A study published this month in the journal Pediatrics challenges this food introduction strategy. In fact, the authors of this study found that the longer the delay in adding several categories of foods, the more risk of allergy and asthma by the age of five.

This new study followed 1000 Finnish children from birth to age five. In addition to tracking food introduction data, the authors measured blood levels of IgE, a class of antibodies associated with allergy.

After correcting for key variables in the data, including maternal age and smoking habits, income, and household pets, the authors found that the longer the duration of exlusive nursing, the higher the risk of developing both food and inhalant allergies.

The level of evidence for the exclusive six month nursing recommendation has always been a little slight. Largely, it was based on a theoretical understanding of the maturation process of the intestinal barrier. Previously published clinical trials have been inconsistent, although they have not challenged current regulations in the way this newest study does.

There is one potential issue that makes this study hard to extrapolate to the whole population, however. The children enrolled all were considered to have high risk of diabetes due to specific mutations in HLA, an important gene that helps to control immune system function.

Because of this particular irregularity, I think it is probably premature to change guidelines around nursing. Still, I think this piece of information makes it hard to support a belief that early introduction of solid foods significantly increases the risk of allergy down the road.

A new report presented at the American Society of Nephrology meeting this week may change this consensus, however. The new study analyzed 3200 women from the Nurses’ Health Study, finding that the risk of significant decline in kidney function was much higher in older women drinking two or more artificially sweetened beverages daily.

This association reportedly held true even after correcting for high blood pressure and diabetes, two of the most common reasons for kidney disease in Americans. Although the beverage industry notes that hypertension and diabetes account for the majority of kidney disease cases, diagnosis of kidney problems has risen dramatically from about the time aspartame came on the market. At least some of these cases of kidney failure are not explained by the increases in diabetes and hypertension incidence.

These results are still preliminary in the sense that they have not been published in full in a peer-reviewed journal. Also, as the interviewed nutritionist notes in the linked article, the Nurses’ Health Study depends on food frequency questionnaires, an imperfect way of determining diet intake. We’ll probably need to see a few more studies like this to confirm that this relationship is a real one.

Another item not clear from the linked news report is which diet beverages these women were drinking. Since the data were gathered based on questionnaires sent out in 1984, 1986, and 1990, it seems likely that aspartame is the most frequently used item. Sucralose, common in beverages today, was not approved until nearly a decade after the last data collection. Saccharin was available during this time period, as well, but sales appear to have been less than for aspartame. This is all speculative, however, and this study likely did not collect data on specific sweetener types.

I am not a big fan of diet drinks. There has been evidence that diet drinks can impair satiety, causing people to eat more calories than they otherwise should. But if this report holds up to further scrutiny, the responsible beverages really should be banned.

This, by the way, might be the LEAST timely (pun sort of intended) health news article of the year.

Source.

Here’s the problem: I think in the CAM community, our conception of “detoxification” has slipped out of a mechanistic / descriptive sense, and into a bit of mysticism. I am working on trying to put together a framework of understanding at a purely mechanistic level, and banging my head against the wall pretty badly.

I think this is partly because the concept of detoxification is also the concept of bioactivation and signaling control. Same enzymes, same organs, same controls, just different substrates. As such, if you start intervening with one process, you’ve gotten into all three. The level of complexity once you’ve gotten here is well beyond our current research understanding.

Second, it seems pretty clear to me, at least this morning, that the phase II level of detoxification is a much more safe place for intervention than the phase I level. But the phase II pathways are so redundant, overlapped, and genetically variable that understanding in a targeted manner where and when to intervene is not at all clear as a clinician. This leaves shotgun prescribing for each phase II substrate as the only viable and scientifically sound strategy in most situations. Which takes us back to the first point - increasing clearance of everything may have unintended consequences that counterbalance the benefits of elimination of xenobiotics.

This is giving me a headache.

Blood mercury levels in both autistic children and typically developing controls were similar those found in previous population samples in the age group, and on average were far below levels toxicologists consider dangerous.

Perhaps predictably, these advocacy groups have suggested that methodological problems make this research less than meaningful. As the study critics have pointed out, there is no perfect screening test for mercury exposure, limiting the level of proof demonstrated by this type of study. Still, the emerging scientific picture is not fully consistent with mercury as a major causative agent.

One aspect of this EHP study that will probably be lost in the concerns about validity of the screening test is that finding that mercury levels are best correlated with fish intake. While advocates have largely focused on mercury exposure from vaccines, a single serving of canned tuna on average contains as much or more mercury as found in thimerosal-containing vaccines. Dental amalgam was also positively associated with mercury exposure in a subset of the children who either regularly chewed gum or showed teeth-grinding behavior.

The study author, interviewed by Reuters, indicated that this study suggests that autism is likely to be caused by a number of different factors rather than a single catastrophic environmental exposure. I’d argue that this study showed no such thing, just a lack of strong association with circulating levels of mercury. Otherwise, I think we continue to need to be open to any new potential explanations that surface.

Which brings me to my central beef with the mercury / autism hypothesis… The certainty I hear these patient advocacy groups express not only defies reason, but it also acts to shut down inquiry into new and potentially fruitful directions.

Estimates of autism prevalence prior to 1980 were below 0.05%. By the early 2000s, widely publicized estimates went as high as 0.7%. There is currently no scientific consensus on the reason for this dramatic change.

This new paper does appear to put the final nail in the coffin of the hypothesis that the increase in prevalence is due to increased awareness of the condition and improved diagnostic methods. Of the 1.1% of children with autism, 17% (0.2% of the population) were reported to be severely affected. Since it is hard to imagine severely autistic children evading diagnosis, the observation that severe autism is 4 times more prevalent than any autism was a generation ago is a compelling argument for a more immediate cause.

Increases in autism prevalence may also necessitate revising the current belief that the condition has a largely genetic basis. Twin and sibling studies have demonstrated a higher prevalence than the general population, indicating a likely genetic component. Still, genetics alone would have difficulty explaining such a dramatic prevalence spike.

Personally, I believe that there is so much noise in the conversation about toxins in the environment that it gets hard to hear the true signal (signal to noise ratio is radio engineering lingo for you young-’uns). This link is pure signal, no noise.

Thanks to the Breast Cancer Resource Center of Tacoma for bringing this one to my attention.

I’m about to say something really controversial here: a little rationing would probably be a good thing in many ways. Let me give an example.

In 2007, the FDA approved a drug called ixabepilone for the treatment of metastatic breast cancer. This approval was based on research like this study. In this research, we see that the average progression-free survival improved by a little more than a month when the new drug was added to an old regimen.

Of course, adding another medication leads to an increase in potential toxicity. In this case, we at least three times as high an incidence of severe neuropathy, fatigue, and low blood counts with the additional medication. Most alarmingly, we saw an increase in treatment-related mortality from 1% to 3% with the additional medication.

So, on the balance, we are trading a month delay in disease progression for a number of significant side effects. And one in fifty people to try the more aggressive treatment will be killed by it. Since these clinical trials tend to have aggressive exclusion criteria that push numbers toward better survival (e.g., they often exclude things like brain metastasis and abnormal liver or immune function), that month delay in disease progression is probably a best-case scenario.

Does that sound like a good risk / benefit trade-off? Now consider that the second medication adds $30,000 to total treatment cost. It shouldn’t be a big surprise to hear that the European regulatory agencies rejected this medication based on the same available data.

I don’t mean this specific example in any way to be a rant against conventional medicine treatment of cancer. It could just as easily have been chosen from any number of medical specialties. I have been thinking about the issue of expensive end-of-life care a lot over the last week after seeing this week’s Newsweek magazine cover story (The Case For Pulling the Plug On Grandma!). I’m really hoping that somebody will soon summon up the fortitude to start talking about this issue, not just in oncology journals, but in the public square.

Here’s a thought experiment for anybody who has made it this far: if I had a CAM therapy for cancer that cost $30K (more than the median income for a single adult in my state), had significant toxicity, and best-case scenario added a month to life expectancy, would you consider me a hero or a charlatan? From the other direction, is it a noble or cruel thing for doctors to offer a very expensive and dangerous treatment to a dying patient knowing that it has at best a marginal effect?

For the most part, my complaints aren’t all that sophisticated. Many of the low-fat packaged foods replace the lost flavor with extra salt. Organic frozen packaged foods are nearly as nutritionally bereft as their conventionally-grown counterparts. 

But then there’s this.  I see this product in pretty much every grocery story I go to (and I’ve got about 5 in heavy rotation). It is made from a soil fungus noted for its toxicity. I have been aware of complaints from consumers for nearly a decade, and pretty much since it came on the market. And it is still being sold as a health-food alternative to eating meat.

I’ve been a vegetarian for more than 15 years, and I’d probably still rather have fast-food hamburgers before eating soil fungus burgers.

Instead, the film turned into a grab bag of hot button issues in modern health - vaccines, amalgams, GMO foods, etc. Watching this stuff unfold on the same day as the march on Washington by opponents of the health care bill, I was struck by just how cynical Americans have become.

When I was growing up, scientists and doctors tended to be thought of (at least by those I knew and learned from) as people of high integrity. I no longer believe this to be the case. Among the points made in this film, with no rebuttal from academic or industry points of view:

• vaccines are widely known to be dangerous and toxic, and are routinely being used on our children as a way to fill the pockets of drug companies
• the Gerson Therapy is one of many (otherwise unnamed by the director) alternative therapies for cancer that were suppressed by the American Cancer Society to make sure physician and drug company profits stay strong
• dental amalgams give off more mercury vapor than the OSHA industrial standards would allow in the workplace
• the American Dental Association will strip licensure from any dentist who doesn’t recommend amalgam fillings for each filled surface

Now, there may be a kernal of science in some or all of the claims above (albiet a pretty small one), but taken together, the world view expressed is a downright paranoic one. We’ve clearly come a long way from the time when Salk and Sabin or Watkins and Crick were among the most trusted and admired of Americans.

Where did all of this mistrust come from? Can it still be undone? What is the role of the CAM provider in maintaining or undermining trust in the conventional medical community? If anybody can provide me a workable answer for one or more of these questions, I’ll feel better about paying $3 to rent a film that was frankly pretty disturbing.

This new research trial was elegant in its simplicity. The authors surveyed the clinicaltrials.gov website for all registered clinical trials between 1999 and 2007. Of these, they took a randomized subset of 10% of the 7515 total research trials. After eliminating incomplete trials and CAM studies (!), they were left with 677 data points.

Of these 677 trials, only 311 (or 46%) had been published. Of the studies sponsored by industry, only 40% had been published.

Of course, it would be useful to know why so many of these results go unpublished, and how all of these missing data would impact current medical practice. The authors provided a few clues.

One more benign explanation is that many of the trials were not posted with an end date, and included other clues that they were meant more for preliminary information gathering than for publication. Presumably, these trials would be followed up with more formal research meant to educate the physician community.

The fact that 70% of the studies reviewed presented positive results does suggest that publication bias may be at work, as well. As anyone who has ever considered a career in medical research would probably attest, publishing positive results is pretty much imperative for career building. And, of course, the pharmaceutical and device industries may have financial incentive to not share inconclusive data.

It is very difficult to know exactly what to do about these findings, even though they are consistent with a number of previously published studies on the subject. But it seems likely that there are treatments used routinely in clinical practice that might not be indicated if clinicians had access to a more full research picture. In the worst case scenario, there are research trials tucked away in the vaults showing that routinely used treatments are potentially dangerous. If this sounds like conspiracy theory, note that Merck in-house documents demonstrate that the company was aware of potential cardiovascular complications from the medication years before this information was shared with physicians.

As an aside, it was not clear why the researchers chose to exclude CAM studies from their analysis. It was interesting to see that less than 1% of registered clinical trials in this country looked at CAM interventions. I’d be very interested to see if these trials were published at a rate similar to the conventional medicine studies.