An important study was just published in the journal Endocrine Practice (the journal of the American Association of Clinical Endocrinologists) that set out to determine if undiagnosed Vitamin B12 deficiency is common among people with type 2 diabetes, even when not taking Metformin (which itself causes B12 deficiency). Their findings: “Almost one-half of type 2 diabetes subjects not taking Metformin had biochemically proven vitamin B12 deficiency.” (And they used a very low benchmark, <200 microgram/dL, to qualify as “low”, which we would call severe deficiency.) Their important conclusion that needs to be more widely communicated: “We conclude that Vitamin B12 deficiency is common amongst type 2 diabetes subjects and is nutritional in nature…This indeed is an important finding, as taking oral Vitamin B12 supplementation is easy, convenient and readily accepted by patients. This is a novel finding and stresses the need for aggressive and early diagnosis and treatment to avoid complications of Vitamin B12 deficiency.” Why wait for type 2 diabetes to develop? Take care of any deficiency, a potential contributing cause, earlier at a preventive stage.
Vitamin B12 is often deficient with type 2 diabetes even without taking Metformin
February 8th, 2010The importance of testing cytokines: prostate cancer
February 7th, 2010Here are a few among many papers that demonstrate the importance of testing cytokines (’messenger molecules’ of the immune system) for prostate cancer.
The is paper published some time ago in the Journal of Clinical Oncology demonstrated that measuring IL6SR and TGF-β1 “improved the ability to predict biochemical progression by a prognostically substantial margin.” In other words, who might need a more aggressive intervention, and who doesn’t?
Cytokines before and after surgery correspond to prostate cancer progression
The authors of this paper published in the journal Clinical Cancer Research note that “We have shown that preoperative plasma levels of transforming growth factor-β1 (TGF-β1), interleukin 6 (IL)-6, and its receptor (IL-6sR) are associated with prostate cancer progression and metastasis. The objectives of this study were to…examine the association of …these markers after surgery with disease progression in a large consecutive cohort of patients.” Their conclusion: “For patients undergoing radical prostatectomy, preoperative plasma levels of TGF-β1 and IL-6sR are associated with metastases…and disease progression. After prostate removal, postoperative TGF-β1 level increases in value over preoperative levels for the prediction of disease progression.”
The investigators who conducted this study that was published in the journal The Prostate set out to test “the ability of several pre-operative blood-based biomarkers to enhance the accuracy of standard post-operative features for the prediction of biochemical recurrence (BCR) after radical prostatectomy (RP).” They measured the cytokines IL-6, ILsR and TGF-β and concluded that “Pre-operative plasma biomarkers improved the accuracy of established post-operative prognostic factors of BCR by a significant margin. Incorporation of these biomarkers into standard predictive models may allow more accurate identification of patients who are likely to fail RP thereby allowing more efficient delivery of adjuvant therapy.”
Omega-3 fatty acids effective for preventing psychosis
February 6th, 2010
This paper just published in the Archives of General Psychiatry reports on a randomized, placebo-controlled trial that set out to “determine whether {omega}-3 PUFAs reduce the rate of progression to first-episode psychotic disorder in adolescents and young adults aged 13 to 25 years with subthreshold psychosis.” (PUFAs = polyunsaturated fatty acids) The omega-3s (fish oil) reduced progression to psychosis and improved function. The authors conclude: “Long-chain {omega}-3 PUFAs reduce the risk of progression to psychotic disorder and may offer a safe and efficacious strategy for indicated prevention in young people with subthreshold psychotic states.” I have found that we can predict who will benefit most from fish oil supplementation for psychiatric and neurological conditions with a fatty acid analysis, a blood test that measures the amounts and ratios of fatty acids in cell membranes.
The importance of testing cytokines: rheumatoid arthritis
February 5th, 2010It has come to my attention that many doctors remain unfamiliar with the clinical value and importance of testing (blood) cytokines. Cytokines are ‘messenger molecules’ of the immune system involved in the regulation of inflammation. Knowledge of their levels helps not just with early diagnosis and prognosis, but can profile immune system imbalance allowing functional treatment to be precisely targeted and bad reactions avoided (even Echinacea can push some people’s immune system in the wrong direction). There are thousands of studies on clinical conditions for which this is important. Here ’s one for rheumatoid arthritis:
Up-regulation of cytokines and chemokines predates the onset of rheumatoid arthritis
This study recently published in the journal Arthritis & Rheumatism (the journal of the American College of Rheumatology) set out to “identify whether cytokines, cytokine-related factors, and chemokines are up-regulated prior to the development of rheumatoid arthritis (RA).” Their conclusion was in line with findings of other investigators: “Individuals in whom RA later developed had significantly increased levels of several cytokines, cytokine-related factors, and chemokines representing the adaptive immune system (Th1, Th2, and Treg cell-related factors.”
Vitamin A helps prevent parasite infections
February 4th, 2010
Anyone treating the underlying causes of chronic diseases is familiar with the important impact of gastrointestinal parasitic infections on the immune system and chronic inflammation, and knows how common they are. This randomized, double-blind placebo-controlled trial recently published in the Journal of Pediatric Gastroenterology and Nutrition offers welcome evidence that Vitamin A supplementation can significantly reduce the incidence of parasitic infections. The conclusion: “These data showed that total parasitic infection and Giardia spp infections were significantly lower in the vitamin A treatment group when compared with the placebo group, suggesting that vitamin A improves the host’s defenses against Giardia infections.” This is not surprising considering the importance of vitamin A for the tissues that line the GI and respiratory tracts and their immune integrity.
Xylitol sweetener reduces dental caries in children
February 3rd, 2010
There is more evidence for the effectiveness of the natural sweetener xylitol in the prevention of dental caries in children in this double-blind randomized clinical trial published in Archives of Pediatrics & Adolescent Medicine. Xylitol given as an oral syrup resulted in these findings: “Compared with the control group, there were significantly fewer decayed teeth in the Xyl-2x and in the Xyl-3x group. No statistical difference was noted between the 2 xylitol treatment groups.” This means that there was no apparent difference between giving the xylitol 2 times per day and 3 times per day. The authors conclude: “Xylitol oral syrup administered topically 2 or 3 times daily at a total daily dose of 8 g was effective in preventing early childhood caries.”
And here’s another study just published in The Journal of Pediatrics, a double-blind randomized controlled trial that also demonstrated similar efficacy for the reduction of dental caries in very young children. The conclusion was identical: “Xylitol oral syrup administered topically 2 or 3 times daily at a total daily dose of 8 g was effective in reducing early childhood caries progression.” As you probably know, xylitol is available in chewing gum and toothpaste. I like the Unda products from Belgium for their additional ingredients.
Increase in death risk from gluten-related gut inflammation
February 2nd, 2010
This paper published in JAMA (The Journal of the American Medical Association) recently examined the risk of death associated with celiac disease. The investigators found a modest but significant increase in risk of death not only with celiac, but also with latent celiac disease and small intestine inflammation. They note that “This risk increase was also seen in children.” The take home message here is that even in the absence of gastrointestinal symptoms (”latent celiac disease”), there is an overall negative impact. The authors’ conclusion: “Risk of death among patients with celiac disease, inflammation, or latent celiac disease is modestly increased.”
New method of CPR is easier and more effective
February 1st, 2010Medicating insomnia when there is reflux can make both much worse
January 31st, 2010
I wonder how many people took note of the extremely important paper published recently in Clinical Gastroenterology and Hepatology. The author marshals twenty additional studies to bolster the finding that, when there is gastroesophageal reflux (GER) disease, medications for insomnia can make both conditions worse: “Sleep-related GER causes insomnia. Patients might not realize that GER is contributing to their insomnia. When patients complain to their physician about their insomnia, they might not appreciate that GER is a contributing factor, so that instead of intensifying GER therapy during sleep time, they prescribe a non-benzodiazepine hypnotic such as zolpidem. This hypnotic prolongs esophageal acid clearance and delays the arousal response, which can further worsen reflux and thus their insomnia. To avoid this cycle, we should consider sleep-related GER as a possible cause of insomnia and treat GER during the sleep period instead of prescribing a hypnotic medication. This investigation has significant clinical relevance.” The author concludes by admonishing doctors: “…common medications used to manage insomnia depress the arousal response that is vital to esophageal refluxate clearance. The data are impressive. Ask your GER patients what happens during sleep!”
The cytokines IL-6 Soluble Receptor and TGF-Beta whether clinically localized prostate cancer will progress or not.
Another study demonstrating cytokines greatly increase the accuracy of predicting the potential for prostate cancer recurrence
Research recently