Michael Carlston, M.D. - Family Practice & Complementary Medicine

Carlston, M.D.
Family Practice and Complementary Medicine

www.carlstonmd.com

September 21, 2007

Dear Patients,

Although it has been a while since I last wrote to you, I have been writing a lot. Last time I promised an announcement. That announcement is that I have begun writing a blog for a company called Veria. It is a very good group of people with far-ranging plans, including a website and a health-oriented television network. We have been negotiating for a couple of years and now it is in motion. The site is not fully functional yet but you can check it out at www.veria.com. My blog is at http://www.veria.com

The blog may be especially useful at first to anyone who wants to catch up on my ongoing commentary on vitamin D as it was clear that I needed to review some of the ietms I had written to you before. I also recently wrote a lengthy piece on cholesterol summarizing some of the controversies. Let me know what you think of it.

In this newsletter:

Attending to A Deficit of Attention
Cruciferous Veggies and Prostate Cancer
Exercise, Body Composition and Weight loss
Vitamin D and Death

Best
Michael Carlston, MD

Attending to A Deficit of Attention
Reading the latest media nutrition splash, I can’t help but sigh and shake my head. In the 1970’s there were few of us in medicine who believed that dietary change had much to offer food-rich Americans. Rarer still was the conviction that additives in our foods were hurting us. The most obvious proof of our ignorance was our foolish belief that food additives could cause some children to be hyperactive and easily distracted. How gratifying then to see one of the most highly regarded medical journals in the world (LANCET) publishing research strongly linking a number of food additives to hyperactivity and distractibility in children.

This six week study of nearly 300 children (aged 3, 8 and 9) was funded by Britain’s Food Standards Agency. The children were randomly divided into two groups. One group were given drinks containing common artificial food colorings and the most wide spread artificial preservative, sodium benzoate. The other group received drinks that looked the same, but did not contain the artificial colors or preservative. The amount the children received each day was equivalent to one to two pieces of candy, and chemically similar to popular soft drinks. The behavioral effects of this intervention were assessed by the children’s parents, teachers and a computer exercise.

The children drinking the artificial color/preservative drink developed typical symptoms of Attention Deficit Hyperactivity Disorder (ADHD). They were unable to focus on tasks or even play with a single object for more than 15 minutes. They became loud and impulsive. The effects were apparent in less than an hour in some children. All children were affected, whether or not they had a history of ADHD. There was no difference in effect between the three year olds and the older children.

Now that we have this evidence, shouldn’t schools be prohibited from selling food containing these additives? After all, the goal of schools is to educate. Why then, should educational institutions sell items known to prevent achievement of their primary task?

Although it is nice to finally have this proof, one can not help but consider the fate of the generation of children with ADHD who grew to adulthood while medical authorities assured their parents that changing their diet would not be helpful. I love research for the answers it can give us, however a responsible clinician will always have to make recommendations “outside the pale” of research-documented therapies. When we don’t know the answer, acknowledging ignorance is the right thing to do.

Cruciferous Veggies and Prostate Cancer
Prostate cancer is one of the most common forms of cancer suffered by men. While most men with low grade prostate cancers usually die from another cause, aggressive prostate cancer is the second most common cause of cancer death among American males. Eating vegetables appears to markedly reduce the likelihood of developing aggressive prostate cancer.

Researchers at the National Cancer Institute (NCI) reviewed data on nearly 30,000 men who were part of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Over a four year period, 1,388 men developed prostate cancer. Men who ate certain kinds of vegetables where much less likely to develop aggressive prostate cancer.

They did not need to eat much to achieve this difference. Men who ate cruciferous vegetables (cauliflower, broccoli, cabbage, Brussels Sprouts, kale, turnips, water cress) or spinach twice a week cut their risk in half, compared to men who ate these vegetables once a month.

Exercise, Body Composition and Weight loss
Recent studies continue to help us refine our knowledge of weight loss and exercise. One landmark was the study a year or two ago finding that middle-aged women lost weight from 1 hour of weight lifting three times a week, but not from aerobic exercise 45 minutes 5-6 days a week. Two small recent studies touch on some of the same issues.

First was a Danish study of three groups of men aged 20 – 40. These untrained men were randomized to playing soccer two to three times a week for an hour, jogging for the same period or inactivity. Both exercise groups lost fat (joggers 4.4 lbs, soccer players 7.7 lbs). The soccer players also gained 4.4 lbs of muscle. The joggers did not gain muscle mass. Both groups demonstrated improved insulin sensitivity, balance and blood pressure.

We know that increased muscle mass is important to healthy body composition and prevents injury, speeds metabolism and so prevents weight gain. Certainly anyone who consistently runs very long distances will be thin. However, few people will do that for the hours it takes. The variability and explosiveness of soccer are similar to weight lifting, and appear to have some similar physiologic effects.

The other study was a Japanese investigation of exercise pattern and fat metabolism published by the American Physiological Society.

Young male subjects (average age 25) were tested under three different conditions –
A) exercising for 60 minutes followed by a 60 minute rest period
B) exercising for 30 minutes followed by 20 minutes rest, then 30 more minutes of exercise and finally 60 minutes rest
C) a control test of 60 minutes rest

They used an exercise bike at 60% of each subjects maximum oxygen uptake for the study. The interrupted exercise protocol caused a significantly increased amount of fat burning to fuel the subjects’ exercise.

This may be difficult for many of us to apply as we are often trying to squeeze exercise into a narrow time frame. On the other hand, it may be that those “lazy” people chatting with friends at the gym are actually disciplining themselves to a fat-burning optimized exercise/rest/exercise cycle.

Vitamin D and Death
Anytime someone does a study, one of the most important decisions is how to measure the effect. Often that is some blood test, which has been linked to a disease: cholesterol, for example. This is always a problem, because changing that test (that disease marker) may not in reality change the risk of the disease. Many years ago we found that fluoride increased bone density, but we also learned that those fluoride-thickened bones broke more easily. Ooops! Death is, of course, the ultimate end point.

Days ago, a study was published in the ARCHIVES OF INTERNAL MEDICINE, looking at the effects of vitamin D on that ultimate outcome. They pooled data from 18 published investigations of vitamin D for a variety of conditions. These studies included over 57,000 subjects, and could be combined because each study included data on death rates. Most of the subjects were healthy and middle aged or older.

Investigators learned that subjects who took a vitamin D supplement (usually 400-800, mean was 528 iu/day) had a death rate 7% lower than those who did not take a vitamin D supplement.

This was a very simple study with equally simple and obvious conclusions. We don’t get enough vitamin D to be healthy.

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September 21, 2007

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