There have been some interesting studies published recently.

You can tell from the list below that they are pretty diverse as well.

Before that though, I'd like to say thanks to Community Market.

A representative of Community Market in Santa Rosa dropped by the office to give us some discount coupons for patients. The coupons are worth $5 off a purchase of $25 or more and are good until the end of March. If you want one stop by (but do call first to be certain we have some left).

Best, Michael Carlston, M.D.
www.carlstonmd.com

The most highly regarded drug class in conventional medicine these days, to a faddish extent perhaps, are the statins. They reduce cholesterol and, maybe more importantly, reduce inflammation.  Both of these effects reduce the risk of heart attack and stroke. Of course diet and exercise do the same so how about a comparison?  That is what researchers did and they found that aggressively pursuing a heart healthy diet rich in plant estrogens did as much to lower cholesterol and C reactive protein as did taking statins in a side by side study.

This intervention did not include exercise so it appears that diet + exercise, two interventions with lots of additional positive "side effects", do more to reduce cardiovascular disease risk than a class of medication whose "side effects" are liver and muscle damage.  This certainly does not mean that there is never a place for using the statins or other meds, just that it is vitally important to implement the more fundamental measures first.

I am a member of the American College of Sports Medicine. That organization and another with which I have had a myriad of ties over the decades (the American Academy of Family Physicians) are campaigning to get Americans exercising or at least moving by promoting the idea of 10,000 steps a day. Using a pedometer people can determine how much they are moving and work to get their activity at or above this healthy threshold. When I've used a pedometer I found that 10,000 steps was roughly what it took me to run 6 miles. I also learned that the days I did not exercise, I'd cover 4 - 6,000 steps. Now, remember the 10,000 steps number.

Some of the smartest researchers study populations with traditional (i.e. long standing) human behaviors which have become rare, to sort out the health effects of the change. A group of researchers recently surveyed adults in an Old Order Amish community in Canada regarding their physical activity and diet patterns. The Old Order Amish work almost entirely as farmers or homemakers. They limit themselves to 19th century technology so everything they do requires much more effort than our travails hunting for the right remote control.

The men averaged well over 18,000 steps a day. 10 hours of their weekly physical activity was at the vigorous (i.e. short of breath) level. One man recorded over 51,000 steps IN ONE DAY while he was walking behind his horses plowing a field. Women were less active but still averaged over 14,000 steps daily. Compared to a study of over 2,000 people living in 12 industrialized countries, the Amish had an activity level 6 six times higher. Remember, the Amish don't need to go to health clubs to achieve this level of activity. However, your situation is different. Every time you chose to flick a light switch instead of going out to chop wood and build a fire you need to make up for your "exercise debt".

It is also interesting that the Amish are rarely obese (4% them, 31% us) and are much less likely to be overweight (26% them, 65% us). To be fair, this assessment of overweight is probably an overestimate because it does not account for the increased relative muscle mass among the Amish, resulting from their physical lifestyle.

I hate to rub in it but researchers also noted that the Amish diet is typically high in calories, fat and refined sugar. Until an Old Amish touts a diet book on Oprah, you will not see anyone advocating this sort of diet for weight loss.

University of Illinois researchers added another study on intellectual functioning to the massive body of literature supporting the beneficial effects of exercise.  They found their 58-78 year old subjects who exercised aerobically improved their ability to concentrate.  This group walked three times a week for 45 minutes, initially raising their heart rates to 50% of maximal heart rate. As the study progressed, the subjects increased the intensity of the aerobic exercise raising their heart rates to 75% of maximum.  The comparison group worked on stretching and muscle toning.

Previous studies of younger, athletic populations have found that the longer subjects exercised the better they made challenging decisions immediately after the exercise.  Other studies have shown improved examination performance with exercise.  I have always found that the my best solutions for difficult problems come to me while running and I often plan lectures or other projects while running for this reason.  Fortunately exercise also seems to help memory because it is most inconvenient to carry a pen and paper while running.

Two recent studies disclose a link between low blood pressure and Alzheimer disease.  One of the studies is a very powerful one because it was prospective.  A prospective study follows a group watching for the appearance of a certain change.  These studies are much more reliable because sick people looking backwards in time tend to dwell on the behaviors that might have created their problem.

The prospective study followed 406 people (aged 75 - 85) for 7 years.  The rate of Alzheimer's was doubled in those subjects whose diastolic (the lower number) blood pressure was 70 or less compared to those with normal (71 - 89) diastolic blood pressure.  The blood pressure readings were recorded for each patient at the beginning of the study. Interestingly, those subjects with moderate systolic hypertension (140 - 179) were 50% LESS likely to develop Alzheimer's than those with normal blood pressure.  Patients whose blood pressure was 180 or above had a risk of Alzheimer's equal to that of those with normal blood pressure.

Is there a causal link?  There may well be however the causal link might be reversed from what you might assume. Alzheimer's and other forms of dementia influence the functioning of the most primal levels of the brain.  Blood pressure is, in part regulated by those areas.  Therefore, low blood pressure could be an early symptom of Alzheimer's.

No matter, it is clear that it is unwise for physicians to lower blood pressure too far.  Another example of the adverse consequences of overmedication.

Possibly the most distressing health news this week for me was the word from the Union of Concerned Scientists (UCS) study which found transgenic contamination in 50% of samples of conventional corn and soy seed stock.  Two different laboratories conducted the tests to ensure accuracy.

There have been some high profile "near misses".  One of those was the 2002 episode when a variety of corn was genetically engineered so that it would produce a vaccine for pigs.  The corn was spread too widely in some Midwestern states and, that time, an emergency intervention by the US Department of Agriculture (apparently) prevented the spread to crops for human consumption.  "Apparently" is a key word here because it would be difficult to identify a new form of human disease related to a genetically engineered pig vaccine and then trace it to the corn chips the victims ate.  

Unfortunately, the UCS study appears to confirm the fears raised by the report from the National Research Council (the research arm of the Institute of Medicine, the National Academy of Sciences and the National Academy of Engineering) last month.  That 219 page report, summarizing nearly three years of deliberations, expressed concern that the government was woefully inadequate in its attempts to regulate this industry and the consequences could be severe.  In a nutshell, the report said that although we have the technology to create unforeseen problems that could wreak havoc, we do not yet possess the capability to confine and safely test the technology.

Despite the misleading article in last year's Wall Street Journal, organically certified foods are rarely contaminated with genetically modified material.  Unfortunately, I can not write "never contaminated" because the simple truth is that you can't wrap a farm field in plastic and pollen hitchhikes by wind, rain, bird and insect from farm to neighboring farm.

So, short of moving to Europe, I guess the best solution is to eat organic, learn about the issue and let the powers that be, in turn, learn of your opinion.

Continuing on the theme of contaminated food supplies -

Prion diseases (Mad Cow for example) come in a variety of forms.  Generally speaking those that arise spontaneously in one species are less contagious to another species than those spontaneously arising in that second species.  "Mad Cow Disease" has gotten a great deal of attention and generated considerable fear because it is a lethal prion disease which can be spread to humans by eating a variety of cow body parts.  In recent decades, we learned that humans develop certain degenerative neurologic diseases, which have now been shown to be caused by prions.  It had been thought that the principle form of these diseases arose by a spontaneous, mutation-like accident occurring in affected individuals.   It was called sporadic CJD (Creutzfeld Jacob Disease).

As a part of the routine testing for prion disease in all European cows, Italian authorities working with Stanley Prusiner of UCSF recently discovered two seemingly healthy cows infected with sporadic CJD.  Sporadic CJD has been though to ONLY be a human disease.  This raises a feed lot full of questions.  Did the cows get it from humans?  Can sporadic CJD, like "Mad Cow" also be caused by human consumption of cow tissues?  Do cows carry sporadic CJD without getting sick and so not raising our concern?

Stay tuned.

Most of my patients recognize that it is a good idea to avoid using medication wherever possible.  This principle is true even when we don't know exactly why.  In other words, it is a sound general principle that medications are powerful and so probably dangerous in one way or another.  It is great to have them as an option but smart to save them for the times they are REALLY necessary.

An example of the importance of this skeptical attitude may be the news about a link between antibiotic use and breast cancer. Breast cancer is unfortunately very common as is antibiotic use.  No one had ever conducted a study to see if there was any connection between them.

A very large study (10,000 women) was conducted by investigating the health care records of women enrolled in a large HMO in the Seattle area.  They compared information on women who developed breast cancer with those who did not.  Surprisingly, researchers found that the more antibiotics a woman used, the greater the likelihood she would develop breast cancer.  Women who had more than 25 antibiotic prescriptions doubled their risk for breast cancer. These findings are in agreement with an earlier Finnish study of 2,000 women with urinary tract infections treated with antibiotics, who subsequently had a higher incidence of breast cancer.

This study does not prove that antibiotics cause breast cancer.  That is possible however it could mean that women who are prone to developing infections are also prone to developing breast cancer or that some other associated factor might be at fault.  If the antibiotic use is simply an indication that repeated infections increase risk for breast cancer, the study shows that taking antibiotics is probably unlikely to help reduce the risk.  It might actually increase it.