RESEARCH ROUND-UP

Clogged Plumbing and Heart Stent Overuse

“Although the image of coronary arteries as kitchen pipes clogged with fat is simple, familiar, and evocative, it is also wrong,” says Michael B. Rothberg, MD, MPH, in a 2013 commentary. That image, however, has led to the overuse of heart stents, small metal mesh tubes that are inserted in an artery during angioplasty. Using a heart stent to hold open and strengthen a blocked coronary artery can be lifesaving during a heart attack; but the procedure does not prevent heart attacks in people with stable cardiovascular disease – a fact most patients and some doctors do not realize.

As Rothberg points out, cardiovascular disease is not a plumbing problem that can be solved with a surgical Roto-Rooter. Angioplasty and heart stents address distinct constrictions or blockages in an artery. These procedures, however, do not address inflammatory damage that is occurring in other parts of the artery, damage that weakens vessels and can lead to rupture. In most cases, cardiac events occur at weakened areas that show little evidence of blockage. “Before rupture,” says Rothberg, “these plaques often do not limit flow and may be invisible to angiography and stress tests. They are therefore not amenable to percutaneous coronary intervention [angioplasty].”

Still, nine out of 10 patients undergoing elective angioplasty believe that the procedure will prevent future cardiac events, according to a small study conducted by Rothberg and colleagues. This erroneous belief is largely cultivated by the “old plumbing analogy” still used in advertisements and educational materials. Rothberg suggests a different analogy to help patients understand cardiovascular disease. He says that cholesterol deposited in arterial walls produces “an inflammatory reaction, like a pimple.” “When those pimples pop, they cause the blood in the arteries to clot at the site,” he explains. “If the clot closes off the entire artery, that causes a heart attack, and emergent medical attention is required to remove the clot.” Sometimes, old plaques, “like scarred old pimples,” partially block blood flow, producing pain. If medication does not relieve the pain, angioplasty is the next option for symptom relief.

Reducing inflammation through evidence-based lifestyle changes (smoking cessation, exercise, stress reduction, and a Mediterranean diet) along with anti-inflammatory medications are the “only effective measures” for preventing heart attacks, says Rothberg. Nonetheless, he expects the plumbing analogy and angioplasty overuse to continue, “… partly because it is difficult to admit that in the past we got it wrong and performed what now appear to have been unnecessary procedures, but also because our current payment system continues to reward interventions based on the old model and cardiac procedures are an important source of hospital revenue.” The average cost of angioplasty in the U.S. is about $30,000, according to New York Times reporter Anahad O’Connor.

• Rothberg MB. Coronary artery disease as clogged pipes: a misconceptual model. Circulation. 2013:6:129-132. Available at https://circoutcomes.ahajournals.org/content/6/1/129. Accessed February 14, 2014.

• O’Connor A. Heart stents still overused, experts say. New York Times. August 15, 2013. Available at https://well.blogs.nytimes.com/2013/08/15/heart-stents-continue-to-be-overused. Accessed February 6, 2014.

Food Sensitivities, Elimination Diets, ADHD, and Weight Gain

The idea that sensitivities to common foods such as wheat, dairy, eggs, and corn cause weight gain is gaining attention. British doctor John Mansfield in his book Six Secrets of Successful Weight Loss asserts that food sensitivities are “by far the commonest single cause of weight gain.” The cover of The Virgin Diet, written by certified nutritionist J. J. Virgin, states: “Why Food Intolerance is the Real Cause of Weight Gain.” Virgin’s program has seven foods to avoid: gluten, soy, dairy, eggs, corn, peanuts, and most sweeteners. Mansfield adds yeast, coffee, tea, potatoes, chocolate, oranges, onions, beef, and pork to the list of foods not tolerated by some people.

I was unable to find any research that links food sensitivity specifically to weight gain. Medical research is just beginning to allow the possibility that common foods can produce symptoms without inciting IgE antibodies. For example, a double-blind, randomized, placebo-controlled study, led by J. R. Biesiekierski, reported that gluten can cause gastrointestinal symptoms in people without celiac disease; but the authors had no idea why: “Non-celiac gluten intolerance may exist, but no clues to the mechanism were elucidated.” So, the theory that food intolerance contributes to weight gain may be true; research studies have just not been performed.

The elimination diet is most valuable for people with chronic health problems or for those who feel fatigued and sluggish. The diet allows people to identify foods that cause symptoms or reactions. A February 2011 Lancet study, for example, showed that a strict elimination diet is a valuable technique for identifying foods that cause ADHD symptoms in children. The elimination diet also gets people off of processed foods – at least temporarily. Most processed foods contain one or more of the foods commonly linked to sensitivities. Could the weight loss attributed to elimination diets be the result of avoiding processed foods and eating whole foods instead?

• Biesiekierski JR, Newnham ED, Irving PM et al. Gluten causes gastrointestinal symptoms in subjects without celiac: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. March 2011;106(3): 508–514. Available at www.researchgate.net. Accessed Dec.5, 2013.
• Hodgekiss A. Food sensitivity could be stopping you lose weight, says doctor who also claims low-fat diets can make you HEAVIER. October 11, 2012. Daily Mail. Available at www.dailymail.co.uk. Accessed November 14, 2013.
• Virgin JJ. The Virgin Diet. Don Mills, Ontario, Canada: Harlequin Enterprises; 2012.

Homeopathy and Asthma

Individualized homeopathic treatment reduced children’s asthma severity and need for conventional medications in a small 2012 observational study led by H. F. Shafei. Thirty children with diagnosed asthma, aged seven to 15, took part in the study. Asthma severity and bronchodilator and/or corticosteroid inhaler use were stable in the year before the children were referred to pediatricians at Egypt’s Homeopathic Clinic of the National Research Center (Cairo), according to Christopher Johnson, ND.

In addition to standard medications, children received homeopathic medicine that best matched their individual physical symptoms and mental-emotional expression. They were given a single dose of a polychrest in 200c potency and a “respiratory remedy” for daily use. Because polychrests affect numerous physical, emotional, and mental aspects, they are often used to support a person’s overall constitution. In this study, Calcarea carbonicum and Natrum muriaticum were the two most frequently prescribed polychrests. Both are associated with coughing and shortness of breath, but the personality profiles differ. Calcarea carbonicum is appropriate for children who tend to be obstinate and worry about their health and safety. Natrum muriaticum is the remedy for children who are hypersensitive to reprimands and want to be left alone when they don’t feel well. In contrast to the constitutional remedy, the respiratory remedy was in a lower potency (up to 30c) and taken daily to address coughing episodes. These remedies were chosen based on symptoms such as coughing triggers, associated pain, sound of the cough, type of mucus (if any), and time that coughing most often occurred.

After six months, the researchers assessed the effect of adjunctive homeopathic therapy by comparing asthma medication use and symptom frequency with baseline measures. At baseline, 33% of the children (n = 10) used inhalers more than once a day; 20% (n = 6) used them once a day; 40% (n = 12) used them two to six times a week; and 7% (n = 2) used them less than twice a week. “After six months of treatment,” writes Johnson, “not a single child was using their inhaler throughout the day and only 6% used inhalers even once a day.” Oral corticosteroid use also fell. Ninety percent of the children (n = 27) needed more than two courses of oral corticosteroid therapy a year before homeopathic treatment, compared with just 10% (n = 3) after treatment.

Symptoms also declined. At baseline, 30% of the children experienced asthma symptoms every day with an addition 23% experiencing symptoms “throughout the day.” By study’s end, only 7% had daily symptoms. None had symptoms that bothered them all day long. The only adverse event was “the appearance of transient skin papules which disappeared in 24 hours… after improvement of asthma symptoms. Most homeopaths would view this as an ‘aggravation’ of symptoms and a positive sign of healing,” says Johnson.

The next step, according to the Egyptian authors, is placebo-controlled study. (I hope these controlled studies, like this one, involve experienced homeopathic doctors.) Although they can save lives, conventional asthma medications have adverse affects, such as adrenal insufficiency, decreased growth, weight gain, delayed puberty, and hyperactivity. Competent homeopathic treatment could lessen the need for the drugs and thereby reduce children’s exposure to these risks.

• Johnson C. Asthma on the rise.: Homeopathy Today. Spring 2013;36
• Shafei HF, AbdelDayen SM, Mohamed NH. Individualized homeopathy in a group of Egyptian asthmatic children [abstract]. Homeopathy. October 2012; 101(4);224–230. Available at www.ncbi.nlm.nih.gov/pubmed/23089218. Accessed March 3, 2014

Forestalling Schizophrenia with Vitamins

About half of all cases of adult mental illness, including schizophrenia, are first diagnosed at around age 14, when the body is undergoing the stress of puberty. The physical, biochemical, and emotional changes of puberty are not the only stresses that contribute to mental illness, Victoria Costello explains in an article for Scientific American Mind. Costello wrote A Lethal Inheritance: A Mother Uncovers the Science behind Three Generations of Mental Illness. Genetics has a role. About 1.1% of the general population is diagnosed with schizophrenia, but that risk increases to 10% to 12% for their offspring. Drawing on experience with her son, Costello urges parents to be proactive in recognizing early signs of schizophrenia and in addressing factors that add stress to genetically susceptible children, factors such as bullying, physical abuse, and cannabis use. In childhood, Costello’s son had many potential indications of schizophrenia such as “impaired body sensations, reduced tolerance to stress, increased emotional reactivity, and, especially, social deficits.” As a teen, he withdrew socially and emotionally, lost his motivation, and developed sleep difficulties and a disregard for hygiene.

Costello urges adult family members to be proactive in protecting their children’s mental-emotional health, calling for transparency and responsibility. Family secrets shrouded in shame can pollute the emotional health of the family system; they need to be revealed. Parents who learn and use good communication skills can help strengthen their children’s mental health. Parents can also find ways to mitigate stresses linked to schizophrenia. By being aware of early signs of schizophrenia, parents can seek help early on. “The earlier the symptoms are noticed, the less invasive or onerous the treatment tends to be,” Costello writes.

Orthomolecular treatment is a viable alternative to pharmaceutical treatment, particularly in the early stage. In one of his last published articles for Journal of Orthomole-cular Medicine, Abram Hoffer, MD, PhD, along with coauthor Frances Fuller, RNCP (Cand), wrote about a 20-year-old patient who came to Hoffer’s clinic with his mother in 2007. The young man “had been diagnosed schizophrenic, or schizo-affective, and was on parenteral drugs.” Unlike conventional medicine that views schizophrenia as an incurable illness requiring lifelong pharmaceutical treatment, orthomolecular medicine uses high doses of vitamins and minerals to bring about recovery. Hoffer told this young man, “… schizophrenia genes are good genes if you feed them properly, which meant giving his genes the vitamins he needed, especially niacin.” In treating over 5000 people with schizophrenia, Hoffer observed that they “aged gracefully, hardly ever got arthritis and rarely got cancer.” Moreover, these people tend to be very intelligent, creative, and talented.

Suggested treatment for this young man included the avoidance of dairy products because of allergy signs that he displayed: dark rings under the eyes, white spots on fingernails, and drinking lots of milk. “Food allergies are trigger factors and have to be eliminated, as the constant inflammation of the gastrointestinal tract creates the ‘leaky gut’ syndrome and prevents the adsorption of nutrients, vitamins and minerals from the small intestine,” Hoffer and Fuller explain. Hoffer also told the young man to take several supplements at the end of his meals: niacin (starting dose of 500 mg t.i.d.), vitamin C 1000 t.i.d.; B complex 100 mg o.d.; vitamin D 6000 IU o.d. in winter and 4000 IU in summer for Canadians; omega-3/salmon oil 1 g t.i.d.; zinc citrate 50 mg o.d. The young man reported improvement within a few weeks.
“Orthomolecular treatment is sophisticated, effective and safe and not time-consuming as many more patients can be seen,” wrote Hoffer and Fuller. “Patients need not be seen as frequently because they recover, in contrast to those given only drugs. The saving in time and money is enormous; there is nothing more economical than recovery.”

• Costello V. A mind in danger. Sci Am Mind. March/April 2012: 31–37.
• Hoffer A, Fuller, F. Orthomolecular treatment of schizophrenia. J Orthomolecular Med. 2009;24(1):9–13. Available at https://orthomolecular.org/library/jom/2009/toc1.shtml. Accessed July 5, 2013.

Sleep Disorders and Vitamin D Deficiency

Is vitamin D deficiency the underlying cause of sleep disorders? S. C. Gominak and W. E. Stumpf argue that it is in their 2012 article for Medical Hypotheses. Vitamin D receptors are located in the same brain areas associated with sleep initiation and maintenance, particularly in the hypothalamus and brainstem. “Vitamin D is now commonly accepted to be … a steroid hormone,” they write. “It is the hormonal link that coordinates our metabolism, and the digestive, cardio-vascular, immune, endocrine, and reproductive systems to the sun.” People now spend less time outdoors, which means less exposure to sunlight, the primary source for vitamin D.

Over a two-year period, the two researchers observed 1500 patients with diverse sleep disorders (obstructive sleep apnea, REM related apnea, absent or reduced REM or slow wave sleep, insomnia) and headache upon waking. Patients, most of whom were vitamin D deficient, slept normally when their vitamin D blood levels stayed between 60 ng/ml and 80 ng/ml with the help of D3 supplementation. If blood levels dropped below 50 ng/ml or rose above 80 ng/ml, the patient’s original sleep problem returned. Supplemen-tation with vitamin D2 (ergocalciferol) actually prevented normal sleep in most patients.

“Our hypothesis, that vitamin D deficiency may be a primary cause of sleep disorders,” say Gominak and Stumpf, “should prompt clinical trials for patients suffering from several sleep disorders that have historically been very difficult to treat: primary insomnia, patients unable to tolerate CPAP, patients inexplicably tired on awakening.”

• Gominak SC, Stumpf WE. The world epidemic of sleep disorders is linked to vitamin D deficiency. Medical Hypotheses. 2012;79:132–135. Available at www.cenegenicsfoundation.org. Accessed August 15, 2013.

Fluoride and Arterial Calcification

Does fluoride contribute to coronary artery calcification? Studies over the past six decades have reported a connection between fluoride, calcium accumulation, and the aorta, according to Tara Blank, PhD. A limited number of human studies have reported coronary artery calcification and loss of arterial elasticity in people with endemic fluorosis. Elasticity loss and calcification are considered major predictors of cardiovascular events. In a 2010 study, fluorosis patients had significantly higher aortic strain index, indicating less elasticity in the ascending aorta, than controls. A 2013 study found that heart recovery rate index abnormalities were significantly higher in fluorosis patients compared with controls. Heart recovery rate index is a marker of autonomic nervous system function.

In a 2011 study, Yuxin Li and colleagues observed a relationship between fluoride uptake and vascular calcification in coronary arteries. They reviewed sodium 18F-fluoride PET/CT imaging data and cardiovascular history belonging to 61 patients who had received full-body scans at Veterans Affairs Greater Los Angeles Healthcare System in 2009–2010. Although sodium 18F-fluoride PET/CT is primarily used to locate ongoing bone formation, this technology can also identify atherosclerotic calcification, according to research by T. Derlin and colleagues (J Nucl Med. 2011;52:362–368). Derlin et al. found mineral deposits in carotid plaque that “significantly [correlated] with atherogenic risk factors,” according to Li et al.

In reviewing patients’ imaging data, Li and colleagues located 361 sites of fluoride uptake in major artery walls in 59  patients and 317 calcification sites in 49 patients. “Fluoride uptake either overlaps with calcification or locates adjacent to the detectable calcium deposits,” the authors state, “suggesting that fluoride uptake and detectable calcification represent different stages of the atherosclerotic process.” They found no significant correlation between the presence of coronary fluoride uptake and cardiovascular risk factors, possibly due to the small number of people involved. Only 42 of the 61 patients had more than one cardiovascular risk factor (hypertension, obesity, diabetes, high cholesterol, smoking history, coronary artery disease history). However, patients who had experienced one or more cardiovascular events had significantly higher coronary fluoride uptake than patients without a history of CV events. This study presents two avenues for further research: the use of fluoride PET/CT imaging as a means of diagnosing atherosclerosis, and increased fluoride uptake as a possible predictor of cardiovascular disease.

• Adali MK, Varol E, Aksoy F, et al. Impaired heart rate recovery in patients with endemic fluorosis [abstract]. Biol Trace Elem Res. February 2013. Available at www.link.springer.com/article/10.1007/s12011-013-9627-6. Accessed March 13, 2013.
• Blank T. Fluoride & arterial calcification. July 2012. Available at www.fluoride alert.org/studies/cardio02/. Accessed February 22, 2013.

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The above is reprinted with permission from Townsend Letter: The Examiner of Alternative Medicine. Visit: www.townsendletter.com