November 2004

Vol. 3, No. 11

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Favorite Five
My favorite 5 articles found in my medical journals this past month or so:

Vitamins Do Not Prevent Cancer and May Increase Likelihood of Death

Antioxidant supplements for prevention of gastrointestinal cancers: a systematic review and meta-analysis by Goran Bjelakovic reported in the October 2004 issue of the Lancet found no “evidence that antioxidant supplements can prevent cancer; on the contrary, they seem to increase overall mortality.”1  This systematic review using very strict criteria (the Cochrane Collaboration methodology) attempted to settle an important controversy on the true benefits of taking vitamin and mineral supplements.  The finding, after reviewing 14- randomized trials involving 170,525 people, who were using beta-carotene, vitamins A, C, E and selenium (alone or in combination) was that there was no effect on esophageal, gastric, colorectal, pancreatic, and liver cancer incidences.  Results from seven studies showed a small, but significant, increase in mortality for those using these supplements.  Furthermore, a combination of beta carotene and vitamin A was associated with a 30% increase in risk of death.  Beta-carotene and vitamin E combinations showed a 10% increase in deaths.  The authors estimate that about 9000 premature deaths occur for every million people exposed to antioxidant supplements.  An increase in belching and yellowing of the skin was also noted with use of beta-carotene.

These researchers also warned that the results should not be translated to the potential effects of fruits and vegetables, which are rich in antioxidants and other substances (like micronutrients, fiber and various phytochemicals which prevent cancer).

Comment:  Many observational studies have found a high intake of fruits and vegetables, which are also high in antioxidant vitamins, is associated with a decreased risk of cancer.  A highly profitable extension of this finding is found in the vitamin pill businesses.  Taking a vitamin pill, rather than making a significant change in diet, also has great consumer appeal.  Unfortunately, there is good evidence that these antioxidant supplements are even more than useless; they may be harmful.  Similar findings of harmful effects of supplements have been found in large studies on the prevention of lung cancer and cardiovascular disease.2-4

A somewhat confusing, recent publication on November 3, 2004 from the Journal of the National Cancer Institute found no benefit from fruit and vegetable intake for the prevention of cancer.5  This research paper’s findings made national headlines; because people love to hear good news about their bad habits and now they do not have to eat their fruits and vegetables.  Interestingly, this lack of benefit was found only in those people who also took vitamin pills. Non-supplement users did experience a significant reduction in cancer from consuming more fruits and vegetables. (All people showed a reduction in cardiovascular disease from eating more fruits and vegetables.)  Therefore, my conclusion is: taking supplements cancels out benefits found in fruits and vegetables.

On November 2, 2004 results of an analysis of 19 studies involving 136,000 people concluded that the overall risk of dying was increased by taking vitamin E pills at commonly consumed dosages (400 IU).6  Taking this much vitamin E for 5 years could increase your risk of dying by 5%.

How Supplements Can Make You Sicker

The important question to answer now is, how can supplements be so harmful?  In concentrated, isolated, forms found in supplements these nutrients cause nutritional imbalances that can have serious health consequences.  Let’s take the example of beta-carotene, which the Lancet study found increased the risk of dying.  

Beta-carotene is one of over 600 substances classified as carotinoids found in yellow and orange fruits and vegetables. Inside our cells are sites of action referred to as “carotinoid receptors” – these are the sites where carotinoids attach and function.  You might think of these receptors as “little stools” upon which the nutrients sit to do their jobs.  When the cell is flooded with beta-carotene by vitamin supplementation (pills), then there is overwhelming competition for these receptor sites (little stools) that excludes their use by the other 599-plus carotinoids – creating a serious nutritional imbalance. 

When found in plants, micronutrients (vitamins and minerals) are present in low concentrations, and they exist in a perfectly balanced, orchestrated, environment with thousands of other vital nutrients that all work together inside the cells of your body.

Therefore, the message is clear and consistent; you should get your nutrients in their original packages and save your money, and possibly your life, by foregoing supplements. You can learn more on this important subject by reading my August 2003 newsletter article,Plants, not Pills, for Vitamins and Minerals.”

1)  Bjelakovic G, Nikolova D, Simonetti RG, Gluud C.  Antioxidant supplements for prevention of gastrointestinal cancers: a systematic review and meta-analysis. Lancet. 2004 Oct 2;364(9441):1219-28.

2)  The Alpha-Tocopherol Beta Carotene cancer prevention study group, The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 330 (1994), pp. 1029–1035.

3)  GS Omenn, GE Goodman, MD Thornquist et al., Effects of a combination of beta-carotene and vitamin A on the lung cancer incidence, total mortality, and cardiovascular mortality in smokers and asbestos-exposed workers. N Engl J Med 334 (1996), pp. 1150–1155.

4)  Heart Protection Study Collaborative Group, MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20536 high-risk individuals: a randomised placebo-controlled trial. Lancet 360 (2002), pp. 23–33. 5)  Hung HC, Joshipura KJ,

5)  Jiang R, Hu FB, Hunter D, Smith-Warner SA, Colditz GA, Rosner B, Spiegelman D, Willett WC.  Fruit and vegetable intake and risk of major chronic disease.  J Natl Cancer Inst. 2004 Nov 3;96(21):1577-84.

6)  Rob Stein, Washington Post. Vitamin E in high doses called unsafe
New study finds increased risk of dying, though critics say data analysis is flawed. http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2004/11/11/MNG2P9PKGJ1.DTL

Chiropractic Care Provides Superior Results 

Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs by Antionio Legorreta in the October 11. 2004 issue of the Archives of Internal Medicine found access to managed chiropractic care can be not only clinically beneficial, but also may reduce overall health care costs.1  This study was done by a medical doctor on the data from a large managed-care organization in Southern California, involving 1.7 million members.  They compared members with and without chiropractic coverage.  Those with coverage had 12% lower annual medical care costs.  This may have been due in part to the kind of people who choose chiropractic care, as part of their insurance coverage – they may be generally healthier people, and interested in a better diet and exercise.  These users of chiropractic care also used fewer high technology services, such as x-rays, MRIs, and surgeries. 

Comment:  Low back pain (LBP) is a very common disorder, with a US population incidence of 80%. Treatment of back pain is the most common therapy provided by chiropractors. Back pain is a $24 billion annual business in the US alone, the leading cause of physician visits, the second leading reason for hospitalization (childbirth is first), the number one cause for long-term disability, and the second most common reason for use of prescription and non-prescription drugs.  In other words, this is big business.  Research has demonstrated the superior benefits of spinal manipulation over the conventional care by medical doctors.2  Most importantly, patient satisfaction is higher than with conventional therapy and that may be the reason for the popularity of chiropractors. The risks are few and the complications (although sometimes serious) are rare with treatment of back pain.  Therefore, for most people, chiropractic care should be one of the earliest reliefs sought for back pain.

You may be thinking that all that physical stress and strain placed on your low back is the cause of back pain.  Not necessarily so; the underlying cause for most back trouble is an unhealthy diet  – and not just because this diet makes people overweight.  Certainly, a protuberant abdomen does place added physical stress on your back, and nearly every overweight patient asking for help with his or her back trouble has been admonished to lose weight. However, a more fundamental source for pain and degenerative disc disease of the back is due to poor circulation caused by hardening of the arteries, atherosclerosis.3  With inadequate blood supply to the back, bones and surrounding tissues, pain develops, similar to angina (chest pains) which stems from an inadequate supply of blood to the heart muscle.  Following prolonged and severe compromise of the circulation to the tissues of the spine, especially the discs, degeneration develops.  The condition is referred to as degenerative disc disease.  This is a condition where the discs (cushions between the back bones) rupture and often bulge, impinging a nerve.  Surgery is a common, but relatively ineffective, solution for ruptured discs.

You should make every effort to keep the circulation to your back wide open with healthy eating and lifestyle habits (no smoking and some exercise).  For helpful information please read my June 2003 newsletter article:  Cleaning Out Your Arteries.

1)  Legorreta AP, Metz RD, Nelson CF, Ray S, Chernicoff HO, Dinubile NA.  Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs.  Arch Intern Med. 2004 Oct 11;164(18):1985-92.

2)  Bronfort G, Haas M, Evans RL, Bouter LM.  Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis.  Spine J. 2004 May-Jun;4(3):335-56.

3)  Kauppila LI, Mikkonen R, Mankinen P, Pelto-Vasenius K, Maenpaa I.  MR aortography and serum cholesterol levels in patients with long-term nonspecific lower back pain.  Spine. 2004 Oct 1;29(19):2147-52.

Commonly Used Antacids May Give You Pneumonia

Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs by Robert Laheij in the October 27, 2004 issue of the Journal of the American Medical Association found the current use of gastric acid-suppressive therapy (such as Tagamet, Zantac, Nexium, Prilosec, etc.) was associated with an increased risk of community-acquired pneumonia.   Higher doses of the antacid, and more effective acid suppression, were associated with a higher risk for developing pneumonia.  Gastric acid is an important barrier against the entrance of microbes, like bacteria, viruses, and fungi, into the body.  When the acid content of the stomach is reduced, then the risk of infection is also increased.

Comment:  Painful indigestion, with accompanying reflux, is so common in people who follow the Western diet that it almost might be considered “a normal part of living.”  Acid indigestion can be relieved by the use of antacid wafers (like TUMS) and liquids (Maalox), which contain alkaline substances which act locally in the stomach to neutralize the acid.  The more “modern way” to reduce acids in the stomach and relieve indigestion is to give pills that act systemically (through the blood stream) to turn off the acid production by cells in the stomach.  These are classified based on their kind of biological action as H2-receptor antagonists (Tagamet or Zantac) and more powerful Proton Pump Inhibitors (Prilosec or Nexium).  Like all medications, these have side effects and concerns about long-term use, including malabsorption of nutrients and the development of stomach cancers – although not much actual trouble has been found.

These antacids are very effective, but they should be used as a last resort.  First, efforts should be made to make the stomach healthy by putting good things inside.  Meats (including poultry and fish) are high in protein and cause the stomach to make more acid.  Calcium from dairy products is also acid-producing.  Therefore, your first effort to relieve acid indigestion is to eat a starch-based diet with fruits and vegetables.  However, there are some plant-foods that commonly cause distress; such as raw vegetables (and especially onions, green peppers, cucumbers, and radishes), fruits juices (but not the whole fruit), and hot spicy foods.  Raising the head of the bed 4 to 6 inches is also a very effective means to relieve reflux and indigestion.  Your final efforts for relief will be pills – start with the wafers and liquids, before resorting to the systemic-acting drugs.  You can learn much more about your intestines by reading the lead articles in my 2002 newsletter articles.  Specifically, my February and March 2002 newsletters offer much advice on relief of acid indigestion and acid reflux disease.

Laheij RJ, Sturkenboom MC, Hassing RJ, Dieleman J, Stricker BH, Jansen JB.  Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA. 2004 Oct 27;292(16):1955-60.

Ulcerative Colitis Relapses with Meat and Beef

Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study by Sarah L. Jowett in the October 2004 issue of the journal Gut found patients with ulcerative colitis had more frequent relapses when they consumed meat, especially red and processed meat, and eggs.1   The investigators felt the risk of relapse, and thus the activity, was from the sulfur compounds found in these animal foods.  Alcoholic beverages, many of which contain sulfur compounds, were also associated with risk of relapse.

Comment: Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the lining of primarily the large intestine.  The inflammation occurs most commonly in the rectum and lower part of the colon, but it may affect the entire colon.  This painful inflammatory bowel disease (IBD) can be debilitating (diarrhea and stomach pains), and even fatal.   To begin to understand the cause of this disease, you must know that ulcerative colitis is found only in parts of the world where people follow the Western diet, high in meat and dairy foods.  This is an autoimmune disease, where the immune system attacks the body (in this case, the bowel primarily).

The course of ulcerative colitis is characterized by frequent exacerbations (relapses).  Previous studies have found a high intake of dairy products, and a low intake of dietary fiber, are associated with relapses.  Patients with ulcerative colitis also have higher concentrations of sulfur in their intestines and the course of the disease correlates with that amount.2  Sulfur appears to be toxic to the intestine.  So, where does all this sulfur come from?

The amount of sulfur in the intestine is increased by consuming animal products, which are inherently high in sulfur-containing amino acids, like methionine and cysteine.

 

Dramatic improvement in patients with ulcerative colitis has been reported with a change to a diet low in sulfur-containing amino acids.2  My experience has been that people with ulcerative colitis, and a similar condition called Crohn’s disease, respond quickly and dramatically with a change to the diet we recommend (starch-based with the addition of fruits and vegetables). This is a diet which is inherently low in sulfur compounds because the foods we recommend contain no animal-derived products.

1)  Jowett SL, Seal CJ, Pearce MS, Phillips E, Gregory W, Barton JR, Welfare MR.  Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study.  Gut. 2004 Oct;53(10):1479-84.

2)  Roediger WE. Decreased sulphur aminoacid intake in ulcerative colitis.
Lancet. 1998 May 23;351(9115):1555.

CT-scans – Looking for Cancer May Cause Cancer

Estimated radiation risks potentially associated with full-body CT screening by David Brenner in the September 2004 issue of the journal Radiology found that a 45-year-old adult who plans to undergo:

One CT full body scan has a 1 in 1250 risk of developing cancer (0.08%);

And he risks, from annual full-body CT examinations up to age 75 (30 examinations), a one in 50 (about 1.9%) chance of developing cancer from the extra radiation.

The authors make the observation that the risk from one full body scan is comparable to the radiation some atomic bomb survivors of Hiroshima and Nagasaki received – where there is clear evidence of cancer risk from radiation.

Comment:

CT-scans (using computerized machines taking multiple x-rays for one examination) are promoted to people as a preventive measure to find disease long before signs and symptoms develop.  Looking for early disease (screening) is very popular because of the hope for prolonging life – perhaps forever.  The introduction of CT scan facilities in almost every medium- to large-sized community in developed countries has resulted in millions of people looking for heart disease, and cancers of the lung and colon.  However, to date there is no evidence that CT-scanning prolongs life.  The FDA, the American College of Radiology, and the US Preventative Task Force do not recommend you have a full-body CT-scan for screening.

The reasons these CT-scans fail to detect disease early enough to better treat, cure, or manage your future illnesses or give you a longer, better life, are many.  For one thing, finding calcium in the coronary (heart) arteries is a sign of chronic disease, and evidence for the presence of rock-hard, stable, non-lethal, plaques.  However, the disease that causes a heart attack and kills is small and soft, and invisible to the CT-scanners – these tiny, invisible, volatile plaques burst and then occlude the artery by suddenly forming a blood clot.  The main problem with CT-scanning for cancer is that the size of a detectable tumor is about 1 cm (1/2 inch) – by this time the cancer has been growing, on average, for 10 years, and if truly cancer, has spread to other parts of the body well beyond the reach of the surgeon.

There is also great risk that “disease” will be found that would never have affected your life.  Unfortunately, the mere act of finding something too often requires more testing and treatments – and these future interventions have definitely been found to hurt and kill people – not to mention the financial costs.  These machines are getting so sophisticated that soon no one will be free of disease.

CT examinations result in much higher doses of radiation than routine x-rays.  This research shows there is a real danger from the radiation.  Since these tests have not been shown to save lives, and they cause anxiety and lead to further testing, I do not recommend routing screening with these high-tech instruments. A further harm is that a “negative examination” can give you a false sense of health, and relieve you of the need to mend your evil ways (like eating and smoking).

Brenner DJ, Elliston CD.  Estimated radiation risks potentially associated with full-body CT screening.  Radiology. 2004 Sep;232(3):735-8.

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