Dr. Arturo M. Volpe

A recent study published in the Journal of the American Medical Association (February 13 2002;287 (6):734-41) found a clear association between long-term hormone replacement therapy (HRT) in women and an increased risk of breast cancer.

The study looked at 705 women who had been diagnosed with breast cancers of all types between 1990 and 1995 as well another 692 randomly selected age-matched women. Researchers concluded that those who had been on long-term HRT, both on estrogen alone and estrogen plus progestin, had a risk of contracting breast cancer of any type that was 60% to 85% higher than that of women who had not been on long-term HRT. When considering only the lobular type of breast cancer, the risk was more than three times higher for the HRT group.

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Metformin (Glucophage) is one of the most commonly prescribed medications for type II or “adult-onset” diabetes, the type of diabetes that does not usually require insulin.

A previously known – although rare – risk associated with this medication is acidosis, a potentially life-threatening condition caused by a build-up of lactic acid in blood.

A recent study (Nutr Metab Cardiovasc Dis, 2001;11:108-116) found that Metformin also raises blood levels of homocysteine, a substance that has been found to cause heart disease. Homocysteine builds up in blood when certain B vitamins are deficient and it is believed that Metformin raises homocysteine levels by blocking the absorption of vitamin B12 and folic acid, two essential nutrients.

In recent years, Metformin has also been prescribed to individuals who are considered at high risk for developing diabetes in the hope of preventing or delaying its onset. A study this year (N Engl J Med 2002;346:393-403) looked at more than 3,000 individuals, all of whom were in this high-risk category and divided them in three groups: one received Metformin, the second a placebo, and the third followed very basic diet and exercise guidelines but received no medication or placebo.

The study concluded that, although Metformin reduced the onset of diabetes by roughly 30% over the placebo group, the basic lifestyle and diet changes recommended in the study were twice as effective, reducing diabetes onset by almost 60%.

Although certain people are more susceptible to this illness because of family history, Type II diabetes is clearly caused by diet and lifestyle. I believe it can be prevented, and often reversed, when these issues are addressed and related nutritional deficiencies are corrected. Herbal products such as cinnamon, a common kitchen spice, have also been shown to help normalize blood sugar and can be helpful while the underlying causes are addressed. Research on cinnamon and diabetes can be found in the Journal of the American College of Nutrition (Aug. 2001;20(4):327-336), although there are no large scale studies due to lack of funding.

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This study, published in The Journal of Allergy and Clinical Immunology (2001;108(4):516-20), looked at infants and small children from two European countries, Sweden and Estonia, analyzing their stools and keeping a record of the bacteria populating their intestinal tracts.

Over a period of time, researchers tracked those children in the group who developed allergies and concluded that the onset of allergies in children was preceded by a prevalence of unhealthy bacteria. In contrast, the children who did not develop allergies had a greater concentration of healthy bacterial species populating their intestinal tracts.

Our intestines are host to a wide variety of bacteria, estimated to number in the trillions. Some of these bacterial species are ‘healthy’ in that they help us digest food, assimilate nutrients and they even produce some of the vitamins we need. Other ‘unhealthy’ bacteria can interfere with proper digestive function and lead to a breakdown of the intestinal lining and a condition sometimes defined as ‘leaky gut’. This can have far-reaching effects on the immune system and overall health.

Babies receive their first exposure to bacteria that will populate their intestines through motherís milk. Other sources include yogurt and other fermented foods. Unhealthy bacteria sometimes become entrenched as a result of a diet that is high in sugar and processed foods, or as a result of repeated or long-term antibiotics.

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Butterbur is a traditional European herb with a long history of use for the treatment of cough and a variety of other conditions. In recent decades, this herb had been abandoned when it was found to contain an alkaloid that can cause cancer. More recently, a German company called Weber & Weber found a way to produce an extract of this herb that does not contain the incriminated alkaloid (a naturally occurring chemical). This company has also been funding large-scale studies to prove the effectiveness of their herbal extract in a variety of conditions. Previous studies had shown that it could help both in the prevention and treatment of migraine headaches and certain types of urinary incontinence.

A current double-blind study published in the British Medical Journal (2002;324(7330):144) found it to be as effective as Zyrtec (Cetirizine) in the treatment of allergies. Over a two-week period, those who took the herbal extract reported the same benefits as those taking Zyrtec, a prescription antihistamine. Even though Zyrtec is a non-sedating antihistamine, many of those who received it in this study reported feeling drowsy, while people taking the herb reported no side effects.

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An article published in the medical journal Neurology (2001; 56(3):385-8) describes ten patients who presented to a clinic complaining of migraine headaches. They all also had other neurological symptoms varying from loss of balance (vertigo), to sensory impairment, however, none of these people had any digestive disturbances.

When tested with MRI and EEG, all of these individuals showed abnormalities in the brain that could explain their symptoms. The author also tested them for intolerance to gluten as part of their evaluation. Gluten is a protein found in wheat, oats, rye and a few other grains. Every one of the ten patients tested positive for gluten intolerance. All recovered completely when they eliminated gluten from their diets. In addition, their EEG and MRI abnormalities vanished. Interestingly, each of these individuals had the same genetic trait, suggesting that there may a genetic predisposition to gluten intolerance. Gluten allergy has been linked with autism, ADHD and migraine headaches in addition to celiac disease, a severe intestinal and neurological disorder.

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An article entitled ìAlternative treatments for attention-deficit/hyperactivity disorder: does evidence support their use? (Altern Ther Health Med 2002;8:68-74) points out a need for alternatives to medication in the management of ADHD. Many children do not tolerate medications and the risks associated with long-term use have not been fully evaluated. The authors also noted that there are few studies validating alternative treatments, primarily because none of the significant financial interests that are likely to fund large-scale studies are backing them. Many alternative approaches are also individually tailored and do not lend themselves to current-day study designs in which all the participants must receive the same medication.
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A new study published in the International Journal of Cancer (2002;97:72-81) compared cancer rates in major developed and developing countries.

1.5% of the North American population was diagnosed with cancer over the past 5 years (this study excluded skin cancers, except for melanoma). Western Europe was second with 1.2%, followed by Australia, New Zealand and, finally, Japan with 1%.

Developing countries were found to have consistently lower rates, a fact that is attributed to the lower life expectancy in those countries. It is reasoned that, since people die younger from other causes, not enough of them reach an age at which cancer becomes more likely.

It is interesting to note, however, that the Japanese – with their dramatically lower cancer rate – have a higher life expectancy than we do. Like the U.S.A., Japan has its share of environmental chemicals and other pollutants, including mercury contamination of its seafood but, overall, the Japanese favor a more traditional diet with fewer processed foods.

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Severe constipation is generally defined as 3 or fewer bowel movements a week. This condition seems to affect many of the children who come to my office. Rarely have parents been informed, before seeing me, of a possible link between constipation in children and allergy to the protein in milk.

What sometimes confuses the issue is that routine blood tests for food allergies may not reveal a reaction to milk, but eliminating milk for a trial period from a child’s diet rarely fails to reduce or eliminate the problem.

A quick search on Medline, the Internet service that searches medical journals, yields 104 studies, all from reputable sources and some from pediatric publications, linking children’s constipation with allergy to milk. A few of these studies are:

• Allergic constipation: association with infantile milk allergy. Clin Pediatr (Phila) 2001 Jul;40(7):399-402
• Cow’s milk and chronic constipation in children. N Engl J Med 1999;340(11):891
• Constipation and intolerance to cow’s milk. J Pediatr Gastroenterol Nutr 2000;30(2):224
• Constipation in children. N Engl J Med 1998;339(16):1155-6
• Allergy to cow’s milk presenting as chronic constipation. Br Med J 1983;287(6405):1593
• Constipation in childhood. BMJ 1989;299(6708):1116-7

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Data for adults shows that the number of people who are overweight increased by more than 50% in the last 10 years. A study published in The Journal of the American Medical Association (JAMA, 2001;286(22):2845) set out to determine if a similar increase could also be seen in children. The study analyzed data from 8,270 children from 1986 to 1998. It concluded that overweight prevalence increased rapidly among American children, particularly among minorities. In addition, overweight children were heavier in 1998 when compared to 1986. The study further concluded that strategies are required “to increase physical activity and encourage healthy eating patterns among children”.

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Many people taking aspirin or Tylenol every day do not even consider chronic renal failure as a possible risk. However, a recent study (N Engl J Med 2001;345(25):1801-1808) shows that there is reason for concern. The study was conducted on 926 patients with newly diagnosed renal failure and 980 control subjects. It used logistic-regression models to estimate the relative risks associated with the use of various analgesics. The study concluded that aspirin or Tylenol were used regularly by 37% and 25%, respectively, of the patients with renal failure and 19% and 12% of the controls. Regular use of either drug was associated with an increase by a factor of 2.5 in the risk of chronic renal failure, and the risk rose with increasing cumulative lifetime doses. However, the study found that the risk of developing kidney failure from either drug was minimal in people without pre-existing kidney disease.

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High levels of ozone in the air we breathe are a major public health problem. It is estimated that more than 130 million Americans live in areas where ozone levels exceed safety standards. Exposure to ozone is known to cause decreased breathing capacity, airway hyperreactivity, and inflammation of the airway passages. In a study last year, (Am J Resp Crit Care Med 2001 164 819) participants were given a combination of antioxidants that included vitamin C, vitamin E and a vegetable cocktail. Antioxidants were found to be protective against decline in lung function but not to reduce markers of inflammation caused by ozone exposure.

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Several studies have shown that chronic inflammation of the brain plays a role in causing Alzheimer’s disease and that long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a lower risk of contracting this disease. However, NSAIDs taken over long periods of time can cause gastrointestinal, liver and renal toxicity.

In one study (J Neurosci 2001;21:8370-7) researchers evaluated the common Indian spice turmeric in mice. After six months of use, the mice eating the turmeric had a significant reduction in two markers of inflammation in the brain and also had less free radical damage to brain cells without experiencing any side effects. Incidentally, mice receiving less turmeric every day did better than those fed larger amounts. The most beneficial dose would be roughly equivalent to 1,600 mg of curcumin per day for a 150 lbs person. Curcumin is believed to be the most active ingredient in turmeric. Researchers caution that, even though this preliminary study is promising, there still is no research in humans on the effects of turmeric.

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Do you still think that the lower your cholesterol, the better your health? Think again. A Canadian study (Epidemiology, 2001;12(2):168-172) followed more than 11,000 individuals for 12 years. Researchers found a significant correlation between low serum cholesterol and the incidence of suicide.

Previous studies had found a relationship between low total cholesterol and depression. Although the mechanism is not fully understood, it is believed that cholesterol plays a role in serotonin metabolism.

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People continue to be told by some medical professionals that there is no known relationship between colon cancer and diet and that they are completely healthy except for this unfortunate event ñ cancer ñ that occurred to them.

In yet another large-scale study (Natl Cancer Inst, 2001;93(7):525-533) that followed more than 60,000 people for almost ten years, researchers found – guess what – that people who ate the least amounts of fresh fruits and vegetables had the highest incidence of colon cancer.

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The IOM is an agency whose stated purpose is to provide scientific information about medicine to the government and to professionals. It previously had staunchly held the position that vaccines are completely safe. However, in an October 2001 report, the IOM stated that mercury found in vaccines may be linked to the escalating incidence of autism. It also recommends that physicians avoid administering vaccines that contain the mercury-laden preservative thimerosal. Although pharmaceutical companies have stopped using thimerosal in newly produced vaccines, significant stocks of older vaccines that contain the preservative are still available and continue to be in use.

The IOM report is based on a July 16 meeting whose full transcript is available at http://www.iom.edu. In the course of this meeting, Neil Halsey, MD of Johns Hopkins University affirmed that scientists had previously failed to recognize the toxic doses of mercury contained in vaccines because packages label thimerosal content as 0.01%. Apparently, these highly educated scientists had looked at 0.01% as a trivial amount and, until recently, had not thought to convert this percentage figure to its equivalent in micrograms and multiply it by the number of vaccines children receive. When they finally did so, they finally saw that infants were being routinely injected with amounts of mercury considered toxic for adults.

I wonder why this admission comes after manufacturers have been given ample time to substitute thimerosal in vaccine production, and why are the thimerosal-containing vaccines still legal? I also wonder to what extent mercury is the cause behind attention and behavior problems that have reached epidemic proportions in our children. If your child is scheduled for a vaccination, you can now demand that the pediatrician use only vaccines that are free of thimerosal.

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This study (JAMA 2001;285 (6):796-8) followed two groups of men and women aged 65 and over for about five years. The first group was made up of African-Americans from Indianapolis and the second group was composed of Africans living in Nigeria. At the end of the study, after adjusting for all other variables, the American group proved to have more than double the rate of Alzheimer’s disease and other types of dementia than the African group. This study again suggests that dementia is an environmental rather than a genetic disorder.

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A survey published in the Journal of Internal Medicine (Jul 2001;16:451-459) reveals that most physicians are dissatisfied with various aspects of their work, including professional autonomy, leisure time available, time available with individual patients and income. When compared with a similar survey performed in 1986, these results show a sharp decline in job satisfaction among MDís.

In my work there is a great deal of job satisfaction, even though leisure time is clearly a problem. More and more MDís are making the switch to nutritional medicine because it gives them the tools to help people regain their health rather than just controlling their symptoms.

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It has been my consistent experience that allergies to common foods – including milk, wheat and eggs – explain the vast majority of migraines. Certain studies were done once and, even though the results were remarkable, they were never repeated – probably for lack of funding. In an older but still valuable study (Lancet, 1979;966-969) 60 migraine sufferers were placed on a strict elimination diet and 85% became migraine-free. Elimination diets are short-term eating plans that require complete avoidance of foods that are most likely to cause a reaction.

When study participants re-introduced the eliminated foods, the most common causes of their migraines were found to be wheat, oranges and eggs. Incidentally, 25% of the participants to the study also happened to have high blood pressure, and in each participant the blood pressure also normalized when they eliminated the foods to which they were allergic.

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It had been known for some time that fish oils help prevent heart disease. More recently a new class of cholesterol-lowering “statin” drugs were also shown to help prevent heart disease. However, these two products were never compared. A recent review article published in the Archives of Internal Medicine (Oct. 2001;161(18):2185-92) looked at a number of existing clinical trials on fish oil and concluded that they “demonstrated reductions in risk that compare favorably with those seen in landmark secondary prevention trials with lipid-lowering drugs.”

The article proposes that fish oils may work by preventing arrhythmias, lowering blood lipids and preventing clot formation.

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It has not been long since the new COX-2 inhibitors (these include Vioxx and Celebrex) were promoted as miracle drugs that would cure the symptoms of arthritis with no side effects. Older anti-inflammatory drugs (NSAIDs) had been associated with bleeding in the stomach and ulcers.
A review article recently published in JAMA (2001;286(8):954-9) analyzed the results from four major studies that included approximately 16,000 patients. In one study patients on the COX-2 inhibitor had more than double the risk of heart attacks and other cardiovascular events than those on NSAIDs.

Another study did not confirm this finding, but in this case patients were taking a COX-2 inhibitor and aspirin at the same time. The authors assume that the aspirin may have had a cardio-protective effect for those patients while at the same increasing the risk of ulcers, the major benefit of COX-2 inhibitors.

When is this madness going to stop? There are many natural treatments for arthritis that are completely free of negative side effects. These include avoidance of allergic foods, glucosamine sulfate, chondroitin, MSM, the vitamin niacinamide, fish oil and various herbs, including Turmeric, Yucca and Boswellia.

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