February 2004

Vol. 3     No. 2  

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My Favorite Five Articles Found in my Recent Medical Journals

One Virtual Colonoscopy Best at Age 55 to 60

Computed Tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults by Perry Pickhardt in the December 4, 2003 New England Journal of Medicine found a much safer and less expensive examination for precancerous colon polyps which works as well as, or better than, optical colonoscopy – a procedure where a 6-foot long, ½ inch diameter, flexible tube is snaked up and down your colon looking for polyps.1  Polyps are precancerous lesions – if they are removed they will not progress to actual cancer which is incurable.  Most gastroenterologists will give you the hard sell to have this procedure performed and one obvious reason is the approximately $2000 charged for the performing the optical colonoscopy.  Plus, this procedure requires intravenous administration of sedatives, a general anesthesia and/or recovery time – and has a real risk for bowel perforation, even in the best of hands (which all gastroenterologists claim they possess).

Virtual colonoscopy involves pre-procedure cleansing of the bowel with laxatives and an enema, patient-controlled inflation of air through the rectum to fill the bowel, followed by multiple CT scanning x-rays.  The procedure does cause discomfort, but most preferred the virtual instead of the optical procedure.  Time for the virtual (CT) procedure is about 14 minutes compared to 32 minutes for the optical colonoscopy.  One disadvantage to the virtual colonoscopy is if a suspicious polyp is found then an optical colonoscopy must follow to remove the polyp.

The recommendation I gave for examination for prevention of bowel (colon) cancer in 1998 in The McDougall Program for Women book was:  Since 90% of cancer occurs after the age of 55 years and the time required for transition from a normal colon to cancer is between 10 and 35 years, an effective way to screen would be to do one exam between the age of 55 and 60.2 This would find most of the cancers already beginning as polyps. If no disease was present at this time, future examinations would be unlikely to benefit the person--since it takes so many years for a cancer to develop, and finally to kill.  Colonoscopy examination with a long flexible tube is most often recommended for evaluation of the colon and rectum; however, my preferred alternative, because of much lower costs and fewer complications, is a double-contrast barium enema and a flexible sigmoidoscope.

Based on these recent findings of the effectiveness, safety, and patient acceptability of virtual colonoscopy, I recommend this procedure to be performed once around age 55 to 60 years – especially for people who have followed the Western diet which causes colon polyps and colon cancer.  For more information see my December 2002 Newsletter article at www.drmcdougall.com.  The real benefits for people who have followed a healthy diet for many years are unknown.

1)  Pickhardt PJ.  Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults.  N Engl J Med. 2003 Dec 4;349(23):2191-200.

2)  Atkin W. Prevention of colorectal cancer by once-only sigmoidoscopy.
Lancet. 1993 Mar 20;341(8847):736-40.

Treating Homocysteine with Vitamins Fails

Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial by James Toole in the February 4, 2002 issue of the Journal of the American Medical Association found no benefit from treating patients following a stroke with a high dose vitamin formula intended to reduce their homocysteine levels.  The homocysteine levels in the blood decreased by 2 units (umol/L) from this treatment, but there was no difference in risk of future strokes, heart attacks, or death compared to a control group on a low dose vitamin preparation.  (Normal homocysteine level is considered less than 10 units.) The experimental vitamin preparation used contained 25 mg of pyridoxine (B6), 0.4 mg of cobalamin (B12) and 2.5 mg of folic acid.

Multiple studies have shown a correlation between elevated levels of the amino acid homocysteine and various diseases common in people who follow the Western diet (stroke, heart attack, deep vein thrombosis, Alzheimer’s disease, etc.).  The “medical” way to solve this problem is to find a pill – in this case a multivitamin.  Unfortunately, as in most cases where dietary problems are treated with drugs, the results are a failure.  The reason is the high homocysteine is not the problem, but only a sign (also called a “maker” or risk factor) elevated by the real problem: an unhealthy diet.  Other signs of an unhealthy diet that are treated with drugs include cholesterol, triglycerides, glucose, and blood pressure.  The results from lowering these signs with drugs are also disappointing and far less than would be seen by correcting the cause.  Therefore, if you wish to lower your homocysteine (as well as other risk factors) and improve your health (at no cost and with no side effects), consume a diet based on starches with the addition of fruits and vegetables.  (See my August 2003 Newsletter lead article, “Plants, not Pills, for Vitamins and Minerals” for more information on this subject.)

Toole JF .  Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial.  JAMA. 2004 Feb 4;291(5):565-75.

Buckle Up Your Back Seat Passengers

Car occupant death according to the restraint use of other occupants: a matched cohort study by Peter Cummings in the January 21, 2004 issue of the Journal of the American Medical Association found your risk of death in a car accident is 21% higher if you fail to have the passenger behind you in the back seat buckle up.  The risk of death is lowest when all occupants are restrained with seat belts.  Their conclusion was obvious:  Persons who wish to reduce their risk of death in a crash should wear a restraint and should ask others in the same car to use their restraints.

Sounds like I should get my 120-pound Rottweiler dog his own safety belt.

Cummings P.  Car occupant death according to the restraint use of other occupants: a matched cohort study.  JAMA. 2004 Jan 21;291(3):343-9.

A Little Exercise Makes a Big Difference

Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE--a randomized controlled study by Cris A. Slentz in the January 12, 2004 issue of The Archives of Internal Medicine found that even without changing their diet most people can prevent weight gain with a small amount of daily walking.  Those walking 30 minutes a day (12 miles a week) weighed 2.4 Kg (5.3 pounds) less than those people who did not exercise at all (the control group), after eight months. More intense exercise (17 miles a week) resulted in more weight loss compared to those who did no exercise – 4.6 Kg (10.1 pounds) more.  The study results implied that as little as 15 minutes a day (6 miles a week) could prevent weight gain with no dieting at all.  Everyone has 15 to 30 minutes a day, which can be dedicated to walking.  Add to this activity a healthy diet – there is no extra time or effort required here – you have to eat regardless of anything else you choose to do – and you have a surefire way to a trim healthy body.

Slentz CA, Duscha BD, Johnson JL, Ketchum K, Aiken LB, Samsa GP, Houmard JA, Bales CW, Kraus WE.  Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE--a randomized controlled study. Arch Intern Med. 2004 Jan 12; 164(1): 31-9.

Be careful About Experimental Trials

Comparison of outcomes in cancer patients treated within and outside clinical trials: conceptual framework and structured review by Jeffrey M Peppercorn in the January 24, 2004 issue of the Lancet found that volunteering for an experimental trial in cancer therapy has not been proven to be in your best interest.

Potential patients are encouraged to participate in “trials” by such false advertising statements as:  “treatment in a clinical trial is often a cancer patient's best option,” and “clinical trials are proven to offer children the best chance of survival."  Unfortunately, these promises have not been shown to be true.  You may want to become part of an experiment in order to benefit mankind, but it is wrong to falsely lead you to believe that it is in your best interest.  So far cancer therapy for most tumors has been a failure.  If you have cancer you need to place effort into making sure your doctors do you no further harm. You should research any proposed treatment at www.nlm.nih.gov. I always recommend a healthy diet as an important part of cancer treatment and prevention.  Read more in “The McDougall Program for Women” book and in my August 2003 Newsletter article, “Lower Cholesterol for Improved Cancer Survival.”

Jeffrey M Peppercorn, Jane C Weeks, E Francis Cook, Steven Joffe.  Comparison of outcomes in cancer patients treated within and outside clinical trials: conceptual framework and structured review. Lancet 2004 Jan; 363:263-270.

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