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September 2008

Vitamin D lowers diabetes risk
Acupuncture helps headaches
B12 may reduce brain atrophy
Obesity worsens asthma
Exercise helps cognitive function
Fish oil helps heart failure
Mediterranean diet improves health

Vitamin D lowers diabetes risk

An epidemiological (population) study in Finland showed that low vitamin D levels were associated with an increased risk of developing diabetes in the subsequent 22 years. The investigators evaluated data from two population pools of men and women aged 40 to 74 years when the initial data was collected from 1973 to 1980. None of the subjects had diabetes at the start of the study.

Over the 22 years, 412 subjects developed diabetes, and they were compared with 986 matched controls. Those men with the highest levels of vitamin D in their serum at the start of the study were 72 percent less likely to develop diabetes than those with the lowest levels. (Knekt P, et al., Serum vitamin D and subsequent occurrence of type 2 diabetes. Epidemiology. 2008 Sep;19(5):666-71.)

The relationship was not seen in women, perhaps because overall women tended to have lower vitamin D levels than men. Low vitamin D levels can interfere with insulin secretion, and other studies have suggested a relationship with diabetes.

Acupuncture helps headaches

A new German study shows that acupuncture combined with usual care for chronic headaches (both migraine and tension headaches) is significantly better than usual care alone in reducing symptoms. This is a much larger study than the one I reported in March showing that acupuncture was better than sham treatments in controlling migraines.

Researchers evaluated 15,056 patients who had either tension headaches or migraines at least twice a month for over a year. They received their usual medical care or acupuncture plus their usual care, and all were then evaluated after 3 and six months. Those who received acupuncture had a decrease in symptom days from 8.4 days per month to 4.7 days per month, while those in the control group had almost no change. (Jena S, et al., Acupuncture in patients with headache. Cephalalgia. 2008 Jul 2. [Epub ahead of print])

The acupuncture patients also had similar benefits in reduction in the intensity of their pain, and improvements in their health-related quality of life. The acupuncture treatments consisted of 15 sessions spread out over 3 months. The benefits that were seen at three months were maintained at six months. The benefits of acupuncture have been variable in other studies, as it is sometimes difficult to create controls, but the migraine study earlier this year showed benefits from acupuncture compared to sham treatments. How acupuncture works is not clear, but, in addition to its long history, numerous studies now show that it is effective for many conditions.

B12 may reduce brain atrophy

Vitamin B12 (cobalamin) is important for normal red blood cell formation as well as brain and nerve function. It is also essential for DNA metabolism and fatty acid breakdown to produce energy at the cellular level. A new study shows that low levels of vitamin B12 are associated with a loss of volume of the brain (atrophy).

The research evaluated 107 subjects from 61 to 87 years old at the start of the study, and they were followed for five years. By standard testing, they all had normal B12 levels, but differences were still apparent with higher and lower levels of the vitamin, as well as markers of B12 metabolism, such as serum levels of methylmalonic acid and homocysteine. (Vogiatzoglou A, et al., Vitamin B12 status and rate of brain volume loss in community-dwelling elderly. Neurology. 2008 Sep 9;71(11):826-32.)

At the end of the study, subjects with the lowest levels of cobalamin and the markers had a six-fold greater risk of developing brain atrophy than those with the highest levels, in spite of the levels all being within the accepted range of normal. This means that standards may need to be increased to prevent brain deterioration.

Even with normal B12 intake, intestinal absorption typically declines with age. Having a normal blood level does not mean that you are protected from functional decline. It is easy to take supplements but large doses may be necessary to overcome the poor absorption, or B12 can be given by injection. One sign of B12 deficiency is pernicious anemia, with enlarged red blood cells, but a blood level of B12 and its markers would be a much more useful test of adequacy.

Obesity worsens asthma

In addition to all its other dangers, a new report shows that obesity is linked to more severe asthma, more hospitalizations resulting from asthma, and a related lower quality of life. In an evaluation of 1113 subjects over 35 years old with asthma-related symptoms, those who were obese (body mass index, or BMI, greater than 30) were almost five times more likely to be hospitalized for asthma than those of normal weight. (Mosen DM, et al., The relationship between obesity and asthma severity and control in adults. J Allergy Clin Immunol. 2008 Sep;122(3):507-11.e6.)

In addition, the obese subjects had almost three times the rate of poor asthma control and triple the quality-of-life problems compared to those with a lower BMI. Obesity is associated with an increase in inflammatory markers, and this may be one reason that it raises the dangers of asthma.

Exercise helps cognitive function

If you need yet more motivation to exercise, Australian researchers have shown that increasing physical activity can slow down the decline in brain function seen with aging and degenerative disorders, such as Alzheimer’s disease. Between 2004 and 2007, 138 subjects with memory problems (but not dementia) were randomly divided into a control group with the usual care and an educational program, and a group put on a 24 week physical activity program. (Lautenschlager NT, Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA. 2008 Sep 3;300(9):1027-37.)

At the beginning of the study, at the end of the 24-week program, and after 18 months, all subjects were evaluated for cognitive function using an Alzheimer’s Disease Assessment Scale. At 24 weeks, the group on the physical activity program had improved by 0.26 points on the scale, while the controls had deteriorated by -1.04 points, making the absolute difference between the groups 1.3 points.

At the 18-month evaluation, those who had been on the physical activity program were still doing significantly better than the controls, although the differences had slightly lessened. The exercise group was 0.69 points better.

The exercise group was asked to do 150 minutes per week of physical activity, and it was most frequently a walking program. Overall, the exercise group averaged 20 minutes more per day of physical activity, so this is not an aggressive exercise program. More activity over a longer period of time might have led to even greater improvement.

Fish oil helps heart failure

Fish oil supplements can help patients with chronic heart failure. In an Italian randomized, double-blind study of 6975 subjects with New York Heart Association class II to IV heart failure (regardless of cause), half were given placebo and half were given 1000 mg of omega-3 oils (combined EPA and DHA from fish). Typical fish oil capsules contain about 30-50 percent omega-3 oils, so a 1000 mg dose would require 2-3 capsules per day.

The subjects were followed up for an average (median) of 3-9 years, looking for the length of time before they died from their disease or were hospitalized for heart problems. (Mozaffarian D, et al., Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet (online) 2008 August 31, 61239-8.)

They found that the fish oil provided an 8-9 percent reduction in either death or hospitalization for heart failure, which is a small benefit but was statistically significant. Had they given a more significant dose the differences might have been even greater. Typical doses for omega-3 supplements would be closer to 2000 to 3000 mg daily. In addition, along with a healthy diet and mild exercise a number of other supplements help heart failure, such as coenzyme Q10, carnitine, vitamin C, taurine, magnesium, hawthorn, and others.

Mediterranean diet improves health

In a meta-analysis of 12 international studies following 1,574,299 people for 3 to 18 years, data show that strict adherence to a Mediterranean diet can lead to a nearly 10 percent reduction in the development of a variety of chronic diseases. The findings showed an overall drop in mortality from all causes of 9 percent.

Among those who adhered to the diet most closely, specific improvements included a 9 percent decline in heart deaths, a 13 percent reduction in the incidence of Parkinson’s disease and Alzheimer’s disease, and a 6 percent lower rate of cancer compared to those who were not as careful about their dietary choices. (Sofi F, et al., Adherence to Mediterranean diet and health status: meta-analysis BMJ (online) 2008 September 11;337:a1344.)

The researchers used a scoring system to evaluate the strictness of adherence to the Mediterranean diet, which consists of large amounts of fruits and vegetables, beans, cereal grains, fish, and olive oil, and is very low in red meat, processed meat, dairy products, and saturated fats.

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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.