lectinology, and the lectin-binding content of certain foods. He hypothesised the extent to which certain traditional food combinations or preparation methods coule neutralise, destroy or otherwise disable the lectins in foods, in what he called “therapeutic cooking”.

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The discussion then opened out to the floor. Naturopath Ken Green noted how Hahnemann, the founder of homoeopathy, ate several kinds of animal protein at every meal. His test subjects, while proving a homoeopathic remedy, had to keep to a very limited diet to avoid confusing the effects of certain foods with that of the homoeopathic proving.

Dr Prannie Rhatigan MD, MIfHI mentioned a forthcoming course she is presenting in conjunction with naturopath Dr. Gaby Wieland: “Exploring the links between blood group and diet”, as part of a cooking weekend at the Organic Centre, 22-23 April 206. www.theorganiccentre.ie

That evening, the group met at one of the Howies restaurants in central Edinburgh, courtesy of NAP Europe. Dr. Semple had been ‘training’ the restaurant staff to provide suitable food for the party comprising individuals of 3 different blood types (the Semples’ usual restaurant had recently changed hands). Everyone was very well catered for, and it was a fitting close to an educational and informative day. The new information presented at this symposium will surely be enough food for thought until the next IfHI meeting, in May 2007, Phoenix, AZ.

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