Medical Food Video Interview on The Balancing Act (TV)

Check out this vide on Medical Foods: 

 

http://www.tmedpharma.com/media/the-balancing-act-v1.php

12/14/12 The Future of Medical Foods - Nutraceuticals World

www.nutraceuticalsworld.com/contents/view_online-exclusives/2011-12-15/the-future-of-medical-foods/

The Future of Medical Foods
Metagenics conference stresses the importance of science as
the foundation of new therapeutic foods formulated to fight
against chronic illness and obesity.

By Joanna Cosgrove

Originally developed to use in the treatment of genetic metabolic diseases in infants, the evolution of medical
foods—products specially formulated to address specific health concerns—has gained steady momentum in
recent years, even earning formal recognition from FDA. The forerunner in the field, San Clemente, CA-based
Metagenics, Inc., delivered a series of workshop presentations on regulatory, research and business trends of
medical foods at the recent World Health Forum at Harvard Medical School. According to Metagenics’ Jeffrey
Bland, PhD, the company’s chief science officer and host of presentations, the future of food lies in the science
of nutrigenomics, the study of how food affects genetic expression at the cellular level.
“Medical foods taken with a low-glycemic Mediterranean diet have been tested and proven effective in reducing
metabolic syndrome, a condition that increases the likelihood of an individual developing heart disease, diabetes
and other lifestyle-related conditions,” noted Dr. Bland. “This discovery is a tremendous benefit to the healthcare
system. Now healthcare practitioners can expand their use of medical foods to help their patients to achieve
better health today, and for the rest of their lives.”
At Metagenics, Dr. Bland helms a team of more than 40 scientists in the field of nutrigenomics, where the
researchers test the phytonutrients found in plants for their health properties. Their work has earned more than
50 international and U.S. patents, and has been published in more than 80 peer-reviewed research journal
articles.
During his presentation, Willy Pardiñas, Metagenics’ senior vice president, general manager of Americas, spoke
about how scientific validation is the foundation for the acceptance and widespread use of promising medical
foods. “The companies that are succeeding with medical foods are those that demonstrate a commitment to real
science and evidence-based medicine,” he said. “They use the highest standards of clinical research including
the double-blind, placebo controlled studies. Now, traditional pharmaceutical companies are beginning to see the
value of medical foods as part of their portfolio, when these products bring clinical proof and broad applicability for
fighting chronic illness.”
J.D. Weir, president and CEO of Primus Pharmaceuticals, echoed Mr. Pardiñas’ sentiments on the principles of
solid science. “If we’re serious about giving healthcare practitioners real solutions for combating chronic disease,
they need to know our solutions work and can deliver predictable outcomes,” he said.
An estimated one-third of Americans currently have metabolic syndrome. Most of those afflicted with this
condition aren’t even aware they have it, or that it is putting them at greater risk of developing a chronic illness.
According to Metagenics, helping patients to reverse metabolic syndrome will significantly lower the number of
individuals who develop heart disease and diabetes, which in turn will fight the rapidly growing epidemic of these
ailments that is occurring around the world.
Robert Lerman, MD, PhD, medical director for Metagenics, moderated a session on the clinical application of
medical foods and cited research published earlier this year in the Journal of Clinical Lipidology on the effect of a
medical food in helping reverse metabolic syndrome. The article reported the findings of a 12-week multi-center
clinical trial conducted at three universities that showed Metagenics’ UltraMeal PLUS 360° medical food and a
low-glycemic Mediterranean diet is almost twice as likely to lower certain cardiovascular risk factors as this
same diet alone, and is 40% more likely to resolve the effects of metabolic syndrome.
Deanna Minich, PhD, Metagenics’ vice president of scientific affairs, addressed the importance of phytonutrients
in the medical food delivery form, while Matthew Tripp, PhD, vice president, research & development, spoke
about the breadth of active ingredients in medical foods that have an impact on chronic disease.
Next Generation Multi
In separate but related news, Metagenics recently announced the launch of a “professional brand” daily
supplement that was formulated in adherence to the same clinical standards as its aforementioned UltraMeal
PLUS 360° medical food.
According to the company, PhytoMulti is positioned as a “Smart Multi” daily supplement designed to “activate
health potential with a science-based combination of phytonutrients, vitamins, and minerals,” targeting “cellular
health to nourish cells, recharge cellular communication, and defend against free radical damage.
Metagenics said PhytoMulti was created using extensive research to develop a strategic combination of
phytonutrients—bioactive secondary metabolites in plant-based foods—known for their antioxidant properties and
“positive influence on cell signaling to communicate healthy messages throughout the body.” The proprietary
formulation of 13 concentrated plant extracts and phytonutrients (resveratrol, lutein, zeaxanthin and lycopene, as
well as an “optimized” blend of essential minerals and vitamins, including vitamin D3, folate and B12) was
scientifically tested for potential biological activity to protect cells via antioxidant capacity and maintenance of
DNA stability.
An independent laboratory evaluated PhytoMulti’s proprietary blend and the entire combination of
ingredients with the new total functional oxygen radical absorbance capacity (ORAC FN) assay that measures
against five major free radicals. Unlike a conventional ORAC, which tests against only one radical, this expanded
in vitro assay was said to have provided “a better sense of antioxidant protection against a variety of potentially
damaging free radicals and other reactive oxygen species.” The analysis of PhytoMulti’s active ingredients
(equivalent to the contents in one tablet) returned a total ORAC FN value of 12,600 trolox, demonstrating
“exceptional” antioxidant capacity.
Metagenics also said the potential of the phytonutrient blend to help maintain DNA stability was validated using
the COMET assay, a complex in vitro test using human immune cells. This assay demonstrated a 52% increase
in DNA stability when cells pretreated with the phytonutrient blend were compared to control cells introduced to
the same oxidative medium (peroxides).
PhytoMulti will be available January 1, 2012, through health practitioners nationwide. PhytoMulti with Iron,
formulated for those who need supplemental iron, will be available February 1, 2012.

Statins and Breast Cancer Risk

Studies put kibosh on statins for breast cancer prevention

By: BRUCE JANCIN, Family Practice News Digital Network

12/10/12

  | 

SAN ANTONIO – New data from the Women’s Health Initiative dash cold water on the idea that statin therapy reduces breast cancer risk.

The updated WHI findings showed no association between prior statin use and breast cancer risk in nearly 155,000 postmenopausal study participants followed prospectively for an average of 10.8 years.

Indeed, the annualized rate of breast cancer was 0.42% in 11,584 statin users and 0.42% in nonusers in this analysis of 7,430 first cases of invasive breast cancer, Dr. Pinkal Desai reported at the San Antonio Breast Cancer Symposium.

Statin potency, duration of use, lipophilicity versus hydrophilicity – none of those factors had any impact, added Dr. Desai of Providence Hospital Medical Center in Southfield, Mich.

In commenting on Dr. Desai’s WHI update at a session on statins and breast cancer risk, Dr. Vered Stearns noted that the new data represent quite a turnabout, since an earlier report from the WHI was one of the major initial triggers of interest in the notion that statins might protect against breast cancer.

That report (J. Natl. Cancer Inst. 2006;98:700-7) analyzed 4,383 cases of invasive breast cancer among study participants followed for a median of 6.7 years. It showed no reduction in breast cancer risk in association with statins overall; however, there was an 18% reduction in risk (P = .02) among users of lipophilic statins, including simvastatin, lovastatin, and fluvastatin. With longer follow-up and more cases, however, that earlier benefit is gone, observed Dr. Stearns of Johns Hopkins University, Baltimore.

Moreover, a new meta-analysis has put a further damper on the hypothesis that statins protect against breast cancer, she continued. The meta-analysis included 13 published cohort and 11 case-control studies with more than 2.4 million participants, including 76,759 breast cancer patients. The investigators, from the National Institute of Pharmaceutical Education and Research in Punjab, India, found that neither statin use overall nor long-term statin therapy affected breast cancer risk (Breast Cancer Res. Treat. 2012;135:261-9).

Dr. Desai noted that the latest WHI findings do contain one glimmer of hope regarding statins and breast cancer: In a multivariate analysis, women on simvastatin were 13% less likely to develop breast cancer than statin nonusers after adjustment for demographic factors, body mass index, smoking, alcohol intake, family history, age at menarche and at first birth, NSAID use, dietary fat, physical activity, and mammography within the past 2 years. However, this trend toward reduced breast cancer risk with simvastatin therapy didn’t achieve statistical significance.

Statins are safe and cheap, and multiple products are readily available. But in light of the discouraging new epidemiologic data, Dr. Stearns declared "I think that the effects of statins as single agents are modest at best. There’s quite a good rationale, though, for prospective studies of them in combination with standard hormonal therapy, chemotherapy, and radiation therapy, as well as with novel cancer treatment agents."

She added that the statins remain worthy of research interest because many of their pleomorphic cellular effects are antineoplastic. The drugs inhibit the mevalonate pathway, down-regulate metalloproteinases, inhibit Rho and Ras activation, decrease CD44 cells, and increase PTEN antibodies, all of which are salutary from an anticarcinogenesis standpoint.

Dr. Desai and Dr. Stearns reported having no financial conflicts of interest.

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Copyright © 2012 International Medical News Group, LLC. All rights reserved. 
This page was printed from www.familypracticenews.com . For reprint inquires, call 877-652-5295, ext. 102.

American Fitness magazine (Nov/Dec 2012) issue





I write for American Fitness quite regularly and this latest issue my Lipotropic article was published.  Incidentially, Tony Horton (celebrity personal trainer) was the cover and featured article.  Very funny because back in 2009 I met Tony at a BeachBody coaches conference when I was asked to speak to the group in launching a meal replacement product called Shakeology.  I had just finished P90X and took Tony's aerobic class (aspects of P90X) and placed myself in the 2nd row.  The class was some 150 or 200 folks.  Was very cool to meet my ''hero'' of the P90X program that Sharon and I so diligently followed.

Any say hope you enjoy the article on Tony and my piece on Lipotropic agents:

Tony Horton Keeping on top by giving more By Cherryh Butler   It's true that most fitness professionals will never see the level of success that celebrity trainer Tony Horton has enjoyed, but the creator of the nation's top-selling workout series, P90X®, is confident that many can easily increase their business and profitability by doing a few specific things—walking the walk, being generous and having a passion for learning new skills. Horton, who set out decades ago to be an actor, but instead found his passion in the gym, believes the most successful trainers and instructors practice what they preach. They eat healthy, work out and take care of themselves. Horton says a trainer should be a role model to his clients. "If you are a trainer, lose the weight and walk the walk," he says. "Out of shape trainers that eat garbage won't be taken seriously. I can't show up at an event—even though I'm 54 years old—not cut and looking fit." YOU'VE GOT TO GIVE TO GET One of the best marketing tactics Horton has in his gym bag of tricks is giving freebies. "A lot of trainers who are fairly successful don't like doing this, but you have to," says Horton, who recently returned from a military base tour, where he volunteered his time. "I still do this to this day; obviously you can't do it all the time, but you can show up to a seminar, and if you are passionate about what you do, and your main focus isn't making money to buy some fancy car—if your passion is altruistic in nature, then you can build your business." DEVELOPING SKILLS No one knows everything about fitness, not even Horton, who recalls a recent track workout he did with four UCLA coaches. "You have to be as fit as you can possibly be, and that means you've got to work on your weaknesses and learn a lot about other techniques," he explains. "I know a little about speed and interval drills, but these guys kicked my ass. And they also gave me fresh ideas. To build your business you've got to be in shape, and you can't be afraid of fresh ideas." Getting stuck in just one type of fitness mode will kill any career. For example, Horton points out that there are only so many people who want to do yoga. The yoga instructor who adds something original to his class, like plyos or unique music, is going to build his business. "I'm not saying you need to throw kettlebells in your yoga class, but you have to find what it is that makes you special, and then find ways to advertise that. A lot of things are going to fail, but that shouldn't slow you down. You fall on your face and get up. People who succeed continue to ask questions of their mentors, but when the answers don't resonate, then you ignore them and keep moving forward." AF WHAT'S TONY DOING NOW? Tony Horton is on a mission to expand his fitness empire. Using the success of his fitness DVDs he's propelling his brand into other industries. For example, his latest project is Tony Horton Kitchen, a meal planning, delivery service to help people learn to eat healthier.  "A lot of people use exercise as an excuse to eat whatever they want, but exercise equals fitness and good food equals health," he says. "Without proper fuel—when one is fighting the other—you've got a problem." The main barriers to proper eating are that people don't have time to cook and that they are also addicted to chemicals found in most foods. Horton's way of eating solves those problems. The system delivers precooked meals to clients each week. They can choose the number of meals they get and also among menu options: vegetarian, vegan or flexitarian. Horton says, "You need a certain amount of variety when it comes to nutrition, and I've provided a meal plan that's tasty but filled with nutrients." Horton doesn't make any bones about the price; with meals costing about $11 each, it's not for a family of eight or a thrifty college student, but it is for someone who can afford to buy organic at a grocery store or eat out at restaurants. "We have organic vegetables, free-range buffalo and wild salmon," he says. "Yeah, wild salmon is expensive, so it's not for everybody, but it's not any more expensive than ordering those things at a restaurant. It shouldn't be a luxury that only rich people do." The next step will be a line of Tony Horton spices and sauces. But he isn't satisfied with staying in the kitchen—he's also working on a deal to endorse sunglasses designed for outdoor activities and is developing a sports clothing line with shoes being the ultimate end goal. A fitness watch may be in the future, too. Cherryh Butler is a certified personal trainer and group fitness instructor in Kansas City, Mo. She has a master's in journalism and contributes to magazines, newspapers and websites all over the country. YOGA, TONY HORTON STYLE "I can things at my age...not because I can do a bunch of pull-ups. It's because I do yoga." —Tony Horton Tony Horton is renowned as the creator and star of the P90X® extreme home fitness system, but many don't know about his yoga side. In the mid-1990s Horton discovered this form of exercise and it changed his life. "I had heard of yoga," says Horton. "But I thought it was silly." Then a woman he was dating invited him to a hatha yoga class. "I had my butt handed to me!" Horton understood that being bad at something was a good thing. And he began taking yoga classes regularly. He noticed that not only did yoga improve his flexibility and range of motion, it gave him more endurance during sports, such as rock climbing and skiing. "I found that yoga allowed me to push harder in all other aspects of fitness without getting hurt." Horton developed his first yoga video, the little known Ho' Ala ke Kino (Awaken the Body) in 1994. Later he worked with a variety of fitness experts developing and testing the 90-day program that was to become Power 90 Extreme, or P90X® for short. And in this system, he included the key element of his own fitness regimen—a full 90-minute yoga class: Yoga X. "A lot of people balked at the idea of an hour and a half yoga video," recalls Horton. "But every class I ever took was that long—so that's what I did." The practice is essential not only for one's physical well-being, but it can be used to deal with life stressors, such as being stuck in traffic or dealing with your boss. With yoga you are centered and connected. Horton endeavors to practice yoga at least twice per week. In addition, he explores various styles when traveling across the country. Horton says, "Every time I have a new teacher I feel like a beginner." Matthew Graham is an AFAA certified personal trainer and freelance writer.

November/December 2012

Introduction and Definition

A lipotropic agent is a compound that removes or inhibits the deposition of lipids (fats) in organs, specifically the liver. With recent weight management programs and the resurgence of the controversial hCG (human chorionic gonadotropin) protocol for weight loss, lipotropic agents like the MIC (Methionine, Inositol & Choline) injection and betaine are coming back into the limelight. To better understand the use of these agents as potential weight loss compounds, we must understand the physiology and pharmacology behind lipotropics.1

History

During the early 1930s, the properties of lipotropic agents were elucidated predominantly by the work of Charles H. Best, a researcher in the field of liver disease and lipid chemistry. There was intense interest in lipotropics with regard to treating particular liver disorders as one perceives with the many peer-reviewed medical journal citings during the 1930s and into the 1950s. The focus was on treatment of fatty liver disease, a problem where lipids accumulate in the hepatic cells. In 1954, Dr. Albert Simeons published his work on the use of a female hormone called hCG in a protocol for significant weight reductions in obese patients.2,3 Today this protocol is again gaining notoriety in a revised format, and with the aid of utilizing lipotropic agents.
Alcoholic fatty liver disease was noted to exist as early as the 1800s and agents were desired to help remove triglyceride or fat collections that poisoned the liver from overconsumption of alcoholic beverages. Nonalcoholic fatty liver disease, a fairly benign process at its onset, was eventually recognized to lead to a more worrisome disorder called NASH (Nonalcoholic Steatohepatitis) in the 1980s at the Mayo Clinic.4 Both nonalcoholic fatty liver and NASH are due primarily to obesity, dysglycemia (diabetes) and hypertriglyceridemia (elevated triglycerides).
A weight loss management program should not be of such narrow focus as to just drop unsightly fat from our bodies, but rather should include loss of visceral and organ fat as well. That is where lipotropic agents come into play. Not only may they be useful in mobilizing fats for weight loss, but they help in reversing the detrimental lipid build-up in organs, especially the liver, that can lead to disease and illness.

Research

The lipotropic agent betaine (trimethylglycine, TMG) is an example of an orally administered compound having dual functions as an osmolyte to protect cells, proteins and enzymes from environmental stress, as well as being a methyl group donor. Betaine is a natural extract from sugar beets and is derived from choline. An important function of betaine is to increase liver glutathione levels while lowering homocysteine concentrations. Betaine is able to synthesize l-methionine from the amino acid homocysteine. Biochemically it participates in the methionine cycle in the liver and kidneys as a methyl donor and neutralizer of free radicals and hydroxyl groups. Inadequate methyl group levels can lead to hypomethylation in important enzymatic pathways that affect hepatic proteins. This methyl group deficiency can result in elevated plasma homocysteine concentrations (known as an independent risk factor for coronary disease and stroke), and it can also result in inadequate fat metabolism leading to steatosis or fatty liver disease. With inadequate betaine consumption in our diet, the result is serum lipid abnormalities or dyslipidemia.5
Choline is a water-soluble essential nutrient and lipotropic agent often grouped with the B-family of vitamins. Choline protects the liver against environmental toxins and poisonings. One way choline protects the liver is by detoxifying amines, byproducts of protein metabolism. In one experiment liver cells were rescued with doses of choline in an intentional poisoning with carbon tetrachloride in laboratory animals.6 In our diet, the best source of choline is lecithin, also known as phosphatidylcholine.7 Lecithin is found naturally in egg yolk and soy beans. Choline goes through an oxidative process converting it to the metabolite betaine, itself a potent lipotropic and free radical scavenger. When we consume fat and lipids and they are absorbed in our alimentary tract, from there they are transported through the bloodstream to the liver in chylomicrons, a type of lipoprotein. Within the liver, these fats and cholesterol are packaged into very-low-density lipoproteins (VLDL) for transportation through blood to tissues that need them. Phosphatidylcholine, or choline, is a component of this transport VLDL particle and without it, the fat and cholesterol would accumulate in a negative way in the liver. Making sure there are no choline deficiencies in our diet, or even making available larger doses of choline, ensures us of mobilizing fat out of the liver and back into circulation to be used for fuel or other purposes by cells.
Dietary cholesterol was shown in experiments to slow down phospholipid turnover in the liver. Conversely, choline and betaine were shown by researchers Dr. Andrew J. Perlman and Dr. I.L. Chaikoff to speed up phospholipid metabolism within an hour after choline ingestion. The choline effects of mobilizing fats appear to linger for up to 12 hours after consumption.8 Diets high in refined grains (low in whole-grain breads, for example) have a relative deficiency in both betaine and choline. This is another reason why whole grains are preferred over refined or processed grains. Besides the lipid effects, low levels of dietary choline and betaine lead to elevated homocysteine levels and their untoward effects on the cardiovascular system.9
It’s noteworthy that the mitochondrial enzyme carnitine palmitoyltransferase-I (CPT-I) is responsible for fatty acid metabolism and is the rate-limiting step of the fatty acid oxidation pathway making it of interest in the treatment of obesity. Researchers feeding high-fat and choline-betaine deficient diets to laboratory animals noticed an increase in NASH with an inactivation or oxidation of the CPT-I mitochondrial enzyme activity.10 Modulation and manipulation of CPT-I may affect energy metabolism and food intake, and research is ongoing into the effects of both stimulation and inhibition of CPT-I and its relationship to obesity management.11
In 1937 Dr. Helen Tucker and Dr. H.C. Eckstein determined methionine to be a lipotropic agent. The experiments of Charles Best and Jessie Ridout showed that even small doses of methionine have the same effect on fat metabolism as higher doses.18,14 Methionine is an essential amino acid that helps the body take control of excessive serum levels of estrogen for one thing. High estrogen levels reduce bile concentrations that are responsible for fat emulsification and lipid passage through the liver. Methionine helps deactivate estrogens leading to improved fat metabolism and mobilization. It is well noted that elevated estrogen levels, especially in males, lead to unsightly adipose depositions and obesity. Overweight men have issues with feminization as their estrogen levels climb. Methionine, along with choline, detoxifies amines in protein metabolism. It also acts as a catalyst for choline and inositol functions. Methionine has another important function in that it affects the body’s levels of glutathione. Glutathione is a compound in the liver that is crucial in hepatic detoxification and acts as a very potent antioxidant. And glutathione is essential to defend the liver against toxic compounds that it metabolizes after oral ingestion.

Inositol (also known as myo-inositol) is a lipotropic agent whose action prevents the trapping of fat in the liver. Inositol is a compound classified as a carbohydrate, although not a classic sugar. It is found naturally in nuts, beans, melons and oranges. Once considered a member of the vitamin B-complex family, it was determined to be synthesized from glucose and thus lost the “vitamin” title as an essential nutrient. However, inositol does have a vital role in human health.15 Inositol and choline together prevent cholesterol from sticking to the arterial walls and inositol helps with the transport of fat through the blood stream.16 In a scientific study, it was demonstrated that choline exhibits more of a lipotropic effect than does inositol in laboratory animals fed both fat-free and fat-containing diets.28 Not to detract from the importance of inositol, it should also be noted that lipotropics tend to work in synergy with one another. Heavy consumption of caffeine can deplete inositol stores, and this may be one facet of how caffeinated beverage consumption today is leading to obesity and dysmetabolism. While each of these lipotropic agents acts alone as a fat-mobilizing compound, they are all related and interdependent upon each other in one fashion or another. Oftentimes the effects of lipotropics are symbiotic if not embellished by the others’ presence. It is very reasonable to coadminister two or more of these agents for best effect.

Use Today in Weight Loss and Health

Today as an adjunct to good nutritional counseling and appropriate dietary protocols for reductions in weight and adipose tissue, lipotropic agents can be used by doctors and nutritionists to help patients lose and control weight. Lipotropic agents certainly have their place among important nutraceutical considerations for weight management protocols. Both oral and intramuscular administration of lipotropics can aid in the maintenance and reduction of weight in those suffering from obesity, diabetes and metabolic syndrome.16 A very common lipotropic “cocktail” is the MIC, which is injected into deep muscle—usually on a weekly basis. Orally administered betaine can be taken as an alternative to the injected forms of the MIC preparation, having similar effects in most cases. There are few contraindications to the use of these lipotropic agents in moderation as they do occur naturally in healthy diets. However, super physiological doses should be administered under the careful supervision of a physician. AF


Yusuf Saleeby, MDis medical director of WellnessOne and WellnessFirst which offer extensive and advanced cardiovascular and stroke biomarker and genetic analysis, including lipid subtypes, Lp(a), HDL2 and HDL3, LDL1-4, ApoB, NT-proBNP, and the 4q25, 9p21, ApoE & KIF6 genotypes, and other evaluations. He is a regular contributor to American Fitness and is on the medical advisory board. He can be reached for comment at ymsaleeby@gmail.com.

REFERENCES: (use the link for full article:  http://americanfitness.squarespace.com/otp-1112/

Medical Foods safer than Pharmaceuticals

Viable alternatives to prescription pain medication:

Advent of Medical Foods

 

By Yusuf (JP) Saleeby, MD

 

 

With recent reports of increased visits to the emergency rooms across this nation for reasons pertaining to prescription drug abuse there is ever more reason to focus on alternatives.  In a 2011 report from the Substance Abuse and Mental Health Services Administration statistics reveal that from 2004-2009 in America there was a rise in Emergency Department (ED) visits due to drug reactions.  Prescription medications, OTC meds and even herbal remedies of all types saw a rise in misuse, abuse, suicide attempts, adverse reactions and accidental ingestions resulting in ED visits.  Part of the rise is due to poly-pharmacy, as the population at large is being prescribed more than one medication by their physicians.  Multiple medication use results in increase risk for untoward effects and complication.  With our aging population this becomes even more an issue, as they tend to “collect’’ medications as they age.

 

Dangerous numbers:

 

In 2009 the report by SAMHSA goes on to state that over 120-million visits were made to nationwide EDs and of these at least 4.5-million were drug/medication related.  Drug-related ED visits increased by over 80-percent since 2004.  In 2009 estimates of about 2.1-million ED visits resulted from the misuse or abuse of medications.  That is about 674 ED visits per 100,000 people per year.  Those 20-years old and younger was at a rate of 473 visits and those 21-years and older was double that.  Just over thirty-five percent involved pharmaceuticals alone and another 25-percent involved pharmaceuticals plus illicit drugs and/or alcohol.  The visits to EDs with side-effects and medical emergencies related to prescription drugs in one fashion or another amounted to 60-percent for that group.  While visits remained stable from 2004 to 2009 on medication alone, there was a 117% rise in the non-medical use of pharmaceuticals, and a 97% rise in pharmaceuticals used with illicit drugs.

 

No matter how you look at it, it is a big national problem.  Some of it is avoidable; others pertain to social issues and the rise of illicit drug use in this country.  From the perspective of a physician this trend can be reversed if doctors prescribe less medication, are judicious in their use of multiple medications, and use the lowest doses possible that results in goal of therapy.  I see too many patients in their 5^th decade of life or greater that are on more than one pharmaceutical (both in the Emergency Department and the wellness clinics I staff).  The older they present, often the larger their purse of drugs and therapeutics.

 

Making changes to improve safety:

 

First step is counseling patients on pharmaceuticals.  Even a single prescription medication is not without side effects; each and every patient should be made aware.  Add a second or third drug and the risk for drug-drug interactions goes up precipitously.  A published study in the December 2008 JAMA by the University of Chicago revealed that in some 3000 individuals surveyed aged 57 to 85 the use of prescription and OTC drugs resulted in a one in 25 risk of major drug-drug interactions.  Halting the behavior of continually adding medication on top of medication is a paradigm that must be adopted by primary care physicians.  After all they are the gatekeepers who monitor and when appropriate should selectively withdraw unnecessary medication.

 

Alternatives to powerful drugs with harmful side effects and strong drug-drug reactions are the more subtle and oftentimes safer herbals and dietary supplements.  However, before we proceeded, many dietary supplements and herbals can themselves be linked to drug-herb interactions often as worrisome as we see with two pharmaceuticals interacting.

 

A more appropriate alternative is the judicious use of ‘’medical foods’’ as alternatives to pharmaceuticals.  Medical foods are those that have a nod from the FDA as approved for medicinal use and prescribed by a physician.  Medical foods are just that, food or compounds  often times amino-acids and natural substances which have been studied to show benefits similar to their more powerful pharmaceutical brothers.  The term medical food, is defined in section 5(b) of the Orphan Drug Act (1983) as "a food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation." 

 

Medical foods are not limited by FDA required labeling often seen on supplements and herbals.  An examples would be the combination of amino-acids, neurotransmitters and select substances in a patented medical food called Theramine® used to augment a lower dose of an NSAID (Naprosyn®) and eventually replacing it completely in some cases.  This process can be undertaken to reduce and eliminate the use of scheduled and habit forming pain medication such as oxycodone, hydrocodone, morphine, and tramadol.  Other medical foods can replace side effect wrought pharmaceuticals such as the SSRI class of anti-depressants (Prozac®, Celexa®) and the anti-anxiety benzodiazepines (Xanax®, Ativan®). Medical foods are extremely popular on the West Coast, but are gaining momentum in the East.  Additional benefits of Medical Foods, besides their safety record, are that many health insurance policies will cover their use.  So now we witness insurance coverage for not only pharmaceuticals (generally not covering supplements and herbals) but coverage for medical foods such as Theramine®.  As more clinical data is collected there will be better acceptance for the use of medical foods by healthcare practitioners.

 

Making Medical Foods available:

 

Medical foods must be prescribed by a physician.  While not a pharmaceutical in the strict sense, they are FDA approved and accepted for specific use in fighting disease and illness.  Wellness One (First) is one of the first center in the region that offers these medical foods through prescription from their staff physicians.  Let us not forget Hippocrates (460-377 BC), the father of Western medicine, is known for saying “Let food be thy medicine and medicine be thy food.”

 

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Dr. Saleeby is medical director of Wellness One of Myrtle Beach and Wellness First of Charleston.  Both centers are integrative wellness and health spas with a focus on integrative protocols for management of illness and disease prevention.  Wellness One and Wellness First are the leaders in bringing the use of Medical Foods to the coastal Carolinas.

 

 

Reference:

 

Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2009: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 11-4659, DAWN Series D-35. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.

 

Qato, DM., et al, Use of Prescription and Over-the-counter Medications and Dietary Supplements Among Older Adults in the United States. JAMA. 2008;300(24):2867-2878.

 

Medical Foods FDA website, Retrieved from http://www.fda.gov/Food/FoodSafety/Product-SpecificInformation/MedicalFoods/default.htm (accessed 11/10/2012)

 

Shell, W.E., et. al., A Double-Blind Controlled Trial of a Single Dose Naproxen and an Amino Acid Medical Food Theramine for the Treatment of Low Back Pain., Am. Journal of Therapeutics, 17(2):133-139, March/April 2010

 

Theramine from Physician Therapeutics, Retrieved from http://ptloffice.com/downloads/marketing/Theramine_latest.pdf (accessed 11/10/2012)

 

Orphan Drug Act FDA website, Retrieved from http://www.fda.gov/RegulatoryInformation/Legislation/FederalFoodDrugandCosmeticActFDCAct/SignificantAmendmentstotheFDCAct/OrphanDrugAct/default.htm (accessed 11/10/2012)

 

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Acupuncture grows in South Carolina

The Post and Courier

Acupuncture is growing in Charleston despite a slow embrace by medical community

• David Quick
   
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• Posted: Tuesday, November 6, 2012 12:01 a.m.

David Quick/Staff Sally Pittman undergoes an acupuncture treatment for migraine headaches and other pain due to Parkinson's disease.

More than two years ago, Sally Pittman — who has a triple whammy of pain from lifelong migrane headaches, sarcoidosis and Parkinson’s disease — used to go through about 120 pills of the painkiller hydrocodone every month.

Then someone suggested that she see local acupuncturist Polly Christy, and it changed her life for the better.

Extra Photos

• Acupuncturist Polly Christy removes a needle from Sally Pittman’s calf.
•  Christy talks with Pittman during an appointment. She has been treating Pittman for two years.

Pittman’s migranes have eased significantly, both in the frequency and severity, and now one bottle of 60 pills of hydrocodone lasts up to three months.

“Acupuncture has helped me tremendously,” says the 62-year-old former accountant who is on disability. “Besides relieving my pain, acupuncture helps my balance, my mobility and motor skill function. ... I’m going to come no matter what. It’s worth it. I see it as a necessity.”

Slow embrace

Western medicine’s acceptance of acupuncture has been slow, but increasingly it is being demonstrated in the description of the ancient Chinese practice as a “complementary” rather than an “alternative” therapy.

Acupuncture involves inserting long, very thin needles just beneath the skin’s surface at specific points on the body to control pain or stress.

Some still believe that acupuncture’s powers remain as a psychological placebo effect, but recently reported studies gave “the most robust evidence” to date that acupuncture is a reasonable referral option.

Medical researchers at Memorial Sloan-Kettering Cancer Center in New York and several universities in England and Germany examined 29 studies involving 18,000 adults and gave acupuncture a thumbs-up for relieving pain from chronic headaches, backaches and arthritis, according to The Associated Press.

The new analysis was published Sept. 10 in the journal Archives of Internal Medicine. The federal government’s National Center for Complementary and Alternative Medicine paid for most of the study, along with a small grant from the Samueli Institute, a nonprofit group that supports research on alternative healing.

The researchers concluded that the needle remedy worked better than usual pain treatment and slightly better than fake acupuncture. That kind of analysis is not the strongest type of research, but the authors took extra steps, including examining raw data from the original studies.

Few downsides

Locally, Dr. Arthur Smith, a board-certified pain management specialist at the Medical University of South Carolina, says he believes in acupuncture and its ability to ease pain.

“Even though it works, we still don’t know how it works,” says Smith, noting that the “art” has benefited from nearly thousands of years of trial-and-error, notably the most enduring pain management process in the history of mankind.

“Studies are hard to do on acupuncture, and you can get conflicting results because of placebo effects, but there are placebo effects in all treatment studies,” Smith says.

Smith, along with acupuncture practitioners, say a major benefit of acupuncture is that it has no side effects. The only downside, Smith says, is the possibility of bruising or risk of infection at the needle site and the cost.

Typically, an acupuncture session can cost up to $100, but to be effective, at least four to six sessions must be undertaken to see if it works. That expense usually is out-of-pocket. Medicare does not cover acupuncture. While some private insurance plans do, those plans usually cap coverage at about six per year.

Saving more

While that pricing structure is different, some local acupuncturists use a pay-what-you-can “sliding scale.”

Chad Houfek, a graduate of the Southwest Acupuncture College in Boulder, Colo., and the College of Charleston, founded Charleston Community Acupuncture nearly three years ago on Savannah Highway in West Ashley to make acupuncture more assessable to the public.

“The main barrier for people getting acupuncture is out-of-pocket expense,” says Houfek, who is part of an international movement called The People’s Organization for Community Acupuncture. “We let people determine what they want to pay, from $20 to $40, and how long they want to stay.”

He admits his lower-cost service does raise suspicion.

“The first question I’m always asked is, ‘Do you reuse your needles?’ ” says Houfek, noting that the answer is “no.”

Like Houfek, local acupuncturist Sarah Stowers also graduated from C of C and the Southwest Acupuncture College in Boulder. She has her own practice, Charleston Acupuncture on East Bay Street, and takes clients at One Respe Wellness Center on Spring Street.

Stowers has noticed not only a growth in her clientele but an increase in the number of acupuncturists in Charleston.

“It’s definitely growing. In the four years since I’ve been here, the number of acupuncturists has doubled,” Stowers says.

Charleston in-roads

Acupuncturists and married couple Polly and Colby Christy moved to Charleston to set up practices in 2005 after graduating from and apprenticing at the TAI Sophia Institute in Maryland, where acupuncture already was moving into the realm of complementary medicine.

The Christys say that medical students from the University of Maryland, Johns Hopkins and the University of Pennsylvania even took the four- to six-week residency in acupuncture at TAI Sophia.

So Polly Christy was in for a rude awakening when she called the S.C. Department of Health and Environmental Control about licensing and was referred to body piercing.

“That was little bit of a shock to me, to be coupled with body piercing, not that there’s anything wrong with it, but it’s not my license,” Christy says. “This is a 3,000-year-old practice that most of the world still uses as their primary form of medicine.”

Christy notes that acupuncture also approaches health with attention to lifestyle, notably eating well, exercising and managing stress.

Colby Christy says it’s been difficult to connect with local hospitals and doctors, other than the ones who have had acupuncture, but says he hopes that will change.

“It’s pretty amazing what can happen with these itty-bitty filaments of a needle that aren’t dipped in anything.”

Question about Jiaogulan and Panax Ginseng

A questions submitted on AllExperts.com

Questioner: Michaël
Subject: Ginseng, Jiaogulan and saponins?
Date Asked: 2012-10-10 14:53:23
Date Answered: 10/14/12

Question:

Hello.

I have done some reading on the internet on adaptogenic herbs, mainly ginseng 
and jiaogulan.

I read that they shouldn't be taken together, because both herbs can dilute the 
blood and combined it dilutes the blood too much. Is this true?

I read that ginseng should be taken in cycles, like daily for 3 weeks and then 
stop taking it for 2-3 weeks before taking it for another 3 weeks, or that 
people can take it in small moderations for longer periods of time when taking 
it every other day, because otherwise the effects of ginseng won't be noticeable 
anymore.

According to researchers jiaogulan has roughly 3 times as many saponins as 
ginseng, but when I read up on jiaogulan, a lot of people say that jiaogulan can 
be drunk throughout the day and no need to go on and off jiaogulan every couple 
of weeks like recommended with ginseng.
So I was wondering, how come it is recommended that ginseng should only be taken 
for a certain period of time, but jiaogulan can be taken for as long as people 
like, despite it having many more saponins? Does jiaogulan have very short-term 
effects compared to ginseng? If so, does that mean that in order to have the 
full effect of jiaogulan that it must be consumed throughout the day?

A couple of months ago I purchased ginseng and today I purchased jiaogulan. When 
I brew a tea from the ginseng, I also eat the ginseng I used to brew the tea so 
I don't waste anything.
So, when brewing a tea from jiaogulan, do almost all of the nutrients/saponins 
get into the liquid? Or would I have to eat the jiaogulan to have full benefit 
of it? Or maybe brew it multiple times, and if so, how many times do you 
recommend?


Sorry for asking so many questions.
Hope to hear a response soon.

--------------

Answer:

Michaël,

For all the details on Adaptogens especially the ones in question, I would say 
read my book.

My book is available on Amazon.com it is called ''Wonder Herbs: A guide to three 
adaptogens" (Xlibris, 2006) and it goes into detail w/ medical literature 
references on all facts on Eleuthero (Siberian Ginseng) and Jiaogulan and 
Rhodiola rosea.

My discussion on Panax is limited, but to answer some of your questions:

Cycling is a theoretical protocol for taking herbals especially for long term.  
There are actually no really good long term studies comparing the use of herbals 
long term indefinitely versus cycling (using one for 3 months and rotating 
through two or more).  Sometimes I recommend this just for variety.  Adaptogens 
are unusual to begin with and we certainly do not fully understand all their 
properties or promises.  Humans do like to make things more complicated then 
they actually are, that said, I do not believe cycling is necessary for safety 
or performance of adaptogens, however, I do recommend it as it has been reported 
by other herbalists.  Research is however, lacking to support to my liking.

When you steep Jiaogulan correctly you are getting a good dose of this herbal, 
however, you will need to drink several glasses a day.  It comes in capsules 
that are standardized which assures you of a correct consistent dose.

Jiaogulan is still a rather obscure herbal in the West.  I think there are less 
untoward effects with this versus Panax Ginseng, and that is why it is my 
choice.  As far as using more than one adaptogen at a time, that is not a 
contraindication, I routinely recommend using 2 or even 3 adaptogens at the same 
time.  Albeit for short bursts of time ... 2 weeks to 3 or 4 months depending on 
the diagnosis and what is trying to be achieved.  It is more of an art than it 
is a science at this point.

Again for more read my book http://bookstore.xlibris.com/Products/SKU-0032822036/default.aspx  
or look it up on Amazon.com.

In good health,

JP Saleeby, MD

Allexperts.com

Cindy Goulding's New Book Interview

Muscadine Red Wine health benefits (reprint)

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• Topics: Food Science and Human Nutrition | Food/Drug/Nutrient Interactions | Sims, Charles | Percival, Susan S

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Immune Benefits of Consuming Red Muscadine Wine¹

Susan S. Percival, Charles A. Sims, Stephen T. Talcott²

Figure 4. 

This publication is a summary of the health benefits that can be derived from consuming muscadine and other red wine. Muscadine wine contains a high level and unique variety of antioxidants which appears to prevent detrimental effects to the immune system caused by alcohol.

Click here to view PDF.

Overview

Wine, and especially red wine, contains compounds that have promising health benefits. Red wine has more potential benefits than white wine or grape juice because of the specific phytochemical compounds found in grape skins that are extracted during fermentation.

Phytochemicals are naturally occurring substances found in fruits and vegetables that have some type of biologic activity. One class of phytochemicals, phenolic compounds, is especially prevalent in grape skins. Phenolic compounds act as antioxidants–substances that neutralize free radicals produced by our normal metabolism. Free radicals are unstable molecules that react rapidly with other molecules leading to cellular damage by oxidation. This damage has been linked to signs of aging, cancer, heart disease, stroke, degeneration of the eye, and other disease processes. Alcohol consumption may cause production of free radicals during its detoxification process in the liver, but the phytochemicals in red wine, and their antioxidant activity may counteract the effects of alcohol detoxification.

Wine is the “ healthiest and most health-giving of drinks.”

--Louis Pasteur

Our research focuses on the muscadine grape species (Vitis rotundifolia) and suggests that there is a greater potential for health benefits from red muscadine wine than from other red grape species. Muscadine grapes (both domesticated and wild) are native to the Southeast region of the United States and have been enjoyed for over 250 years. They have been shown to be rich in total phenolic compounds, ellagic acid, and catechins (Tables 1 and 2).

Table 1. 

Comparison of Phenolic Compounds in Muscadine and Cabernet Sauvignon Wines. Source: Auw, Blanco, O Keefe and Sims, 1996¹

Mg/Liter	Muscadine Wine (HP)	Cabernet Sauvignon Wine (HP)
Total Phenols	834	534
Gallic acid	14	3
Ellagic acid	8	None detected
Catechin	5	11
Epicatechin	22	2
B3 procyanidin	0.3	25

Table 2. 

Effect of Processing and Fermentation Time on Phenolic Compounds of Muscadine and Cabernet Sauvignon Wines. Source:Auw, Blanco, O Keefe and Sims, 1996¹

Grape	Compound	Immediate press	Hot press	1-3 day skin fermentation	7 day skin fermentation
Muscadine	Ellagic acid	0.5	8	3	6
	Gallic acid	4	14	45	148
	Catechin + epicatechin	3	30	40	120
Cabernet	Gallic acid	2	3	7	16
	Catechin + epicatechin	8	13	60	73

Table 3. 

Effect of Processing and Fermentation Time on Phenolic Compounds in Muscadine Wine Source: Talcott and Lee³, 2002

Compound	Cold Press	Hot press 3 day skin fermentation	Hot press 5 day skin fermentation	Hot press 7day skin fermentation
Ellagic acid	3	56	54	53
Quercetin	1.5	40	37	34
Total Phenolics	403	1600	1840	1860

Depending on the type of processing, muscadine wine may contain 3-4 times more phenolic compounds than wine made from California red wine grapes (Vitis vinifera). Ellagic acid, a known anti-cancer compound, is found in appreciable amounts in muscadine wine, but not in Cabernet wine for example (Tables 1 and 3). Quercetin is a potent antioxidant compound found in significant quantities many fruits and vegetables including muscadine wine and other red wines as well.

We investigated the health benefits of wine on the immune system in an animal model. If alcohol detoxification creates free radicals, we expected to see unfavorable effects on the immune system. Mice consumed a red muscadine wine (V. rotundifolia, phenolic content 1731 mg/L), a cabernet sauvignon (V. vinifera, phenolic content 912 mg/L), ethanol (all at 6% alcohol), or water for 8 weeks. At the end of this time, we made half of the mice mildly ill with an injection of lipopolysaccharide (LPS), a compound derived from bacteria. The amount of wine consumed by the mice was equivalent to two and one-half glasses of wine by an adult human, based on calories consumed. This is a moderate intake.

Our first observation was that mice consuming either of the wines had significantly greater plasma total antioxidant levels than mice consuming water or ethanol (Figure 1). This indicates that antioxidant protective activity can accumulate in the blood with moderate amounts of wine. The normal response to an injection of LPS is a higher plasma antioxidant capacity due to the release of the production of acute phase reactants in the blood. Notice in Figure 1 that the animals that consumed straight ethanol were not able to raise their antioxidant levels significantly.

Figure 1.  

Total antioxidant capacity of plasma of mice consuming red wines, ethanol or water for 8 wk with and without lipopolysaccharide (LPS) stimulation. Values represent the means ± SD, n = 4 in the group without treatment and n = 6 in the lipopolysaccharide-stimulated group. Bars with different letters are significantly different at P < 0.05. Source: Percival SS, Sims CA. Wine modifies the effects of alcohol on immune cells of mice. J.Nutr. 2000;130:1091-1094.

T lymphocytes are a type of white blood cell important to immunity and host protection. During an immune response, T cells migrate out of the blood into the lymph system. As shown in Figure 2, baseline levels of T cells in the animals that consumed ethanol were lower than the control animals or in either of the wine-drinking animals. When stimulated with LPS, the T cell levels stayed the same in the ethanol-drinking group compared to before LPS, suggesting that the cells did not migrate out as expected. Thus, ethanol had a detrimental effect on this aspect of immunity. Our results clearly show that when the same amount of ethanol is consumed in the form of wine, the immune system responded appropriately.

Figure 2.  

T Lymphocytes as a percentage of total leukocytes in mice consuming red wines, ethanol, or water for 8 wk with and without lipopolysaccharide (LPS) stimulation. Values represent the means ± SD, = 4 in the group without treatment and n = 6 in the LPSstimulated group. Bars having different letters are significantly different at P < 0.05. Source: Percival SS, Sims CA. Wine modifies the effects of alcohol on immune cells of mice. J.Nutr. 2000;130:1091-1094.

Natural killer (NK) cells are a type of lethal lymphocyte that combat tumor cells and infected cells in the body. Similar to T cells, the number of NK cells present in the blood was lower in the ethanol-consuming animals compared to the animals that consumed the same amount of ethanol in the form of wine and the animals that consumed water (Figure 3).

Figure 3.  

Natural killer cells as a percentage of total lymphocytes in mice consuming red wines, ethanol, or water for 8 wk with and without lipopolysaccharide (LPS) stimulation. Values represent the means ± SD, n = 4 in the group without treatment and n = 6 in the LPSstimulated group. Bars having different letters are significantly different at P < 0.05.. Source: Percival SS, Sims CA. Wine modifies the effects of alcohol on immune cells of mice. J.Nutr. 2000;130:1091-1094.

The normal response to LPS is an increased appearance of NK in the blood. Consumption of muscadine wine resulted in a significant increase in number of NK cells in the blood compared to the control and the cabernet-consuming animals. While muscadine grapes have a unique phenolic profile compared to the cabernet, the component that is responsible for the higher proportion of NK cells after LPS stimulation is still unknown.

Finally, specific alcohol detoxification enzymes in liver were measured (data not shown). Changes occurred in the levels of Phase 1 and Phase 2 enzymes that were interpreted as protective. Muscadine wine differed from the Cabernet, which was interpreted as more protective. From this study, we concluded that red wine contains compounds that offset the detrimental effects of ethanol. Wine consumption increased antioxidant activity in the blood and did not result in lower T lymphocytes and NK cells in the blood.

This research is further discussed on these websites, as well as others.

http://www.banchanida.com/redwine/016.html

http://news.ufl.edu/1999/08/05/red-wine/

http://www.seniorworld.com/articles/a19991028110521.html

More information on Muscadine grapes can be found at

http://www.ars.usda.gov/is/AR/archive/nov97/musc1197.htm

http://edis.ifas.ufl.edu/MG215

References

1. Auw J, Blanco V, O'Keefe S, Sims CA. Effect of processing on the phenolics and color of Cabernet Sauvignon, Chambourcin, and Noble wines and juices. Am.J.Enol.Vitic. 1996;47:279-286.
2. Percival SS, Sims CA. Wine modifies the effects of alcohol on immune cells of mice. J.Nutr. 2000;130:1091-1094.
3. Talcott, S.T. and Lee, J-H. Ellagic acid and flavonoid antioxidant content of muscadine wine and juice J. Agric. Food Chem. 2002, 50: 3186-3192.

Footnotes

1. 

This document is FSHN02-4, one of a series of the Food Science and Human Nutrition Department, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication: September 2002. Reviewed May 2011.

2. 

S.S. Percival, Ph.D., professor; C.A. Sims, Ph.D., professor; and S.T. Talcott, Ph.D., assistant professor, all of the Food Science and Human Nutrition Department, Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611-0370. title, Food Science and Human Nutrition Department, Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611-0370.

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