Here’s an interesting news item. I don’t really have anything to add, other than it is nice to read this presented so matter of factly, rather than as some sort of flaky experiment. Well, that and then the fact that they spelled doctors wrong in the header (do they need a new medical proofreader)?
Can any historically-minded readers tell us when the last example of acupuncture treatment of soldiers would have occured? Would it have been modern China, or perhaps much longer ago?
I just completed writing a monograph on a marker of DNA damage in the body called 8-OHdG (8-hydroxydeoxyguanosine). I was quite surprised to find how useful lab tests checking for this compound are for assessing the level of DNA damage in the body. I expect tests for 8-OHdG will soon be available commercially. We are now incorporating this test into our artificial intelligence system.
8-hydroxydeoxyguanosine (8-OHdG) is produced when the DNA innuclear or mitochondrial DNA is damaged by free radicals created inside the body or absorbed from food. When the DNA is repaired, 8-OHdG is released and since it is water soluble, is excreted in the urine, so it can be easily measured. High amounts of 8-OHdG in the urine is a biomarker indicating that cells are under too much stress from free radicals, and is therefore a risk factor for many diseases, including cancer, atherosclerosis and diabetes.
The amount of 8-OHdG your body produces is primarily determined by your diet, lifestyle and environmental toxin exposure. Smokers have as much as 300% more than non-smokers, those who live in polluted cities have almost twice the levels than those living in rural settings, and there is a direct correlation between urinary 8-OHdG and mercury exposure (those with the highest level of mercury exposure have 5-times the levels of urinary 8-OHdG).
Fortunately, you can reduce your levels of 8-OHdG by enjoying a diet rich in colorful fruits and vegetables (especially those that are blue/black), almonds, the spice curcumin, and green tea. Supplementation with coenzyme Q10 also helps lessen your body’s production of 8-OHdG.
Wu LL, Chiou CC, Chang PY, Wu JT. Urinary 8-OHdG: a marker of oxidative stress to DNA and a risk factor for cancer, atherosclerosis and diabetics. Clin Chim Acta. 2004 Jan;339(1-2):1-9
Bisphenol A (or BPA) is a chemical used in the process of making plastic. It is one of the key building blocks of PVC, which is in turn used in pipes, cans, drink containers, and other similar products.
About 93% of Americans undergoing a spot urine test will spill measurable amounts of BPA. This chemical has been linked to some potential detrimental effects, most importantly an ability to exert an estrogen-like effect. It is this potential for hormone-like activity that makes this recent study so concerning.
Previous research studies have determined that single doses of BPA, while having potentially detrimental effects, clear out of the body very quickly (with a half-life of 2-4 hours). The new report, looking at a chronic exposure model rather than single dose, concluded that the half-life is likely to be much longer, perhaps more than a single day. More alarmingly, people at the highest concentrations of BPA didn’t appear to demonstrate any correlation between serum level and last exposure time. (warning - this gets pretty detailed below the break)
Well, I’ve seen it again. As many of you probably know, my practice is largely made up of patients undergoing conventional cancer care looking for integrative medicine options to complement their treatment. Last night, I saw another patient in what has become a very disturbing pattern - people who forego potentially curative treatments for experimental options as suggested by a non-oncologist provider. Unfortunately, because my visit last night is very likely to involve a legal battle and/or licensure challenge, I don’t think it is appropriate to discuss any particulars in a public forum.
Instead, I’d like to open up some questions to my colleagues: where do we draw a line in the sand that separates responsible CAM care from egregious fraud? How do we simultaneously protect patient rights to choice and informed consent without taking options off the table (or are there options we should be taking off the table)? Where is the line beyond which it is not ethical to charge a fee for an experimental treatment or evaluation?
These are questions where conventional providers have clear guidance, and a structure in place for situations where ethics violations occur. It is a bigger challenge to come up with an ethical standard for heterogeneous practices in the integrative medicine world, but I believe it can and should be done.
Part of my concern in this matter is righteous indignation pointed directly at providers who blur the lines between theoretical and proven, between curative treatments and a crapshoot. Part of my concern is that a single high profile case that blows out of control in a public forum hurts all of us in the CAM community. And a small part of my concern, but it needs to said nonetheless, is that the economic pressures seem to reinforce the most cavalier practices (patients like being told they can be cured, after all, even if the cure is far-fetched).
Two of my students made very astute and relevant comments about this case last night (and I couldn’t be prouder of them). One said, “gee, it sounds really easy to take advantage of people with cancer.” I think (hope?) her implication was that this is a horrible thing to do to a vulnerable person. The other student comment was a bit more complicated. To paraphrase, he said “forget for a second the distinctions between medical doctor, osteopath, naturopath, chiropractor - I think every one of us needs to personally consider whether we are being a responsible physician.” I humbly submit that the CAM fields need to do a little soul searching about this last point, especially as it relates to people living with cancer.
One of the most frequent questions I hear from patients in the teaching clinic is “should I eat an alkaline-forming diet?” Putting aside for the moment that alkaline-forming diet is a concept that seems to mean many things to different people, it is very difficult from the current scientific understanding to give a solid answer to this question.
Contrary to the claims found strewn around the internet, I think it is very clear that alkaline-forming diets do not make cancer go away. Sure, in a test tube, pH does influence cancer growth. But since tissue and blood pH are fairly stable in vivo, this is probably not a clinically relevant finding.
The one area where low pH diets do appear to have the potential to be damaging is in calcium metabolism. A recent meta-analysis in the American Journal of Clinical Nutrition shows that the more acid the urine, the greater the calcium loss. This finding does not appear to be related to any measuring error (like the increased ability to measure calcium at lower pH), and appears true across a wide range of pH measurements.
A popular CAM book recently recommended strict carbohydrate restriction for people living with diabetes. This recommendation was not consistent with the current American Diabetes Association (ADA) standards, which suggest a carb intake of 45-65% of total calories. Until this month, there have been no studies to evaluate the safety or efficacy of this strategy beyond one year.
The new study, published in this week’s American Journal of Clinical Nutrition, retrospectively analyzed data from the Diabetes Control and Complications Trial. What they found was that over a five year period, type 1 diabetics eating more fat or less carbohydrate had higher hemoglobin A1c (HbA1c) levels (indicating worse diabetes control) than people who stayed close to ADA guidelines.
Doctors and researchers have been struggling for a while now to come up with a reliable and inexpensive screening test to identify excessive oxidative stress. There are several interesting possibilities, including urinary 8-hydroxyguanine and RBC glutathione. Unfortunately, these tests are difficult to obtain, and normal ranges are not well established.
Luckily, however, there is a test that many of us find on a standard serum panel that can give information about oxidative stress. That test is gamma-glutamyltransferase, or GGT. GGT is involved in the cellular metabolism of glutathione, and production is upregulated as endogenous glutathione levels go down.
The problem here is that other issues, particularly alcohol-related liver damage, tend to push GGT levels up. Patient history and other liver enzymes may help to distinguish whether hepatotoxicity is the source of the increase.
GGT elevations, even within the normal range, have been identified as independent risk factors for diabetes and stroke. This association appears to emerge at levels of GGT above about 35 U/L, with 52 U/L as the upper bound of normal.
Like any other flawed screening test, a mild elevation in GGT shouldn’t be considered hard and fast proof of oxidative stress. But in the presence of confirming factors in the patient history, it may be another important piece of clinical information.
Some of you may have heard this already, but as we launch our blog, there is another prominent American moving into a new career. I spent a few minutes this morning reading about his plans for health care reform.
Since many of these items were extensively covered through the looooong campaign, there are few surprises here, but a couple items caught my eye. The first was blatant self-interest - the new adminstration promises to end the practice of “overcharging doctors for their malpractice insurance.” Forgive my cynicism, but I’ll believe it when I see it. Rising malpractice rates have been a primary reason why primary care medicine is a primarily difficult business model. Those of us in the CAM community have watched our malpractice rates go up at a rate of as much as 50% from year to year (if we can even find someone to cover us) as the insurance reimbursement for our services (if we get any at all) stays largely flat.
The drive to ensure that preventive services are fully covered is a noble one. It is not hard to see how that extended coverage could potentially benefit integrative medicine providers, many of whom provide largely preventive care. It is interesting, though, to see the continued conflation of prevention and screening. Screening tests like mammography and PSA do not prevent cancers - they diagnose them earlier, hopefully in more treatable stages. While screening can be a useful tool, I believe that moving our focus from prevention to screening undersells the importance of counseling good dietary and lifestyle habits at yearly checkup visits starting early in life. Until we get serious about real preventive care, we will not be equipped to reign in health care costs without reducing available services.
Welcome to the science blog for the Salugenecists research team. We will be using this blog to discuss concepts relevant to integrative medicine practice. Topics will include research update and commentary, political issues, controversies, and clinical anecdotes. We will welcome and value reader participation, including requests for new posting topics. Thanks, and check back frequently for updates.