Tag Archives: BMJ

Safety of metal-on-metal hip implants.

This report has been publicised widely, so people are likely to ask, ”How safe are metal-on-metal hip replacements, and what should I do if I have one?

  • Metal-on-metal implants, which have been used since the late 1990s, are made of cobalt-chromium alloy rather than ceramic or polyethylene, and this may lead to ion leakage.
  • High levels of metal ions can destroy muscle and bone and leak into the bloodstream, spreading to the lymph nodes, spleen, liver, and kidneys, before leaving the body in the urine. The ions have also been liked to chromosomal damage and cancer.
  • The 49 000 UK  people with metal-on-metal hip implants with a femoral diameter of 36 mm or more will need follow-up tests for the rest of their lives (Medicines and Healthcare Products Regulatory Agency advice).
  • This will mean annual blood test to check metal ion concentrations.
  • People with symptoms of hip problems (such as swelling, pain, or limping) should have annual magnetic resonance imaging (MRI).
  • Asymptomatic  people with raised ion concentrations (>7 micrograms per litre) should receive repeat testing three months later and MRI if concentrations continue to rise.

Read the full article (British Medical Journal) here.

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Sugar, gout and metabolic syndrome

Consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men. This was the finding of a study published in the British Medical Journal back in 2008. Gout is a joint disease which causes extreme pain and swelling. It is most common in men aged 40 and older. It is caused by excess uric acid in the blood (hyperuricaemia) which leads to uric acid crystals collecting around the joints.

In the United States, levels of gout have doubled over the last few decades, which coincided with a substantial increase in the consumption of soft drinks and fructose (a simple sugar and the only carbohydrate known to increase uric acid levels). Conventional dietary recommendations for gout have focused on the restriction of purines (found in high levels in meat and meat products, especially liver and kidney) and alcohol but with no restriction of sugar sweetened soft drinks.

With this in mind, researchers in the US and Canada examined the relation between intake of sugar sweetened soft drinks and fructose and the risk of gout. They followed over 46,000 men aged 40 years and over with no history of gout. The men completed regular questionnaires on their intake of more than 130 foods and beverages, including sugar sweetened soft drinks and diet soft drinks, over a period of 12 years. Different types of fruits and fruit juices (high in natural fructose) were also assessed.

At the start of the study, and every two years thereafter, information on weight, regular use of medications and medical conditions were also recorded. Gout was diagnosed according to American College of Rheumatology criteria. During 12 years of follow-up, the researchers documented 755 newly diagnosed cases of gout. The risk of gout increased with increasing intake of sugar sweetened soft drinks. The risk was significantly increased with an intake level of 5-6 servings per week and the risk was 85% higher among men who consumed two or more servings of sugar-sweetened soft drinks per day compared to those who consumed less than one serving per month. These associations were independent of other risk factors for gout such as body mass index, age, diuretic use, high blood pressure, alcohol intake, and dietary factors.

Diet soft drinks were not associated with the risk of gout.

Fruit juice and fructose rich fruits (apples and oranges) were associated with a higher risk of gout. However, the authors stress that this finding needs to be balanced against the benefit of fruit and vegetable intake to prevent other chronic disorders like high blood pressure, coronary heart disease, stroke and certain types of cancer.

In conclusion, the 2008 findings provide evidence that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout, say the authors. Furthermore, fructose rich fruits and fruit juices may also increase the risk. In contrast, diet soft drinks were not associated with the risk of gout.

To bring this article more up to date, fructose does now appear to be closely associated with a number of uric acid related disorders that include high blood pressure, fatty liver, generalised inflammation, elevated blood fats (lipids) as well as the growing epidemic of abdominal obesity and type-II diabetes.

Adopting a low glycaemic style diet would appear to be the way forward for many who have become habitual sugar and fructose consumers; not only will it reduce the problems associated with gout this dietary approach will minimise the growing problem of metabolic syndrome.

Further reading

Hypothesis: Could Excessive Fructose Intake and Uric Acid Cause Type 2 Diabetes?

Pre-diabetes; what can be done?

Hi GI foods and heart disease

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Is there a risk between Calcium and getting a heart attack?

Calcium pills increase the risk of heart attacks” was the latest worrying headline for many a little while ago. As if we don’t have enough to worry about now our trusted and protective calcium dose is out to get us! However, this is not really new news. Taking pure elemental calcium has always been questioned in connection with unwanted calcification of soft tissues and potentially associated with the calcium-based plaques seen in the walls of diseased blood vessels. The current study, published in July issue of the BMJ, took this a stage further by suggesting that those who took elemental calcium in doses of 500mg or more were increasing their risk of a heart attack. The BMJ study analysed 11 previous studies covering some 11,921 people over 4 years. Out of these people 296 had heart attacks of which 166 were taking calcium (over 500mg/day) and the rest (130) were on placebos. The trial participants were mostly female, and the trial only involved elemental calcium, not calcium combined with vitamin D or any other nutrient. In fact, studies that used calcium and vitamin D combinations were actively excluded from the analysis. When the numbers were statistically crunched elemental calcium appeared to increase the risk of a heart attack by roughly 30%. Oddly enough in 2008 the BBC reported on research conducted at the University of Minnesota that showed owning a cat appears to reduce the risk of a heart attack by 40%; could buying a cat be an antidote to the problem?

On a more clinical note, the reassuring aspect of this story is that pure elemental calcium, taken in isolation, appears to be the issue. Personally, I can’t remember the last time I came across a patient that was taking pure calcium in the absence of other key factors such as vitamin D or vitamin K or as part of a multiple bone complex, such as OsteoPrime. I feel reassurance is needed in these cases where the benefits clearly outweigh the risks for bone health.

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What to do when “Statins” just don’t suit you?

The association between heart disease and cholesterol has enjoyed a long and sometimes rather volatile relationship. Without doubt, those with certain genetic defects causing their cholesterols to rocket into double figures have a predisposition to clogged arteries and heart disease well before their time but controversy rages on regarding the true impact of cholesterol on coronary artery disease; does simply reducing the cholesterol level really play such an important role when off set against the growing list of side effects experienced by users of cholesterol lowering drugs known as statins.
A number of recent studies have thrown a shroud or confusion over the whole cholesterol issue. In a large study involving over 1800 people with existing arterial disease just lowering their bad cholesterol (LDL) for 4 years made no difference to the progression of the disease. However, what did become apparent was that 105 unexpected cases of cancer occurred in the drug treated group compared to 70 cases in the non-drug treated group. To date, no one can confidently point a finger at the drug as a trigger for the cancer cases but it does raise suspicion that needs further investigation. The drug being tested was a combination of simvastatin and ezeimibe known as Inegy.
Other less serious but now well documented side effects from statin therapy include muscle pain and weakness (myopathy) and damage to the liver. Some experts dismiss these side effects as rare and not significant compared to their effectiveness in lowering cholesterol but if simply lowering the cholesterol is not the main issue could thousands of statin users be exposing themselves to unnecessary side effects and misery. Interestingly, Professor Beatrice Golomb of the University of California San Diego agrees. She found that muscle symptoms are far from rare with statin drugs. Professor Golomb comments that “there’s a multibillion-dollar industry ensuring that you hear all the good things about statins, but no interest group ensuring that you hear the other side.” On her research based web site, http://www.statineffects.com, Professor Golomb outlines why she is particularly concerned with the effect of statins on moods and memory describing how “it’s common to find patients on the drugs who report trouble finding the right word or forgetting what task they are supposed to be doing.” Supporting this alternative view on cholesterol is the Danish physician and cholesterol expert Dr Uffe Ravnskov who also publishes a cholesterol information web site that can be found at www.ravnskov.nu. Dr Ravnskov commented in the British Medical Journal that two of the big statin trials deliberately excluded patients who had suffered side-effects in pre-trial tests, and then claimed that the number of side-effects reported was low.
However we can’t avoid the fact that heart disease is a real problem in the UK. The British Heart Foundation state that collectively, heart and circulatory diseases cause more than a third (36%) of all deaths in the UK, accounting for over 208,000 deaths each year. With statistics like this being circulated and our obsession with cholesterol levels it comes as no surprise that the food supplement products known as Red Yeast Rice (RYR) hit the headlines. The news that a 600mg dose of RYR taken morning and evening significantly reduced blood fats (lowering total cholesterol, triglycerides and LDL) while raising the healthy cholesterol levels known as HDL was just what the growing army or statin intolerant people wanted to hear. The study (published in the June 2008 issue of the American Journal of Cardiology) involves some 5000 people over a time period of four and a half years. What was even more interesting was the fact that al those in the study has suffered a previous heart attack and were taken off all conventional drugs before starting the RYR trial. Unlike the study involving the drug combination mentioned at the start of this feature the RYR intake group demonstrated a reduction in disease reoccurrence and no associated side effects.
For those wishing to try a RYR product consider Red Yeast Rice Gold, a certified organic food supplement known to be free from impurities. It is not recommended that you combine RYR with statin drugs. It would make sense to avoid Grapefruit juice since this may increase the risk of side effects and avoid St Johns wort since this may reduce the effectiveness of RYR. Because there are no studies to the contrary, the use of RYR products during pregnancy and breast feeding is not recommended. For a good overview of RYR and its actions and interactions click here.

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What’s so special about garlic?

What is it about garlic that makes it so good for us. For countless centuries garlic has been listed and quoted as a health promoting agent by generations of healers, herbalists, naturopath and now, even conventional doctors and recommending it!
Garlic is a member of the onion family of vegetables and just like onions it contains powerful oils that give food a characteristic flavour. Its ability to spice meals up probably explains why the onion family has featured so high in traditional diets and recipes foe so long. Studies into the effects of diet on health now confirm that onions and garlic can promote heart health, benefit blood pressure and reduce inflammation, a key feature of so many degenerative diseases. A common report from regular garlic users is its apparent ability to help keep the body free of opportunistic infections such as the common cold. This may be partly due to garlic’s effect on the immune system and partky due to its “cleansing” effect o the respiratory system. Many of the oils in garlic have antimicrobial actions that may keep our lungs and nasal passages free from bugs. Diet also appears to be playing an important role in other degenerative problems. Several reliable medical studies now confirm that following the so-called Mediterranean diet , which includes the liberal use of onions and garlic, reduces the incidence of conditions such as Parkinson’s and Alzheimer’s disease. What’s more, those following such a diet were, on average, 9% less likely to die young according to the study published in the British Medical Journal. So, we return to our initial question; what is it in garlic that makes it so good for us?
To start with, garlic contains many organic compounds that have been the focus of intensive study for many years. However, one compound has always emerged as a key player in garlic’s ability to support circulatory and general health. It is the most biologically active ingredient in garlic and the cause of garlic’s characteristic odour. The twist comes in the fact that this substance is not present in the intact garlic bulb, it is only present when the bulb is crushed and an enzyme is released that converts an inert ingredient found in the garlic bulb into this active substance known as allicin. For those interested the chemistry goes like this; when the garlic bulb is crushed Alliin (the inert, non active substance found in the garlic bulb) is converted by the enzyme alliinase (released during the crushing process) into allicin (the key active compound). Its easy to do this at home, sniff an intact garlic bulb and it is odourless. Crush it and the smell emerges almost immediately, that’s the effect of the enzyme on the alliin. With the identification that allicin is the key agent science soon made the links between heart health and garlic. Spin off research also discovered that the immune system benefits from allicin along with the lining of the digestive tract and bowels.
For those who don’t like garlic or wish to avoid the odour on the breath supplements are the obvious answer but choosing the right one can be a task in itself. Do you opt for garlic oil capsules, freeze dried garlic tablets, odourless preparations or aged garlic, and this is just the start. If you are looking for a simple, easy to take tablet that guarantees the allicin content and is odour free than Garlinase is your product of choice. Its enteric coating protects the ingredients from the acid levels of the stomach ensuring that no odour is detected on the breath. Being made from fresh garlic the alliin and allinase are preserved until the tablet is digested after which the key reaction occurs resulting in allicin being produced and released slowly within the gut. This preparation delivers the key agent and eliminated the odour in one!

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What’s the evidence?


In the August issue of Hadley Wood News my 200 words of “wisdom” focused on the rather contentious issue of Evidence Based Medicine. What’s it all about and can it be applied to the alternative arena. I seriously doubt we will ever come to a firm agreement on this subject but its worth a bit of dialog any way!
In my professional world, alternative medicine that is, results often speak louder than the supporting evidence for the my treatments. It may sound rather crude but if my patients don’t get or at least feel better my clinic would simply not survive. Hadley Wood Healthcare has been in operation for over 20 years now so something must be working. In this situation the evidence could be viewed as what ever we are doing does get results, but how those results are achieved is probably not fully understood from the purely scientific standpoint. I/we, the practitioners of the holistic approach, could be seen as practicing results-based rather than evidence-based medicine.

However, is this actually a bad thing? Should we have to wait for the evidence to catch up with the results? Take, for example, the much published case for using the herbal remedy St John’s wort in depression. The results documented by herbalists can be traced back for hundreds of years but only recently have scientific studies confirmed its ability to be as good if not better than regular antidepressants for treating mild to moderate depression. A look at the BMJ’s Best Treatment web site and pop St Johns wort in the search box you can do your own research and come to your own conclusions. Interestingly one of the most recent bits of research comments that; “Does it work? Probably“. and goes on to say that “St. John’s wort is likely to help you if you have mild or moderate depression. However, the research on St. John’s wort isn’t as good as the research on antidepressants”. Well… would you expect multiple millions to be turned over to research into a herbal remedy when we have plenty of drugs to sell? Oh, call me an old cynic if you wish but I am a realist. What this says to me is that, yes, we see that St Johns wort works in depression but we can’t endorse it because the studies are not as good as the multi-million pound funded drug trials. However, if the herb showed one wisp of a side effect it would be whisked off the shelf quicker than a Daily Mail headline could go to press.
The problem here is simple. If one of my herbal or natural remedies went to trial and was shown to be as good as the conventional drug it would be re-classified as a drug and taken off the market or produced by one or two big manufacturers and sold at a premium. Not only would this limit choice it would stifle any innovation in the natural health industry.
As much as I like the sound of the evidence based approach I prefer the reassurance of the traditional results driven approach. Why re-invent the wheel when it works just fine? If we had to wait for the evidence base to catch up with the results many people would have miss out on an effective natural therapy and, on the other hand, robbed of the freedom of choice. What a dull world it would be if there were no alternatives around. The evidence based articles go to great lengths informing us of what does not work but offers very little in the way of what one could try.

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A New Look at Hyperactivity in Children

Food additives and hyperactivity – a new look at an old problem

We have all experienced the problem either with our own children or with a friends; behaviour and mood rapidly changing after eating processed or highly coloured food. Naturally we make the knee jerk judgement and commit that food to the growing list of culprits responsible for turning our kids into little monsters. Few would question the benefit of changing our children’s diets for ones higher in fresh natural foods whilst avoiding the potential chemical time bombs of processed food but is there any actual evidence to say that these foods are the real triggers?
This was the topic in a recent editorial published in the British Medical Journal. When a study involving some 297 children aged between 3 and 9 were analysed some interesting results came to light. One of the key factors in this study was the fact that unlike many other investigations none of the children in this cross section had any previous diagnosis of attention-deficit or hyperactivity disorder. Despite this the results still showed an adverse effect on behaviour with an intake of additives equivalent to that found in two 56 g bag of sweets.
No one can agree – who can you trust?
Following the publication of this study the European Food Safety Authority (EFSA) soon jumped in and rejected the claims in news articles that two mixtures of food colours along with the preservative sodium benzoate had any adverse effect on behaviour. However, following a re-analysis of the results the EFSA was forced to revise their view and had to re-publish their comments. The EFAS panel discovered that the figures they questioned did actually mirror the results of the original study. Their final comment on the subject was characteristically low key; “the study provides limited evidence that the two different mixtures had a small and statistically significant effect on activity and attention” This statement, as low key as it may appear, is an important step forward because if additives alters the behaviour of normal children, even in a small way, the study has profound implications for children with hyperactivity who are far more sensitive to many things including chemicals. It is true to say that food and additives are not the prime cause of behavioural problems in hyperactive children, the condition is complex and highly individual, but anecdotal reports from parents, teachers and health professionals do point a finger most certainly at foods as potent triggers. Sadly, eliminating colourings and preservatives are still regarded by some as an alternative rather than a standard approach. In light of the current studies and years of almost impossible to avoid anecdotal accounts it is difficult to understand why simply improving the diet and removing “junk” needs so much science to support its use. Despite this, the two-pronged conventional approach is still firmly entrenched primarily in drug therapy and sometimes referral for behavioural therapy. With the growing bank of evidence to support the role of diet modification it is surprising that this simple task is not tackled from the onset keeping in mind that there is, in fact, less evidence published for the benefits of behavioural therapy! This probably explains why around 50% of children attending specilist medical clinics also concurrently use alternative medicines.

The additives defiantly to avoid
Sunset yellow (E110) – Colouring found in squashes
Carmoisine (E122) – Red colouring in jellies
Tartrazine (E102) – New colouring in lollies, fizzy drinks
Ponceau 4R (E124) – Red colouringSodium benzoate (E211) – Preservative
Quinoline yellow (E104) – Food colouring
Allura red AC (E129) – Orange / red food dye

What else can be done?
A quick check of the internet will yield a plethora of cures and remedies for ADHD and hyperactivity disorders. A simple Google search for “ADAH products” narrowed down to UK sites only resulted in 81,800 sites coming up!
Among the many sites there is some good information and within this information can be found some guiding lights in the grey area that lies between alternative and conventional medicine. One such beacon in the mist is Dr Jeff Bradstreet MD. Jeff is a family doctor based in Florida where is founded the International Child Development Resource Centre. As well as his clinical work he is also a Professor of Neuroscience at Stetson University, Florida and the Southwest College of Naturopathic Medicine in Phoenix Arizona. With his feet firmly in two camps, the conventional and naturopathic, Dr Bradstreet is well placed to push nutritional research forward in the management of ADHD and hyperactivity.
Over the years Dr Bradstreet has found few nutrients that have been of particularly helpful to children with behavioural issues. In addition to the much publicised omega-3 fish oils these include phosphatidylserine (PS), the amino acids taurine and L-theanine as well as the powerful antioxidant N-acetylcysteine and the nutrient dimethylaminethanol (DMAE).
Getting the balance right
Interestingly, two of these nutrients naturally work very closely within the body, in fact PS is made DMAE. It has long been known that PS forms a vital building block supporting the structure of every cell in the body as well as playing an important role in the production of chemical substances needed for healthy and balanced nerve function. Known as neurotransmitters, these substances regulate the activity of the brain and are known to be out of balance in cases of ADHD and hyperactivity. In one study 75% of children who took PS supplements experienced increased levels of focus and attention. By using both PS and DMAE together those with poor ability to absorb and metabolise PS can still benefit since once within the body DMAE can be converted into PS. For children attending school it is good to know that neither PS or DMAE have ever caused drowsiness or reduced alertness.
Boost those alpha-waves
In all cases of ADHD and hyperactivity management the biggest problem facing parents and children alike is the common side effect of drowsiness associated with prescribed drugs. Getting the balance right is not easy, an over excited brain can’t be expected to focus on the task in hand or conform to the rigours of school or modern life.
In seeking a remedy for this Green tea appeared to offer an answer. The soothing and relaxing effects associated with Green tea are derived from its L-theanine content. This amino acid, once isolated and purified, has become a popular supplement with people suffering from anxiety and stress related problems since it produces a relaxed state of mind with no drowsiness. It was finally discovered that L-theanine enhanced the brains alpha-waves. A brain with good alpha-wave activity is associated with a state of relaxed alertness. By applying this knowledge L-theanine has been of great help to children with hyperactive behaviour and poor focus. It is a very safe supplement and well tolerated. Depending on age, 100mg taken up to three times a day appears to offer effective support. L-theanine is also found in Dr Bradstreets own formula that combines all the above into a convenient supplement.
Putting it all together
No one can say that they have the universal remedy for ADHD or hyperactivity, the condition is far to complex for any one remedy or life style adjustment to work in isolation or universally. However, the evidence is mounting from UK studies into the effects of diet manipulation while in America the nutritional supplement research is laying the foundations for additional measures. By blending the two approaches overall health can only bee seen to benefit from improved food intake and optimal nutritional support.

Links
Dr Jeff Bradstreet
Recommended UK supplements web site
Recommended USA supplements web site
North London Natural Health Clinic
Scotland based Natural Health Clinic

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