Research
Guest post: Blueberry season
14/Oct/12 12:27 PM
Guest post by Jacob Schor, ND, FABNO
The recent publication of Riso et al’s results in the June issue of the European Journal of Nutrition has left me ruminating on the impact geography plays into our choice of “medicinal foods.”
This study measured the impact of blueberries on a series of biomarkers of oxidative stress. It was a textbook perfect randomized placebo controlled trial with crossover. Eighteen middleaged males (mean age 48 years) drank a smoothie made from freeze-dried wild blueberry powder twice a day for 6 weeks. The drink contained 375 mg of blueberry anthocyanins, equal to about a cup of blueberries. While a long list of biomarkers were evaluated in the participants blood, most did not change significantly. There were two significant changes. Drinking wild blueberry smoothies significantly reduced the levels of endogenously oxidized DNA bases (from 12.5 to 9.6 p ≤ 0.01) and the levels of H(2)O(2)-induced DNA damage (from 45.8 to 37.2 p ≤ 0.01). No effect was found after the placebo drink.
This is interesting to some people. It adds additional weight to the evidence that blueberries are exceptionally healthy foods to eat. We knew this already.
What I’m finding interesting is where this research was done. The lead author, Patrizia Riso and colleagues are from the Department of Food, Environmental and Nutritional Sciences, Università degli Studi di Milano, in Milan, Italy. [1]
Pardon me if I sound politically incorrect, but what are Italians doing studying wild blueberries?
Blueberries are native to North America. Italy has a grand total of only 680 acres of blueberries planted as of 2010.
So what’s going on? It appears that blueberries are suddenly a desirable commodity worldwide. From 2005 to 2010, blueberry the acreage planted in blueberries has increased by 83%. Acreage in North America has increased by 53% and in South America has more than doubled. The western hemisphere, North and South America account for 81% of blueberry acreage. During this period North American acreage has increased by an estimated +53% and South American acreage has more than doubled. As of 2010, North and South America account for 86% of the world’s blueberry acreage producing 491 million and 153 million pounds respectively. The entire Mediterranean and African regions produce a total of only five million pounds. [2]
Perhaps this explains why Riso et al gave their study participants blueberry powder. Fresh blueberries may have been too hard to find. Certainly it would be hard to find real wild blueberries of the sort one collects in mountain meadows in direct competition with hungry bears.
Wondering about these Italian blueberries prompts me to look at the other randomized clinical trials using blueberries.
There is the Wilms’ study published back in August 2007. In that study, 168 volunteers drank a daily glass of blueberry/apple juice for a month. The researchers found that plasma quercetin, ascorbic acid and trolox equivalent antioxidant capacity (TEAC) were all significantly increased. The researchers also reported a 20% protection (P < 0.01) against ex vivo hydrogen peroxide-provoked oxidative DNA damage.
Where was this research done? Maastricht University, The Netherlands. [3]
In 2010 there were just 1,180 acres of blueberries growing in the Netherlands.
An October 2010 paper written by Stull et al and published in Nutrition Journal reported that chemicals in blueberries improve insulin sensitivity in obese, insulin-resistant men and women. In this double-blinded randomized controlled trial, fifteen obese volunteers drank smoothies twice a day, each of which contained 22.5 grams of blueberry “bioactives,” while a control group consumed similar smoothies but without the blueberries. Insulin sensitivity improved more in the blueberry group than in the placebo group. The daily dose of “bioactives” consumed by these study participants contained 668 mg of anthocyanins, and was equivalent to approximately ~2 cups of fresh whole blueberries. These researchers were from Baton Rouge, Louisiana. [4]
The entire state of Louisiana has 466 acres of land planted with commercial blueberries. [5]
An April 2010 study done by researchers from the University of Cincinnati reported that nine older adults who drank a daily serving of wild blueberry juice had significant improvements in cognitive function including paired associate learning and word list recall. They also tended toward a reduction in depressive symptoms. [6] Ohio grows even fewer blueberries than Louisiana, only 378 acres. [7]
A December 2011 published study reported that regular consumption of a blueberry drink improved intestinal flora. After six weeks Bifidobacterium spp. significantly increased. [8] This study was also conducted by Italians. Remember just 680 acres.
A December 2011 paper was written McAnulty et al from Appalachian State University.
This is the research group that specializes in measuring the oxidative impact of strenuous exercise. We’ve written about them in the past. They did the quercetin and bicycle racing studies. In this study they examined the impact of eating 250 gram of blueberries per day for 6 week and then eating a larger dose, 375 grams, an hour before a long hard run (2.5 hours at 72% maximal oxygen consumption). Twenty-five well-trained athletes took part in the study. Compared to a control group who went through the run, the blueberry group had increased natural killer NK counts. Even a single dose of blueberries eaten just before the run, reduces oxidative stress and increases anti-inflammatory cytokines. [9]
North Carolina, finally a state that produces blueberries. They produce almost 12% of the US annual blueberry crop and average about 6,000 acres planted in blueberries each year. [10] Notice that this study used real blueberries.
Given the number and variety of benefits seen in these studies, not to mention the numerous studies done in animals, there seems to be little doubt that blueberries are good for us.
What I find confusing is why the research on blueberries isn’t coming from the state universities in regions known for their blueberries, in particular Maine, Michigan, New Jersey?
This year’s wild blueberry crop in Maine is predicted to be the largest in history. Maine has over 60,000 acres of wild blueberries that are managed for picking. [11,12]
I can’t help but think that scientists fall prey to the same sort of attraction to novelty as the rest of us. Americans now purchase anything that claims to contain Acai berry. Marketers find a willing audience when they sell exotic fruit juices from Hawaii or Thailand, juices that taste horrible but are still consumed for their health benefits. Is it any wonder that the Italians and Dutch are fascinated with blueberries?
References:
- Riso P, Klimis-Zacas D, Del Bo' C, Martini D, Campolo J, Vendrame S, Møller P, Loft S, De Maria R, Porrini M. Effect of a wild blueberry (Vaccinium angustifolium) drink intervention on markers of oxidative stress, inflammation and endothelial function in humans with cardiovascular risk factors. Eur J Nutr. 2012 Jun 26.
- http://www.growingproduce.com/article/26272/2/trends-in-world-blueberry-production
- Wilms LC, Boots AW, de Boer VC, Maas LM, Pachen DM, Gottschalk RW, et al. Impact of multiple genetic polymorphisms on effects of a 4-week blueberry juice intervention on ex vivo induced lymphocytic DNA damage in human volunteers. Carcinogenesis. 2007 Aug;28(8):1800-6.
- Stull AJ, Cash KC, Johnson WD, Champagne CM, Cefalu WT. Bioactives in blueberries improve insulin sensitivity in obese, insulin-resistant men and women. J Nutr. 2010 Oct;140(10):1764-8.
- http://www.lsuagcenter.com/agsummary/narrative
- Krikorian R, Shidler MD, Nash TA, Kalt W, Vinqvist-Tymchuk MR, Shukitt-Hale B, Joseph JA. Blueberry supplementation improves memory in older adults. J Agric Food Chem. 2010 Apr 14;58(7):3996-4000.
- http://www.agriculture.purdue.edu/aganswers/story.asp?storyID=6738
- Vendrame S, Guglielmetti S, Riso P, Arioli S, Klimis-Zacas D, Porrini M. Six-week consumption of a wild blueberry powder drink increases bifidobacteria in the human gut. J Agric Food Chem. 2011 Dec 28;59(24):12815-20.
- McAnulty LS, Nieman DC, Dumke CL, Shooter LA, Henson DA, Utter AC, et al. Effect of blueberry ingestion on natural killer cell counts, oxidative stress, and inflammation prior to and after 2.5 h of running. Appl Physiol Nutr Metab. 2011 Dec;36(6):976-84.
- North Carolina, finally a state that produces blueberries. They produce almost 12 % of the US annual blueberry crop.
- http://bangordailynews.com/2012/07/29/business/maine-blueberries-producing-biggest-crop-in-a-decade/
- http://umaine.edu/blueberries/
Comments
Confused about food sensitivity testing?
27/Mar/12 06:08 PM
by Kate Whimster, BCom, MIFHI, ND
This subject is covered in a past post What's the difference between food sensitivity, allergy, or intolerance?, but given the recent media attention on food sensitivity testing I wanted to provide a pro/con (in this case beginning with the “con” side) summary for anyone who might have questions. Then I’ll explain how I look at food sensitivities in my practice.
Question: Is there value to food sensitivity testing?
Con:
There has been a lot of media coverage in response to an article (unfortunately you need to be CMAJ member for full access) by Dr. Elana Lavine in the Canadian Medical Association Journal criticizing food sensitivity testing.
Pro:
There are several counter-arguments to be made to Dr. Lavine’s assertions:
Contrary to what Dr. Lavine asserts, there is research evidence for the use of food sensitivity testing:
Here is a good, succinct rebuttal from Dr. Elaine Chin and here is a press release from the Ontario Association of Naturopathic Doctors.
My thoughts:
In my practice, food sensitivity testing is not my first choice for treatment, but I have used it in certain circumstances. Here are some key points I consider:
This subject is covered in a past post What's the difference between food sensitivity, allergy, or intolerance?, but given the recent media attention on food sensitivity testing I wanted to provide a pro/con (in this case beginning with the “con” side) summary for anyone who might have questions. Then I’ll explain how I look at food sensitivities in my practice.
Question: Is there value to food sensitivity testing?
Con:
There has been a lot of media coverage in response to an article (unfortunately you need to be CMAJ member for full access) by Dr. Elana Lavine in the Canadian Medical Association Journal criticizing food sensitivity testing.
- Here is an article from the Globe and Mail: Tests for food allergies, sensitivities a ‘waste of money,’ doctor says
- And here is a video with a bit of a more balanced perspective from the CBC: Food sensitivity tests
Pro:
There are several counter-arguments to be made to Dr. Lavine’s assertions:
- IgE testing (for food allergy) and IgG testing (for food sensitivities) are different things. For a great comparison, here is a presentation from Rocky Mountain Analytical, one provider of food sensitivity testing. For a good summary, check out the chart on slide 11.
- A skin-prick test, while considered the gold standard “allergy” test, is not a method that tests your response to food in the way you are actually exposed to food. You don’t eat through your skin, you interact with food via your digestive tract. And the response that your body makes to food can be an IgE response (quick, itchy, clear cause and effect) or an IgG response (delayed, vague symptoms, difficult to identify cause).
- Only a medical professional (naturopathic doctor ideally or a medical doctor well-versed in nutrition) can understand how to best administer the test to get the most useful results and use this information for effective treatment.
Contrary to what Dr. Lavine asserts, there is research evidence for the use of food sensitivity testing:
- This article summarizes some research on IgG allergy testing
- Food-specific serum IgG4 and IgE titers to common food antigens in irritable bowel syndrome
- Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial
- Serum IgG responses to food antigens in the italian population evaluated by highly sensitive and specific ELISA test
- Specific humoral response to cows' milk proteins and ovalbumin in children with atopic dermatitis
- Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics
- A critical review of IgG immunoglobulins and food allergy implications in systemic health
- I’m sure there is even more to be found - check out PubMed if you are interested.
Here is a good, succinct rebuttal from Dr. Elaine Chin and here is a press release from the Ontario Association of Naturopathic Doctors.
My thoughts:
In my practice, food sensitivity testing is not my first choice for treatment, but I have used it in certain circumstances. Here are some key points I consider:
- The test measures only one point in time. Human beings, however, are constantly adapting and changing. At the time of testing, results indicate a particular response to foods. But how might these responses change as your immune system is balanced such that it does not react to substances that are not harmful? I see changes in immune response all the time, most commonly when I treat seasonal allergies. I’ve treated patients who have progressed from constant anti-histamine usage (that was still not controlling symptoms) one year to nearly no symptoms and no need for medication the next.
- Nutrition is a major part of my treatment with most patients. My approach to nutrition is that there are no “bad” foods, just foods that work well for you (the patient) and others that don’t fuel your body in the best way to achieve optimal wellness. I look to personalized nutrition to identify what the best nutritional approach will be for each individual.
- There are several health concerns that warrant investigation into food sensitivities, such as: most digestive concerns (IBS, constipation, diarrhea, acid reflux), asthma, migraines, chronic fatigue, fibromyalgia, allergy symptoms, skin issues (eczema, psoriasis, acne), arthritis), failure to thrive, and more. The question is, what is the best way to determine foods that may contribute to these conditions?
- Before testing, I encourage patients to do an elimination diet, which is considered the gold standard for identifying foods that may be contributing to symptoms. This approach is both diagnosis and treatment at once: patients usually experience a significant reduction in symptoms while in the elimination phase (confirming that eliminated foods contribute), they immediately begin to alter habits (perhaps the most challenging aspects of naturopathic treatment), and they gain firsthand experience of how foods affect them during the reintroduction phase.
- However, some patients prefer more objective information via a lab test and find this more motivating for changing habits. Also, some patients may find the elimination diet very challenging and would prefer a more focused elimination diet based on lab results. In either of these cases, it is important to use the test results as a guide and symptoms as feedback to determine if the treatment approach is effective.
- In the case of gluten sensitivity, I also find lab results more motivating for patients, since 100% avoidance of gluten can be challenging and having “hard data” as well as other lab results to monitor (one example would be anti-thyroid antibodies) can help ensure higher compliance and therefore improved outcomes.
Achieve your goals with a vision board
26/Dec/11 09:57 AM
by Kate Whimster, BCom, MIFHI, ND
If you’ve read/watched The Secret or maybe other books about the power of attraction or intention, you’ve probably heard of a vision board. A vision board is simply a visual representation of your goals. It’s a tool to imagine what it is like to have what you seek and it can be a lot of fun to make! This time of year is when most people make New Year’s resolutions... How about this year, instead of making resolutions that you likely won’t keep, you instead set goals and make a vision board to help you manifest those goals? Here are 5 easy steps to making your vision board:
Step 1: Set goals
This is the most important step! If you don’t know what your goals are, how will you ever achieve them? You should probably spend the most time on this step because it shapes all the following steps. Your goals can relate to anything: career, relationships, health, finances, travel, investments, whatever. You might consider a different vision board for each if that suits you better.
Have you ever heard of that Harvard study on goal setting? Interviewers asked Harvard MBA students whether they had clear, written goals for their future and made plans to accomplish them. 84% had no goals, 13% had goals but they were not written, and 3% had clear, written goals and plans to accomplish them. 10 years later, the 13% with goals were earning, on average, twice as much as the 84% without goals. However, the 3% with clear, written goals were earning, on average, 10 times as much as the other 97%! This information is prolific in the business community as evidence of the power of committing your goals to paper. Unfortunately, this story has been debunked by Fast Company and several others!
However, that doesn’t mean that setting clear, written goals isn’t effective! There is actual research in this area, most notably this study by Gail Matthews. She found that those with written goals accomplished significantly more, those who shared their commitments publicly accomplished significantly more, and those who held themselves accountable accomplished significantly more.
This is all to say: goals are important, but so is DOING SOMETHING with those goals. A vision board is a key part of making your goals into something productive.
Step 2: Visualize and feel
This step is the most fun! All you need to do here is use your imagination! Remember that thing you used to use a lot as a kid when you played dress-up or make-believe? Time to pull it out of the dusty corner and get it working for you again.
Take some time AWAY from the computer, phone, office, kids, spouse, desk, etc to sit quietly and think about what it would be like to achieve your goals. What would your life look like if you got everything you wanted? How would you feel?
Write down some simple notes or even draw if that works better. You want to have some guiding ideas of what you need to put on your vision board that will show you what your goals look like and that will inspire you to feel the feeling of accomplishing your goals.
Step 3: Collect images and words
Now that you know what accomplishing your goals looks like and feels like, you need to find visuals that match. This step is also lots of fun because you get to be creative! When was the last time you did something creative? This step is like window-shopping for all the things you want in life.
Look in magazines for photos you like or even search online. Google Images is a great resource - simply type in what you want, like “cute puppy” and look through the images you get back for one that resonates with you. You can also use the web in other ways. Do you want a great car? Go to the manufacturer’s site and often you can design the car you want with all the features you want and print out the photo! Want a fantastic house? Go on MLS and search for the right house for you and print the listing! This also works for less material things, like a happy marriage and fulfilling family life. Look for photos of happy couples and smiling children. You can also use your own photos of yourself and others as long as they represent how you want to feel and what you want.
If you like to paint or draw, why not create your own images exactly the way you want? Why not use other things you love, like colours, textures, symbols, patterns, ribbons, paper, and great quotes or phrases?
I’ll give you a couple of examples of what I put on my vision board:
Your vision board can be made out of anything you want. First, you need something to put all your images and words on and this will determine what other supplies you need. Here are a few ideas:
Step 5: Create! And place.
Now that you have all you need, create your vision board! Arrange your images and words any way you like. Again, this is your chance to be creative in way you may not have been since primary school!
Place you vision board in a prominent place where you can look at it often, such as your office or bedroom. Use your vision board as a reminder of how your goals look and feel. Whenever you see it, take a moment to experience the feeling of realizing your goals. You can also use your vision board as a reminder to meditate on your goals.
If you’ve read/watched The Secret or maybe other books about the power of attraction or intention, you’ve probably heard of a vision board. A vision board is simply a visual representation of your goals. It’s a tool to imagine what it is like to have what you seek and it can be a lot of fun to make! This time of year is when most people make New Year’s resolutions... How about this year, instead of making resolutions that you likely won’t keep, you instead set goals and make a vision board to help you manifest those goals? Here are 5 easy steps to making your vision board:
- Set goals
- Visualize and feel
- Collect images/words
- Collect supplies
- Create and place
Step 1: Set goals
This is the most important step! If you don’t know what your goals are, how will you ever achieve them? You should probably spend the most time on this step because it shapes all the following steps. Your goals can relate to anything: career, relationships, health, finances, travel, investments, whatever. You might consider a different vision board for each if that suits you better.
Have you ever heard of that Harvard study on goal setting? Interviewers asked Harvard MBA students whether they had clear, written goals for their future and made plans to accomplish them. 84% had no goals, 13% had goals but they were not written, and 3% had clear, written goals and plans to accomplish them. 10 years later, the 13% with goals were earning, on average, twice as much as the 84% without goals. However, the 3% with clear, written goals were earning, on average, 10 times as much as the other 97%! This information is prolific in the business community as evidence of the power of committing your goals to paper. Unfortunately, this story has been debunked by Fast Company and several others!
However, that doesn’t mean that setting clear, written goals isn’t effective! There is actual research in this area, most notably this study by Gail Matthews. She found that those with written goals accomplished significantly more, those who shared their commitments publicly accomplished significantly more, and those who held themselves accountable accomplished significantly more.
This is all to say: goals are important, but so is DOING SOMETHING with those goals. A vision board is a key part of making your goals into something productive.
Step 2: Visualize and feel
This step is the most fun! All you need to do here is use your imagination! Remember that thing you used to use a lot as a kid when you played dress-up or make-believe? Time to pull it out of the dusty corner and get it working for you again.
Take some time AWAY from the computer, phone, office, kids, spouse, desk, etc to sit quietly and think about what it would be like to achieve your goals. What would your life look like if you got everything you wanted? How would you feel?
Write down some simple notes or even draw if that works better. You want to have some guiding ideas of what you need to put on your vision board that will show you what your goals look like and that will inspire you to feel the feeling of accomplishing your goals.
Step 3: Collect images and words
Now that you know what accomplishing your goals looks like and feels like, you need to find visuals that match. This step is also lots of fun because you get to be creative! When was the last time you did something creative? This step is like window-shopping for all the things you want in life.
Look in magazines for photos you like or even search online. Google Images is a great resource - simply type in what you want, like “cute puppy” and look through the images you get back for one that resonates with you. You can also use the web in other ways. Do you want a great car? Go to the manufacturer’s site and often you can design the car you want with all the features you want and print out the photo! Want a fantastic house? Go on MLS and search for the right house for you and print the listing! This also works for less material things, like a happy marriage and fulfilling family life. Look for photos of happy couples and smiling children. You can also use your own photos of yourself and others as long as they represent how you want to feel and what you want.
If you like to paint or draw, why not create your own images exactly the way you want? Why not use other things you love, like colours, textures, symbols, patterns, ribbons, paper, and great quotes or phrases?
I’ll give you a couple of examples of what I put on my vision board:
- I want to build my naturopathic practice and see more patients, so I made up an ideal weekly schedule in my calendar in which I put in how many new patient visits I want in a week and how many follow-up visits I want. I also put in there time to exercise, time for social events, and time off. Then I printed my schedule and put it on my vision board. When I made my vision board I was not that busy. The next month was my slowest month in practice ever, but then over the next 3 months I got busier and busier and now my weekly schedule looks like what is on my vision board!
- I went on MLS and searched for houses that fit certain criteria I want (number of bedrooms, neighbourhood, etc), but price was not a factor. I found a house I really liked and printed the listing and put it on my vision board. This house happens to be quite close to where I currently live, so it would be even better for me to go over there and take a look in person!
Your vision board can be made out of anything you want. First, you need something to put all your images and words on and this will determine what other supplies you need. Here are a few ideas:
- Corkboard and pins
- Posterboard and glue/tape
- Wall in your home and some way to stick things up (like sticky tack)
- Magnet board and magnets (this is what I used)
- Large picture frame, piece of cardboard to go in it, and glue/tape
- Fridge and magnets (this is great for kids to play with!)
Step 5: Create! And place.
Now that you have all you need, create your vision board! Arrange your images and words any way you like. Again, this is your chance to be creative in way you may not have been since primary school!
Place you vision board in a prominent place where you can look at it often, such as your office or bedroom. Use your vision board as a reminder of how your goals look and feel. Whenever you see it, take a moment to experience the feeling of realizing your goals. You can also use your vision board as a reminder to meditate on your goals.
Gluten sensitivity, part 1: definitions, prevalence, presentation
23/Apr/11 01:26 PM
by Kate Whimster, BCom, MIFHI, ND
What do osteoporosis, anemia, hypothyroidism, irritability, diarrhea, and constipation have in common? They are all signs and symptoms of gluten sensitivity. I’ve been meaning to write about this topic since I attended a seminar on gluten sensitivity in October 2009! A recent article in the Wall Street Journal called “Clues to Gluten Sensitivity” has helped me get in gear to cover this enormous topic. This is part 1 of a multi-part series of blogs I plan to write. Stay tuned for more!
What is gluten sensitivity?
As mentioned in the article linked above, it is important to understand the difference between celiac disease and gluten sensitivity. “Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.(1)” “Gluten sensitivity (GS) encompasses a collection of medical conditions in which gluten has an adverse effect.(2)” These medical conditions can be related to damage to the small intestine or may present in other ways.
Which foods contain gluten?
Gluten-containing foods:
Oats should technically be safe to eat on a gluten-free diet but most commercial oats are contaminated with gluten as they are farmed, transported, and packaged. You can buy gluten-free oats, such as Bob’s Red Mill Gluten-Free Oats. A small number of gluten sensitive people may also be sensitive to oats, so it is important to assess this for each patient individually.
Prevalence
This information is specific to celiac disease (see definition above), but still gives a good idea of the prevalence and importance of diagnosis.
Prevalence of celiac disease (3):
Those diagnosed with celiac disease between 2-4 years of age had a 10.5% chance of developing an autoimmune disorder. Additional findings show that the later one is diagnosed, the more likely her or she is to develop and autoimmune condition (5):
Age at diagnosis and chance of developing an autoimmune condition:
4-12 yrs: 16.7%
12-20 yrs: 27%
Over 20 yrs: 34%
As is now becoming clear, patients may have “silent” or atypical form that presents with no gastrointestinal symptoms. (6)
(7)
Signs and symptoms
Signs and symptoms of celiac disease (1):
Signs and symptoms of “silent” celiac disease (8):
Children:
References:
What do osteoporosis, anemia, hypothyroidism, irritability, diarrhea, and constipation have in common? They are all signs and symptoms of gluten sensitivity. I’ve been meaning to write about this topic since I attended a seminar on gluten sensitivity in October 2009! A recent article in the Wall Street Journal called “Clues to Gluten Sensitivity” has helped me get in gear to cover this enormous topic. This is part 1 of a multi-part series of blogs I plan to write. Stay tuned for more!
What is gluten sensitivity?
As mentioned in the article linked above, it is important to understand the difference between celiac disease and gluten sensitivity. “Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.(1)” “Gluten sensitivity (GS) encompasses a collection of medical conditions in which gluten has an adverse effect.(2)” These medical conditions can be related to damage to the small intestine or may present in other ways.
Which foods contain gluten?
Gluten-containing foods:
- Wheat (all forms, including durum, semolina, spelt, kamut, couscous, bulgar, etc)
- Rye
- Barley
Oats should technically be safe to eat on a gluten-free diet but most commercial oats are contaminated with gluten as they are farmed, transported, and packaged. You can buy gluten-free oats, such as Bob’s Red Mill Gluten-Free Oats. A small number of gluten sensitive people may also be sensitive to oats, so it is important to assess this for each patient individually.
Prevalence
This information is specific to celiac disease (see definition above), but still gives a good idea of the prevalence and importance of diagnosis.
Prevalence of celiac disease (3):
- In average healthy people: 1 in 133
- In people with related symptoms: 1 in 56
- In people with first-degree relatives (parent, child, sibling) who are celiac: 1 in 22
- In people with second-degree relatives (aunt, uncle, cousin) who are celiac: 1 in 39
- 60% of children and 41% of adults diagnosed during the study were asymptomatic (without any symptoms).
Those diagnosed with celiac disease between 2-4 years of age had a 10.5% chance of developing an autoimmune disorder. Additional findings show that the later one is diagnosed, the more likely her or she is to develop and autoimmune condition (5):
Age at diagnosis and chance of developing an autoimmune condition:
4-12 yrs: 16.7%
12-20 yrs: 27%
Over 20 yrs: 34%
As is now becoming clear, patients may have “silent” or atypical form that presents with no gastrointestinal symptoms. (6)
(7)Signs and symptoms
Signs and symptoms of celiac disease (1):
- Abdominal pain, bloating, gas, or indigestion
- Constipation
- Decreased appetite (may also be increased or unchanged)
- Diarrhea, either constant or off and on
- Lactose intolerance (common when the person is diagnosed, usually goes away after treatment)
- Nausea and vomiting
- Stools that float, are foul smelling, bloody, or “fatty”
- Unexplained weight loss (although people can be overweight or of normal weight)
Signs and symptoms of “silent” celiac disease (8):
Children:
- Short stature
- Anemia
- Neurologic symptoms
- Dermatitis herpetiformis
- Anemia
- Reduced bone density (osteopenia/osteoporosis)
- Apthous stomatitis, dental enamel defects
- Infertility, recurrent miscarriage
- Irritable bowel syndrome (IBS)
- Dyspepsia
- Esophageal reflux
- Neurologic symptoms
- Autoimmune diseases
References:
- http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001280/
- http://en.wikipedia.org/wiki/Gluten_sensitivity
- Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92.
- Green PHR, Stavropoulos SN, Panagi SG, Goldstein SL, Mcmahon DJ, Absan H, Neugut AI. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol. 2001 Jan;96(1):126-31.
- Ventura A, Magazzù G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Gastroenterology. 1999 Aug;117(2):297-303.
- Sanders DS, Hurlstone DP, McAlindon ME, Hadjivassiliou M, Cross SS, Wild G, Atkins CJ. Antibody negative coeliac disease presenting in elderly people--an easily missed diagnosis. BMJ. 2005 Apr 2;330(7494):775-6.
- Feighery C. Fortnightly review: coeliac disease. BMJ. 1999 Jul 24;319(7204):236-9.
- Green PH, Alaedini A, Sander HW, Brannagan TH 3rd, Latov N, Chin RL. Mechanisms underlying celiac disease and its neurologic manifestations. Cell Mol Life Sci. 2005 Apr;62(7-8):791-9.
Give me fever
28/Feb/11 04:08 PM
by Kate Whimster, BCom, MIFHI, ND
I just read this article called “Lifting a veil of fear to see the benefits of fever” and I had to share it. This is a hot topic (excuse the pun!) among parents and healthcare providers that, despite logic, evidence, and experience, is still widely misunderstood.
Key messages:
The article cites the following research:
“Fever phobia: misconceptions of parents about fevers”
“Fever phobia revisited: have parental misconceptions about fever changed in 20 years?”
I also found a study called “Pediatric emergency department nurses' perspectives on fever in children” which concluded that “fever phobia and inconsistent treatment approaches occur among experienced pediatric emergency registered nurses. These phobias and inconsistencies subsequently could be conveyed to parents.” So it’s not just parents who are confused! Healthcare providers are perpetuating this misconception through ignorance: “‘Doctors are part of the problem,’ Schmitt said. Some of the phobia comes from doctors and nurses, he said, ‘doctors and nurses who weren’t taught about fever and all the wondrous things fever does in the animal kingdom.’”
I think another major reason that parents fear fever so much is that they are far too influenced by the sheer number and force of advertisements for medication to suppress fevers in children. I think I see at least one ad daily for children’s Tylenol or Advil these days - all sending a clear message that fever is not OK and you must medicate!
So what is a worried parent to do?
I just read this article called “Lifting a veil of fear to see the benefits of fever” and I had to share it. This is a hot topic (excuse the pun!) among parents and healthcare providers that, despite logic, evidence, and experience, is still widely misunderstood.
Key messages:
- Fever is a signal that the immune system is working. Fever is actually a useful tool of the immune system that helps your body fight infection.
- There is a widely held misconception that fevers are dangerous. “In fact, fever does not harm the brain or the body, though it does increase the need for fluids. Even untreated, fevers rarely rise higher than 104 or 105 degrees.”
- Despite ongoing efforts to educate parents, fever remains a major concern and causes a lot of panic.
The article cites the following research:
“Fever phobia: misconceptions of parents about fevers”
“Fever phobia revisited: have parental misconceptions about fever changed in 20 years?”
I also found a study called “Pediatric emergency department nurses' perspectives on fever in children” which concluded that “fever phobia and inconsistent treatment approaches occur among experienced pediatric emergency registered nurses. These phobias and inconsistencies subsequently could be conveyed to parents.” So it’s not just parents who are confused! Healthcare providers are perpetuating this misconception through ignorance: “‘Doctors are part of the problem,’ Schmitt said. Some of the phobia comes from doctors and nurses, he said, ‘doctors and nurses who weren’t taught about fever and all the wondrous things fever does in the animal kingdom.’”
I think another major reason that parents fear fever so much is that they are far too influenced by the sheer number and force of advertisements for medication to suppress fevers in children. I think I see at least one ad daily for children’s Tylenol or Advil these days - all sending a clear message that fever is not OK and you must medicate!
So what is a worried parent to do?
- Remember that the body is designed to heal itself. Symptoms (including fever) are part of this process, so be careful to support the body rather than suppress.
- Equip yourself to understand and manage illness at home where appropriate. This also means knowing when to seek professional help! A naturopathic doctor is a vital part of learning about your health and can equip you to take responsibility.
- Don’t seek medical advice from advertisements! Go to those who are educated and trained to address your issue, and always think critically about advice you receive.
Sick kids
09/Feb/11 10:08 AM
by Kate Whimster, BCom, MIFHI, ND
Wow, there are so many topics to choose from when writing about kids and health! I have a lot of issues I want to explore, but I’m going to start with a couple of articles about kids and getting sick.
First up, a study called Short- and Long-term Risk of Infections as a Function of Group Child Care Attendance published in the Archives of Pediatrics & Adolescent Medicine found that, as we all know, children start getting more infections when they start spending lots of time around other kids! And, when children start group child care before age 2 and a half, they get more infections at that time, but less infections during elementary school years. Again this makes total sense! Kids are programmed to expose themselves to all kinds of pathogens from a very early age and this is an important part of their “immune education” which is done during those crucial childhood years before puberty and must last a lifetime. So getting sick is not a bad thing at all, as long as parents know how to manage it in a health-promoting way being careful to avoid suppression. A naturopathic doctor is a great resource to learn how to manage common childhood infections.
The second study I want to share is called Antibiotic Exposure by 6 Months and Asthma and Allergy at 6 Years: Findings in a Cohort of 1,401 US Children published in the American Journal of Epidemiology and adds further information to the association between antibiotic use in infancy and the development of childhood asthma. This article called Early Antibiotic Use Can Lead to Increased Risk of Childhood Asthma does a great job of summarizing the findings and explaining the mechanism behind this effect, which may be that antibiotics have a major impact on the beneficial bacteria in the digestive tract, which are an important factor in immune response. When these bacteria are disrupted, the type of immune response mounted is altered, resulting in pathologies such as asthma. Something the article does not mention that is a great tool in preventing, mitigating, and treating this type of issue longer term is the use of probiotics. There is already loads of evidence that probiotics are effective in both the prevention and treatment of asthma and many other childhood illnesses. Perhaps I will explore the topic in more detail in a future blog...
The importance of building a healthy immune system and ensuring appropriate and effective immune response cannot be emphasized enough. Personally, based on the evidence that exists and continues to emerge, we are only just beginning to understand how our choices and medical treatments impact our immune systems in both the long and short term. This idea has implications far beyond asthma; it also ties into allergic, autoimmune diseases, vaccines, and many other issues.
Wow, there are so many topics to choose from when writing about kids and health! I have a lot of issues I want to explore, but I’m going to start with a couple of articles about kids and getting sick.
First up, a study called Short- and Long-term Risk of Infections as a Function of Group Child Care Attendance published in the Archives of Pediatrics & Adolescent Medicine found that, as we all know, children start getting more infections when they start spending lots of time around other kids! And, when children start group child care before age 2 and a half, they get more infections at that time, but less infections during elementary school years. Again this makes total sense! Kids are programmed to expose themselves to all kinds of pathogens from a very early age and this is an important part of their “immune education” which is done during those crucial childhood years before puberty and must last a lifetime. So getting sick is not a bad thing at all, as long as parents know how to manage it in a health-promoting way being careful to avoid suppression. A naturopathic doctor is a great resource to learn how to manage common childhood infections.
The second study I want to share is called Antibiotic Exposure by 6 Months and Asthma and Allergy at 6 Years: Findings in a Cohort of 1,401 US Children published in the American Journal of Epidemiology and adds further information to the association between antibiotic use in infancy and the development of childhood asthma. This article called Early Antibiotic Use Can Lead to Increased Risk of Childhood Asthma does a great job of summarizing the findings and explaining the mechanism behind this effect, which may be that antibiotics have a major impact on the beneficial bacteria in the digestive tract, which are an important factor in immune response. When these bacteria are disrupted, the type of immune response mounted is altered, resulting in pathologies such as asthma. Something the article does not mention that is a great tool in preventing, mitigating, and treating this type of issue longer term is the use of probiotics. There is already loads of evidence that probiotics are effective in both the prevention and treatment of asthma and many other childhood illnesses. Perhaps I will explore the topic in more detail in a future blog...
The importance of building a healthy immune system and ensuring appropriate and effective immune response cannot be emphasized enough. Personally, based on the evidence that exists and continues to emerge, we are only just beginning to understand how our choices and medical treatments impact our immune systems in both the long and short term. This idea has implications far beyond asthma; it also ties into allergic, autoimmune diseases, vaccines, and many other issues.
Taking homeopathy seriously
02/Feb/11 12:55 PM
by Kate Whimster, BCom, MIFHI, ND
The debate over homeopathy rages on! I just read this article in the Huffington Post in which Nobel Prize winner Luc Montagnier (the virologist who discovered the AIDS virus) explains why he supports homeopathy. The article cites a fair bit of research into homeopathy, which makes for a great read if you want to learn more. Thanks Theresa Jahn, ND for sending me the link!
The article makes some great points in favour of homeopathy that I wanted to highlight:
Reading through the comments on this article, I also found a link to this page on frequently asked questions about homeopathy. This is a really detailed Q&A on all the most-asked questions about homeopathy and is a great place to start if you want to learn about this wonderful modality. Enjoy!
The debate over homeopathy rages on! I just read this article in the Huffington Post in which Nobel Prize winner Luc Montagnier (the virologist who discovered the AIDS virus) explains why he supports homeopathy. The article cites a fair bit of research into homeopathy, which makes for a great read if you want to learn more. Thanks Theresa Jahn, ND for sending me the link!
The article makes some great points in favour of homeopathy that I wanted to highlight:
- “Most clinical research conducted on homeopathic medicines that has been published in peer-review journals have shown positive clinical results,(3, 4) especially in the treatment of respiratory allergies (5, 6), influenza, (7) fibromyalgia, (8, 9) rheumatoid arthritis, (10) childhood diarrhea, (11) post-surgical abdominal surgery recovery, (12) attention deficit disorder, (13) and reduction in the side effects of conventional cancer treatments. (14).”
- “In addition to clinical trials, several hundred basic science studies have confirmed the biological activity of homeopathic medicines. One type of basic science trials, called in vitro studies, found 67 experiments (1/3 of them replications) and nearly 3/4 of all replications were positive. (15, 16).”
- Homeopathy “gained widespread popularity in the U.S. and Europe during the 19th century due to the impressive results people experienced in the treatment of epidemics that raged during that time, including cholera, typhoid, yellow fever, scarlet fever, and influenza.”
- “High dilutions of something are not nothing. They are water structures which mimic the original molecules."
Reading through the comments on this article, I also found a link to this page on frequently asked questions about homeopathy. This is a really detailed Q&A on all the most-asked questions about homeopathy and is a great place to start if you want to learn about this wonderful modality. Enjoy!
Homeopathy: cure or con?
14/Jan/11 12:02 PM
by Kate Whimster, BCom, MIFHI, ND
Tonight CBC Marketplace will air a report called Cure or Con? on homeopathy. Even though the report has not aired yet, there are lots of comments! From what I can tell from their preview, I doubt that these journalists have actually investigated homeopathy in-depth and that their “research” is likely a waste of time and money. I look forward to watching it to see what they have done.
I use homeopathy as part of my practice with great results and have written blogs about it on this site. If you are interested in learning more about homeopathy, start with my blog Homeopathy primer. For information about research into homeopathy, check out Homeopathy literature review.
What most people consider research is often only the tip of the iceberg as far as information goes. True “evidence-based medicine” encompasses clinical experience as well! Check out my blog Is evidence-based medicine compatible with naturopathic principles for a more a discussion on this topic and my blog Mythology of science-based medicine for even more insight into medical research.
Tonight CBC Marketplace will air a report called Cure or Con? on homeopathy. Even though the report has not aired yet, there are lots of comments! From what I can tell from their preview, I doubt that these journalists have actually investigated homeopathy in-depth and that their “research” is likely a waste of time and money. I look forward to watching it to see what they have done.
I use homeopathy as part of my practice with great results and have written blogs about it on this site. If you are interested in learning more about homeopathy, start with my blog Homeopathy primer. For information about research into homeopathy, check out Homeopathy literature review.
What most people consider research is often only the tip of the iceberg as far as information goes. True “evidence-based medicine” encompasses clinical experience as well! Check out my blog Is evidence-based medicine compatible with naturopathic principles for a more a discussion on this topic and my blog Mythology of science-based medicine for even more insight into medical research.
The secrets of sleep
28/Jun/10 11:23 AM
Fascinating National Geographic article about sleep. Also, check out my previous blog on Sleep and Metabolic Syndrome.
Homeopathy literature review
18/Feb/10 09:37 AM
by Kate Whimster, BCom, MIFHI, ND
Homeopathy is often criticized for having little research evidence available. This blog is a compilation of what I have learned in examining research evidence for homeopathy published in conventional medical journals. For more info on homeopathy, please see a previous blog entitled “Homeopathy primer.”
One of the major reasons that the results of most mainstream research on homeopathy are often inconclusive because the methods used usually do not honour the principles of homeopathy and therefore the research does not actually evaluate the practice of homeopathy. Aphorism 104 in the Organon explains how a practitioner can take and treat a case homeopathically:
“Once the totality of symptoms that principally determine and distinguish the disease case … has been exactly recorded, the most difficult work is done … He can then select … a well-aimed, similar, artificial disease potence, in the form of a homeopathically chosen medicinal means, to oppose the total disease image (1).”
Unfortunately, remedies are often not prescribed individually and are instead selected based on typical clinical presentation of pathology.
A meta-analysis published by Shang et al. in the Lancet in 2005 compared placebo-controlled homeopathy trials to conventional medicine trials matched by disorder and type and determined that “the clinical effects of homoeopathy, but not those of conventional medicine, are unspecific placebo or context effects (2).” The homeopathy trials were categorized classical, clinical, or complex homoeopathy (or as isopathy). Specifically,
“Classical homoeopathy was defined as comprehensive homoeopathic history-taking, followed by the prescription of a single individualised remedy, possibly with subsequent change of remedy in response to changing symptoms. If no comprehensive homoeopathic history was taken and all patients received a single, identical remedy, interventions were classified as clinical homoeopathy (2).”
Only “classical” homeopathy trials actually reflect the use of remedies according to homeopathic principles as set out in the Organon. “Clinical” homeopathy is the substitution of homeopathic remedies for conventional medicine and therefore not the practice of homeopathy. Of 110 homeopathy trials analyzed, only 18 were categorized as “classical” while 48 “clinical” homeopathy trials were analyzed. The selection of trials for this analysis therefore precluded results that would accurately evaluate the effects of homeopathic treatment.
Rutten and Stolper analyzed post-publication data from the Shang paper and concluded that:
“Re-analysis of Shang's post-publication data did not support the conclusion that homeopathy is a placebo effect. The conclusion that homeopathy is and that conventional is not a placebo effect was not based on comparative analysis and not justified because of heterogeneity and lack of sensitivity analysis. If we confine ourselves to the predefined hypotheses and the part of the analysis that is indeed comparative, the conclusion should be that quality of homeopathic trials is better than of conventional trials, for all trials (p=0.03) as well as for smaller trials (p=0.003) (3).”
A review by Lüdtke and Rutten also came to this conclusion. Their meta-analysis determined that “homeopathy had a significant effect beyond placebo (OR=0.76; 95% CI: 0.59-0.99; p=0.039) (4).” and that, “Shang's negative results were mainly influenced by one single trial (4).” They concluded: “Shang's results and conclusions are less definite than had been presented (4).”
Linde et al. published a review of randomized controlled trials of individualized homeopathy in the Lancet in 1998. In this review, the team clarified that, “in individualized homeopathy the choice of the remedy for treatment is not based on a conventional diagnosis but on the match of the patient’s particular symptoms with the ‘remedy picture (5)’” and also conceded that, “no attempt was made to assess the ‘homeopathic’ quality of the trials. The reviewer’s knowledge and experience homeopathy are insufficient for such judgments (5).” While recognizing their limited comprehension of homeopathy, Linde et al. reviewed 32 studies, providing detailed information about each study’s methodology, including whether remedies were indeed prescribed homeopathically:
“In 20 trials, the choice of the remedy seemed to be unrestricted (approach 1), in 2 trials patients were included only if they matched the remedy picture of one of a preset range of remedies (approach 2), in 7 studies patients were included (without taking into account "homeopathic" aspects) and then the best fitting remedy had to be chosen from a range of predefined remedies was prescribed (approach 3), and in 3 trials only one remedy was applied and patients were entered only if they matched the remedy picture (approach 4) (5).”
Only 19 trials provided “sufficient data for meta-analysis (5),” although not all of these trials were of high methodological quality nor did all of them use individualized therapy. Of 12 trials categorized as “likely to have good methodological quality” or “unlikely to have major flaws,” all except two favoured homeopathy over placebo (5). Of these 12 highest quality trials, seven were individualized, and all except one favoured homeopathy. This review relied on the data from the 19 trials (both individualized and otherwise) and concluded: “while overall the results indicate that individualized homeopathy is superior to placebo, the methodologically better trials have less positive results and confirmatory independent replications are lacking. The evidence from these trials that individualized is clearly more efficacious than placebo is, therefore, not fully convincing (5).”
This review, which recognized individualization of treatment in homeopathy, is a step in the right direction. Conducting useful research on homeopathy within the conventional medical paradigm requires a greater understanding of the system of medicine being investigated in order to truly evaluate the use of homeopathy as a treatment modality.
Finally, a long-term observational study by Witt et al. assessed perceived change in complaint severity and quality of life at baseline, and after 2 and 8 years in 3,709 patients treated with homeopathy. In this study, physicians were free to choose treatment which “usually included the prescription of homeopathic medicines according to homeopathic principles, but also could include the onset, change, or withdrawal of a conventional medicine, referrals to specialists, or admission to a hospital (6).” At eight years, 32.9% of patients were still receiving homeopathic treatment, 29.2% of patients stopped treatment due to perceived major improvements in health, 26.0% stopped treatment because they did not feel homeopathy helped enough, 7.1% of patients stopped treatment for reasons unrelated to efficacy of therapy, and 3.6% stopped treatment without reason (6). The researchers concluded that, “patients who seek homeopathic treatment are likely to improve considerably, although this effect must not be attributed to homeopathic treatment alone. These effects persisted for 8 years (6).”
1. Hahnemann S. Organon of the Medical Art. Palo Alto: Birdcage Books; 1996, p. 141.
2. Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005 Aug 27-Sep 2;366(9487):726-32.
3. Rutten AL, Stolper CF. The 2005 meta-analysis of homeopathy: the importance of post-publication data. Homeopathy. 2008 Oct;97(4):169-77.
4. Lüdtke R, Rutten AL. The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. J Clin Epidemiol. 2008 Dec;61(12):1197-204. Epub 2008 Oct 1. Review.
5. Linde K, Melchart D. Randomized controlled trials of individualized homeopathy: a state-of-the-art review. J Altern Complement Med. 1998 Winter;4(4):371-88. Review.
6. Witt CM, Lüdtke R, Mengler N, Willich SN. How healthy are chronically ill patients after eight years of homeopathic treatment?--Results from a long term observational study. BMC Public Health. 2008 Dec 17;8:413.
Homeopathy is often criticized for having little research evidence available. This blog is a compilation of what I have learned in examining research evidence for homeopathy published in conventional medical journals. For more info on homeopathy, please see a previous blog entitled “Homeopathy primer.”
One of the major reasons that the results of most mainstream research on homeopathy are often inconclusive because the methods used usually do not honour the principles of homeopathy and therefore the research does not actually evaluate the practice of homeopathy. Aphorism 104 in the Organon explains how a practitioner can take and treat a case homeopathically:
“Once the totality of symptoms that principally determine and distinguish the disease case … has been exactly recorded, the most difficult work is done … He can then select … a well-aimed, similar, artificial disease potence, in the form of a homeopathically chosen medicinal means, to oppose the total disease image (1).”
Unfortunately, remedies are often not prescribed individually and are instead selected based on typical clinical presentation of pathology.
A meta-analysis published by Shang et al. in the Lancet in 2005 compared placebo-controlled homeopathy trials to conventional medicine trials matched by disorder and type and determined that “the clinical effects of homoeopathy, but not those of conventional medicine, are unspecific placebo or context effects (2).” The homeopathy trials were categorized classical, clinical, or complex homoeopathy (or as isopathy). Specifically,
“Classical homoeopathy was defined as comprehensive homoeopathic history-taking, followed by the prescription of a single individualised remedy, possibly with subsequent change of remedy in response to changing symptoms. If no comprehensive homoeopathic history was taken and all patients received a single, identical remedy, interventions were classified as clinical homoeopathy (2).”
Only “classical” homeopathy trials actually reflect the use of remedies according to homeopathic principles as set out in the Organon. “Clinical” homeopathy is the substitution of homeopathic remedies for conventional medicine and therefore not the practice of homeopathy. Of 110 homeopathy trials analyzed, only 18 were categorized as “classical” while 48 “clinical” homeopathy trials were analyzed. The selection of trials for this analysis therefore precluded results that would accurately evaluate the effects of homeopathic treatment.
Rutten and Stolper analyzed post-publication data from the Shang paper and concluded that:
“Re-analysis of Shang's post-publication data did not support the conclusion that homeopathy is a placebo effect. The conclusion that homeopathy is and that conventional is not a placebo effect was not based on comparative analysis and not justified because of heterogeneity and lack of sensitivity analysis. If we confine ourselves to the predefined hypotheses and the part of the analysis that is indeed comparative, the conclusion should be that quality of homeopathic trials is better than of conventional trials, for all trials (p=0.03) as well as for smaller trials (p=0.003) (3).”
A review by Lüdtke and Rutten also came to this conclusion. Their meta-analysis determined that “homeopathy had a significant effect beyond placebo (OR=0.76; 95% CI: 0.59-0.99; p=0.039) (4).” and that, “Shang's negative results were mainly influenced by one single trial (4).” They concluded: “Shang's results and conclusions are less definite than had been presented (4).”
Linde et al. published a review of randomized controlled trials of individualized homeopathy in the Lancet in 1998. In this review, the team clarified that, “in individualized homeopathy the choice of the remedy for treatment is not based on a conventional diagnosis but on the match of the patient’s particular symptoms with the ‘remedy picture (5)’” and also conceded that, “no attempt was made to assess the ‘homeopathic’ quality of the trials. The reviewer’s knowledge and experience homeopathy are insufficient for such judgments (5).” While recognizing their limited comprehension of homeopathy, Linde et al. reviewed 32 studies, providing detailed information about each study’s methodology, including whether remedies were indeed prescribed homeopathically:
“In 20 trials, the choice of the remedy seemed to be unrestricted (approach 1), in 2 trials patients were included only if they matched the remedy picture of one of a preset range of remedies (approach 2), in 7 studies patients were included (without taking into account "homeopathic" aspects) and then the best fitting remedy had to be chosen from a range of predefined remedies was prescribed (approach 3), and in 3 trials only one remedy was applied and patients were entered only if they matched the remedy picture (approach 4) (5).”
Only 19 trials provided “sufficient data for meta-analysis (5),” although not all of these trials were of high methodological quality nor did all of them use individualized therapy. Of 12 trials categorized as “likely to have good methodological quality” or “unlikely to have major flaws,” all except two favoured homeopathy over placebo (5). Of these 12 highest quality trials, seven were individualized, and all except one favoured homeopathy. This review relied on the data from the 19 trials (both individualized and otherwise) and concluded: “while overall the results indicate that individualized homeopathy is superior to placebo, the methodologically better trials have less positive results and confirmatory independent replications are lacking. The evidence from these trials that individualized is clearly more efficacious than placebo is, therefore, not fully convincing (5).”
This review, which recognized individualization of treatment in homeopathy, is a step in the right direction. Conducting useful research on homeopathy within the conventional medical paradigm requires a greater understanding of the system of medicine being investigated in order to truly evaluate the use of homeopathy as a treatment modality.
Finally, a long-term observational study by Witt et al. assessed perceived change in complaint severity and quality of life at baseline, and after 2 and 8 years in 3,709 patients treated with homeopathy. In this study, physicians were free to choose treatment which “usually included the prescription of homeopathic medicines according to homeopathic principles, but also could include the onset, change, or withdrawal of a conventional medicine, referrals to specialists, or admission to a hospital (6).” At eight years, 32.9% of patients were still receiving homeopathic treatment, 29.2% of patients stopped treatment due to perceived major improvements in health, 26.0% stopped treatment because they did not feel homeopathy helped enough, 7.1% of patients stopped treatment for reasons unrelated to efficacy of therapy, and 3.6% stopped treatment without reason (6). The researchers concluded that, “patients who seek homeopathic treatment are likely to improve considerably, although this effect must not be attributed to homeopathic treatment alone. These effects persisted for 8 years (6).”
1. Hahnemann S. Organon of the Medical Art. Palo Alto: Birdcage Books; 1996, p. 141.
2. Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005 Aug 27-Sep 2;366(9487):726-32.
3. Rutten AL, Stolper CF. The 2005 meta-analysis of homeopathy: the importance of post-publication data. Homeopathy. 2008 Oct;97(4):169-77.
4. Lüdtke R, Rutten AL. The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. J Clin Epidemiol. 2008 Dec;61(12):1197-204. Epub 2008 Oct 1. Review.
5. Linde K, Melchart D. Randomized controlled trials of individualized homeopathy: a state-of-the-art review. J Altern Complement Med. 1998 Winter;4(4):371-88. Review.
6. Witt CM, Lüdtke R, Mengler N, Willich SN. How healthy are chronically ill patients after eight years of homeopathic treatment?--Results from a long term observational study. BMC Public Health. 2008 Dec 17;8:413.
Is evidence-based medicine compatible with naturopathic principles?
08/Feb/10 05:50 PM
by Kate Whimster, BCom, MIFHI, ND
One of the most common criticisms of natural medicine is that it lacks supportive evidence. This is simply not true! In many cases, there is as much or more research evidence for natural medicine as conventional medicine. However, there are also areas in which the research evidence is sparse or incomplete. The purpose of this blog is to clarify the true meaning of evidence-based medicine (EBM) and explore its role in contributing to natural medicine.
Evidence-based medicine (EBM) is defined as the “conscientious, explicit and judicious use of current best evidence in making decisions about care of individual patients (1).” Furthermore:
“The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice (1).”
This definition of evidence-based medicine does not conflict with the principles of naturopathic medicine. Naturopathic medicine is based on a large body of evidence gathered through systematic research and knowledge gained through clinical experience. Its principles support the application of this information to devise the most effective treatment for our patients.
However, the colloquial understanding of EBM supports randomized, double blind, placebo-controlled studies as gold standard of knowledge and leaves little room for other forms of research or for clinical experience.
Conventionally understood EBM is limited in encouraging health care that adheres to naturopathic principles. First, EBM does not recognize holistic treatment of individuals, and in fact seeks to boil down complex information to a simple conclusion recognizing only how the majority of subjects respond to a single intervention. Not only does this ignore the knowledge that could be gained through examining all the subjects in a study and why they each responded in the way that they did, but also is not necessarily applicable to real life health care since patients are nearly never under controlled conditions and subject to only one intervention. Naturopathic doctors are interested in treating real patients in the real world and therefore in gathering knowledge in any area that will serve this purpose. In many cases, this knowledge includes clinical observation and experience with real patients.
Second, funding committed to research is not allocated based on what areas of knowledge are the most interesting, warrant the most investigation, or even may be the most beneficial to the public. Most research is conducted by pharmaceutical companies on products they hope to bring to market in order to earn profits for shareholders. Unfortunately, this capitalist drive behind health knowledge is not conducive to researching how low-cost treatments such as diet and lifestyle changes can be far more effective than any drug. It is also not conducive to gaining knowledge through “failed” experiments, such as when pharmaceutical research does not yield results favourable to the drug being researched. Currently, pharmaceutical companies are not required to publish such research, although there is a movement to change this, thankfully. Naturopathic doctors are interested in achieving results, even if there is no particular product to sell.
Finally, naturopathic doctors also act as teachers, seeking to empower patients with information so that they can care for themselves. EBM places power in a faceless research environment, removing it from clinicians with decades of experience, and therefore also removing it from individual patients who may know their unique needs best.
Therefore, while the official definition of EBM does fit with naturopathic principles, the applied definition, in terms of how the health care system actually operates, does not.
For more information and more of my thoughts on conventional medical research, please see my previous blog Mythology of science-based medicine.
1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312 (7023):71–2.
One of the most common criticisms of natural medicine is that it lacks supportive evidence. This is simply not true! In many cases, there is as much or more research evidence for natural medicine as conventional medicine. However, there are also areas in which the research evidence is sparse or incomplete. The purpose of this blog is to clarify the true meaning of evidence-based medicine (EBM) and explore its role in contributing to natural medicine.
Evidence-based medicine (EBM) is defined as the “conscientious, explicit and judicious use of current best evidence in making decisions about care of individual patients (1).” Furthermore:
“The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice (1).”
This definition of evidence-based medicine does not conflict with the principles of naturopathic medicine. Naturopathic medicine is based on a large body of evidence gathered through systematic research and knowledge gained through clinical experience. Its principles support the application of this information to devise the most effective treatment for our patients.
However, the colloquial understanding of EBM supports randomized, double blind, placebo-controlled studies as gold standard of knowledge and leaves little room for other forms of research or for clinical experience.
Conventionally understood EBM is limited in encouraging health care that adheres to naturopathic principles. First, EBM does not recognize holistic treatment of individuals, and in fact seeks to boil down complex information to a simple conclusion recognizing only how the majority of subjects respond to a single intervention. Not only does this ignore the knowledge that could be gained through examining all the subjects in a study and why they each responded in the way that they did, but also is not necessarily applicable to real life health care since patients are nearly never under controlled conditions and subject to only one intervention. Naturopathic doctors are interested in treating real patients in the real world and therefore in gathering knowledge in any area that will serve this purpose. In many cases, this knowledge includes clinical observation and experience with real patients.
Second, funding committed to research is not allocated based on what areas of knowledge are the most interesting, warrant the most investigation, or even may be the most beneficial to the public. Most research is conducted by pharmaceutical companies on products they hope to bring to market in order to earn profits for shareholders. Unfortunately, this capitalist drive behind health knowledge is not conducive to researching how low-cost treatments such as diet and lifestyle changes can be far more effective than any drug. It is also not conducive to gaining knowledge through “failed” experiments, such as when pharmaceutical research does not yield results favourable to the drug being researched. Currently, pharmaceutical companies are not required to publish such research, although there is a movement to change this, thankfully. Naturopathic doctors are interested in achieving results, even if there is no particular product to sell.
Finally, naturopathic doctors also act as teachers, seeking to empower patients with information so that they can care for themselves. EBM places power in a faceless research environment, removing it from clinicians with decades of experience, and therefore also removing it from individual patients who may know their unique needs best.
Therefore, while the official definition of EBM does fit with naturopathic principles, the applied definition, in terms of how the health care system actually operates, does not.
For more information and more of my thoughts on conventional medical research, please see my previous blog Mythology of science-based medicine.
1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312 (7023):71–2.
Mythology of science-based medicine
12/Jan/10 04:30 PM
by Kate Whimster, BCom, MIFHI, ND
This blog emerged after reading several different articles about the state of conventional medical care and some of the misperceptions surrounding efficacy of conventional medical treatments.
First, an article titled The Mythology of Science-Based Medicine provides examples of conventional medical interventions considered to be safe, valid, or effective when in fact they lack scientific basis or have been proven ineffective. This article provides links to sources and some responses from the authors and other medical experts in the comments. Here is an addendum to that article further addressing comments.
Second, an article titled How Common Are Medical Mistakes? which delves into the startling fact that the third leading cause of death of Americans is iatrogenic causes, meaning caused by doctors, medical treatment, or diagnostic procedures.
Finally, a few of my thoughts on this topic:
The “gold-standard” of medical research is the double-blind randomized controlled trial, which attempts to isolate the effect of a single intervention and control all other factors (including many features of patients such as pre-existing conditions, medications, lifestyle, diet, etc.) This makes sense in a research context but has little bearing on reality, in which medical interventions are used in conjunction with other treatments in a wide variety of patients. It is important to understand that a clinical trial is only the first step in evaluating treatment. It provides information on how something works and verifies safety in the short-term but is most definitely not a verdict on the effectiveness in the real world. This can only truly be gauged in the context of an uncontrolled patient population over time.
Something important to note about bypass surgery and angioplasty is that while they do not extend life (which is the case for many common medical treatments), this is not the only important measure to consider! Quality of life is also incredibly important and these procedures can make a major difference here. Patients with cardiovascular disease who in the past would not have these options would be severely limited by the inability to engage in even the most basic everyday activities but would also not be ill enough that they would pass away. These procedures have allowed many patients to return to a more normal level of activity and participation in life which is invaluable, even if their lifespan remains the same.
Regarding antidepressants, it should not be surprising that they are not very effective except in cases of severe depression. In most cases, antidepressants are the sole treatment prescribed despite mountains of evidence that combining them with other treatments (most notably psychotherapy) is far more effective. For many patients with depression, there are valid reasons to feel depressed, such as grief, declining health, emotional stressors, post-partum changes, etc. Depression is a natural human response to life’s ups and downs. Unfortunately most of us are just not equipped to accept and work through life’s challenges on our own. Psychotherapy can be enormously helpful in arming patients with coping and self-care skills. There are also many patients for whom antidepressants are very useful in boosting them up enough so that they can actively seek other treatments to address the underlying causes of depression, but the key here is that the cause must be addressed and corrected. Otherwise antidepressants either just don’t cut it or simply mask a problem that will re-emerge once the patient discontinues the medication. This is common considering the many uncomfortable and intolerable side-effects of these medications. There are so many proven and safe treatments for depression (such as nutrition, exercise, supplements, lifestyle changes, homeopathy, therapy) that can be used in place of or in conjunction with antidepressants to achieve much better outcomes.
This blog emerged after reading several different articles about the state of conventional medical care and some of the misperceptions surrounding efficacy of conventional medical treatments.
First, an article titled The Mythology of Science-Based Medicine provides examples of conventional medical interventions considered to be safe, valid, or effective when in fact they lack scientific basis or have been proven ineffective. This article provides links to sources and some responses from the authors and other medical experts in the comments. Here is an addendum to that article further addressing comments.
Second, an article titled How Common Are Medical Mistakes? which delves into the startling fact that the third leading cause of death of Americans is iatrogenic causes, meaning caused by doctors, medical treatment, or diagnostic procedures.
Finally, a few of my thoughts on this topic:
The “gold-standard” of medical research is the double-blind randomized controlled trial, which attempts to isolate the effect of a single intervention and control all other factors (including many features of patients such as pre-existing conditions, medications, lifestyle, diet, etc.) This makes sense in a research context but has little bearing on reality, in which medical interventions are used in conjunction with other treatments in a wide variety of patients. It is important to understand that a clinical trial is only the first step in evaluating treatment. It provides information on how something works and verifies safety in the short-term but is most definitely not a verdict on the effectiveness in the real world. This can only truly be gauged in the context of an uncontrolled patient population over time.
Something important to note about bypass surgery and angioplasty is that while they do not extend life (which is the case for many common medical treatments), this is not the only important measure to consider! Quality of life is also incredibly important and these procedures can make a major difference here. Patients with cardiovascular disease who in the past would not have these options would be severely limited by the inability to engage in even the most basic everyday activities but would also not be ill enough that they would pass away. These procedures have allowed many patients to return to a more normal level of activity and participation in life which is invaluable, even if their lifespan remains the same.
Regarding antidepressants, it should not be surprising that they are not very effective except in cases of severe depression. In most cases, antidepressants are the sole treatment prescribed despite mountains of evidence that combining them with other treatments (most notably psychotherapy) is far more effective. For many patients with depression, there are valid reasons to feel depressed, such as grief, declining health, emotional stressors, post-partum changes, etc. Depression is a natural human response to life’s ups and downs. Unfortunately most of us are just not equipped to accept and work through life’s challenges on our own. Psychotherapy can be enormously helpful in arming patients with coping and self-care skills. There are also many patients for whom antidepressants are very useful in boosting them up enough so that they can actively seek other treatments to address the underlying causes of depression, but the key here is that the cause must be addressed and corrected. Otherwise antidepressants either just don’t cut it or simply mask a problem that will re-emerge once the patient discontinues the medication. This is common considering the many uncomfortable and intolerable side-effects of these medications. There are so many proven and safe treatments for depression (such as nutrition, exercise, supplements, lifestyle changes, homeopathy, therapy) that can be used in place of or in conjunction with antidepressants to achieve much better outcomes.
Sleep and metabolic syndrome
24/Nov/09 10:56 AM
by Kate Whimster, BCom, MIFHI, ND
I wrote a research paper looking the relationship between sleep duration and metabolic syndrome and this blog is a summary of what I learned. References are listed at the end and can be found on PubMed.
Metabolic syndrome is a group of metabolic risk factors used to identify individuals at risk for cardiovascular disease (1). A correlation between sleep duration and the development of metabolic syndrome has been observed.
The National Cholesterol Education Program (NCEP) Adult Treatment Panel III diagnosis of metabolic syndrome requires the presence of three or more of the following features (1):
1. Waist circumference:
- Men: Greater than or equal to 102cm (40in)
- Women: Greater than or equal to 88cm (35in)
2. Triglycerides: Greater than or equal to 1.7mmol/L (150 mg/dL)
3. HDL cholesterol:
- Men: Less than 1.0mmol/L (40mg/dL)
- Women: Less than 1.3mmol/L (50mg/dL)
4. Blood pressure: Greater than or equal to 130/85 mmHg or medicated for hypertension
5. Fasting blood glucose: Greater than or equal to 5.6mmol/L (100mg/dL) or medicated for hyperglycemia
First-line treatment focuses on lifestyle factors such as dietary modification and increased physical activity (1). However, given that “‘normal’ average sleep duration has decreased from about 9 h per night in 1910 to about 7.5 h currently, (2)” and mounting evidence that sleep deprivation causes physiological changes that lead to metabolic syndrome, sleep deprivation is another important lifestyle factor to consider.
Short sleep duration (less than 6 hours per night) is associated with the highest risk for metabolic syndrome, but long sleep duration (more than 8 or 9 hours per night) is also associated with increased risk. The lowest risk was seen in subjects sleeping 7-8 hours per night (3,4).
With regards to abdominal obesity, “very short and short sleepers were at least 1.6 times more likely to meet criteria for abdominal obesity … compared with individuals who slept 7 to 8 hours per night (4).”
There is also a correlation between insulin resistance and sleep duration, both short and long: “with the reference group, the odds of meeting the glucose criterion were at least 1.7 times greater in the very short (< 6 hours) and long (> 8 hours) sleeper groups (4).” It is also likely that insulin resistance due to altered metabolism resulting from inadequate sleep develops gradually over years. One study restricted sleep in healthy young men to four hours per night for six nights and found that sleep debt led to impaired carbohydrate tolerance. Decreased morning insulin sensitivity was observed after 6 days of sleep restriction compared to when subjects were fully rested (6). “These results suggest that insulin sensitivity was lower on the 6th than on the 5th day of sleep restriction and thus that insulin resistance may develop progressively with increasing exposure to partial sleep loss (5).”
The Sleep Heart Health Study found that sleep duration was associated with risk of hypertension, with those sleeping less than 6 and 6-7 hours and those sleeping 8-9 and 9 or more hours demonstrating increased risk (6). A longitudinal analyses of the first National Health and Nutrition Examination Survey demonstrated that sleep durations of “< or =5 hours per night were associated with a significantly increased risk of hypertension … in subjects between the ages of 32 and 59 years (7).”
The studies discussed above have also found a relationship between increased sleep and metabolic syndrome. When examined more closely in one study, relationships between long sleep duration and metabolic syndrome and elevated glucose “were no longer significant with adjustment for use of antihypertensive medication, which has been shown to impact fasting blood glucose levels (4).” There is also a relationship between long sleep duration and sleep apnea, suggesting that “long sleep duration is a proxy for sleep disordered breathing and that sleep apnea drives the relationship between long sleep duration and health outcomes (4).”
Sleep quality is also an important factor to consider. An observational, cross-sectional study demonstrated that “poor global sleep-quality scores on the Pittsburgh Sleep Quality Index were related significantly to the presence of the metabolic syndrome (8).”
Studies relating sleep duration to metabolic changes are often confounded by pre-existing conditions (such as diabetes or hypertension), lifestyle habits (such as smoking, diet, alcohol intake, and caffeine intake), and other factors affecting sleep (such as sleep apnea). It is therefore important that studies of sleep duration take these factors into account and control for them as much as possible in order to establish a clear relationship between sleep and health outcomes. One researcher has challenged the above conclusions by offering three criticisms. First, “few obese adults/children are short sleepers, and few short sleeping adults/children are obese or suffer obesity-related disorders (9).” Second, the clinical risk only emerges from very short or long sleep duration and develops over many years, so while acute sleep restriction does lead to leads to glucose intolerance and metabolic syndrome “this is too little sleep and cannot be sustained beyond a few days (9).” Finally, he offers an alternative explanation for the relationship between sleep and metabolism: “habitually insufficient sleep could contribute towards obesity, metabolic syndrome, etc., via sleepiness-related inactivity and excess energy intake (9).”
It seems obvious that sleep is an important factor in health, but it is often overlooked by both conventional and naturopathic practitioners. Based on the studies discussed, the optimal sleep duration is between 7-8 hours per night. Many patients fail to prioritize sleep or have trouble falling asleep easily, both issues that can be greatly aided by naturopathic interventions. Sleep quality is also an important consideration and naturopathic doctors are also well equipped to make recommendations in this area.
1. MD Consult. Metabolic Syndrome. Accessed 18 Nov 2008. Available at: http://www.mdconsult.com.
2. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999 Oct 23;354(9188):1435-9.
3. Choi KM, Lee JS, Park HS, Baik SH, Choi DS, Kim SM. Relationship between sleep duration and the metabolic syndrome: Korean National Health and Nutrition Survey 2001. Int J Obes (Lond). 2008 Jul;32(7):1091-7. Epub 2008 May 13.
4. Hall MH, Muldoon MF, Jennings JR, Buysse DJ, Flory JD, Manuck SB. Self-reported sleep duration is associated with the metabolic syndrome in midlife adults. Sleep. 2008 May 1;31(5):635-43.
5. Knutson KL, Spiegel K, Penev P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Med Rev. 2007 Jun;11(3):163-78. Epub 2007 Apr 17. Review.
6. Gottlieb DJ, Redline S, Nieto FJ, Baldwin CM, Newman AB, Resnick HE, Punjabi NM. Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep. 2006 Aug 1;29(8):1009-14.
7. Gangwisch JE, Heymsfield SB, Boden-Albala B, Buijs RM, Kreier F, Pickering TG, Rundle AG, Zammit GK, Malaspina D. Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey. Hypertension. 2006 May;47(5):833-9. Epub 2006 Apr 3.
8. Jennings JR, Muldoon MF, Hall M, Buysse DJ, Manuck SB. Self-reported sleep quality is associated with the metabolic syndrome. Sleep. 2007 Feb 1;30(2):219-23.
9. Horne JA. Short sleep is a questionable risk factor for obesity and related disorders: statistical versus clinical significance. Biol Psychol 2008;77:266-76.
I wrote a research paper looking the relationship between sleep duration and metabolic syndrome and this blog is a summary of what I learned. References are listed at the end and can be found on PubMed.
Metabolic syndrome is a group of metabolic risk factors used to identify individuals at risk for cardiovascular disease (1). A correlation between sleep duration and the development of metabolic syndrome has been observed.
The National Cholesterol Education Program (NCEP) Adult Treatment Panel III diagnosis of metabolic syndrome requires the presence of three or more of the following features (1):
1. Waist circumference:
- Men: Greater than or equal to 102cm (40in)
- Women: Greater than or equal to 88cm (35in)
2. Triglycerides: Greater than or equal to 1.7mmol/L (150 mg/dL)
3. HDL cholesterol:
- Men: Less than 1.0mmol/L (40mg/dL)
- Women: Less than 1.3mmol/L (50mg/dL)
4. Blood pressure: Greater than or equal to 130/85 mmHg or medicated for hypertension
5. Fasting blood glucose: Greater than or equal to 5.6mmol/L (100mg/dL) or medicated for hyperglycemia
First-line treatment focuses on lifestyle factors such as dietary modification and increased physical activity (1). However, given that “‘normal’ average sleep duration has decreased from about 9 h per night in 1910 to about 7.5 h currently, (2)” and mounting evidence that sleep deprivation causes physiological changes that lead to metabolic syndrome, sleep deprivation is another important lifestyle factor to consider.
Short sleep duration (less than 6 hours per night) is associated with the highest risk for metabolic syndrome, but long sleep duration (more than 8 or 9 hours per night) is also associated with increased risk. The lowest risk was seen in subjects sleeping 7-8 hours per night (3,4).
With regards to abdominal obesity, “very short and short sleepers were at least 1.6 times more likely to meet criteria for abdominal obesity … compared with individuals who slept 7 to 8 hours per night (4).”
There is also a correlation between insulin resistance and sleep duration, both short and long: “with the reference group, the odds of meeting the glucose criterion were at least 1.7 times greater in the very short (< 6 hours) and long (> 8 hours) sleeper groups (4).” It is also likely that insulin resistance due to altered metabolism resulting from inadequate sleep develops gradually over years. One study restricted sleep in healthy young men to four hours per night for six nights and found that sleep debt led to impaired carbohydrate tolerance. Decreased morning insulin sensitivity was observed after 6 days of sleep restriction compared to when subjects were fully rested (6). “These results suggest that insulin sensitivity was lower on the 6th than on the 5th day of sleep restriction and thus that insulin resistance may develop progressively with increasing exposure to partial sleep loss (5).”
The Sleep Heart Health Study found that sleep duration was associated with risk of hypertension, with those sleeping less than 6 and 6-7 hours and those sleeping 8-9 and 9 or more hours demonstrating increased risk (6). A longitudinal analyses of the first National Health and Nutrition Examination Survey demonstrated that sleep durations of “< or =5 hours per night were associated with a significantly increased risk of hypertension … in subjects between the ages of 32 and 59 years (7).”
The studies discussed above have also found a relationship between increased sleep and metabolic syndrome. When examined more closely in one study, relationships between long sleep duration and metabolic syndrome and elevated glucose “were no longer significant with adjustment for use of antihypertensive medication, which has been shown to impact fasting blood glucose levels (4).” There is also a relationship between long sleep duration and sleep apnea, suggesting that “long sleep duration is a proxy for sleep disordered breathing and that sleep apnea drives the relationship between long sleep duration and health outcomes (4).”
Sleep quality is also an important factor to consider. An observational, cross-sectional study demonstrated that “poor global sleep-quality scores on the Pittsburgh Sleep Quality Index were related significantly to the presence of the metabolic syndrome (8).”
Studies relating sleep duration to metabolic changes are often confounded by pre-existing conditions (such as diabetes or hypertension), lifestyle habits (such as smoking, diet, alcohol intake, and caffeine intake), and other factors affecting sleep (such as sleep apnea). It is therefore important that studies of sleep duration take these factors into account and control for them as much as possible in order to establish a clear relationship between sleep and health outcomes. One researcher has challenged the above conclusions by offering three criticisms. First, “few obese adults/children are short sleepers, and few short sleeping adults/children are obese or suffer obesity-related disorders (9).” Second, the clinical risk only emerges from very short or long sleep duration and develops over many years, so while acute sleep restriction does lead to leads to glucose intolerance and metabolic syndrome “this is too little sleep and cannot be sustained beyond a few days (9).” Finally, he offers an alternative explanation for the relationship between sleep and metabolism: “habitually insufficient sleep could contribute towards obesity, metabolic syndrome, etc., via sleepiness-related inactivity and excess energy intake (9).”
It seems obvious that sleep is an important factor in health, but it is often overlooked by both conventional and naturopathic practitioners. Based on the studies discussed, the optimal sleep duration is between 7-8 hours per night. Many patients fail to prioritize sleep or have trouble falling asleep easily, both issues that can be greatly aided by naturopathic interventions. Sleep quality is also an important consideration and naturopathic doctors are also well equipped to make recommendations in this area.
1. MD Consult. Metabolic Syndrome. Accessed 18 Nov 2008. Available at: http://www.mdconsult.com.
2. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999 Oct 23;354(9188):1435-9.
3. Choi KM, Lee JS, Park HS, Baik SH, Choi DS, Kim SM. Relationship between sleep duration and the metabolic syndrome: Korean National Health and Nutrition Survey 2001. Int J Obes (Lond). 2008 Jul;32(7):1091-7. Epub 2008 May 13.
4. Hall MH, Muldoon MF, Jennings JR, Buysse DJ, Flory JD, Manuck SB. Self-reported sleep duration is associated with the metabolic syndrome in midlife adults. Sleep. 2008 May 1;31(5):635-43.
5. Knutson KL, Spiegel K, Penev P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Med Rev. 2007 Jun;11(3):163-78. Epub 2007 Apr 17. Review.
6. Gottlieb DJ, Redline S, Nieto FJ, Baldwin CM, Newman AB, Resnick HE, Punjabi NM. Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep. 2006 Aug 1;29(8):1009-14.
7. Gangwisch JE, Heymsfield SB, Boden-Albala B, Buijs RM, Kreier F, Pickering TG, Rundle AG, Zammit GK, Malaspina D. Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey. Hypertension. 2006 May;47(5):833-9. Epub 2006 Apr 3.
8. Jennings JR, Muldoon MF, Hall M, Buysse DJ, Manuck SB. Self-reported sleep quality is associated with the metabolic syndrome. Sleep. 2007 Feb 1;30(2):219-23.
9. Horne JA. Short sleep is a questionable risk factor for obesity and related disorders: statistical versus clinical significance. Biol Psychol 2008;77:266-76.
Thyroid, iodine, and breast health
03/Jul/09 10:53 AM
by Kate Whimster, BCom, MIFHI, ND
This blog was originally published on December 2, 2008 here.
I wrote a research paper looking the relationships between thyroid function, breast pathologies, and the role of iodine supplementation. This blog is a summary of what I learned. References are listed at the end and can be found on PubMed.
First, thyroid. There is an observed correlation between thyroid dysfunction and breast cancer (1,2,3), particularly hypothyroidism (3,4). Decreased function of the thyroid gland and rising TSH are also associated with a doubling in the risk of development of fibrocystic breast disease (5).
Next, iodine and breasts. Both breast tissue and thyroid tissue concentrate iodine (6) and deficiency of iodine causes “atypical tissue and physiologic changes in both” (7). One researcher noted that “geographic differences in the rates of breast, endometrial, and ovarian cancer appear to be inversely correlated with dietary iodine intake” (8). For example, in Japan seaweed (high in both iodine and selenium) is a major part of the diet and may play a role in the low incidence of both benign and malignant breast disease in that country (9).
A study on rats demonstrated a reduction in breast cancer incidence with iodine treatment (10). With regard to fibrocystic breast disease, randomized, double-blind, placebo-controlled, multicenter clinical trials (the gold-standard of conventional medicine!) have demonstrated that supplementation with iodide/iodine significantly reduced breast pain, tenderness, and nodularity (11,12).
So how does this work? One theory is that iodine deficiency leads to a state of excess estrogen (13), increasing the risk of a whole host of cancers. Iodine is also believed to suppress tumour growth (14), induce tumour cell death (15), and regulate genes that influence hormone metabolism, cell cycle, growth, and differentiation (16).
Why is this useful information? Everything in the body is connected, particularly the endocrine system. So, when something is going wrong in one area, like thyroid function, there are likely also going to be issues either immediately or down the road with another area, particularly reproductive organs. The causal mechanisms are not clear yet, but it is prudent to assess breast health when patients present with thyroid dysfunction and vice versa. There is evidence to suggest that iodine is effective nutritional treatment for fibrocystic breast disease and it may also be useful in reproductive cancers. Molecular iodine, rather than iodide, was found to be most effective and have the least adverse effects on the thyroid (12).
There is lots of other interesting information that I was not able to get to, such as a deeper look at the interaction of sex hormones with thyroid function and other influences on hormonal balance, such as sleep. Maybe one day I’ll have time to do more research and I’ll post an update!
References:
1. Turken O, NarIn Y, DemIrbas S, Onde ME, Sayan O, KandemIr EG, YaylacI M, Ozturk A. Breast cancer in association with thyroid disorders. Breast Cancer Res. 2003;5(5):R110-3. Epub 2003 Jun 5. PMID: 12927040
2. Saraiva PP, Figueiredo NB, Padovani CR, Brentani MM, Nogueira CR. Profile of thyroid hormones in breast cancer patients. Braz J Med Biol Res. 2005 May;38(5):761-5. Epub 2005 May 25. PMID: 15917958
3. Giani C, Fierabracci P, Bonacci R, Gigliotti A, Campani D, De Negri F, Cecchetti D, Martino E, Pinchera A. Relationship between breast cancer and thyroid disease: relevance of autoimmune thyroid disorders in breast malignancy. J Clin Endocrinol Metab. 1996 Mar;81(3):990-4.
4. Kuijpens JL, Nyklíctek I, Louwman MW, Weetman TA, Pop VJ, Coebergh JW. Hypothyroidism might be related to breast cancer in post-menopausal women. Thyroid. 2005 Nov;15(11):1253-9. PMID: 16356089
5. Mardaleishvili KG, Nemsadze GG, Metreveli DS, Roinishvili TL. [About correlation of dysfunction of the thyroid gland with fibrocystic diseases in women] Georgian Med News. 2006 Nov;(140):30-2. Russian.
6. Patrick L. Iodine: deficiency and therapeutic considerations. Altern Med Rev. 2008 Jun;13(2):116-27. Review. PMID: 18590348
7. Eskin BA, Grotkowski CE, Connolly CP, Ghent WR. Different tissue responses for iodine and iodide in rat thyroid and mammary glands. Biol Trace Elem Res. 1995 Jul;49(1):9-19. PMID: 7577324
8. Stadel BV. Dietary iodine and risk of breast, endometrial, and ovarian cancer. Lancet. 1976 Apr 24;1(7965):890-1. PMID: 58152
9. Cann SA, van Netten JP, van Netten C. Hypothesis: iodine, selenium and the development of breast cancer. Cancer Causes Control. 2000 Feb;11(2):121-7. Review. PMID: 10710195
10. García-Solís P, Alfaro Y, Anguiano B, Delgado G, Guzman RC, Nandi S, Díaz-Muñoz M, Vázquez-Martínez O, Aceves C. Inhibition of N-methyl-N-nitrosourea-induced mammary carcinogenesis by molecular iodine (I2) but not by iodide (I-) treatment Evidence that I2 prevents cancer promotion. Mol Cell Endocrinol. 2005 May 31;236(1-2):49-57. Epub 2005 Apr 13. PMID: 15922087
11. Kessler JH. The effect of supraphysiologic levels of iodine on patients with cyclic mastalgia. Breast J. 2004 Jul-Aug;10(4):328-36. PMID: 15239792
12. Ghent WR, Eskin BA, Low DA, Hill LP. Iodine replacement in fibrocystic disease of the breast. Can J Surg. 1993 Oct;36(5):453-60. PMID: 8221402
13. Stadel BV. Dietary iodine and risk of breast, endometrial, and ovarian cancer. Lancet. 1976 Apr 24;1(7965):890-1. PMID: 58152
14. Funahashi H, Imai T, Tanaka Y, Tobinaga J, Wada M, Morita T, Yamada F, Tsukamura K, Oiwa M, Kikumori T, Narita T, Takagi H. Suppressive effect of iodine on DMBA-induced breast tumor growth in the rat. J Surg Oncol. 1996 Mar;61(3):209-13. PMID: 8637209
15. Shrivastava A, Tiwari M, Sinha RA, Kumar A, Balapure AK, Bajpai VK, Sharma R, Mitra K, Tandon A, Godbole MM. Molecular iodine induces caspase-independent apoptosis in human breast carcinoma cells involving the mitochondria-mediated pathway. J Biol Chem. 2006 Jul 14;281(28):19762-71. Epub 2006 May 5. PMID: 16679319
16. Stoddard FR 2nd, Brooks AD, Eskin BA, Johannes GJ. Iodine alters gene expression in the MCF7 breast cancer cell line: evidence for an anti-estrogen effect of iodine. Int J Med Sci. 2008 Jul 8;5(4):189-96. PMID: 18645607
This blog was originally published on December 2, 2008 here.
I wrote a research paper looking the relationships between thyroid function, breast pathologies, and the role of iodine supplementation. This blog is a summary of what I learned. References are listed at the end and can be found on PubMed.
First, thyroid. There is an observed correlation between thyroid dysfunction and breast cancer (1,2,3), particularly hypothyroidism (3,4). Decreased function of the thyroid gland and rising TSH are also associated with a doubling in the risk of development of fibrocystic breast disease (5).
Next, iodine and breasts. Both breast tissue and thyroid tissue concentrate iodine (6) and deficiency of iodine causes “atypical tissue and physiologic changes in both” (7). One researcher noted that “geographic differences in the rates of breast, endometrial, and ovarian cancer appear to be inversely correlated with dietary iodine intake” (8). For example, in Japan seaweed (high in both iodine and selenium) is a major part of the diet and may play a role in the low incidence of both benign and malignant breast disease in that country (9).
A study on rats demonstrated a reduction in breast cancer incidence with iodine treatment (10). With regard to fibrocystic breast disease, randomized, double-blind, placebo-controlled, multicenter clinical trials (the gold-standard of conventional medicine!) have demonstrated that supplementation with iodide/iodine significantly reduced breast pain, tenderness, and nodularity (11,12).
So how does this work? One theory is that iodine deficiency leads to a state of excess estrogen (13), increasing the risk of a whole host of cancers. Iodine is also believed to suppress tumour growth (14), induce tumour cell death (15), and regulate genes that influence hormone metabolism, cell cycle, growth, and differentiation (16).
Why is this useful information? Everything in the body is connected, particularly the endocrine system. So, when something is going wrong in one area, like thyroid function, there are likely also going to be issues either immediately or down the road with another area, particularly reproductive organs. The causal mechanisms are not clear yet, but it is prudent to assess breast health when patients present with thyroid dysfunction and vice versa. There is evidence to suggest that iodine is effective nutritional treatment for fibrocystic breast disease and it may also be useful in reproductive cancers. Molecular iodine, rather than iodide, was found to be most effective and have the least adverse effects on the thyroid (12).
There is lots of other interesting information that I was not able to get to, such as a deeper look at the interaction of sex hormones with thyroid function and other influences on hormonal balance, such as sleep. Maybe one day I’ll have time to do more research and I’ll post an update!
References:
1. Turken O, NarIn Y, DemIrbas S, Onde ME, Sayan O, KandemIr EG, YaylacI M, Ozturk A. Breast cancer in association with thyroid disorders. Breast Cancer Res. 2003;5(5):R110-3. Epub 2003 Jun 5. PMID: 12927040
2. Saraiva PP, Figueiredo NB, Padovani CR, Brentani MM, Nogueira CR. Profile of thyroid hormones in breast cancer patients. Braz J Med Biol Res. 2005 May;38(5):761-5. Epub 2005 May 25. PMID: 15917958
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