Move Over Cholesterol

Can you imagine any substance getting a worse rap than cholesterol? After all, how many people do you know who (1) have never purchased a product that was labeled "low cholesterol" or "cholesterol free," or (2) have never seen an advertisement for Lipitor (atorvastatin), the $12.9 billion dollar, best-selling, cholesterol-lowering statin drug of 2006, or (3) have never had their cholesterol measured, either in a doctor's office or a shopping mall?

Well, it's time to start imagining a new substance moving onto health's center stage.

FULL STORY:

That substance is homocysteine - a relatively unknown amino acid that was the subject of 500 research studies in 2006 and nearly 2,500 studies over the past 5 years. Similar to elevated cholesterol, elevated homocysteine is now considered an independent risk factor for atherosclerosis (clogging of the arteries). It's also been linked to increased risk of stroke, diabetes-related kidney problems, and age-related cognitive problems.

What's unique about homocysteine is its place in our metabolism. When properly metabolized, homocysteine can help us detoxify environmental pollutants and other unwanted substances in our body. It can also bolster our antioxidant system and help prevent damage to our tissue from free radicals. But when it isn't properly metabolized and it builds up inside our bloodstream (a condition called hyperhomocysteinemia), homocysteine can cause a multitude of problems.

What researchers now understand is that homocysteine latches on to cells throughout our body (including cells along our blood vessel walls) and disrupts their activity. With nerve cells, the result is over-stimulation and eventual damage to the nervous system. With the endothelial cells lining our blood vessels, the result is a weakened cardiovascular structure and eventual heart disease.

Fortunately, we've got practical ways to lower our risk of hyperhomocysteinemia. We can start out by having our blood level of homocysteine measured, to see if it's too high. Second, we can often lower it (as well as prevent it from becoming too elevated) by increasing our dietary intake of vitamins B6, B12, and folate. Green leafy vegetables are a great start for the B6 and folate. Non-plant foods are better for B12. Shrimp, scallops, snapper, and salmon are some of our favorites.

References:

1. Homocysteine-lowering trials for prevention of cardiovascular events: a review of the design and power of the large randomized trials. Am Heart J. 2006 Feb; 151(2):282-7.
2. Carlsson, C. M. Homocysteine lowering with folic acid and vitamin B supplements: effects on cardiovascular disease in older adults. Drugs Aging. 2006; 23(6):491-502.
3. Castro, R.; Rivera, I.; Blom, H. J.; Jakobs, C., and Tavares de Almeida, I. Homocysteine metabolism, hyperhomocysteinaemia and vascular disease: an overview. J Inherit Metab Dis. 2006 Feb; 29(1):3-20.
4. Ceperkovic, Z. [The role of increased levels of homocysteine in the development of cardiovascular diseases]. Med Pregl. 2006 Mar-2006 Apr 30; 59(3-4):143-7.
5. Guthikonda, S. and Haynes, W. G. Homocysteine: role and implications in atherosclerosis. Curr Atheroscler Rep. 2006 Mar; 8(2):100-6.
6. Hankey, G. J. Is plasma homocysteine a modifiable risk factor for stroke? Nat Clin Pract Neurol. 2006 Jan; 2(1):26-33.
7. Jacobs, P.; Wood, L., and Bick, R. Homocysteine in vascular disease: an emerging clinical perspective. Cardiovasc J S Afr. 2006 May-2006 Jun 30; 17(3):135-9.

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Research Interpretation in Natural Medicine

One of the consistent controversies in the complementary and alternative medicine (CAM) community is how to interpret the vast quantity of research that comes out on a weekly basis. Market forces both supportive of and against CAM interventions often help to distort findings in the public eye.

Perhaps the biggest difficulty in interpretation of CAM research is that studies of unconventional approaches are almost uniformly of lower quality than studies in modern surgery or pharmacology. This lower quality is generally more a function of resource limitations than any intent, and is reflected in smaller numbers of subjects, problems with randomization or blinding of studies, or difficult to measure outcomes.

Still, lower quality research is still science, and is important in advancing our knowledge, as long as our interpretations are valid. Here are the different levels of research study, and some idea of the level of evidence they represent:

• Double-blind, placebo-controlled trial: Usually the highest standard of research study. Here, researchers can demonstrate cause and effect most clearly. Even though this method can yield flawed results, this level of research is often sufficient to make a conclusion about a new treatment.

• Unblinded clinical trial: Here, subjects in the study get a treatment, but they may not be compared to a similar group not receiving treatment, and are aware of the treatment they are getting. While this type of study is not definitive, it can help to identify potentially useful treatments worthy of further study.

• Epidemiology or survey study: These are studies that survey a large group of people and attempt to find correlations between disease and health habits. These studies do not demonstrate cause and effect, but when they yield consistent results, can still sway medical opinion. Much of what doctors know about diet and exercise comes from this type of research.

• Anecdote or case report: These describe the outcome of a single patient after a specific intervention. While patients and consumers often find this level of evidence compelling, I do not. Published case reports go through a peer-review process, which makes them more credible than other anecdotes. Interesting and important treatments often are first reported as a single case, but further research is virtually always necessary to confirm results.

• Preclinical research: Animal and test-tube studies help to show the mechanisms by which treatments may work. They should not be the basis for general health recommendations, but when results are consistent with higher level studies, they can help to fill in knowledge gaps.

• Meta-analysis: As their name suggests, this type of study gather together multiple research studies, sometimes of different levels of evidence. A meta-analysis is only as good as the studies analyzed, but can often highlight bias inherent in individual research studies.

Complicated and subtle interventions like diet and lifestyle changes are simultaneously thought to be some of the most important predictors of human health outcomes, and among the most difficult treatments to effectively study. For this reason, diet and lifestyle recommendations are often made based on the results of survey research, supported by consistent animal and test-tube findings. If you have been puzzled by how frequently healthy diet recommendations seem to change, this lower level of evidence may help to explain the inconsistency.

There are several questions I tend to ask about new treatments before I consider bringing them into my clinical practice. Here are a few:

1. Has the safety of the intervention been properly demonstrated in human beings (not just animals)?


2. What level of research is there to demonstrate efficacy?


3. Are the conclusions of the researchers plausible? Do they overreach?


4. Is this new treatment option equivalent to or better than other available treatments?

Matt Brignall, ND

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Diabetes Decreases Life Expectancy - Protect Yourself

Having diabetes decreases life expectancy in persons over age 50 by an average of 7.5 years for men, and 8.2 years for women, compared to persons without the condition, reveals research using data from the Framingham Heart Study, which recruited 5,209 men and women starting in 1948 and has examined them twice yearly for more than 46 years.

Published in the June 11, 2007 issue of the Archives of Internal Medicine (Franco OH, Steyerberg EW, et al.) the data also shows that men with diabetes have 2.4 times the risk of developing cardiovascular disease and 1.7 times the risk of dying from it, compared to men without diabetes. For women with diabetes, the risk of developing cardiovascular disease is 2.5 times and risk of dying from it 2.2 times that of their diabetes-free peers.

Add to these frightening statistics the fact that a global diabetes epidemic is underway with an estimated 217 million people with diabetes worldwide (a number that is expected to increase to 300 million by 2025), plus the fact that a fundamental cause of diabetes is the unhealthy "Western" diet, and it becomes obvious that optimal nutrition is essential for diabetes prevention and healthy aging.

Follow a Mediterranean-style Diet

A review study in the March 2007 issue of the Journal of Nutritional Biochemistry (Schroder H) strongly suggests that a Mediterranean-style diet including lots of vegetables, fresh fruits, unrefined grains, beans, cold water fish, nuts, seeds, and olive oil as the main source of fat, offers significant protection against both type 2 diabetes and obesity.

Not only do numerous population studies consistently show a protective effect of a Mediterranean diet against diabetes, but a number of physiological mechanisms that explain why have now been identified. In brief, the Mediterranean diet is rich in:

• Appetite-satisfying fiber, which slows the rate at which foods are digested and glucose is delivered into the bloodstream. When fiber is present in a meal, the small intestine secretes peptides, such as cholecystokinin, that signal fullness to the brain. Legumes and nuts, two fiber-rich staples in the Mediterranean diet, have been shown to greatly increase cholechystokinin secretion.


• Healthy fats from olive oil, cold water fish, nuts and seeds. Some evidence suggests that oleic acid, the predominant fatty acid in olive oil, is associated with lower insulin resistance. Olive oil has also been shown to increase the rate at which fat is oxidized (burned) after meals in women with abdominal obesity. The omega-3-fatty acids supplied by cold water fish, walnuts and flaxseed render cell membranes more flexible and receptive to insulin signaling.


• Protective antioxidants and phytonutrients. In addition to vitamin antioxidants such as beta-carotene, E and C, the characteristic foods of the Mediterranean diet provide a wide variety of phytonutrients with potent, synergistic antioxidant activity. Free radical damage (oxidative stress) plays a crucial role in the development of insulin resistance and beta cell dysfunction. (Beta cells are responsible for the production of insulin.) Even short-term administration of virgin olive oil has been found to decrease several markers of oxidative stress.


• Magnesium, liberally supplied by vegetables, whole grains, legumes and nuts, is an essential co-factor in enzymes required for cellular energy production. Studies have linked insufficient magnesium with increased incidence of type 2 diabetes.


• Moderate red-wine consumption. In the Mediterranean, a glass of red wine often accompanies lunch or dinner. In human population studies, moderate alcohol consumption has been shown to enhance insulin sensitivity and increase levels of adiponectin, a signaling molecule that stimulates cells' burning of both fatty acids and glucose (sugar).


• And because, a Mediterranean diet is filled with nutrient-dense foods, which supply fewer calories overall, this delicious way of eating automatically promotes a healthy weight, again lessening your risk of type 2 diabetes.

Bottomline: Change to a healthy Mediterranean-type diet and dramatically lower your risk of becoming part of the diabetes epidemic.

Lara Pizzorno, MA, LMT

1. Franco OH, Steyerberg EW, Hu FB, Mackenbach J, Nusselder W. Associations of diabetes mellitus with total life expectancy and life expectancy with and without cardiovascular disease. Arch Intern Med. 2007 Jun 11;167(11):1145-51. PMID: 17563022
2. Schroder H. Protective mechanisms of the Mediterranean diet in obesity and type 2 diabetes. J Nutr Biochem. 2007 Mar;18(3):149-60. Epub 2006 Sep 11. PMID: 16963247
   

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