Category Archives: Public Health

4 Unconventional Things You Didn’t Know Were Making You Fat

The human body is a strange and wondrous place. There are many reasons why a person might gain weight. Eating the wrong kind of food, the wrong amount of food, or not enough exercise are well established reasons. However, there are some no-so-common reasons that might play a role as well.

Road Traffic Noise

Exposure to a combination of road traffic, rail, and aircraft noise may pose the greatest risk of acquiring a spare tire — otherwise known as central obesity, and thought to be one of the most harmful types of fat deposition around the body. In a recent study researchers assessed how much road traffic, rail, and aircraft noise 5075 people living in five suburban and rural areas around Stockholm, Sweden, had been exposed to since 1999. The analysis indicated no link between road traffic noise and BMI. But there was an association between road traffic noise and waist size, with a 0.21 cm increase for every additional 5 dB increase in exposure, although this was only significant among women. Similarly, there was a link to waist:hip ratio, with a change of 0.16 for every 5 dB increase in noise exposure to road traffic; this association was stronger in men.

What gives? Noise exposure may be an important physiological stressor and bump up the production of the hormone cortisol, high levels of which are thought to have a role in fat deposition around the middle of the body, researchers suggest. Additionally, noise exposure might disrupt sleep, another known factor to contribute to weight gain.

Too Many Food Choices

A new study in mice by researchers in the Virginia Tech College of Agriculture and Life Sciences and the Edward Via College of Osteopathic Medicine has shown that the environment in which a child lives may be an equal if not stronger force in determining obesity than their mother’s diet. Researchers found that having too many food choices increases the obesity problem. In fact, researchers found that having a choice of a high-fat and low-fat diet does not help — offspring in this situation tended to eat even more. Their findings were recently released in the journal Endocrinology. “We like variety,” said Deborah Good, an author of the paper and an associate professor of human nutrition, foods, and exercise at Virginia Tech. “But when there is a choice, we eat more than when there is not any variety.” Moral of the story? Simple is better for our waistlines.

The Inability To Stay Warm

A new study suggests that a biological inability to create sufficient core body heat could be linked to the obesity epidemic. The study found that obesity is associated with a significant reduction of body core temperature during daytime hours. Journal Editor Francesco Portaluppi explains that the reduced ability of obese people to spend energy as heat compared to lean individuals could result in long term weight gain (about 2 kg (4.5 lb.)) per year, depending on the lifestyle. “Since body core temperature represents a marker of energy expenditure, results from this study suggest that a diurnal thermogenic handicap can play a crucial role in favoring weight gain in obese subjects,” said article co-author Pietro Cortelli, MD, Ph.D. The fix? Generate more body heat. And how does one do that? Exercise of course!

Environmental Pollution

A team of Spanish scientists, which includes several researchers from the University of Granada, has confirmed that there is a relation between the levels of certain environmental pollutants that a person accumulates in his or her body and their level of obesity. Subjects with more pollutants in their bodies tend to have higher levels of cholesterol and triglycerides, which are important risk factors for cardiovascular disease. The research has analyzed the levels of pollutants accumulated in adipose tissue (fat) in nearly 300 men and women, who were attended in the surgery services of two hospitals in the province of Granada (Spain). The substances analyzed, known as persistent organic pollutants (POPs), can remain in the environment for years, even decades, without degrading.

“Humans are exposed to POPs mainly through diet. Besides, POPs accumulate gradually in body fat, and this is the reason why the median levels in our study give us an idea of an individual’s accumulated exposition over a number of years,” says Juan Pedro Arrebola, the main author of the article. There is evidence that human exposure to certain chemical substances called “obesogenic” could favor the growth and proliferation of adipocytes (fat cells), and provoke therefore an increase in body fat.

Do your best to avoid exposing yourself unnecessarily to chemicals that might be problematic. Perhaps the most powerful way to do this is avoid processed food which is loaded with these chemicals from their own packaging.

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9 Signs You Have A Leaky Gut

The gut is the gateway to health. If your gut is healthy, chances are that you’re in good health. However, there’s a condition called leaky gut that can lead to a host of health problems.

What is a leaky gut?

The gut is naturally permeable to very small molecules in order to absorb these vital nutrients. In fact, regulating intestinal permeability is one of the basic functions of the cells that line the intestinal wall. In sensitive people, gluten can cause the gut cells to release zonulin, a protein that can break apart tight junctions in the intestinal lining. Other factors — such as infections, toxins, stress and age — can also cause these tight junctions to break apart.

Once these tight junctions get broken apart, you have a leaky gut. When your gut is leaky, things like toxins, microbes, undigested food particles, and more can escape from your intestines and travel throughout your body via your bloodstream. Your immune system marks these “foreign invaders” as pathogens and attacks them. The immune response to these invaders can appear in the form of any of the nine signs you have a leaky gut, which are listed below.

What causes leaky gut?

The main culprits are foods, infections, and toxins. Gluten is the number one cause of leaky gut. Other inflammatory foods like dairy or toxic foods, such sugar and excessive alcohol, are suspected as well. The most common infectious causes are candida overgrowth, intestinal parasites, and small intestine bacterial overgrowth (SIBO). Toxins come in the form of medications, like Motrin, Advil, steroids, antibiotics, and acid-reducing drugs, and environmental toxins like mercury, pesticides and BPA from plastics. Stress and age also contribute to a leaky gut.

If you suffer from any of the following conditions, it’s likely that you have a leaky gut:

9 Signs You Have a Leaky Gut

1. Digestive issues such as gas, bloating, diarrhea or irritable bowel syndrome (IBS).

2. Seasonal allergies or asthma.

3. Hormonal imbalances such as PMS or PCOS.

4. Diagnosis of an autoimmune disease such as rheumatoid arthritis, Hashimoto’s thyroiditis, lupus, psoriasis, or celiac disease.

5. Diagnosis of chronic fatigue or fibromyalgia.

6. Mood and mind issues such as depression, anxiety, ADD or ADHD.

7. Skin issues such as acne, rosacea, or eczema.

8. Diagnosis of candida overgrowth.

9. Food allergies or food intolerances.

How do you heal a leaky gut?

1. Remove.

Remove the bad. The goal is to get rid of things that negatively affect the environment of the GI tract, such as inflammatory and toxic foods, and intestinal infections.

2. Replace.

Replace the good. Add back the essential ingredients for proper digestion and absorption, such as digestive enzymes, hydrochloric acid and bile acids.

3. Reinoculate.

It’s critical to restore beneficial bacteria to reestablish a healthy balance of good bacteria.

4. Repair.

It’s essential to provide the nutrients necessary to help the gut repair itself. One of my favorite supplements is L-glutamine, an amino acid that helps to rejuvenate the lining of the gut wall.

If you still have symptoms after following the above recommendations, I would recommend finding a Functional Medicine physician in your area to work with you and to order a comprehensive stool test.

via 9 Signs You Have A Leaky Gut.

Dr. Court’s Comments:

Leaky gut was once considered quackery. Today, an abundance of research supports that it does exist and that it plays a major role in many diseases. Much of what we do in our day to day lives contributes to the development of leaky gut. If you know what these factors are, they are easily avoided and optimal health is easily achieved.

If you’d like more detail, including in depth examination of the techniques you can use to heal leaky gut, watch my webinar here:

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Ibuprofen Kills Thousands Each Year. Here are 10 Natural Alternatives

A recent Reuters’ article opened with the following stunning sentence:

“Long-term high-dose use of painkillers such as ibuprofen or diclofenac is ‘equally hazardous’ in terms of heart attack risk as use of the drug Vioxx, which was withdrawn due to its potential dangers, researchers said.”

The 2004 Vioxx recall, as you may remember, was spurred by the nearly 30,000 excess cases of heart attacks and sudden cardiac deaths caused by the drug between 1999-2003. Despite the fact that scientific research had accumulated as early as 2000 linking Vioxx to increased heart attacks and strokes, the drug’s manufacturer Merck, and the FDA, remained silent as the death toll steadily increased.

The Reuters report focused on new research published in Lancet indicating the risk of heart attack increases as much as a third and the risk of heart failure doubles among heavier users of NSAID drugs.

INFLAMED: Our Default Bodily State

Why are so many folks taking NSAID drugs like ibuprofen anyway?

Pain and unhealthy levels of inflammation are fast becoming default bodily states in the industrialized world. While in most cases we can adjust the underlying pro-inflammatory conditions by altering our diet, and reducing stress and environmental chemical exposures, these approaches take time, discipline and energy, and sometimes we just want the pain to stop now. In those often compulsive moments we find ourselves popping an over-the-counter pill to kill the pain.

The problem with this approach is that, if we do it often enough, we may kill ourselves along with the pain…

Ibuprofen really is a perfect example of this. As mentioned above, this petrochemical-derivative has been linked to significantly increased risk of heart attack and increased cardiac and all-cause mortality (when combined with aspirin), with over two dozen serious adverse health effects, including:

  • Anemia[1]
  • DNA Damage[2]
  • Hearing Loss[3]
  • Hypertension[4]
  • Influenza Mortality[5]
  • Miscarriage[6]

Ibuprofen is, in fact, not unique in elevating cardiovascular disease risk and/or mortality. The entire category of non-steroidal anti-inflammatory drugs (NSAIDs) appears to have this under-recognized dark side; cardiovascular disease and cardiac mortality score highest on the list of over 100 unintended adverse health effects associated with their use. See also our analysis of the rarely acknowledged dark side to aspirin: The Evidence Against Aspirin And For Natural Alternatives.

So, what does one do? Pain is pain. Whether it happens to you, or you witness it in another (which can be worse), finding relief is a top priority.

Research on Natural Alternatives To Ibuprofen

Here is some evidence-based research on alternatives to ibuprofen, sourced from the National Library of Medicine:

  1. Ginger – A 2009 study found that ginger capsules (250 mg, four times daily) were as effective as the drugs mefenamic acid and ibuprofen for relieving pain in women associated with their menstrual cycle (primary dysmenorrhea). [7]
  2. Topical Arnica – A 2007 human study found that topical treatment with arnica was as effective as ibuprofen for hand osteoarthritis, but with lower incidence of side effects.[8]
  3. Combination: Astaxanthin, Ginkgo biloba and Vitamin C – A 2011 animal study found this combination to be equal to or better than ibuprofen for reducing asthma-associated respiratory inflammation.[9]
  4. Chinese Skullcap (baicalin) – A 2003 animal study found that a compound in Chinese skullcap known as baicalin was equipotent to ibuprofen in reducing pain.[10]
  5. Omega-3 fatty acids: A 2006 human study found that omega-3 fatty acids (between 1200-2400 mg daily) were as effective as ibuprofen in reducing arthritis pain, but with the added benefit of having less side effects.[11]
  6. Panax Ginseng – A 2008 animal study found that panax ginseng had analgesic and anti-inflammatory activity similar to ibuprofen, indicating its possible anti-rheumatoid arthritis properties.[12]
  7. St. John’s Wort – A 2004 animal study found that St. John’s wort was twice as effective as ibuprofen as a pain-killer.[13]
  8. Anthrocyanins from Sweet Cherries & Raspberries – A 2001 study cell study found that anthrocyanins extracted from raspberries and sweet cherries were as effective as ibuprofen and naproxen at suppressing the inflammation-associated enzyme known as cyclooxygenase-1 and 2.[14]
  9. Holy Basil – A 2000 study found that holy basil contains compounds with anti-inflammatory activity comparable to ibuprofen, naproxen and aspirin.[15]
  10. Olive Oil (oleocanthal) – a compound found within olive oil known as oleocanthal has been shown to have anti-inflammatory properties similar to ibuprofen.[16]

[1] Direct cytotoxicity of non-steroidal anti-inflammatory drugs in acidic media: model study on human erythrocytes with DIDS-inhibited anion exchanger. Pharmazie. 2002 Dec;57(12):848-51. PMID: 12561250

[2] Genotoxicity of ibuprofen in mouse bone marrow cells in vivo. Drug Chem Toxicol. 2012 Jan 27. Epub 2012 Jan 27. PMID: 22283434

[3] Analgesic use and the risk of hearing loss in men. Am J Med. 2010 Mar;123(3):231-7. PMID: 20193831

[4] Effect on blood pressure of lumiracoxib versus ibuprofen in patients with osteoarthritis and controlled hypertension: a randomized trial. J Hypertens. 2008 Aug;26(8):1695-702. PMID: 18622250

[5] The effect on mortality of antipyretics in the treatment of influenza infection: systematic review and meta-analysis. J R Soc Med. 2010 Oct;103(10):403-11. PMID: 20929891

[6]  Taking non-aspirin NSAIDs in early pregnancy doubles risk of miscarriage, study shows. BMJ. 2011 ;343:d5769. Epub 2011 Sep 9. PMID: 21908536

[7] Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea. J Altern Complement Med. 2009 Feb 13. PMID: 19216660

[8] Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomised, double-blind study. Rheumatol Int. 2007 Apr;27(6):585-91. Epub 2007 Feb 22. PMID: 17318618

[9] Summative interaction between astaxanthin, Ginkgo biloba extract (EGb761) and vitamin C in suppression of respiratory inflammation: a comparison with ibuprofen. Phytother Res. 2011 Jan;25(1):128-36. PMID: 20632299

[10] The antiinflammatory and analgesic effects of baicalin in carrageenan-evoked thermal hyperalgesia. Anesth Analg. 2003 Dec;97(6):1724-9. PMID: 14633550

[11] Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31. PMID: 16531187

[12] Potential analgesic and anti-inflammatory activities of Panax ginseng head butanolic fraction in animals. Food Chem Toxicol. 2008 Dec;46(12):3749-52. Epub 2008 Oct 1. PMID: 18930781

[13] Antinociceptive activity of methanolic extracts of St. John’s Wort (Hypericum perforatum) preparation. Pak J Pharm Sci. 2004 Jul;17(2):13-9. PMID: 16414593

[14] Cyclooxygenase inhibitory and antioxidant cyanidin glycosides in cherries and berries. Phytomedicine. 2001 Sep;8(5):362-9. PMID: 11695879

[15] Antioxidant and cyclooxygenase inhibitory phenolic compounds from Ocimum sanctum Linn. Phytomedicine. 2000 Mar;7(1):7-13. PMID: 10782484

[16] Molecular mechanisms of inflammation. Anti-inflammatory benefits of virgin olive oil and the phenolic compound oleocanthal. Curr Pharm Des. 2011 ;17(8):754-68. PMID: 21443487.

via Ibuprofen Kills Thousands Each Year, So What Is The Alternative?.

Dr. Court’s Comments:

When approaching pain, it’s best to always address the source of the pain. If it’s structural, a chiropractor is a good option. If it’s metabolic, such as an autoimmune disease, then a doctor trained in functional medicine will be best. They will likely use some of the things listed above to provide relief in addition to functional testing designed to treat the cause of your symptoms, not simply cover them up with medication. Dietary changes are almost always needed. The American diet is pro-inflammatory with high levels of omega-6 fatty acids. These omega-6s feed the inflammatory pathways, allowing people to over produce the pain causing molecules. Once this is addressed, people often feel much better. Remember, just about every chemical we make in our bodies, good or bad, is heavily dependent on dietary factors. If you correct those dietary factors, you correct the dysfunction.

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Are you eating your way to a hormonal imbalance? 50 foods to avoid.

PROPYL PARABEN

Are you eating an endocrine disruptor?

The pastry you’re thinking about buying may contain the preservative propyl paraben, linked to disruptions in hormone signaling.

According to ingredient data obtained by EWG’s Food Scores: Rate Your Plate, an online database and app that helps consumers eat healthier, propyl paraben is in 49 widely-available processed foods, including Sara Lee cinnamon rolls, Weight Watchers cakes and La Banderita Corn Tortillas.

Last year, EWG turned the spotlight on propyl paraben in its Dirty Dozen Guide To Food Additives because the federal Food and Drug Administration has listed its use in food as “Generally Recognized As Safe.” Despite mounting evidence that propyl paraben disrupts the endocrine system, the FDA has failed to take action to eliminate its use in food or reassess its safety.

In 2002 researchers at the Tokyo Metropolitan Institute of Public Health discovered that propyl paraben decreased sperm counts in young rats at and below the concentrations which the U.S. Food and Drug Administration considers safe for human consumption in food (Oishi 2002; 21CFR184.1670).

Other researchers have confirmed propyl paraben’s effects on the endocrine system. It acts as a synthetic estrogenic compound and can alter hormone signaling and gene expression (Routledge 1998; Terasaka 2006; Vo 2011; Wróbel 2014). A recent study by researchers at the Harvard School of Public Health suggested that exposure to propyl paraben might be associated with diminished fertility (Smith 2013).

Proper endocrine signaling is particularly important during critical windows of development—while in the womb and during childhood and adolescence. Chemicals that disrupt hormone signaling can lead to adverse effects on development, reproduction, and the neurological and immune systems.

Citing the study by the researchers in Tokyo, the European Food Safety Authority issued an advisory in 2004 that the presumed safe exposure level for propyl paraben in food was no longer valid because it affected sex hormones and the male reproductive organs in young rats (EFSA 2004). Based on that advice, in 2006, regulators removed propyl paraben from the list of food additives authorized for use in the European Union.

Propyl paraben is starting to disappear from some cosmetics, so it is a wonder that it is still allowed in food. If you browse the personal care product aisles in any drug store, you are likely to see labels advertising that certain body washes, lotions, and other items are “paraben free”. Under pressure from EWG and other health advocates, in August 2012 Johnson & Johnson voluntarily pledged to remove this and other members of the paraben family from all its baby products. Brands such as Alba, Origins and Burt’s Bees don’t use parabens at all.

Yet Americans are still widely exposed to this chemical. In 2010 research led by Antonia Calafat, Ph.D., a respected chemist at the federal Centers for Disease Control and Prevention, reported that 92.7 percent of Americans tested had propyl paraben in their urine (Calafat 2010).

via Propyl Paraben | EWG.

50 Foods Containing Propyl Paraben

  • Amport Foods Chocolate & Nut Trail Mix
  • Archer Farms Gourmet Dessert Cookies
  • Arizona Snack Company Canyon Runner II Trail
  • Arizona Snack Company Sweet Energy Trail
  • Cafe Valley Apple Spice Mini Muffins Apple Spice
  • Cafe Valley Banana Nut Mini Muffins
  • Cafe Valley Blueberry Mini Muffins
  • Cafe Valley Cake Pumpkin Cream Cheese
  • Cafe Valley Chocolate Chips Mini Muffins
  • Cafe Valley Corn Mini Muffins
  • Cafe Valley Lemon Poppyseed Mini Muffins
  • Cafe Valley Orange Cranberry Mini Muffins
  • Cafe Valley Pumpkin Chocolate Chip Mini Muffins
  • Creative Occasions Old Fashioned Carrot Cream Cheese Cake
  • Elizabeth’s Naturals Psychedelic Sunday Mix
  • Emerald Breakfast On The Go Peanut Butter Chocolate Banana Nut & Granola Mix
  • Energy Club Fancy Mojo Mix
  • Energy Club Nuts N Chocolate Blend
  • Entenmann’s Coconut Crunch Donuts
  • Essential Everyday Classic Trail Mix
  • Island Snacks Fancy Chocolate Mix
  • La Banderita White Corn Tortillas
  • La Banderita Yellow Corn Tortillas
  • Little Debbie Pecan Spinwheels
  • Newton’s Naturals Get The Munchies Trail Mix
  • Nuevo Leon Tortillas
  • Oh Yeah! Candies Chocolate Caramel
  • Ole Mexican Foods Corn Tortillas
  • Patissa Pumpkin Pie Cream Puffs
  • Premium Orchard Rainbow Trail Mix
  • Private Selection Strawberry Rhubarb Pie
  • Quality Club Deluxe Moxxi Mix
  • Roundy’s Cranberry Trail Mix
  • Roundy’s Pak O Snax
  • Sara Lee Cinnamon Rolls
  • Sara Lee Honey Glazed Buns
  • Setton Farms Hiker’s Trail Mix
  • Superior Chocolate Nut Trail Mix
  • Superior Mini Chocolate Eclairs
  • Sweet P’s Bake Shop Black & White Cookies
  • Tropical Corn Tortillas, Traditional Style
  • Turano Brat & Sausage Rolls
  • Weight Watchers Carrot Crème Cake
  • Weight Watchers Chocolate Crème Cake
  • Weight Watchers Golden Sponge Cake
  • Weight Watchers Lemon Creme Cake
  • Weight Watchers Red Velvet Creme Cake
  • Weis Cross’n Country
  • Weis Milk Chocolate Candies

References:

Calafat AM, Ye X, Wong LY, Bishop AM, Needham LL. 2010. Urinary concentrations of four parabens in the U.S. population: NHANES 2005-2006. Environ Health Perspect. 118(5):679-85.

21CFR184.1670. Available: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=184.1670 [Accessed February 7, 2015]

EFSA. 2004. Opinion of the Scientific Panel on food additives, flavourings, processing aids and materials in contact with food (AFC) related to para hydroxybenzoates (E 214-219). EFSA Journal. 83, 1-26.

Oishi S. Effects of propyl paraben on the male reproductive system. Food Chem Toxicol. 2002 Dec;40(12):1807-13.

Routledge EJ, Parker J, Odum J, Ashby J, Sumpter JP. 1998. Some alkyl hydroxy benzoate preservatives (parabens) are estrogenic. Toxicol Appl Pharmacol. 153(1):12-9.

Smith KW, Souter I, Dimitriadis I, Ehrlich S, Williams PL, Calafat AM, Hauser R. 2013. Urinary paraben concentrations and ovarian aging among women from a fertility center. Environ Health Perspect. 121(11-12):1299-305.

Terasaka S, Inoue A, Tanji M, Kiyama R. 2006. Expression profiling of estrogen-responsive genes in breast cancer cells treated with alkylphenols, chlorinated phenols, parabens, or bis- and benzoylphenols for evaluation of estrogenic activity. Toxicol Lett. 163(2):130-41. Epub 2005 Nov 8.

Vo TT, Jung EM, Choi KC, Yu FH, Jeung EB. 2011. Estrogen receptor α is involved in the induction of Calbindin-D(9k) and progesterone receptor by parabens in GH3 cells: a biomarker gene for screening xenoestrogens. Steroids. 76(7):675-81.

Wróbel AM, Gregoraszczuk EL. 2014. Actions of methyl-, propyl- and butylparaben on estrogen receptor-α and -β and the progesterone receptor in MCF-7 cancer cells and non-cancerous MCF-10A cells. Toxicol Lett. 230(3):375-381

Dr. Court’s Comments:

Endocrine disruptors like parabens and others such as BPA, PFOA, phthalates,  and PCBs are potent chemicals that surround us ubiquitously. Their ability to disrupt our hormonal system has lead to changes in how our bodies function. BPA was originally created as a synthetic estrogen, albeit a weak one. However, because we are exposed to it all the time, those weak estrogenic effects are magnified. BPA, PFOA, phthalates and PCBs are classified as obesogens. That means they cause weight gain. They do this by increasing the number of fat cells we have and increasing our ability to store fat. More fat cells storing more fat means we are increasingly overweight. Avoidance of these chemicals is probably impossible, however, do your best to minimize exposure. First and foremost, avoid processed foods. They are loaded with these chemicals. Secondly, buy products that specify ‘BPA free’ or ‘phthalate free.’ Last, but not least, exercise regularly to assist your body in detoxifying you system.

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Exercise largely absent from US medical school curriculum, study shows

Exercise may play a critical role in maintaining good health, but fewer than half of the physicians trained in the United States in 2013 received formal education or training on the subject, according to new research from Oregon State University.

A review of medical school curriculums showed that a majority of U.S. institutions did not offer any courses on physical activity, and when the courses were offered, they were rarely required, said Brad Cardinal, a professor of exercise and sport science in OSU’s College of Public Health and Human Sciences. That could leave doctors ill-prepared to assist patients who could benefit from exercise, said Cardinal, the study’s lead author.

“There are immense medical benefits to exercise; it can help as much as medicine to address some health concerns,” said Cardinal, who is a national expert on the benefits of physical activity. “Because exercise has medicinal as well as other benefits, I was surprised that medical schools didn’t spend more time on it.”

An article on the findings has been accepted for publication in an upcoming issue of the Journal of Physical Activity and Health. Co-authors are Eugene A. Park and MooSong Kim of OSU, and Marita K. Cardinal of Western Oregon University. The study was supported by OSU.

For the study, researchers reviewed U.S. medical schools’ websites, looking for all physical activity-related coursework. They reviewed both public and private schools, and schools of medicine and osteopathic medicine. In all, 118 of the 170 accredited schools had curriculum information available online.

Of those, 51 percent offered no physical activity related coursework, and 21 percent offered only one course. And 82 percent of the schools reviewed did not require students to take any physical activity-related courses.

Schools may be spending more time on the topic than appears in the published curriculum, but the absence of physical activity in those documents suggests exercise education is not formalized or institutionalized to the degree it ought to be, given its role in helping people stay healthy, Cardinal said.

“I’m an outsider looking in, and I was expecting to see more than what we did,” he said.

Lifestyle-related chronic illnesses such as heart disease and diabetes are among the leading causes of death and disability, and one of the most important ways to prevent such chronic diseases is through regular physical activity participation, he said.

Physicians play a significant and influential role in encouraging and assisting patients who need or are trying to get more exercise, but past research has shown that many physicians lack the education, skills or confidence to educate and counsel patients about their physical activity, Cardinal said.

“Understanding why and how to exercise, and knowing how to help people who are struggling to make it a habit, is really important,” he said.

This issue is gaining more attention nationally.The American College of Sports Medicine supports an “Exercise is Medicine” initiative, designed to encourage primary care physicians and other health care providers to include physical activity in the treatment plans of their patients.

Exercise is also a key component of the U.S. government’s “Healthy People 2020” initiative to improve health across the nation, and the National Physical Activity Plan to increase physical activity for all Americans, Cardinal said.

If medical schools do not include physical activity education in their curriculums, physicians or other health care workers may need to find other ways to educate themselves about exercise and its role in keeping people healthy, or perhaps give the nod to other professionals who can, Cardinal said.

“We really need to see something happen to address this,” he said. “How do we get it more institutionalized into medical school curriculum? This is a question researchers have been asking for 40 years now. It is about time we figured it out.”

via Exercise largely absent from US medical school curriculum, study shows — ScienceDaily.

Dr. Court’s Comments:

While I am sure exercise is emphasized to some degree in all medical curricula, it is disturbing to know that the most effective treatment (along with diet) for chronic disease prevention is not formally taught to the students who will eventually be entrusted with keeping people from getting sick. Combine this with the information that almost no nutrition is taught in medical school either, I think we may have found why our medical system is so broken. Research is very clear that disease is far easier to prevent than it is to treat once it’s developed. Prevention is with diet and exercise. My experience in practice has taught me that most medical doctors are terribly ill-equipped to recommend the right kind of diet or exercise to their patients. Some of the information being given to patients is flat out wrong. They often recommend things that make patients more likely, not less, to develop chronic disease. A scary thought, indeed.

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Recommendation for vitamin D intake was miscalculated, is far too low, experts say

Researchers at UC San Diego and Creighton University have challenged the intake of vitamin D recommended by the National Academy of Sciences (NAS) Institute of Medicine (IOM), stating that their Recommended Dietary Allowance (RDA) for vitamin D underestimates the need by a factor of ten.

In a letter published last week in the journal Nutrients the scientists confirmed a calculation error noted by other investigators, by using a data set from a different population. Dr. Cedric F. Garland, Dr.P.H., adjunct professor at UC San Diego’s Department of Family Medicine and Public Health said his group was able to confirm findings published by Dr. Paul Veugelers from the University of Alberta School of Public Health that were reported last October in the same journal.

“Both these studies suggest that the IOM underestimated the requirement substantially,” said Garland. “The error has broad implications for public health regarding disease prevention and achieving the stated goal of ensuring that the whole population has enough vitamin D to maintain bone health.”

The recommended intake of vitamin D specified by the IOM is 600 IU/day through age 70 years, and 800 IU/day for older ages. “Calculations by us and other researchers have shown that these doses are only about one-tenth those needed to cut incidence of diseases related to vitamin D deficiency,” Garland explained.

Robert Heaney, M.D., of Creighton University wrote: “We call for the NAS-IOM and all public health authorities concerned with transmitting accurate nutritional information to the public to designate, as the RDA, a value of approximately 7,000 IU/day from all sources.”

“This intake is well below the upper level intake specified by IOM as safe for teens and adults, 10,000 IU/day,” Garland said. Other authors were C. Baggerly and C. French, of GrassrootsHealth, a voluntary organization in San Diego CA, and E.D. Gorham, Ph.D., of UC San Diego.

via Recommendation for vitamin D intake was miscalculated, is far too low, experts say — ScienceDaily.

Dr. Court’s Commentary – 

I’ve been recommending anywhere from 4,000-6,000IU/day of vitamin D (supplementally) to my patients for many years. This is consistent with the above recommendations that people get about 7,000IU/day from all sources. Vitamin D deficiency is a culprit in many diseases of aging, and the IOM’s recommendations were far too low. It’s good to see this becoming more well recognized.

Only one study has been done (that I can find) that actually measured how much vitamin D human beings use on a daily basis. The conclusion of that study was that humans use about 4,000-6,000IU per day (hence my recommendation). In that context, the IOM’s recommendation of 600-800IU/day becomes even more startling.

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Do Antibiotics Raise Diabetes Risk via Gut Microbiota?

People who take multiple courses of antibiotics may face an increased risk of developing both type 1 and type 2 diabetes, potentially through alterations in gut microbiota, conclude US researchers.

The team, led by Ben Boursi, MD, a postdoctoral researcher in the department of gastroenterology at the University of Pennsylvania, Philadelphia, found that the risk of diabetes was increased by up to 37%, depending on the type of antibiotic and the number of courses prescribed.

“Overprescription of antibiotics is already a problem around the world as bacteria become increasingly resistant to their effects,” commented Dr Boursi in a statement.

“Our findings are important, not only for understanding how diabetes may develop, but as a warning to reduce unnecessary antibiotic treatments that might do more harm than good.”

The study was published online ahead of print March 24 in the European Journal of Endocrinology.

The More Courses of Antibiotics, the Greater the Risk

Dr Boursi explained that studies both in animal models and humans have shown an association between changes in gut microbiota in response to antibiotic exposure and obesity, insulin resistance, and diabetes.

Speaking to Medscape Medical News, he noted: “In mice, we know that germ-free mice are lean and, by fecal transplantation, we can transmit obesity to them. We also know that low dose of penicillin may induce obesity in mice models.”

He added that there have been several studies in humans indicating that exposure to antibiotics in early childhood is associated with an increased risk of obesity in later life, while other investigations have reported differences in gut microbiota between people with and without diabetes.

To investigate further, Dr Boursi and colleagues conducted a nested case-control study using data from the Health Improvement Network (THIN), a UK population-based database, from which they identified 1,804,170 patients with acceptable medical records.

As diabetes is associated with an increased risk of infection, the team wanted to exclude all cases with prediabetes or undiagnosed diabetes. To do that, they removed all patients diagnosed with diabetes within 183 days of starting follow-up and included only patients with exposure to antibiotics more than 1 year prior to the index date.

From the original cohort, they were able to select 208,002 diabetes patients and 815,576 controls matched for age, sex, general practice site, and duration of follow-up before the index date.

Conditional logistic regression analysis revealed that exposure to a single antibiotic prescription was not associated with an increased risk of diabetes, adjusted for body mass index (BMI), smoking, last blood glucose level, and the number of infections before the index date, alongside a history of coronary artery disease and hyperlipidemia.

However, treatment with two to five courses of antibiotics was linked to an increased risk of diabetes with penicillin, cephalosporins, macrolides, and quinolones, at adjusted odds ratios (ORs) ranging from 1.08 for penicillin to 1.15 for quinolones.

The highest risk for diabetes was seen among people who received more than five courses of quinolones, at an adjusted OR of 1.37. An increased risk of diabetes was also seen in patients who took more than five courses of tetracyclines, at an adjusted OR of 1.21.

Interestingly, the researchers were unable to find an association between diabetes risk and treatment with imidazole, antiviral drugs, and antifungals, regardless of the number of courses.

To account for further possible confounding factors, the researchers repeated the analysis only in individuals without skin or urinary-tract infections, which are more common among diabetes patients. This had no impact on the results.

Next Steps

When the analysis was restricted to type 1 diabetes, the risk was increased only following exposure to more than five courses of penicillin or two to five courses of cephalosporin, at odds ratios of 1.41 and 1.63, respectively.

Commenting on the findings, study coauthor Yu-Xiao Yang, MD, assistant professor of medicine and epidemiology, University of Pennsylvania, pointed out their investigation was observational in nature.

“We are not able to establish cause and effect necessarily, but it is actually pretty consistent with the experimental data, which is more definitive in terms of the animal data than in humans.”

Dr Yang said that the next step for the team will be to expand their focus, as the antibiotics data “provide indirect evidence suggesting the importance of gut microbiota on metabolic outcomes, including diabetes.”

Describing their findings as “important evidence,” he concluded: “Based on this indirect evidence and existing data in animals, we are planning to more directly investigate the effect of altered microbe environments in humans.”

The work was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences at the National Institutes of Health. The authors have reported no relevant financial relationships.

Eur J Endocrinol. 2015. Published online March 24, 2015. Abstract

via Do Antibiotics Raise Diabetes Risk via Gut Microbiota?.

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