Gonstead New York Wellness

Yo yo dieting increases CVD risk

2010-03-09T11:38:00.002-05:00

We all want to lose weight... and there's nothing wrong with dieting... question is, are you losing your weight the healthy way? A recent study below shows that yo-yo dieting increases your cardiovascular disease risk.

How I lost 45 pounds and kept it off over the course of 4 years. I kept it simple and realistic.

1. Reduce sugar and sweets in your diet. So if you drink soda, replace it with water. You can lose 10 pounds right there!

2. Avoid fried foods and junk foods. All the chemicals in the foods are harmful to your body, whatever your body can't break down, it will wall off and store it away in fat as a protective defensive mechanism!

3. Eat fresh fruits and vegetables! This is key! Fresh fruits and veggies have a lot of vital enzymes and nutrients that many vitamin pills or supplements don't have. Your body needs those nutrients for optimal health. If it doesn't function right, your body can't burn the fuel (food you ate) properly and stores it away as fat!

4. Start an exercise program you enjoy doing. I admit it, I don't like to exercise but I love martial arts! Find something you love to do, whether it's basketball, swimming, gardening, doesn't matter. The key is you have to enjoy it. If you don't, you won't stick with the program.

Weight Fluctuations Among Normal-Weight Individuals Increases CVD Risk

March 5, 2010 (San Francisco, California) -- Weight cycling, where an individual's body-mass index (BMI) fluctuates during a two-year period, is associated with an increased risk of cardiovascular disease among normal-weight individuals, according to the results of a new study [1]. These weight cyclers have a risk of adverse events similar to individuals who are overweight, while overweight individuals who cycled did not experience an additional increased risk of cardiovascular events over and above the risk associated with their increased weight, report
investigators.

"We were looking at the overall weight status--how heavy the individual was between the ages of 40 and 55 years--and whether or not the weight went up and down during that period," lead investigator *Dr Molly Waring* (University of Massachusetts Medical Center, Worchester) told
*heart/wire/ *. "We found that compared with people who were normal weight, or pretty steady weight, the normal-weight individuals whose weight went up and down during the two-year period, as well as those who were overweight and obese, all had a higher risk of cardiovascular
disease and death."

The results of the study were presented here this week at *EPI|PNAM 2010*, the *Cardiovascular Disease Epidemiology and Prevention* and *Nutrition, Physical Activity, and Metabolism 2010 Conference*.

*Weight Across Time Rather Than a Point in Time*

To *heart/wire/ *, Waring said the purpose of the study was to examine patients' weight across a spectrum of years rather than a point in time to determine whether changes in weight influenced their health risk. The thinking, she said, was that a patient's weight at age 40 or 50 was less relevant than weight over the course of a lifetime.

Using data from the *Framingham Heart Study*, the researchers quantified the effect of overall weight status and weight cycling in 1429 participants aged 40 to 55 years old. Weight status and weight cycling was categorized using component scoring that allowed researchers to capture the weight patterns across middle age. In this study, weight cycling was defined as a change of one BMI unit within the two-year period. That works out to be about five pounds for an individual who is five feet tall and seven pounds for six-foot tall male, said Waring.

Results showed that compared with an overall normal-weight trajectory without weight cycling, normal-weight individuals whose weight went up and down over the study period had a 50% greater risk of cardiovascular disease events and a 40% greater risk of cardiovascular mortality. These normal-weight cyclers were also at a significantly increased risk of cerebrovascular accidents and coronary heart disease events when compared with normal-weight individuals whose weight did not fluctuate.

*Risks of Cardiovascular Disease and Cardiovascular Mortality*

Events

Adjusted hazard ratio (95% CI)

*Cardiovascular disease events*

*Normal weight, no cycling*

Referent

*Normal weight, cycling*

1.5 (1.2-2.0)

*Overweight, no cycling*

1.7 (1.3-2.2)

*Overweight, cycling*

1.8 (1.4-2.2)

*Obese*

2.7 (2.0-3.5)

*Cardiovascular mortality *

*Normal weight, no cycling*

Referent

*Normal weight, cycling*

1.4 (1.0-2.0)

*Overweight, no cycling*

1.3 (0.9-2.0)

*Overweight, cycling*

1.6 (1.1-2.2)

*Obese*

1.8 (1.1-2.9)

Comparatively, overweight individuals who maintained a constant weight and those whose weight cycled during middle age had similar risks of cardiovascular, cerebrovascular, and coronary heart disease events. In addition, they had similar risks of cardiovascular and overall mortality.

"Among people who are overweight, those whose weight varied within the two-year period were not at any higher risk of cardiovascular disease and death than those overweight individuals whose weight remained steady," said Waring. "I think that's a positive finding from the study,
because we know how difficult it is for patients to lose weight and to keep it off. It's encouraging in that if they are trying to lose weight but gain it back because they're not able to maintain the lifestyle changes, it's not putting them at greater risk. The message is to keep trying."

For normal-weight patients, this study emphasized the importance of keeping the weight off, because even periods of normal weight won't protect against cardiovascular disease events if the patients' weight fluctuates up and down, she said.

References

1. Waring ME, Eaton CB, Lapane KL, et al. Weight cycling and overall
weight status during middle age and incident cardiovascular
disease events and all-cause and cardiovascular mortality.
EPI|PNAM 2010; March 3, 2010; San Francisco, CA. Abstract P138.

Movie popcorn not fattening? Think again.

2009-11-24T11:58:00.002-05:00

Next time you head out to the theaters and buy a snack, watch out for high fatty foods.

Study conducted by the Center for Science in the Public Interest (CSPI) found that movie popcorn is loaded with much higher calories and fats than what the theaters state.

Regal movie theaters list medium popcorn 720 calories, and large 960 calories. CSPI found medium and large had 1,200 calories and 60 grams of saturated fat. Small has 670 calories and 34 grams of saturated fat. Put it to perspective, that's like eating a Burger King Whopper or a pound of baby back ribs topped with a scoop of ice cream except popcorn has 3 times more saturated fat. Each squirt of the buttery oil on your popcorn adds another 130 calories.

Next time you head out the theaters, consider bringing some healthy snacks to munch on.

Dr. Ryan Suh, DC
www.gonsteadny.com

Niacin (Vitamin B3) reduces atherosclerosis unlike Zetia and Vytorin

2009-11-15T23:28:00.005-05:00

A recent study shows that Zetia and Vytorin lowers cholesterol but does NOT reduce athrosclerosis, the plaque buildup in artery walls that leads to heart attacks. However, Niaspan (Vitamin B3 or Niacin) significantly reduces athrosclerosis.

There were *two* heart attacks, heart-related deaths or other heart-related problems in the 160 people given Niaspan, and *nine* among the 165 on Zetia.

Also of note, Zetia and Vytorin costs $3 to 4/day whereas Vitamin B3 costs $0.30 to 0.50/day. That's right folks, 30 cents/day.

If you wish to reduce your chances of a heart attack, eat healthy, exercise, and make sure you have enough Vitamin B3. If you experience Niacin flush, then make sure the Vitamin B3 contains Inositol Hexanicotinate which doesn't cause the flush.

Dr. Suh, DC
www.gonsteadny.com

Dieting tips...

2009-11-07T18:44:00.005-05:00

Here's one simple way to lose weight...

Chew and eat your food SLOWLY

A recent study shows that "wolfing" your food can make you gain weight. By eating quickly, like what most New Yorkers do, it doesn't properly signal your body that nutrition is coming down it's way. In essence, that "I'm Full" signal gets delayed, which causes you to overeat more calories than your body needs.

Wolfing down food also puts more strain on your digestive tract. Chewing food helps to physically break down the food so the acid and enzymes in the stomach and small intestines don't have to work nearly as hard. In addition, we release some digestive enzymes in our mouth during chewing. So, would it come to anyone surprise why we would get indigestion or belly aches more so when we quickly overeat?

If you have that issue of eating quickly but can't slow down, how about choosing a different food to eat. Meals that are processed or fast foods may be quicker to eat but they pack on a lot of calories. Eating fresh raw fruits forces you to slow down and physically chew the food. Also, considering it takes about 4-5 bites to eat one hamburger that's loaded with 300-500 calories, that same 4-5 bites into a fresh Apple has 120-180 calories. Not only is it less calories, it also has more enzymes and nutrients than a fatty hamburger.

So, grab that fruit!

Dr. Suh, DC
www.gonsteadny.com

Cell phone radiation

2009-09-27T09:01:00.001-04:00

Learn how much electromagnetic radiation is being emitted by your cellphone at this link:

Cell-phone radiation

Use of Low-Dose Aspirin in Primary Prevention of Cardiovascular Events Not Recommended

2009-09-02T18:00:00.000-04:00

August 30, 2009 (Barcelona, Spain) — The use of low-dose aspirin in the primary prevention of cardiovascular events in healthy individuals with asymptomatic atherosclerosis is currently not warranted, according to the lead researcher of a large "real-world" study presented today at the European Society of Cardiology (ESC) 2009 Congress.

In the randomized trial of 3350 subjects deemed at high risk for cardiovascular and cerebrovascular events because of a low ankle-brachial index (ABI) (<0.95), aspirin had absolutely no effect on reducing events compared with placebo, Dr Gerry Fowkes (University of Edinburgh, Scotland) reported on behalf of the Aspirin for Asymptomatic Atherosclerosis (AAA) trialists.

However, aspirin did increase the risk of major hemorrhage.

The bleeding effect "is a real obstacle," Fowkes told heartwire . "I don't think the evidence is convincing enough as yet that aspirin should be used routinely in the general population."

The results of the trial are in conflict with findings from a meta-analysis from the Antithrombotic Trialists' (ATT) collaboration, which was published earlier this year in the Lancet [1], discussant Dr Carlo Patrono (Catholic University School of Medicine, Rome, Italy) told ESC attendees. He questioned how the results of AAA could be interpreted in light of the 12% relative risk reduction in serious cardiovascular events, largely driven by a reduction in nonfatal MI, that was seen in the ATT trial.

AAA Done Where the Need for Prevention Is Great

The AAA was a pragmatic trial, Fowkes explained, conducted in a deprived population in central Scotland, where rates of coronary heart disease and related mortality are high. "We wanted to get at where the problem actually existed in the population," he said.

Between 1998 and 2001, the AAA trialists invited men and women 50 to 75 years of age to undergo screening for asymptomatic atherosclerosis by measuring their ABI. A low ABI in otherwise-healthy individuals has been shown to be related to an increased risk of future cardiovascular events. Because it is simple and noninvasive, the ABI has the potential to be used as a screening test to detect high-risk individuals, Fowkes explained.

Of the more than 166 000 invitations that were sent out, the trialists ended up screening 28 980 individuals. Of this number, 3350 had a low ABI and were thus eligible to be entered into the trial.

They were randomly allocated to 100-mg enteric coated aspirin daily or to placebo and followed for a mean of 8.2 years. The primary end point of the trial was the composite of an initial fatal or nonfatal coronary event, stroke, or revascularization. Secondary end points were all vascular events, which included a composite of initial fatal or nonfatal coronary event, stroke, or revascularization, angina, intermittent claudication, transient ischemic attack, and all-cause mortality.

Patients in both groups were matched for age (mean age 62 years), gender (roughly 30% were men), and comorbidities. One-third of the study population consisted of smokers.

Aspirin had no effect in terms of reducing cardiovascular and cerebrovascular events. In all, there were 357 events, 181 (10.8%) in the aspirin group and 176 (10.5%) in the placebo group (hazard ratio 1.03, 95% CI 0.84–1.27).

Primary End-Point Results for Aspirin vs Placebo
End point Aspirin (n=1675), n (%) Placebo (n=1675), n (%)
Fatal coronary event 28 (1.7) 18 (1.1)
Fatal stroke 7 (0.4) 12 (0.7)
Nonfatal coronary event 62 (3.7) 68 (4.1)
Nonfatal stroke 37 (2.2) 38 (2.3)
Coronary revascularization 24 (1.4) 20 (1.2)
Peripheral revascularization 23 (1.4) 20 (1.2)

Interestingly, cancer mortality was higher in the placebo group than in the aspirin group, Fowkes noted.

Adverse events, including major hemorrhage, were greater in the aspirin group (HR 1.71, 95% CI 0.99–2.97).

Adverse Events With Aspirin vs Placebo
Adverse event Aspirin (n=1675), n (%) Placebo (n=1675), n (%)
Major hemorrhage 34 (2.0) 20 (1.2)
Gastrointestinal ulcer 14 (0.8) 8 (0.5)

Fowkes pointed out that 40% of patients were noncompliant and did not take their aspirin as prescribed over the duration of the trial. Such a low compliance rate could have affected the results. "The 60% compliance rate is the typical level of compliance that you will find in the primary-prevention setting, and obviously there are many reasons that people stop taking aspirin. So whether aspirin is beneficial in clinical practice among patients who have a low ankle-brachial index and who are fully compliant with aspirin is unknown, and so our results cannot be extrapolated to that situation," he said.

heartwire asked Fowkes what he thinks may work for primary prevention in people with asymptomatic atherosclerosis, now that aspirin appears to be ineffective. "We don't have any strong evidence about what would work, but I think that given that these are high-risk individuals, it is probably reasonable to give them a statin. I think it would prove to be cost-effective to give a statin," he said. "Obviously, there is the possibility of giving a stronger antiplatelet such as clopidogrel or some of these new drugs that are being developed, but one would have to trial those properly."

AAA Underpowered

Patrono said the AAA study may have been underpowered and suggested that was one reason for its negative findings. "The sample size would have to be about four times larger to achieve the power to show a 12% relative risk reduction," he said.

Other reasons: "The presence of peripheral arterial disease, whether symptomatic or asymptomatic, may render platelet activation more critically dependent on ATP than thromboxane release, and there is some experimental as well as clinical evidence supporting this possibility."

An accelerated platelet turnover associated with peripheral arterial disease--at least in some patients--may also be a cause for the discrepancy, Patrono said.

To try to dissect out potential explanations, Fowkes and Dr Colin Baigent (Oxford University, UK), lead author of the ATT trial, have agreed to see how the AAA study would fit into the ATT meta-analysis. When available, the results will be posted by the Clinical Trial Service Unit, Patrono said.

Fowkes told heartwire that there is no reason to think that the relative reduction in cardiovascular events created by aspirin should be different in the primary or secondary setting. It's just that the benefits in the secondary setting far outweigh the risks. "The absolute reduction is much higher in secondary prevention than in primary prevention, but the level of bleeding is the same. So in secondary prevention, you've got a big reduction in events and a small amount of bleeding. In primary prevention, you have a smaller amount of reduction of events, and the same amount of bleeding. These two have got to be counterbalanced in the primary-prevention situation, and that is where the concern is at the moment."

Packaged Meat

2009-08-31T22:08:00.002-04:00

Be careful of what you buy. Even more reason to buy Organic meat.

Sports and Chiropractic

2009-08-21T22:47:00.002-04:00

These athletes use chiropractic to keep them in peak condition, shouldn't you?

HPV Vaccine: Debate Over Benefits, Marketing, and New Adverse Event Data

2009-08-19T13:53:00.001-04:00

August 18, 2009 — The benefit of vaccinating against human papilloma virus (HPV) to prevent cervical cancer is questioned in an editorial in the Journal of the American Medical Association.

"The theory behind the vaccine is sound: if HPV infection can be prevented, cancer will not occur," writes editorialist Charlotte Haug, MD, PhD, from the Journal of the Norwegian Medical Association. "But in practice, the issue is more complex."

HPV is the most prevalent sexually transmitted infection, "but the virus does not appear to be very harmful because almost all HPV infections are cleared by the immune system," she explains. In a few women, the HPV infection persists, and some women may develop precancerous cervical lesions and eventually cancer, Dr. Haug writes, "but it is currently impossible to predict in which women this will occur."

"The net benefit of the HPV vaccine to a woman is uncertain," Dr. Haug comments. "Even if persistently infected with HPV, a woman most likely will not develop cancer if she is regularly screened [with cervical smear tests]."

Dr. Haug has spoken out against HPV vaccination previously. Last year, she urged caution over widespread vaccination programs in an editorial in the New England Journal of Medicine (2008;359:861–862), as reported by Medscape Oncology at the time.

This latest editorial accompanies 2 articles published in the same issue of JAMA. One of the articles is critical of the marketing of the HPV vaccine Gardasil (Merck & Co) in the United States, and the other details adverse events that have been reported with the vaccine since it was launched there in 2006.

Dr. Haug comments that, in view of the uncertain benefit from the HPV vaccine, "only a small risk of harmful effects from the vaccine" is acceptable.

The balance between the risks and benefits of HPV vaccination should rest only on medical and scientific evidence, Dr. Haug states.

However, she warns that this balance is "easily skewed" if other matters weigh in; for example, profit for a company or gains for physicians — issues that are explored in the article on marketing.

"The balance will also tilt if adverse events are not calculated correctly," Dr. Haug comments, and her editorial points out limitations of the system used for collecting adverse event reports, detailed in the other article.

Criticism of Gardasil Marketing

The article discussing the marketing of Gardasil in the United States was authored by Sheila Rothman, PhD, from sociomedical sciences and David Rothman, PhD, from social medicine, both at the Columbia College of Physicians and Surgeons, New York City.

Merck & Co promoted Gardasil primarily to "guard" against cervical cancer, rather than promoting it as a vaccine against HPV viruses or sexually transmitted diseases, the authors note. (The vaccine is active against 4 virus subtypes: HPV-6, HPV-11, HPV-16, and HPV-18; HPV-16 and HPV-18 are responsible for about 70% of cervical cancers worldwide and can also cause other anogenital cancers, whereas HPV-6 and HPV-11 are the most common causes of genital warts).

The marketing was so successful that in its first year, Gardasil was named in the industry journal Pharmaceutical Executive as the "brand of the year" for building a "market out of thin air," the authors point out.

"By making this vaccine's target disease cervical cancer, the sexual transmission of HPV was minimized, the threat of cervical cancer to all adolescents maximized, and the subpopulations most at risk practically ignored," they write.

"Rather than concentrating on populations in geographical areas with excess cervical cancer mortality, including African Americans in the South, Latinos along the Texas-Mexico border, and whites in Appalachia, the marketing campaign posited that every girl was at equal risk," Dr. Rothman and Dr. Rothman write.

"That these arguments were delivered by professional medical associations (PMAs) is cause for concern," they add. Merck & Co funded activities at the American College of Obstetricians and Gynecologists, the American Society for Colposcopy and Cervical Pathology, the Society for Gynecologic Oncologists, and the American College Health Association.

Among the company-funded activities were speaker lecture kits and education resource panels, with sample answers to patient questions, as well sample press releases and sample letters to parents and students explaining why they should have the vaccine. The authors detail specific instances in which the message being promulgated by PMAs was influenced by Merck & Co.

Approached for comment, Diane Harper, MD, from the University of Missouri- Kansas City School of Medicine, Kansas City, Missouri, commented to Medscape Oncology that the PMAs "must confess to both their memberships and to the women whose health they serve that they were overtly exuberant in their hopefulness for vaccination and are guilty of presenting essentially only the information that Merck wanted presented."

She added, "In order to move on from this mistake, PMAs need to work with researcher clinicians to develop informed consents that include detailed risks and benefits of vaccination and screening." Dr. Harper also said that, now that serious adverse events have been documented, full disclosure of benefits and risks must be presented in all educational lectures.

Dr. Harper is professor and vice-chair, Obstetrics and Gynecology, Community and Family Medicine and Informatics and Personalized Medicine, and she conducted the phase 2 and phase 3 trials for Gardasil, authoring their publications. She has spoken out previously about the HPV vaccine and its marketing, and in particular about how the message about the need for regular cervical smears was overshadowed by "aggressive and inappropriate promotion of the vaccine."

Dr. Harper also commented that nowhere in any of the information about Gardasil has it been pointed out that in developed countries such as the United States, which have Papanicolaou (Pap) screening programs in place, the HPV vaccine will do little to decrease the already very small cancer rate but mostly will allow screening intervals to be extended safely.

Also approached by Medscape Oncology for comment, Maurie Markman, MD, professor of gynecologic medical oncology at the M.D. Anderson Cancer Center, Houston, Texas, questioned the credibility of the article on marketing, which is published as a "special communication." The authors are social scientists, he points out, and they "quote opinions from editorials as if they equate to facts." He emphasized the need to distinguish opinion from data and pointed out that there was no reference to any of the extensive peer-reviewed research articles on the HPV vaccine, which have accumulated data from thousands of patients.

Dr. Markman said he cannot comment directly about the claims made in the article, but added that he would be concerned if there were any truth to the idea that PMAs were not acting appropriately.

However, he strongly disagreed with one of the main points made in the article — the implied criticism of Merck & Co for promoting the vaccine for the prevention of cervical cancer. "I can't say how strongly I disagree with this — in fact, I am appalled," Dr. Markman told Medscape Oncology.

This vaccine does prevent cervical cancer, he emphasized, on the basis of all the data that are available, and "you cannot get better studies or a better strategy," he added. He acknowledges that there is no proof, as yet, but "it will take another 30 years or so to have that proof, and in the meantime, thousands of women will have died from cervical cancer."

"This paper is opinion masquerading as data," Dr. Markman said, and he added that it was "potentially harmful, as it may make people who have already received the vaccine think that they made a mistake."

(In fact, Gardasil is licensed for the prevention of cancer and is only the second vaccine to have this indication, point out the authors from the other article, all of who are from either the Centers for Disease Control and Prevention [CDC] or the US Food and Drug Administration. The first was the hepatitis B vaccine against liver cancer, which is also marketed by Merck & Co. Dr. Rothman and Dr. Rothman suggest that the company learned valuable lessons in the marketing of this first vaccine, which helped it make the marketing of Gardasil so successful.)

Dr. Harper says that HPV vaccination has a role to play in the prevention of cervical cancer. However, she emphasizes the need for regular cervical smears and points out that even women who are vaccinated need to have regular smears, as otherwise they are still at risk for developing cancer. In addition, women who do not receive the vaccine can still protect themselves equally well by undergoing regular Pap tests.

HPV vaccination will prevent more cervical cancers in populations that do not have access to cervical cancer screening, she continued. Some developing countries without screening have an incidence of cervical cancer that is 5 to 12 times higher than that seen in the United States. Because the death rate from cervical cancer is so much higher in these populations, they may also tolerate a high rate of serious adverse events, including death, that have been associated with Gardasil, Dr. Harper commented.

However, in the United States, the usefulness of the vaccine is to increase the chance that a woman's next Pap test will be normal, Dr. Harper commented. Women must still have Pap tests after vaccination, and vaccination alone in the United States will only incrementally reduce the rate of cervical cancer, with its greatest benefit being to increase the screening interval between screens, and hence being a cost-saving device, she added. In fact, if women who are vaccinated stop going for Pap smears, the incidence rate for cervical cancer would increase, she said.

In the United States, the death rate from cervical cancer (3/100,000 women by statistics from the CDC) is at present similar to the rate of reported serious adverse events from Gardasil (3.4/100,000 doses distributed), Dr. Harper pointed out. "This is a sobering reality," she commented. "Would a parent accept such a rate of serious adverse events if the same cancer prevention can occur with continued Pap screening? Is there any acceptable level of risk of serious adverse events, including death, to prevent genital warts?" she asked, referring to one of the vaccine's other benefits.

Latest Adverse Event Data

The latest data on adverse events with Gardasil, published in the same issue of the journal, comes from the US Vaccine Adverse Event Reporting System (VAERS). In total, 12,424 adverse events after immunization were reported to in United States between June 2006 and December 2008, during which an estimated 23 million doses had been distributed (with a course of 3 doses per person recommended). This represents a reporting rate of 53.9 reports per 100,000 doses distributed.

Of these, 772 reports (6.2% of the total) were described as serious, including 32 reports of death.

The authors, headed by Barbara Slade, MD, from the CDC, comment that most of the rates of adverse events after immunization were "not greater than the background rates compared with other vaccines," with the exception of syncope and venous thromboembolic events, which were higher for the HPV vaccine.

These 2 events, syncope and thromboembolic events, were also reported for the HPV vaccine at a higher rate during this postlicensure period than they had been in clinical trials before marketing, the authors note.

Syncope or syncope vasovagal was mentioned in 1896 reports, and dizziness was mentioned in 1572 and nausea in 1164 reports. The reporting rate was 8.2 cases per 100,000 doses distributed. The majority (>90% – 95%) of these reports were classified as nonserious, the authors note. However, some of the reports mentioned falls, and some of these led to fractures, concussions, hemorrhages, and lacerations.

Venous thromboembolic events were mentioned in 56 reports, giving a reporting rate of 0.2 cases per 100,000 doses distributed. Of these, 19 cases involved pulmonary embolism, and 4 of these resulted in death.

Other adverse events included local site reactions (reporting rate, 7.5 cases per 100,000 doses distributed), headache (4.1 cases per 100,000 doses distributed), hypersensitivity reactions (3.1 cases per 100,000 doses distributed), urticaria (2.6 cases per 100,000 doses distributed), autoimmune reactions (0.2 cases per 100,000 doses distributed), Guillain-Barré syndrome (0.2 cases per 100,000 doses distributed), anaphylaxis (0.1 cases per 100,000 doses distributed), death (0.1 cases per 100,000 doses distributed), transverse myelitis (0.04 cases per 100,000 doses distributed), pancreatitis (0.04 cases per 100,000 doses distributed), and motor neuron disease (0.009).

Dr. Markman commented to Medscape Oncology that he saw nothing very new or surprising in this article and said that the surveillance shows that the vaccine is "generally quite safe."

Dr. Harper agreed that "HPV vaccination is generally safe for most girls or women," but she also commented that the adverse events reported are "quite significant."

However, Dr. Harper was critical of the system in which the reports were collected. "VAERS, by all accounts, is an inadequate reporting system whose function in this form is biased towards not showing causality," she said. The definition of the denominator (those exposed to the vaccine) is very broad — if this figure was divided by 3 for women who received all 3 doses, then the reporting rate would be increased, she added.

"If a statistical association is shown with this level of inaccuracy, then it is truly there," Dr. Harper commented. "But conversely, if no statistical association is seen, one cannot conclude that there is no association."

This point is also made by Dr. Haug in her editorial. She points out limitations of the VAERS reporting system, which the authors themselves emphasize by saying that the "data must be interpreted cautiously and cannot generally be used to infer causal association." Dr. Haug, however, adds that "these limitations work both ways: it is also difficult to conclude that a serious event is not caused by the vaccine."

Dr. Harper also highlighted another concern about the VAERS data. The majority of the reports (68%) were submitted by the manufacturer (Merck & Co), which the authors say compares with a rate of 40% from manufacturers of other vaccines. But for nearly 90% of these reports, Merck & Co would not provide the CDC with any follow-up information to investigate possible statistical causality link. As the authors pointed out in the article, this is unusual behavior for a pharmaceutical company, Dr. Harper comments. During the same reporting period, manufacturers reported only 14.5% of the adverse events associated with Menactra (a meningitis vaccine from sanofi pasteur) and only 7.5% of the adverse events associated with Adacel (a polio vaccine from sanofi pasteur), she points out.

"Why would Merck make a concentrated effort at reporting nearly 70% of the adverse events for Gardasil if they did not want to control the information?" Dr. Harper comments. "Legislation needs to be enacted to require adverse events reported to pharma to include medical and contact information for potential follow-up by the CDC."

The editorialist and the authors of both articles have disclosed no relevant financial relationships. Dr. Harper reports having received honoraria from Merck & Co and GlaxoSmithKline, and institutions at which she has worked have received funding from both companies to support clinical trials on HPV vaccines. Dr. Markman reports having received grants for educational activities from Eli Lilly and serving as an advisor or consultant for Genentech, Celgene Corporation, Tibotec, and Boehringer Ingelheim.

JAMA. 2009;302:750–757, 795–796, 781–786.

Watching TV: Even Worse for Kids Than You Think

2009-08-06T16:20:00.007-04:00

By Alice Park

It's no secret that sedentary behavior contributes to obesity and chronically poor health. But not all sedentary behaviors are created equal, according to a new study that examines the link between blood pressure in children and their choice of inactive pastimes, including watching TV, using the computer and reading.

Researchers in the U.S. and Spain collaborated on the study of 111 children ages 3 to 8 and found that of all the forms of inactivity they examined, television-viewing was the worst. It was linked to significantly higher blood pressure in children — the more TV kids watched, the higher their blood pressure — and the effect held true regardless of whether a child was heavy or at a healthy weight. What's more, other sedentary behaviors, like using a computer, were not associated with similar blood-pressure hikes, according to the study, which was published in the Archives of Pediatric and Adolescent Medicine.

"These results show that sedentary behavior, and more specifically television-viewing, is related to blood pressure independent of body fat or obesity level," says Dr. Joey Eisenmann, a kinesiologist at Michigan State University and one of the study's co-authors.

To determine levels of inactivity over one week, the children in the study wore accelerometers, which resemble pedometers but instead of tracking distance, they record the body's acceleration in a vertical plane — sitting results in a score of zero, and walking and running produce progressively higher scores. The researchers considered anything under a score of 50 per day as sedentary. They coupled this data with reports from the children's parents about how much time the kids spent in inactive pursuits, including watching television, sitting at a computer, playing video games, reading or doing other projects that don't require much movement.

The children were sedentary for five hours each day, and 1.5 of those hours were spent in front of a TV, computer or video game, on average. When the researchers further broke down screen time by activity, TV-viewing had the strongest correlation with higher blood pressure. Kids watching from 90 to 330 minutes of television each day had systolic and diastolic blood-pressure readings (the two numbers that indicate pressure caused by blood pumping from the top and bottom chambers of the heart, respectively) that were five to seven points higher than those of children watching less than half an hour of television a day.

"These results show that TV-viewing really is the worst of all possible sedentary activities," says Dr. David Ludwig, director of the Optimal Weight for Life Program at Children's Hospital Boston, who was not part of the study. The American Academy of Pediatrics recommends that children under 2 should not watch any television and that older children limit their viewing to one to two hours per day.

So what is it about watching TV that's worse than playing video games or surfing the Internet? Certainly, playing games and using computers involve some movement, like fidgeting or changing body positions, but is that enough to explain the difference? The study's authors propose several other possible explanations. For instance, beyond the complete inactivity involved with TV-viewing — which alone raises the risk of high blood pressure — children may be compounding their sloth by eating junk food. "A full bag of chips or a plate of hot dogs can disappear a lot more quickly while watching TV than they might at any other occasion," says Ludwig. And the types of foods that children are likely to be eating in front of the tube, like salty snacks, can push up blood pressure readings.

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This is one of the latest studies that demonstrate watching TV isn't good for you or for your children. In addition, one recent study by the Journal of the American Dietetic Association examined Saturday cartoon commercials and found that half were related to food. And 90% of those food commercials were high in fat, sodium (salt), sugar, processed/chemical foods, or low in nutrition. A recipe for making your child obese!

Here's another food for thought. CDC found that 57% of 8-16 yr olds have TV in their rooms. Children with TV in their rooms watch 1.5 hours more per day than those without.

Be the proactive parent. Limit TV viewing to 1 hour and get your kids to play outside! They'll be more healthier physically, mentally, and emotionally!

Dr. Ryan Suh, DC
www.gonsteadny.com

FDA: Arthritis drugs pose cancer risk to children

2009-08-05T00:10:00.004-04:00

Is it worth the trade-off? Are you willing to trade pain for increase risk of cancer? These Tumor Necrosis Factor (TNF) blocker medications (Humira, Remicade, Simponi, Cimzia, and Enbrel) are a double-bladed sword. We need TNF in our body. It helps regulate our immune system and it's responsible for keeping cancer in check. An imbalance of TNF, whether it's too much or too little can be a problem. Instead of using a drug to artificially reduce TNF level, how about addressing the cause of increase TNF? Avoid processed and chemical foods that causes high inflammation. Eat more foods that reduces inflammation like Omega-3's (fish), Olive oil (non-heated), fresh fruits and dark veggies. You may experience reduce arthritic pain.

-Dr. Ryan Suh, DC
www.gonsteadny.com

By MATTHEW PERRONE, AP Business Writer Matthew Perrone, Ap Business Writer – Tue Aug 4, 7:04 pm ET

WASHINGTON – Federal regulators on Tuesday added stronger warnings to a group of best-selling drugs used to treat arthritis and other inflammatory diseases, saying they can increase the risk of cancer in children and adolescents.

After more than a year of review, Food and Drug Administration scientists said the drugs appear to increase the risk of cancer after they are used beyond 2 1/2 years. The agency studied several dozen reports of cancer in children taking the drugs, some of which were fatal. Half of the cases were lymphomas, a cancer that attacks the immune system.

The drugs are known as tumor necrosis factor blockers and work by neutralizing a protein that, when overproduced, causes inflammation and damage to bones, cartilage and other tissue. The drugs are prescribed to children with rheumatoid arthritis, inflammatory bowel disorder and Crohn's disease.

The FDA will bolster the "black box" warning on the five drugs sold in the U.S., including Abbott Laboratories' Humira, Johnson & Johnson's Remicade and Simponi, and Enbrel which is co-marketed by Amgen Inc. and Wyeth. All the products are multibillion-dollar sellers. Enbrel was the biggest moneymaker of the group with sales of $3.4 billion last year.

The action also affects Belgian drugmaker UCB's Cimzia, which launched in May.

Shares of North Chicago-based Abbott Laboratories and New Brunswick, N.J.-based J&J fell after the FDA announcement.

Along with updating the drugs' labels, the FDA is requiring companies to add information about cancer risks to the medication guides given to patients. The FDA said it is also working with the manufacturers to further define the scope of the cancer risk.

J&J said in a statement it "will coordinate closely with the FDA to ensure that health care providers, patients and caregivers are properly informed."

Amgen and Wyeth said they will continue working with regulators to evaluate "the potential risks and benefits" of their drug.

Smart chickens weren't duped by foul play

2009-08-03T22:05:00.005-04:00

http://tinyurl.com/lx5mm7

By Eleanor Momberg

Chickens refusing to eat the maize they had been fed has led to the discovery that their feed had been genetically modified to include a well-known weed and insect killer.

Strilli Oppenheimer was recently approached by Dawid Klopper, the head gardener at the family estate, Brenthurst, informing her that her indigenous African chickens were refusing to eat the mealies in the chicken feed bought from a large supplier. Concerned that the birds may be ingesting genetically modified maize, she instructed Klopper to have the maize tested.

The chickens' diet was immediately changed to include organic vegetables, Oppenheimer stopped consuming the home-grown eggs and the maize was sent to the GMO testing facility at the University of the Free State for analysis.

The results confirmed Oppenheimer's initial suspicion - the maize had been genetically engineered to produce proteins that are toxic to certain insects and weeds.

"It contained BT1 which makes the maize insect resistant, as well as Roundup which makes it weed resistant. This is the first report we have had of chickens not eating GM feed," said a GM expert.

While small quantities of BT1 and Roundup weed killer were found in the seeds, the concern remained with the cumulative effect of GM feed, not only on the chickens, but also on the eggs they produced for the family.

"This is of serious concern. Do you know that 96 percent of soya-based foods are genetically modified and that maize in South Africa is contaminated," asked Oppenheimer, pointing out that research by well-known scientist Dr Arpad Pusztai had shown that rats fed on GM potatoes suffered from a weakened immune system and stunted growth of their internal organs, including the liver, kidneys and brain.

Pusztai was fired by the Rowett Research Institute in the UK in 1998 after his research into the human nutritional consequences of GM. His findings had far-reaching implications for the biotech industry, which had contended that GM crops and products would not adversely affect human health.

International research has shown a direct link between certain types of genetic engineering and cancer.

Gundula Azeez and Coilin Nunan of The Soil Association, a UK environmental charity, stated in their paper, "GM Crops - the health effects", that international research had shown that milk, eggs and meat from GM-fed animals contained GM crop DNA, concluding that it was likely that people were frequently being exposed to GM DNA.

They concluded that because of the lapses in extensive safety assessments, there were "very good scientific reasons for being concerned about the safety of GM crops".

Rose Williams, acting director of Biowatch, said globally there was great concern that GM products had not been adequately tested in terms of their effect on people, animals and the environment.

"There has been no testing on humans, very limited testing on animals and very little research on environmental impacts. This is the case globally, but in South Africa even less work has been done, even though the commercial release of GM maize, GM soya and GM cotton has been approved."

Williams said concerns by NGOs such as Biowatch, the African Centre for Biosafety and SAFeAGE about the lack of control over GM crops and contamination of non-GM crops had largely been ignored.

"Government has not done enough to protect the public from the potential threats of GM foods. There is also the matter of liability - who will take responsibility for people's losses and any health problems relating to consumption of GM foods, whether they are for people or for animals."

Williams said the contamination of non-GM crops was a real problem, with the biotech industry leading people to believe that co-existence of GM and non-GM crops was possible. "But it is not," she said.

While the recently implemented Consumer Protection Act called for the labelling of GM foods, the regulations linked to the measure had yet to be finalised.

About her chickens' refusal to eat their maize, Oppenheimer said: "They're smart."

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It goes without saying, animals are smart enough to recognize there's something wrong with the food. Even rats are getting sick on genetically modified food. Why are we eating GMO food? Do you want to be LESS healthy? I always follow a simple rule... If God didn't make it, don't eat it.

Dr. Ryan Suh, DC
www.gonsteadny.com

Lack of Vitamin D in Children 'Shocking'

2009-08-03T12:30:00.006-04:00

Lack of Vitamin D in Children "Shocking"

About 70 percent of U.S. children have low levels of vitamin D, which puts them at higher risk for bone and heart disease, researchers said today.

"We expected the prevalence of vitamin D deficiency would be high, but the magnitude of the problem nationwide was shocking," said Dr. Juhi Kumar of Children's Hospital at Montefiore Medical Center.

Cases of rickets, a bone disease in infants caused by low vitamin D levels, have also been increasing, other research shows.

The new finding, from a nationwide study, adds to growing evidence that children as well as many adults also lack the vitamin.

"Several small studies had found a high prevalence of vitamin D deficiency in specific populations of children, but no one had examined this issue nationwide," said study leader Dr. Michal L. Melamed of the Albert Einstein College of Medicine of Yeshiva University.

The cause? Poor diet and lack of sunshine, the researchers conclude today in the online version of the journal Pediatrics.

Millions of children

The researchers analyzed data on more than 6,000 children, ages 1 to 21, collected by the National Health and Nutrition Examination Survey 2001-2004.

The researchers found that 9 percent, or 7.6 million children across the country, were vitamin D deficient and another 61 percent, or 50.8 million, were vitamin D insufficient.

Low levels were especially common in girls, African-Americans, Mexican-Americans, the obese, those who drank milk less than once a week, and those who spent more than four hours a day watching TV, playing videogames, or using computers. The deficiency was more common among the older children in the data set, too.

Lighter skin is more efficient at producing vitamin D. So darker-skinned people produce less when exposed to sunlight.

The decline in vitamin D levels in the United States was reported widely a year ago and has been underway for 20 years, Melamed said.

"Kids have more sedentary lifestyles today and are not spending as much time outdoors," Melamed said. "The widespread use of sunscreens, which block UV-B rays, has only compounded the problem."

The body uses UV-B sunlight to convert a form of cholesterol in the skin into vitamin D.

What to do

Melamed recommends that children should consume more foods rich in vitamin D, such as milk and fish. "But it's very hard to get enough vitamin D from dietary sources alone," she said.

Vitamin D supplementation can help. In the study, children who took vitamin D supplements (400 IU/day) were less likely to be deficient in the vitamin. However, only 4 percent of the study population actually used supplements.

The American Academy of Pediatrics, which recently updated its vitamin D guidelines, now recommends that infants, children, and teens should take 400 IU per day in supplement form.
Supplements are especially important for children living in northerly regions where the sun may be too weak to maintain healthy vitamin D levels. Supplements are also critical for infants who are breast-fed, the researchers said in a statement today. Breast milk contains relatively little vitamin D, while formula is fortified with the vitamin.

What else can parents do?"It would good for them to turn off the TV and send their kids outside," Melamed said. "Just 15 to 20 minutes a day should be enough. And unless they burn easily, don't put sunscreen on them until they've been out in the sun for 10 minutes, so they get the good stuff but not sun damage."

Other experts caution that extended exposure to the sun — tanning and burning — increases the risk of deadly skin cancer.

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This is a growing concern. Kids should be outside playing, not indoors playing video games. Getting your Vitamin D is one important benefit, studies have also shown that playing outside helps kids and teenagers grow healthier and stronger bones and muscles, regulate their hormones better, less likely to be overweight, perform better in school, and do well socially. Adults should be doing the same as well. Being outside helps relieve stress, refocuses your mind, improve your overall health, and helps regulate your weight. So, what are you waiting for? It's a beautiful day outside! Seize the day!

Dr. Ryan Suh, DC

www.gonsteadny.com

Flaxseed Reduces Blood Lipids

2009-08-01T10:52:00.005-04:00

Instead of relying on statin medications which have side-effects, including depriving your heart of Co-Enzyme Q10 for proper function, consider using Flax seed or fish oil which provides Omega 3 essential fatty acids to reduce your cholesterol and LDL levels!

Dr. Ryan Suh, DC
www.gonsteadny.com

July 29, 2009 — Whole flaxseed and flaxseed lignans significantly reduce circulating total cholesterol and low-density lipoprotein (LDL) cholesterol levels, showing their greatest effect in postmenopausal women and individuals with high initial cholesterol concentrations, according to the results of a meta-analysis published in the August 2009 issue of the American Journal of Clinical Nutrition.

"Owing to the promising results in preclinical models, many clinical trials have been performed to determine the outcomes of flaxseed intervention (whole flaxseed, flaxseed oil, or lignans) on various cardiometabolic risk factors, particularly blood lipids," write An Pan, MSc, from the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Chinese Academy of Sciences, Shanghai, China, and colleagues. "However, the findings from most of the previous clinical trials were inconsistent, and the discrepancies could be attributed to small sample size, insufficient study duration, variation in study designs, and diversity of the test product."

Total, LDL Cholesterol Levels Reduced

The aim of this study was to evaluate whether administration of flaxseed or its derivatives could improve total, LDL, and high-density lipoprotein (HDL) cholesterol levels and triglyceride levels by making use of the increased statistical power afforded by a meta-analysis.

The researchers searched all randomized controlled trials of flaxseed or its derivatives on lipid profiles in adults, which were published in English from January 1990 to October 2008. They also attempted to contact authors of unpublished data. Study quality was assessed with use of the Jadad score; 16 studies were classified as high quality (Jadad score of 4 or 5), and 12 studies were classified as low quality (Jadad score of 2 or 3).

The 28 trials used in the meta-analysis comprised a total of 1381 study subjects. Five were conducted exclusively in postmenopausal women, 1 was done in premenopausal women, 10 trials were conducted in men, 10 trials were conducted in both sexes, 1 trial did not indicate the sex composition of the study sample, and 1 trial reported results separately by sex.

The median duration of the trials was 8.5 weeks, (range, 2 - 52 weeks). Flaxseed in whole, ground, or defatted form was tested in 10 of the 28 trials in doses that ranged from 20 to 50 g (2 - 5 tablespoons), and flaxseed oil was tested in 13 of the trials.

A significant reduction in total cholesterol levels was found in studies using whole flaxseed, with a net change of –0.19 mmol/L (95% confidence interval [CI], –0.29 to –0.09 mmol/L) and also in studies using lignan supplements, where the net change was –0.28 mmol/L (95% CI, –0.55 to –0.01 mmol/L). Similarly, a significant reduction in LDL cholesterol levels was found with whole flaxseed (net change, –0.16 mmol/L; 95% CI, –0.25 to –0.06 mmol/L) and lignan supplements (–0.16 mmol/L; 95% CI, –0.31 to –0.01 mmol/L). However, there were no significant changes in total and LDL cholesterol levels with the intervention of flaxseed oil, the study authors report.

Women vs men had greater reductions in total cholesterol levels with flaxseed. The mean reduction for women was –0.24 mmol/L (95% CI, –0.36 to 0.12 mmol/L), and for men, the mean reduction was –0.09 mmol/L (95% CI, –0.05 to 0.23 mmol/L). The same was found with reductions in LDL cholesterol levels: for women, the mean reduction was –0.17 mmol/L (95% CI, –0.28 to –0.06 mmol/L), and for men, the mean reduction was –0.07 mmol/L (95% CI, –0.04 to 0.18 mmol/L).

The authors also report that total and LDL cholesterol levels were reduced to a greater degree in the high-quality studies (net change, –0.13 mmol/L; 95% CI, –0.24 to –0.02 mmol/L) vs the low-quality studies (net change, –0.08 mmol/L; 95% CI, 0.16 to –0.01 mmol/L). No significant changes were detected in the low-quality studies, they add.

When the studies were stratified according to initial lipid status, significant reductions in total cholesterol levels were found in the studies including subjects with high initial concentrations, defined as 5.7 mmol/L for total cholesterol and 3.4 mmol/L for LDL cholesterol. For these individuals, the mean change in total cholesterol level was –0.17 mmol/L (95% CI, –0.32 to –0.03 mmol/L), and the mean change in LDL cholesterol level was –0.13 mmol/L (95% CI, – 0.23 to –0.02 mmol/L). In comparison, the mean change in total cholesterol levels for subjects with lower initial concentrations was 0.03 mmol/L (95% CI, –0.11 to 0.17 mmol/L), and the mean change in LDL cholesterol levels was 0.00 mmol/L (95% CI, –0.12 to 0.12 mmol/L).

There were no significant changes in HDL cholesterol or triglyceride levels.

Interpret Findings With Caution

The authors point out that the limitations of their study include the heterogeneity of the studies in the meta-analysis, and a lack of information on the quality, quantity, and bioavailability of the flaxseed that was used. Therefore, they write, their findings must be interpreted with caution.

The results of this meta-analysis indicate that flaxseed consumption may be a useful dietary approach for the prevention of hypercholesterolemia, especially in some patient subgroups, the authors conclude. They add that further studies should be done to investigate the effectiveness of flaxseed supplementation on cardiometabolic risk factors other than blood lipids and, ultimately, on cardiovascular disease–related morbidity and mortality.

Dr. Pan has disclosed no relevant financial relationships.

Am J Clin Nutr. 2009;90:288-297.Abstract