Vitamins and Supplements - More may be worse!

Supplement companies are quick to advertise their unsubstantiated claims for success. Indeed, a small study that has marginal impact can lead to an explosion of vitamin recommendations (it was found that turmeric supplement in 13 mice resulted in a small improvement in their ability to run a maze; this article was quoted in many turmeric supplements as medical proof that it prevents Alzheimer's!!).

Now some reports have surfaced that certain vitamins can be harmful when used in excess; and excess can mean amounts just above therapeutic recommendations!

Could High Maternal Folate and B12 Levels Be Linked to Autism?

Although previous studies have found that adequate folic acid supplementation is associated with reduced autism risk, in this report researchers looked at the mothers' serum folate and B12 levels within 1–3 days of giving birth. Women with very high folate levels (above 59 nmol/L) had roughly twice the risk for having a child who developed autism, relative to women with lower levels. In addition, high B12 levels (above 600 pmol/L) were associated with three times the risk for autism — and if both levels were high, the child had 17 times the risk. So more may not be better!

http://www.eurekalert.org/pub_releases/2016-05/jhub-tmf050916.php

Calcium Supplements Linked to Dementia Risk

In a study released recently (Neurology 10.1212), using Swedish registries, researchers followed 700 women aged 70 to 92 without dementia at baseline. Roughly 14% were using calcium supplements at baseline, and about half were still doing so at follow-up 5 years later.

Some 59 women developed dementia during the study. Calcium use at baseline was associated with increased risk for dementia -- but only among women with a history of stroke or evidence of arteriosclerosis. This is definitely NOT a cause and effect, but suggests that calcium supplementation should only be used if there is a real indication and proof that it helps. Currently we do not even know that it prevents or helps with osteoporosis! Guidelines suggest no more than 500 mg per day.

Why are we paying so much for drugs?

Drug companies develop many life altering drugs that are desperately needed. However, they have managed to maintain profit margins of about 20% and up to 42%, substantially higher than other corporations of their size.

They do this through pricing and marketing. As a physician it makes me ashamed to note that most doctors succumb to these techniques to prescribe drugs where there are equivalent generics at far lower cost. And they also write for medication with little or no proven effect!

For example, in 2013, trials with two new (and very expensive) diabetes drugs, saxagliptin (Onglyza) and alogliptin (Nesina) — found no effect on preventing heart attacks and strokes even though they did lower the sugar a small amount. And we are not treating diabetes just to lower the sugars; we really want to prevent the complications; which these drugs apparently do not. Sanjay Kaul, a frequent FDA adviser, pointed out "So, we have a drug that yields modest glycemic efficacy [lowering sugar], is neutral with respect to cardiometabolic factors (lipids, weight, blood pressure), does not kill you or land you in a hospital, and yet is a blockbuster drug nearly five times over! What is the big news here? That it does not kill you or land you in a hospital? Or that it is a blockbuster drug nearly five times over without evidence of microvascular or macrovascular outcome benefit? Miracle of medicine or miracle of marketing?"

In a recent article in JAMA, it was found that substituting equally effective generic drugs could save $70 billion dollars from 2010-2012. Researchers interviewed 100,000 U.S. people about their prescription drug use. Over 3 years, an estimated $760 billion was spent on prescription drugs. Excess expenditure because a brand-name drug was used instead of a generic within the same class accounted for roughly 10% of total prescribed medication expenditure. One of the worst culprits was cholesterol drugs. In my practice I spend many visits changing patients from overpriced brand drugs (about $150-$200 a month) - usually prescribed by cardiologists - to generics (about $5 per month) that are equally effective.

It seems that physicians will never learn and we need to allow insurance companies and the government to negotiate with Big Pharma!

Advances in Medicine - Almost Magical

Medical science has been advancing by leaps and bounds, and here I describe some of the almost magical breakthroughs that will soon (hopefully) become available:

NanoParticle Vaccines

The recent outbreaks of Ebola and Zika virus has reminded us how difficult it is to treat and prevent viral illnesses. The most effective way we have is a vaccine, but these can take 6 months or more to develop.

A team at the Massachusetts Institute of Technology and Harvard created nanoparticles that contained a “payload” of RNA that coded for particular non-toxic viral proteins. Once inside the body, this RNA replicon can keep churning out that protein and lead to an anti-body response. Injecting mice with single doses of vaccines for influenza, and Ebolavirus provided long term protection to mice against lethal doses of each of those microbes, without adverse effects.

This would truly be an amazing advance!

Chahal JS et al., Proc Natl Acad Sci U S A 2016 Jul 19; 113:E4133

A Cure For Diabetes in a Single Treatment

The brain controls our appetites, and may have a weight thermostat setting that makes it difficult for us to keep the pounds off. A team of researchers injected a growth factor molecule into the brain of mice who had been bred to have obesity and type 2 diabetes. They expected a transient drop in sugar, but within one week, and before any significant weight loss, the mice were cured of their diabetes. They also continued to lose weight to a normal level and maintain a normal sugar level for 5 months!- this after one treatment!

The treatment also worked in 2 other animal models, and is effective if the molecule is inhaled rather than injected into the brain! Is this result too good to be true? Stay tuned.

Scarlett JM et al., Nat Med 2016 Jul 22:800

NanoParticles to Prevent Obesity

In humans, the much more prevalent white fat cells store fat, but brown fat cells burn fat. There are several molecules that can convert white fat into brown fat, but the restricting factor is how to get these molecules to their target.

Now, a team created nanoparticles with two properties: (1) they contained these molecules; (2) they adhered selectively to blood vessels of white fat. In obese mice, these nanoparticles homed to white fat, transformed white fat into brown fat, inhibited weight gain, and improved blood levels of cholesterol, triglycerides, and insulin.

Xue Y et al., Proc Natl Acad Sci U S A 2016 May 17; 113:5552

Trends in Obesity and the Worst Restaurants

Medical science has been struggling with the causes and ways to prevent obesity, which is one of the worst health issues in this country.

First, we need to once again address our diet! The Center for Science in the Public Interest has called out nine unhealthy dishes at restaurant chains in its annual Xtreme Eating Awards.

https://cspinet.org/news/dave-busters-uno-among-2016-xtreme-eating-award-recipients-20160801

One of this year's nine winners is the Whole Hog Burger at Uno Pizzeria & Grill, which has five types of meat and four types of cheese. It packs more calories than an adult needs in a day, along with six days' worth of sodium. This does not help!

In Golden NH et al., Pediatrics 2016 Aug 22, the researchers summarized some knowledge about obesity in children:

The following behaviors are associated with obesity and eating disorders in adolescents:

• Dieting: associated with a 2.0-fold increased risk for becoming overweight and a 1.5-fold increased risk for binge eating.

• Family meals: improve the quality of dietary intake and provide opportunities for modeling healthy food choices.

• Weight talk: comments made by parentsabout their own weight or to encourage their child's weight loss may be perceived as hurtful, even when well-intended.

• Teasing about weight by a family member.

To help prevent obesity and eating disorders, the report recommends pediatricians do the following:

• Discourage dieting, skipping meals, and diet pills; focus on healthy eating and physical activity rather than on weight.

• Promote a positive body image.

• Suggest more-frequent family meals.

• Encourage families to talk about healthy eating rather than weight.

• Ask overweight and obese adolescents if they are being mistreated or bullied; address issues with patient and family.

• Monitor weight loss in adolescents who should lose weight.

In addition, Trajkovski M and Wollheim CB., reporting in Nature 2016 Jun 9; 534:185, have found the the bacteria growing in the intestine of fat people is different than others, and suggest that this may be related to their diet, the antibiotics they took as children, and, specifically, certain proteins produced by these abnormal bacteria.

In another study, evaluating participants of the show "The Biggest Loser", (Obesity (Silver Spring) 2016 May 2), researchers found that there was an unusual adaption that led to regaining the weight easily. In the past, evolution selected for a trait that helped protect our hungry ancestors: In the face of substantial weight loss, our resting metabolic rate falls. We burn fewer calories, thereby discouraging further weight loss.

However, in fat people, their metabolic rate did not increase when they ate more calories, resulting in rapid weight gain. This may be a genetic adaption that can only be overcome by consistent exercise

Drug Price Rip Offs - Greedy Companies to Blame

Most of you have heard about the huge increase in the price of EpiPen (in the USA only). The company gives vague excuses.

An analysis in the Journal of the American Medical Association, JAMA. 2016;316(8):858-871, has revealed it is only a result of the greed of the pharmaceutical companies.

The researchers found little or no correlation between the cost of the development of a drug (pharma's favorite excuse) and its price in the United States. This country is proud(?) to have the highest price for pharmaceuticals in the world.

They assign blame to two major factors: protection from competition by manufacturers of generic versions and prohibitions against negotiating lower prices (as insisted upon by our heavily lobbied congress and senate). Also at fault are government-granted monopoly rights for new drugs and legal (and chemical) maneuverings to extend those monopolies.

The companies are found to charge whatever the market can bear.

You can also review the epipen controversy in the New York Times.

well.blogs.nytimes.com/2016/08/22/epipen-price-rise-sparks-concern-for-allergy-sufferers/