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July 2003

Drug (Pharmaceutical!) Crime
Pattern of Abuse
Inflammatory Bowel Disease (IBD)
Natural Remedies for IBD
Other Supplements for IBD
Ask Dr. J: Insomnia
References
In the Health News
Diet and Disease
Recipe of the Month: Cold Cucumber-Yogurt-Dill Soup

Drug (Pharmaceutical!) Crime

Dear Friends,

I was surprisingly shocked by a recent news article about the fraud and deception on the part of a large drug company, AstraZeneca. Surprising because I am quite aware of promotion schemes that drug companies have been involved in over the years, and the overwhelming financial power of these companies to influence medical education and doctors’ prescribing habits.

The criminal actions were this: the drug reps would give free samples of the prostate cancer drug, Zoladex, to physicians, and encourage them to bill Medicare for reimbursement when they administered the drugs. (The prosecutors could never prove that the company officials were aware of or directing this practice, but absence of evidence is not the same as evidence of absence.) The company settled with over $350 million dollars (a mere drop in the bucket for them), and admission of guilt!

Although the drug companies are no longer able to directly pay physicians with free trips and other benefits, they always seem to find new ways to influence the pocketbooks and capture the sympathies of doctors when it comes to prescribing their drugs.

In addition, the company agreed to settle another charge without admitting guilt. They were accused of inducing doctors to buy Zoladex by offering to set and report to Medicare falsely high prices for the drug. In this way, prescribing doctors who went along with the scheme could collect higher fees when billing Medicare. Astonishingly, many doctors defended the fraudulent practice by saying they needed the money to cover their incredibly high operational costs for treating cancer.

Pattern of Abuse

This is not the first time that drug companies have tampered with prescribing practices using financial inducements to doctors. Another prostate drug, Lupron, was similarly promoted by TAP Pharmaceuticals, and they settled for $875 million. It makes you wonder whether doctors are prescribing for medical or financial reasons. Doctors often prescribe through habit, and drug companies try to influence these habits early on.

Witness the incredible promotion of Nexium to both the public and to doctors. This “purple pill” is a modified version of Prilosec, for treatment of acid indigestion, ulcers, and related digestive disorders. Nexium’s only apparent advance is that it is newly patented, whereas Prilosec is now off patent (and much less profitable).

Scientifically validated benefits are good reasons for a doctor to prescribe a medicine. Financial incentives and fraud are, or should be, much less convincing.

Inflammatory Bowel Disease (IBD)

Inflammation of the bowel usually takes one of two forms–ulcerative colitis, confined to the large intestine (colon), or Crohn’s disease, which is usually in the small intestine, but may extend into the colon, as well. This is a serious medical condition. Irritable bowel syndrome is also a serious health problem, although not life threatening or requiring surgery or drugs, and this condition never causes bloody diarrhea.

The usual symptoms of Crohn’s disease include cramping, bloating, abdominal pain, fever, and diarrhea, with or without blood. With time, ulcerations and fissures may form around the rectum and anus. The symptoms of ulcerative colitis are almost identical, and both conditions feature inflammation and ulceration. To make the diagnosis, it is important to be tested, but the natural treatments for both are quite similar.

It is not known precisely what causes either condition, but autoimmunity is a component of both diseases and food allergies are thought to contribute in some cases. Some doctors suggest that yeast overgrowth in the intestinal tract is another contributing factor.
Conventional treatments include anti-inflammatory drugs, drugs for diarrhea, and steroids (prednisone) for more intense symptoms. In many cases, patients go on to have surgery to remove diseased sections of bowel, and sometimes they have to have a permanent colostomy or ileostomy with a bag. Some patients are also treated with immune suppressant drugs.

Natural Remedies for IBD

You may not need any of these treatments with the right diet and supplement program, plus some exercise and stress management. However, these approaches also may work well combined with conventional treatment, reducing the necessary doses of medications.
A diet that is low in land-animal fat (as opposed to fish) and hydrogenated oils may help reduce the tendency to inflammation. A 1997 review revealed an increased risk of IBD in people who consumed higher levels of fat, especially animal fat, cholesterol, and sucrose. A lower risk was seen in people who consumed more fluids, fruit, magnesium, and vitamin C.

A Japanese reveiw in 1996 showed similar correlations. In this study, the risks were increased by total fat (including conventional vegetable oil), animal fat, animal protein, and milk protein consumption. While the strongest correlation with increased risk was with animal protein, the lowest risk was associated with vegetable protein intake.
For general health, it is wise to include a wide variety of fresh vegetables and fruits in the diet. Also, you should not be afraid of fiber. It is more important to avoid junk and highly processed sugary and fatty fast foods. Also include whole grains and beans to your diet.

Unlike land-animal fat, flaxseed and fish oil contain fatty acids that reduce inflammation. Flaxseed (which has not been studied as much as fish oil) can be taken either as freshly ground seeds (in juice or smoothies), or as organic oil in capsules, or as liquid in salads or on cooked vegetables or potatoes. (Keep it frozen until it is opened, and then in the refrigerator to slow the oxidation until it is used up.)
Fish oils contain the fatty acids EPA and DHA, and are usually taken in capsule form, up to 10 to 12 per day to get the effective dose. Sometimes a lower dose is adequate. These fatty acids also help with other autoimmune disorders, including rheumatoid arthritis, lupus, and others.

Other Supplements for IBD

Vitamn C is depleted by inflammatory disease. Intestinal mucosal membranes are damaged by free radicals during inflammation and their vitamin C status declines, so supplements can help provide protection. I usually recommend at least 4 to 6 gms daily, although intravenous doses are often helpful as vitamin C has anti-inflammatory effects.

L-glutamine is an important dietary supplement in any bowel disorder. This amino acid supports normal immune function and white blood cell production, recovery from surgery, burns, and trauma, protection of tissues exposed to radiation, and improving function in patients undergoing cancer treatment.

Typical glutamine supplements are 4000 to 8000 mg daily, but some severe inflammatory bowel disease might require even higher doses.
In animal studies with experimental colitis, curcumin, one of the spices in curry, helps as an anti-inflammatory and an antioxidant. These studies from India and Japan suggest that curcumin, with its high level of safety, should be considered as part of a comprehensive treatment program for IBD.

Probiotic supplements, or “friendly bacteria” help to repopulate the intestinal tract with beneficial organisms (“normal flora”). These supplements include Lactobacillus acidophilus, and Lactobacillus bifidus (bifidobacteria). They support immune function, protect against infections, help treat diarrhea, and control ulcerative colitis.
High-quality probiotics have about 10 billion organisms per gram. Typical supplement doses are 10 to 40 billion organisms. I usually recommend a mixture of L. acidophilus and L. bifidus in equal amounts. These supplements help restore normal organisms after antibiotic therapy.

Nutritional status tends to be depleted in IBD. Taking a good multivitamin/mineral is essential to maintain basic health, immune status, and recovery ability. Common one-per-day supplements are never adequate in a variety of nutrients, beyond prevention of serious deficiency diseases. A higher potency supplement, usually requiring 4 to 6 pills a day is better (One example is Ultra Vitality, from QCI Nutritionals.)

Ask Dr. J: Insomnia

Q. I have difficulty getting enough sleep at night. Are there any drug-free treatments for this?
-- HS, Tokyo, Japan, by Email

A. Insomnia is a common health problem. Lack of adequate sleep leads to depression, fatigue, poor concentration, and poor physical stamina. Some people can’t fall asleep, while others are able to fall asleep easily, but they wake early and cannot go back to sleep.

Psychological problems, stress, poor diet, lack of exercise, obesity, low back pain and other pain syndromes, smoking, caffeine, and even food allergies, can all contribute to insomnia. Alcohol consumption can also disturb sleep patterns. Of course, when people have sleep problems, and can’t stay awake for their work, they tend to take more caffeine to maintain their alertness, and this can perpetuate the problem.

Most sedative or anti-anxiety drugs used to treat the problem, such as Valium, Restoril, Serax, or Ambien, may have side effects, including fatigue, headaches, dizziness, and nausea. They also lose effectiveness if taken consistently.

The best approach is to eat a healthy diet. Avoid sugary/fatty foods foods, caffeine, alcohol, and any known food allergens. It is also important to address the underlying physical or psychological problems, and to get more regular exercise.

Supplements may also help with insomnia, without the side effects of medications. Magnesium is a relaxant, and is commonly deficient in the diet. I often suggest 200 to 400 mg at bedtime. The amino acid, 5-hydroxytryptophan (50 to 100 mg) is also helpful as a precursor to serotonin, which reduces anxiety.

Melatonin, is a hormone from the pineal gland that controls the body clock, and supplements (3 to 6 mg) often improve sleep. Valerian (400 to 600 mg of standardized extract) is as effective as the medications, but without side effects.

Numerous studies still show the advantage of a high-complex-carbohydrate, mostly-vegetarian diet for health, longevity, and less obesity, cancer, diabetes, and heart disease mortality.

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References

Drug (Pharmaceutical!) Crime:

Reuters, June 20, 2003 AstraZeneca to Pay Cancer Drug Fine

Inflammatory Bowel Disease:

Simopoulos AP, Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr 2002 Dec;21(6):495-505.

Ergas D, et al., n-3 fatty acids and the immune system in autoimmunity. Isr Med Assoc J 2002 Jan;4(1):34-8.

Reif S, et al., Pre-illness dietary factors in inflammatory bowel disease. Gut 1997 Jun;40(6):754-60.

Buffinton GD, Doe WF, Altered ascorbic acid status in...inflammatory bowel disease patients. Free Radic Res 1995 Feb;22(2):131-43.

Biondo-Simoes Mde L, et al., ...inflammatory colitis treated with an elemental diet, glutamine and 5-ASA. An experimental study in rats. Arq Gastroenterol 1998 Apr-Jun;35(2):116-25. (Portugese)

Lacey JM, Wilmore DW, Is glutamine a conditionally essential amino acid? Nutr Rev 1990 Aug;48(8):297-309.

Ameho CK, et al., ...glutamine supplementation on interleukin 8 and tumour necrosis factor alpha...in...colitis. Gut 1997 Oct;41(4):487-93.

Paulo FL, Effects of oral supplement of L-glutamine on diverted colon wall. J Cell Mol Med 2002 Jul-Sep;6(3):377-82.

Klimberg VS, Souba WW, The importance of intestinal glutamine metabolism in maintaining a healthy gastrointestinal tract... Surg Annu 1990;22:61-76.

Souba WW, et al., Oral glutamine reduces bacterial translocation following abdominal radiation. J Surg Res 1990 Jan;48(1):1-5.

Ukil A, et al., Curcumin...reduces mucosal injury in...colitis. Br J Pharmacol 2003 May;139(2):209-18.

Fujiwara M, et al., Inhibitory Effects of Bifidobacterium longum on Experimental Ulcerative Colitis... Digestion 2003;67(1-2):90-5.

Macfarlane GT, Cummings JH, Probiotics, infection and immunity. Curr Opin Infect Dis 2002 Oct;15(5):501-6.

Ask Dr. J: Insomnia:

Janson C, et al., Insomnia in men-a 10-year prospective population based study. Sleep 2001 Jun 15;24(4):425-30.

Ziegler G, et al., ...valerian...in the treatment of non-organic insomnia... study. Eur J Med Res 2002 Nov 25;7(11):480-6.

In the Health News

Whether or not you have diabetes, it appears that laughter reduces the usual rise in blood sugar after meals (poorly controlled sugar increases risks for heart disease, blindness, and kidney disease). Laughter has many benefits, improving immunity, circulation, and mood. (Hayashi K, et al., Laughter lowered the increase in postprandial blood glucose. Diabetes Care. 2003 May;26(5):1651-2; reported in Reuters Health, May 22, 2003.) Watching funny movies or listening to humorous CD’s are good meal accompaniments.

Stress reduction and positive attitudes really do make people happy. Buddhists studied in India had brain scans indicating that they were tranquil and happy (Flanagan O, The colour of happiness. New Scientist, 2003 May 24;178(2396):44). This and other studies indicate that mindful meditation is associated with positive emotions, and can reduce fear and anger. Meditation appears to be effective not only during the practice, but also throughout the day. Treating depression with drugs does not make people happy.

Diet and Disease

Women in Japan who consumed the most soy isoflavones (genistein) and miso (fermented soy) had the lowest risk of breast cancer. Yamamoto S, et al., Soy,isoflavones, and breast cancer risk in Japan. JNCI, 2003 Jun 18;95(12):906-13. The highest consumption led to a 50 percent reduction in risk. Women with the lowest soy intake consumed 250 times more genistein than Western white women, their breast cancer rates were lower than in US women. Be careful, though,miso is high in salt. Dietary soy is particularly protective when consumed during adolescence. Studies of adults have been inconsistent. An earlier study showed that soy intake halved the risk of death from gastric cancer (Nagata C, et al., ...soy product intake and stomach cancer death. Br J Cancer 2002 Jul 1;87(1):31-6).

Recipe of the Month: Cold Cucumber-Yogurt-Dill Soup

Although I was eager for the warm weather to arrive, now I want to cook as little as possible (but still enjoy delicious foods). This recipe is a variation of a Mediterranean staple. I use English cucumbers, as they are seedless and usually unwaxed. Shred the cucumbers, and add them to an equal amount of non-fat plain yogurt, with a little water and fresh lemon juice to make it a soupy consistency. Add some crushed garlic, a small amount of flaxseed oil or extra virgin olive oil, a dash of cumin, ground pepper, and chopped fresh dill. Stir all this together, and garnish with sliced fresh scallion greens and crushed walnuts. You can use almost any fresh herb (oregano or mint are both great). If you prefer, you can substitute plain soy yogurt for the dairy.

 


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CONSULTATIONS:

From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

I primarily do phone consultations, as well as email and instant messaging consults.


Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.

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