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Content 7

 

The Doctor and the Pharmacist

Radio Show Articles:
July 23, 2011

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GSK to Recall Antibiotic-Containing Plasticizers in Hong Kong
ACOG Endorses Annual Mammograms for Women in Their 40s
Multifaceted Podiatry Treatment of Foot Pain Prevents Falls in Elders
Vegetarian, High-Fiber Diets Linked to Lower Risk for Diverticular Disease
Brain Patterns of Sleep During Sleep Deprivation: An Animal Study
Low Dietary Calcium Intake Raises Risk for Fracture and Osteoporosis
Risk for Diabetes Increases with Statin Dose
The Wellness Experts’ Guide to Cleansing

GSK to Recall Antibiotic-Containing Plasticizers in Hong Kong
     Hong Kong has ordered pharmaceutical giant GlaxoSmithKline to recall Augmentin Tablets, which contained several plasticizers, including diisodecyl phthalate (DIDP), di(2-ethylhexyl) phthalate (DEHP), and diisononyl phthalate (DINP), raising "quality concerns." The levels were considered "unlikely to cause acute harmful effects" if the antibiotics were taken according to the recommended dosage, the Department of Health said in a statement, but it said it would seek advice on possible legal actions against GSK.
     GSK could not provide a satisfactory explanation on sources of the plasticizers; the drug firm said it had launched an "urgent and thorough investigation" to determine the source of the additives. Last month, Hong Kong's health watchdog ordered a recall of the antibiotic in syrup form after it discovered elevated levels of DIDP, warning that long-term consumption at high levels may have adverse effects on the liver.
     China, South Korea, the Philippines, and Hong Kong have banned imports of certain food and drinks from Taiwan after some were found to contain plasticizers, which experts say can cause hormone problems in children. Taiwan prosecutors said last month they were seeking long jail terms for four people on charges of selling the banned chemicals to food makers, triggering the island's worst food scare in decades.
www.reuters.com/article/2011/07/19/idUSL3E7IJ0D020110719
www.khaleejtimes.com/displayarticle.asp?xfile=data/international/
2011/July/international_July931.xml§ion=international&col=

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ACOG Endorses Annual Mammograms for Women in Their 40s
     The American College of Obstetricians and Gynecologists now recommends annual mammography in women who are 40 years and older. Previously, they had recommended screening every 1 to 2 years for women in their 40s and annual screening beginning at age 50.
     The group changed the recommendation based on the relatively short sojourn time in this age group (the interval from when a mammogram detects cancer to when a patient becomes symptomatic), breast cancer incidence, and the potential to lower breast cancer mortality.
     The guidelines, published in Obstetrics & Gynecology, are in line with those of several imaging groups, but not those of the U.S. Preventive Services Task Force, which in 2009 recommended against routine mammography for women in their 40s, saying that such screening should be individualized. The ACOG guidelines include a discussion of the differences between the two sets of recommendations.
http://www.acog.org/from_home/publications/press_releases/nr07-20-11-2.cfm
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BMJ 2011 Jun 16; 342:d3411
Multifaceted Podiatry Treatment of Foot Pain Prevents Falls in Elders
Intervention patients received appropriate footwear and a home-based foot and ankle
exercise program.

     Among elders, foot problems are associated with falling, which is a major risk factor for fracture. In this randomized controlled trial, Australian investigators compared the effectiveness of a multifaceted podiatry intervention versus routine podiatric care in preventing falls in 305 community-dwelling elders (mean age, 74; 69% women) who had chronic foot pain, were receiving podiatric care, and were at elevated risk for falls.
     Both control and intervention groups continued with the podiatric care they were currently receiving. The intervention group also received a multifaceted treatment package consisting of prefabricated full-length foot orthotics, advice on and provision of appropriate footwear, a home-based foot and ankle exercise program, and education in fall prevention. The control group received podiatric care only. At 1-year follow-up, number of falls was significantly lower in the intervention group than in the control group (103 vs. 161 falls). The intervention group experienced one fracture, and the control group suffered seven fractures — a not-quite-significant result (P=0.07) that likely reflected an underpowered study.
     Comment: This study has a number of limitations: The investigators could not blind the participants to their group allocation and do not define or describe the podiatric care the participants received before and continued throughout the trial. Nevertheless, the results suggest that a relatively simple multifaceted podiatry intervention can prevent falls in elders with foot pain and at elevated risk for falls. Combined with other simple measures to prevent falls (e.g., avoidance of medications that promote falls, maximizing vision, home hazard assessment and modification), this intervention might substantially lower morbidity and costs (which, according to the CDC, were about US$24 billion in 2005) associated with falls among U.S. elders.
Paul S. Mueller, MD, MPH, FACP Published in Journal Watch General Medicine
July 21, 2011
     Citation(s):Spink MJ et al. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: Randomised controlled trial. BMJ 2011 Jun 16; 342:d3411. (http://dx.doi.org/10.1136/bmj.d3411) http://www.ncbi.nlm.nih.gov/pubmed/21680622?dopt=Abstract
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Vegetarian, High-Fiber Diets Linked to Lower Risk for Diverticular Disease
     Vegetarian and high-fiber diets are each associated with lower risk for hospitalization or death from diverticular disease, according to a prospective study in BMJ.
     Some 47,000 "generally health conscious" adults in the U.K. completed dietary and lifestyle questionnaires and then were followed for nearly 12 years. About one third of participants said they were vegetarian.
     During follow-up, there were 806 hospital admissions and 6 deaths from diverticular disease. After multivariable adjustment, vegetarians had a roughly 30% lower risk for diverticular disease compared with meat eaters, and participants in the highest quintile of fiber intake had about a 40% reduced risk compared with those in the lowest quintile.
     The authors note that vegetarianism and high fiber intake are "correlated with rapid bowel transit times and increased frequency of bowel movements, which could be the biological mechanism" underlying the lower risk for diverticular disease observed here.
http://www.bmj.com/content/343/bmj.d4131.full
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Nature 2011 Apr 28; 472:443
Brain Patterns of Sleep During Sleep Deprivation: An Animal Study
As the contemporary songwriter Ben Lee put it, "Awake is the new sleep."
     Ordinarily, during awake times, brain waves are relatively fast and of low amplitude, different from the slow, high-amplitude, non–rapid eye movement sleep patterns on electroencephalography (EEG). But most people have noticed times during sleep deprivation when parts of their brain seem to be "foggy," even when they are not feeling sleepy. To examine this phenomenon, researchers measured brain activity during and after sleep deprivation in rats.
     EEG and local field potential (LFP) electrode arrays were implanted in frontal and parietal cortices. For sleep deprivation, rats were kept awake (via exposure to novel objects) for 4 hours past their usual bedtimes. Measurements continued for 10 hours, including 6 hours of post-deprivation sleep. To determine changes in performance, researchers trained the rats on a behavioral measure, retrieval of sugar pellets, before sleep deprivation.
     During sleep deprivation, the rats appeared fully awake (e.g., eyes open, moving about) but showed increasing impairment on the behavioral task. The usual awake pattern of fast, low-amplitude waves was interspersed with local areas of slow, high waves typical of sleep, and LFP spectra showed a cessation of neuronal firing. These local sleep patterns, seen in both frontal and parietal areas, occurred with increasing frequency as sleep deprivation continued. Sleep after deprivation showed decreasing slow waves with increased time asleep (i.e., a pattern opposite from that of the sleep-deprived state).
     Comment: These data have particular clinical relevance for people who claim to feel fully awake (although some of their neurons may be "asleep") during employment that requires sleep deprivation, such as long-haul truck drivers and medical house staff. How these findings pertain to manic sleepless states is an interesting future research question.
Barbara Geller, MD Published in Journal Watch Psychiatry May 27, 2011
     Citation(s): Vyazovskiy VV et al. Local sleep in awake rats. Nature 2011 Apr 28; 472:443.
http://www.ncbi.nlm.nih.gov/pubmed/21525926?dopt=Abstract
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BMJ 2011 May 24; 342:d1473
Low Dietary Calcium Intake Raises Risk for Fracture and Osteoporosis
During 19 years, first fracture of any type was significantly more common among women with low daily dietary calcium intake (≤750 mg).
     Observational studies and randomized trials of dietary or supplemental calcium to prevent fractures have yielded inconsistent results. In this prospective observational study, investigators determined the associations between dietary calcium intake and risk for any fracture among a population-based cohort of 61,000 Swedish women; risk for osteoporosis was evaluated in a randomly selected subcohort of 5000 women.
     During a median 19-year follow-up, 24% of women experienced first fractures of any type, 6% suffered first hip fractures, and 20% developed osteoporosis. After adjustment for multiple variables, risk for first fracture of any type was significantly higher among women in the lowest dietary calcium–intake quintile (≤750 mg/day; hazard ratio, 1.2) than among women in the third (middle) quintile (882–996 mg/day). Similar results for the lowest versus the middle quintile were found for first hip fracture (HR, 1.3) and osteoporosis (HR, 1.5). Low vitamin D intake was associated with excess fracture risk. In contrast, women in the middle and highest (>1137 mg/day) quintiles had similar risks for fracture of any type and similar risks for osteoporosis, but those in the highest quintile exhibited excess risk for hip fracture (HR, 1.2). Of note, results were similar when total calcium intake (i.e., including supplements) instead of dietary calcium intake was evaluated.
     Comment: In this study, higher-than-median intake of calcium did not lower risk for any fracture, hip fracture, or osteoporosis, which casts further doubt on the role of supplemental calcium in preventing these outcomes. Perhaps the most relevant finding was that low dietary calcium intake indeed was associated with excess risk for fracture and osteoporosis. The authors conclude that "in the prevention of osteoporotic fractures emphasis should be placed on individuals with a low intake of calcium rather than increasing the intake of those already consuming satisfactory amounts."
Paul S. Mueller, MD, MPH, FACP Published in Journal Watch General Medicine July 19, 2011
     Citation(s):Warensjö E et al. Dietary calcium intake and risk of fracture and osteoporosis: Prospective longitudinal cohort study. BMJ 2011 May 24; 342:d1473. (http://dx.doi.org/10.1136/bmj.d1473) http://www.ncbi.nlm.nih.gov/pubmed/21610048?dopt=Abstract
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JAMA 2011 Jun 22/29; 305:2556
Risk for Diabetes Increases with Statin Dose
Risk was highest with intensive-dose therapy.
     Small trials and a meta-analysis have suggested that intensive- versus moderate-dose statin therapy is associated with elevated risk for developing insulin resistance and type 2 diabetes (JW Gen Med Mar 4 2010). Researchers explored this association in a meta-analysis of five randomized statin trials with nearly 33,000 participants who did not have diabetes at baseline.
     During a mean follow-up of 4.9 years, 8.4% of participants developed diabetes, and 20.4% experienced major adverse cardiovascular (CV) events. Intensive-dose therapy (daily atorvastatin [Lipitor; 80 mg] or simvastatin [80 mg]) was compared with moderate-dose therapy (daily atorvastatin [10 mg], simvastatin [20 mg], or pravastatin [40 mg]). Risk for diabetes was higher by 12% in the intensive-dose group, with a number needed to treat [NNT] of 498 patients treated for 1 year for 1 patient to develop diabetes. Risk for CV events was lowered by 16% with an NNT of 155 for 1 patient to benefit.
     Comment: These somewhat counterintuitive results have no obvious biological explanation. The excess risk for developing type 2 diabetes is less than the lower risk for a CV event. Closer-than-usual monitoring might be appropriate for these patients, but they likely are monitored closely already because they are usually at elevated risk.
Thomas L. Schwenk, MD Published in Journal Watch General Medicine July 19, 2011
     Citation(s): Preiss D et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: A meta-analysis. JAMA 2011 Jun 22/29; 305:2556. (http://dx.doi.org/10.1001/jama.2011.860)
http://www.ncbi.nlm.nih.gov/pubmed/21693744?dopt=Abstract
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http://newsletter.vitalchoice.com/e_article002164729.cfm?x=bjLsKDp,b1h1R7NC
The Wellness Experts’ Guide to Cleansing
     Faddish juice fasts can shed pounds speedily … but our experts agree that a slower, whole-foods approach to cleansing is healthier and more sustainable  by Teri Tsang Barrett
One thing’s for certain. The juice cleanse has gone mainstream. Celebrities like Julia Roberts and Beyoncé have gone public with their affection for juice delivery services like NYC’s Blueprint Cleanse and that old dieting stalwart, the Master Cleanse. But are they effective? Depends on the goal.

     “The motivation for these cleanses is typically weight loss,” says Bonnie Taub-Dix, a NYC-based nutritionist and author of Read It Before You Eat It, who points out that most people who lose weight on trendy cleanses tend to gain it back. For those looking for more of a digestive tune-up – following, say, an overindulgent summer barbecue – the experts are split when it comes to endorsing the recent spate of pricey juice and raw-food cleanses to get back on track. But they’re all in agreement that easy lifestyle fixes (read: inexpensive) can be just as effective. Here are 5 simple expert-endorsed tips to cleansing and getting your systems back on track.

1) Find the right time to do it.  
     Timing is everything, and that applies to cleansing as well. Don’t pick the week a big work project is due to focus on detoxing. Dr. Ron Stram, Director at the Center for Integrative Health and Healing, cites a low-stress environment as being necessary for optimal results. “Activity level should be moderate and you should feel relaxed,” he says.

     And let’s not forget sleep. Pamela Salzman, a holistic health counselor based in Los Angeles, states that sleep is when detoxification and physical restoration occurs. Plus, “people who are under-rested are more susceptible to illness and tend to make poor dietary choices,” says Monica Reinagel, nutritionist and author of Nutrition Diva’s Secrets for a Healthy Diet.

     Taub-Dix agrees, saying, “You end up reaching for a cookie instead of a nap.” She also says sustained wellness comes from practicing the trifecta of exercise, healthy diet, and sleep: “Think of a 3-legged stool. Take away one of those legs and the stool won’t be stable.” 

2) Create a sustainable cleanse.
     Most experts who aren’t fans of juice cleanses point out it’s not feasible to sustain them and their effects for a prolonged period of time. “Healthful cleansing has just as much to do with moderation as overeating,” says Taub-Dix, who suggests taking an overall look at your diet and eating habits to assess what’s missing and what you really need to add for good health. Set goals that can be integrated into your life, such as planning, shopping for, and eating a well-balanced breakfast for a week to combat the mid-morning slump. “The reality is that fad diets are based on some sort of truth that go off the deep end,” she says. Apply common-sense principles, such as eliminating processed foods and caffeine or eating more raw food. Avoid extremes and look for sustainable change.

     Reinagel also says that a 24-hour fast may be useful for people who are overly dependent on food and need to “break the cycle,” adding that a fast has “little to do with resting the digestive organs, but can reduce inflammation and improve immune response.” No matter what, fasting for a prolonged period of time or drastically reducing your caloric intake aren’t good ideas. “Your body actually needs food to cleanse and won’t be able to function properly while fasting,” says Salzman.

3) Up your intake of fruits and vegetables.
     Certain powerhouse fruits and veggies will offer more benefits on a cleanse than others. Salzman favors dark green, leafy vegetables, like kale and parsley, as they’re “rich in chlorophyll, one of nature’s natural detoxifiers.” She also recommends adding lemon juice to your water and food, as it “breaks up and draws out stagnant mucus in the body.”
Dr. Stram advocates consuming cruciferous vegetables such as cabbage, cauliflower, and bok choy, all of which contain compounds that help the liver detoxify. “Fruits and vegetables promote healthy colon function,” adds Reinagel, meaning that they help flush out toxins.

4) Chug more water.
     The easiest, fastest way to jumpstart a cleanse is to properly hydrate. “Water hydrates the cells and helps flush your circulatory and lymph systems,” says Dr. Stram. Translation: Your internal system of checks and balances won’t function at its best unless you’re drinking enough water. Plus, “cleansing is about eliminating toxins,” says Salzman. “Once your body releases toxins, you must up your intake of water to dilute them and flush them out.”

5) Give it time to kick in.
     Most people find the first few days the most challenging. “Sometimes you feel worse before you feel better,” says Salzman. “Many people experience symptoms of withdrawal from sugar, caffeine or chemicals in foods. Headaches and irritability are very common as toxins enter the bloodstream.” Dr. Stram will advise patients combating caffeine withdrawal to switch to green tea for a few days.

     If you’re sticking to healthful, “clean” foods, drinking lots of water, aiming for adequate sleep, and still feeling rotten, give your body the time needed to expel the toxins first, before turning to more drastic, less balanced fad cleanses.

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