Monday, November 15, 2010

No Environment in Medical Practice

Most of us need little convincing that the air in urban environments is
polluted. Climates are changing. The belief that the food chain is contaminated with toxic chemicals is universal and readily validated. But, what branch of the medical sciences will responsible for the diagnosis and treatment of patients who suffer environmental disease? Who is studying and documenting the new patterns of illness that emerge from our deteriorating circumstances? Where do sick people with ill-defined illness get help? Who is changing the curricula of medical schools and teaching medical students what is really going on out there?

The underlying idea of medical practice is to receive the sick and injured, patch their wounds and alleviate suffering when there is no effective treatment.Whatever the determinants of injury and disease are, the doctor and the hospital are ready to attempt rescue you. It is up to you, dear reader, to investigate the causes of disease and to change your food and environment so that you are less likely to become injured and ill. Physicians who work in occupational medicine develop expertise in the toxicology of work environments. Government agencies such as NIOSH in the USA developed standards for limiting toxic chemical exposures and provided information about work hazards. The US EPA set standards intended to reduce air and water pollution but its policies and powers have been constrained by political interference.

Not much progress has been made in bringing knowledge of the environment into community medical offices and hospitals; in this regard medical practice reveals itself to be out-of-date and often irrelevant to the real needs of many patients. Instead the environment has come to hospital in the form of  destructive winds, floods and sudden unexpected changes in environments that people often assumed to be more stable and enduring. No medical specialty has assumed the responsibility of applying knowledge of environmental principles, ecology, or toxicology to all citizens. It is difficult for anyone suffering any sort of environmental problem or chemical toxicity to get even a cursory hearing from public health authorities or individual physicians. Lung disease is usually treated as an individual problem with little or no reference to the environment that people with lung disease share.
The only physicians directly involved in toxicology issues work in
occupational medicine and supervise working conditions in industries that expose workers to dust, molds,  toxic chemicals and other hazards. Here the emphasis is on preventing acute exposures to toxins in concentrations that are known to be harmful. Little is known about the long term effects of chemical exposure at low doses and there is a tendency for authorities to deny illness caused by chronic exposure.

Allergists intend to deal with some of the medical problems caused by the environment, but often limit their knowledge and practice to a few selected environmental problems, such as hay fever and asthma. Even though asthma receives considerable research attention, the contribution of indoor and outdoor air pollutants and allergy to food proteins is not well understood and ignored in medical practice. By narrowing the definition of allergy to type 1 hypersensitivity, allergists leave patients without help. Some physicians perceive the shortcoming of the medical system and begin to move toward a new methodology. Many years ago, Knicker, a prominent Allergist and Immunologist, stated many years ago, in a challenge to his colleagues: "The estimated group of 40 million citizens with classical allergies is possibly the most underserved of all diseases in the U.S; medical marketing surveys suggest that many atopic individuals are not yet diagnosed or are poorly treated. In addition, there are millions of other individuals who have unrecognized adverse reactions to various antigens, foods, chemicals, and environmental or occupational triggers." (Knicker WT. Deciding the Future for the Practice of Allergy and Immunology 1985 Annals of Allergy.55;106-113 )
Selner and Staudenmayer stated: "...Allergists typically have focused exclusively on the respiratory system, the skin, and the gastrointestinal tract, to the exclusion of other body systems. They are generally not familiar with the toxologic literature which suggests that attention must be paid to symptoms other than those characteristically anticipated with IgE-mediated allergic response. Allergists must broaden their interests to include all body systems other than those traditionally associated with immunological phenomenon if they are to appropriately respond to patients needs and society's expectations."
They referred to the need for a whole systems approach - a comprehensive approach to the interactions of food, air, and water with human bodies. While Knicker and others urged allergists and immunologists to emerge from the practice of narrowly defining their specialty, into the real modern world, with all its unsolved medical problems, the American and Canadian Allergy associations moved to further limit the scope of their practice and focused on skin tests for allergy and asthma as an allergic disease related to pollen and dust allergy. The needs of sick people were neglected while professional debates and methodological arguments continue to this day.

More Biology is Needed In Medicine
A biologist sees living creatures connected to and interacting with their environment. It is normal for a biologist to think in terms of populations, food supply, seasons, weather, and social-behaviors, and to do field studies which reveal patterns of adaptation to specific environments. Anyone who has worked with animals or fish in closed environments knows how critical environmental conditions and diet are in determining both the behavior and the physical status of the residents. When a fish in an aquarium displays disturbed behavior, you do
not call a fish psychiatrist; you check the oxygen concentration, temperature, and pH of the water. You have to clean the tank and change the fish diet.
A proper biological method of medicine recognizes and solves problems in food, air, and water supplies. A steady flow of molecules from the environment enters the body of each individual through the air breathed and the food and liquids ingested. This body-input determines health and disease in whole populations over the long-term and the moment to moment functional capacity of the individual. The quality and composition of air, food, and water changes continuously. The illusion of food continuity in the supermarket conceals changes in the growth, contamination, storage, spoiling, transportation, and merchandising of food products.

Air Quality Inside Buildings

Air pollution, both indoor and outdoor, is a significant cause of health problems worldwide. Home environments contain airborne allergens, infections, irritants and toxins that can reduce the quality of life and cause disease. Indoor work and living environments concentrate air contaminants and create "sick buildings."
Every year, approximately 1,000 new chemicals are developed and added to the 70,000 chemicals, 9 million mixtures, formulations and blends of chemicals already in commercial use. Some of these chemicals are purchased for home use, others pollute work environments. Workers contaminated with industrial and agricultural chemicals bring some home on the clothing and skin. Few of these chemicals have been adequately assessed for their potential toxicity, either individually or in combination with other chemicals. Indoor air is often more polluted than outdoor air.  A decrease in indoor air quality is the result of reduced ventilation and efficient construction practices, sealing homes and office buildings from the outdoor environment. Reduced ventilation contributes to the "Sick Building Syndrome" (SBS) with symptoms such a headache, fatigue, malaise, mental confusion, eye and throat irritation, coughing and wheezing.
Air inside buildings contains local aerosols that are more concentrated than outdoor air. The term "dust" refers to the larger particles in the aerosol that settle on walls and furniture. A smoker in the living room of a house produces a toxic aerosol that permeates the rest of the house. Smoke particles settle on walls and every object in a room so that a smoker leaves a trail of contamination that non-smokers smell as soon as they enter the room. Indoor air contains a living aerosol of microorganisms that infect or trigger allergic reactions. Spores of bacteria and fungi are microscopic and may persist for months or years. The abundance of microorganisms, even in a very clean house, surprises most people who have tests done to assess air quality. Insects and their excretions and body parts form part of the aerosol. Allergy to dust mites is often recognized. Other insects are common and are usually not recognized.
See Airborne Fungal Diseases

Chemicals Found in Indoor Air
Hazardous chemicals are used at home. Studies have shown that cancer risks from airborne chemicals can be higher for home environments than for hazardous waste disposal sites. The concentration of chemicals is determined by the airflow (or lack of it),heating appliances, the use of chemcials such as cleaners, perfumes, paints, adhesives, furnishings and the smoking habits of the inhabitants.
Common Indoor Airborne Chemicals
  1. 1,1,1-Trichloroethane Benezene
  2. Formaldehyde Alipthatic Hydrocarbons
  3. Chlordane Chloroform
  4. Styrene Trichloroethylene
  5. Toluene Xylene
  6. Dichloromethane Tetrachloroethylene
  7. Alcohols N-Hexanol
  8. Ethyl Acetate Acetone
  9. Radon 4-Phenylcyclohexene
  10. Carbon Monoxide Carbon Dioxide
  11. Polycyclic Aromatic Hydrocarbons
There are 80 or more main chemical components found in cigarette smoke and a wide variety of toxins created from the degradation and out-gassing of synthetic and treated materials and plastics. Indoor air is often a greater source of exposure to hazardous chemicals than is outdoor exposure according to a study by the US EPA. They looked for 20 chemicals in a variety of locations and found 11 chemicals at all locations -
1,1,1-trichloroethane, p-xylene, ethylbenzene, tetrachloroethylene, o-xylene, p-dichlorobenzene, chloroform, trichloroethylene, and carbon tetrachloride.

See Learn More About Air Quality

Wednesday, May 05, 2010

Brain Drug Warnings: Antipsychotic Drugs For Seniors

There is growing problem with inappropriate and excessive drug prescription to people over the age of 65. Physicians routinely prescribe anti-psychotic drugs to their aging patients; the benefits are doubtful and the negative effects are well established. In a review of physicians’ attitudes and prescribing practices, Damestoy et al stated: “The inappropriate use of medications by elderly patients has become a public health concern because of its prevalence and its potential impact on patient autonomy…physicians were unanimous in their view of the aging process as a very negative experience.”

In April 2010, the drug company, AstraZeneca, agreed to pay $520 million to settle US government allegations that it illegally promoted the anti-psychotic drug Seroquel (quetiapine fumarate) as a treatment for medical conditions for which it had not received approval — such as Alzheimer's disease, depression and sleeplessness. AstraZeneca's total sales of Seroquel reached $4.87 billion in 2009.

Fick et al stated: “A literature search will uncover articles that describe the toxic effects of medications and drug-related problems for older adults. It has been conclusively demonstrated that the toxic effects of medications and drug-related problems can have profound medical and safety consequences for older adults, with enormous economic consequences on the healthcare system…. If medication-related problems were ranked as a disease by cause of death, it would be the fifth leading cause of death in the United States. Therefore, the prevention and recognition of drug-related problems in elderly patients is one of the principal healthcare ( aka medicalcare) quality and safety issues for this decade… An extensive survey of the literature was conducted of all relevant medications used in elderly patients…This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity. “

Some of the drugs prescribed are tranquillizers and sleeping pills that add to memory loss and confusion, effects that are easily ignored in the elderly.  More potent mind drugs harm elderly patients. These drugs will not correct aberrant behavior, improve cognition or memory but almost inevitably will disable and further damage an already compromised brain. Patient demand has always driven the prescription drug industry to produce more chemicals and physicians are encouraged to prescribe these chemicals for "off-label indications". A well–trained physician will understand that psychotropic drugs are mostly useful for brief interventions and that long-term use is usually not desirable. Patients become dependent on psychotropic drugs and many demand renewed prescriptions over many years. Damestoy stated: “Many of the (elderly) patients had been using psychotropic medication for a long time, some for as long as 20 years. Patients with a strong attachment to anxiolytic drugs… become demanding and difficult when their use of psychotropic drugs was questioned.”

The path of least resistance for physicians is to enquire little and renew prescriptions automatically. In a study of 224 patients with a diagnosis of probable Alzheimer's disease, that risk of deterioration was significantly higher among patients who were taking antipsychotics or sedatives compared with those who were not on any drugs. Patients who were taking both antipsychotics and sedatives had the highest risk of rapid deterioration.

Antipsychotic drugs were developed to treat schizophrenia, a disease of young people. The “atypical antipsychotics,” clozapine, olanzapine, quetiapine and risperidone have all been used to treat elderly patients, especially those with dementia. There is no evidence that any of these drugs will alleviate dementia in any way. They are used, for example, as “chemical straight jackets” to immobilize nursing home residents. Among the problems created by these drugs are Parkinson’s disease, weight gain, and diabetes.  Janssen-Ortho, the company that markets Risperdal (risperidone), issued drug safety information bulletin linking the drug to increased risk of strokes in elderly patients. Since there is significant doubt that this drug should be used in any elderly patients, the increased risk of diabetes and stroke is a definitive contraindication. The strength of the association between antipsychotics and diabetes varies. A number of reports implicate chlorpromazine, clozapine, and olanzapine. An Ontario study involving 20,000 patients in nursing homes revealed that 25% of the residents are prescribed antipsychotic medications within the first year of admission. I would suggest a more appropriate use would be less than 1% of residents.

The Institute for Clinical Evaluative Sciences, in Toronto, Ontario, Canada carried out a surveillance study of antipsychotic drug use in adults with dementia 66 years of age or older. The records of 20,682 adults living in the community and 20,559 adults living in a nursing home were examined. The most commonly prescribed atypical antipsychotics were risperidone, olanzapine, and quetiapine, and the most common conventional antipsychotics were haloperidol, loxapine, and thioridazine hydrochloride. They found that patients given antipsychotic drugs were up to 4 times more likely to be hospitalized or die within 30 days. They warned that serious side effects occur shortly after starting the therapy.

From the Human Brain in Health and Disease by Stephen Gislason MD

Friday, April 23, 2010

Mental, Neurological IIlness and Diet

While neurological diseases and “mental illnesses” appear to be a vast pool of suffering with diverse causes, mostly unknown, I continue to propose a simple and obvious approach to prevention and treatment of disease. I have written about nutritional programming (NP), an ambitious approach to diet design that addresses all the complicated issues of resolving health problems related to food intake, a form of molecular engineering or programming. Good, Fernandes and West stated in their review of Nutrition and Immunity many years ago: “We look forward to the time when the prophylactic and therapeutic potential of scientifically controlled diet, along with cellular, molecular, and hormonal engineering, may be realized and applied. Freedom of many disorders which have historically deprived us of our genetic legacy of a long and healthy life is certainly a worthwhile objective."

The food supply is critically important to brain function. There are many ideas which link food ingestion and the environment to brain dysfunction and disease. We can ask some simple questions to inspire further inquiry, such as: Are mental and neurological diseases diet related? Are the victims deficient in critical nutrients, or poisoned by excesses of nutrients? Are some dementias caused by the toxicity of food additives, pesticides and/or food contaminants? Do these diseases combine food toxicity and food allergy and emerge slowly in complex combinations? Do the most afflicted people drink more alcoholic beverages, tea, and coffee; eat more fast foods, cheese, bread, or meat? Where do they live? What environmental toxins are common in their food, water and air?

These and related questions about diet and disease have never been answered in terms of meaningful research; however, there are a thousand clues in the research literature which point to diverse problems and many potential solutions . My experience with food-related psychopathology suggests that modern diets are probably responsible for cerebrovascular disease, most strokes, all diabetic neuropathies, some learning and behavioral problems in children, some mental illness, some depressions, some dementias and some neurological disease of undefined origin. The mechanisms are of these disorders are multiple and complex.

You can imagine an alternative world. For example, what if no-one ate too much of the wrong food and everyone did physical work every day? What if the consumption of tobacco, caffeine and alcohol disappeared suddenly? Would you expect humans in general would feel and function better? Would babies be born healthier? Would babies’ brains work better?

What if packaged, processed, fast foods disappeared tomorrow and every child ate more fruits and vegetables? What if children took a balanced vitamin-mineral supplement everyday? Would all those children feel and function better? Would their IQ scores be higher? Would they do better in school? What if combustion engines were replaced by fuels cells converting hydrogen to water? There would be no toxic hydrocarbons, less carbon monoxide and less carbon dioxide.

What if vehicular traffic vanished from cities and paved areas were replaced with walking and cycling paths, gardens, orchards, and flowers? What if vegetables were grown in market gardens within cities where parking lots used to be? Would human brains work better? Would urbanites be healthier, happier and more productive? Why not continue imagining how you would construct an ideal world? You cannot imagine an ideal world without imagining an ideal diet and an ideal environment to live in.

Nutrition can be thought of as an idealized, abstract look at the possible (but not real) outcomes of eating food. The role of foods themselves, as objects of behavior and regulators of internal body dynamics, are relatively ignored. The possibility of things going wrong with digestion, absorption, and metabolism and with immune surveillance of these processes, while considered in medical science, is seldom a concern in medical practice. The dietitian often assumes that nothing will go wrong with food-body interactions - nutrients that are in the food are available to the body without complications. A physician generally assumes that nothing will go wrong during the processing of food or will consider a small number of adverse effects ignoring a number of pathological possibilities that may be the key to enigmatic disease.

To pursue a strategy of nutritional therapy, you assume that things routinely go wrong with food-body interactions. Since food ingestion creates dysfunction and disease by a variety of mechanisms, nutritional therapy is based on removing the causes of illness by correcting a faulty food supply. The supreme technique of nutritional therapy is, therefore, diet revision, a strategy of correcting disease by modifying food choices and eating behaviors.

Proper diet revision restores control over a confusing, chaotic set of circumstances and symptoms. A systematic method of diet revision with full participation of the patient in evaluating and selecting foods has never been included in medical practice.  Efforts to change a patient’s food supply also encounter the irrational elements of eating behavior. Diet revision often turns into a struggle with fast foods, compulsive eating, emotional issues, family and societal issues.

The Alpha Nutrition Program evolved as a standard method of diet revision. The program should be viewed as a prototype that encourages the development of nutritional therapy as a systematic study. Since resolving delayed patterns of food allergy in common disorders such as eczema, migraine, asthma, and irritable bowel were priorities, this method of diet revision was influenced by allergy practice. The basic idea is to reduce or eliminate problem foods first. Once a patient clears their original symptoms, they have heightened reactivity and food challenges are more unpleasant, risky, and obvious.

Human Brain in Health and Disease by Stephen Gislason MD

Monday, April 05, 2010

Weight Loss Fantasy and Fraud

Thousands of weight loss schemes have been marketed -some sincere but flawed, others frankly fraudulent. Some estimates of cost suggest over 40 billion dollars a year is spent in the USA alone on retail products and schemes offered for weight loss while increasing numbers of people are becoming obese. Diet Plans such as the Atkins diet and the South Beach variants are pitched by persistent advertising and many people join the parade of followers. Some lose weight, but almost all regain the weight they lost.

Infomercials, shown on cable TV promise that you can lose all the weight you want while you eat everything you want are false and not to be believed. This is what everyone wants of, course, a quick cure, but there is no easy path. It doesn't matter what they are trying to sell you - crab shells (chitin), fat absorbers, fat burners, magic mushrooms, wonder bark from Brazil, magic cellulite pills, pyruvate, creatine, garcinia cambogia, green goop, algae, magic genies in a bottle - it's all a great fantasy that will not come true.

There is no magic diet. The medical community, food industry, dietitians government health and regulatory agencies, magazine publishers and diet businesses are all helpless as Americans and Canadians consume excessive amounts of food and become increasingly obese. This epidemic of obesity threatens to bankrupt the health care system in both countries. Weight loss products and claims appear to be out of control as regulatory agencies in the USA and Canada only made token attempts to stop fraud.
A new wave of "reality" shows on TV show people attempting to lose weight and reveal how difficult it is to lose, how hard you have to work, how much you have to change your food choices and how much you will depend on other people to support your effort. The simple truth is – it's easier to gain weight than to lose it. Research has shown several important features of body weight management. There are powerful biological controllers of eating behaviors, appetite and weight regulation. There are genetic tendencies toward excess weight and obesity-causing gene mutations have been discovered. European and North American diets are flawed. There is excess fat and sugar in "normal" foods and food is too abundant. Eating has become entertainment. This is a bad idea if you want to stay slim. The modern lifestyle is flawed. There is too much sitting, too much convenience and too little physical work. Recreational eating must be abandoned in favor of recreational exercise

Weight issues are usually discussed as individual problems. The reality is that obesity is an expanding global problem. Because overeating causes many diseases, this global problem is often described as a disease epidemic that spreads like an infectious disease. An intelligent approach to each individual who is overweight is to recognize that this one person is a member of a group whose members all participate in creating dysfunction and disease. Obesity can only be understood as a family problem and then a societal problem. Remedies do involve changes in the behavior of individuals but these changes depend on a supporting group that changes the way the community operates.

Fat storage has a purpose and offers benefits. Everyone stores some white fat to provide insulation and body shape. Our facial contours are constructed from fat. The shape of women’s bodies differ from men’s bodies because of carefully designed fat deposits in the breast, abdomen and buttocks. Extra fat is a good insulator and keeps you warm. Extra fat is buoyant and helps you float in water. Marine mammals are all fat because they swim in cold water. Eskimos are fat so that they can survive cold winters when food is scarce. Brown fat is a source of heat; calories are burned in brown fat to warm the body.

Children hear stories about prudent animals who prepare for the future and do well and imprudent animals who only live for the present and perish. The child knows that squirrels store nuts for the winter and bees survive the winter by eating the honey they made during the summer. Bears get fat in the summer so that they can hibernate during the winter. The challenge of a seasonal food supply is expressed in acquisitive behavior, gaining weight and hoarding food. Most humans seem to have an odd mixture of prudent and imprudent behaviors and only a small number appear to be good at long-term planning. 
Humans are relatively tolerant of short-term food deprivation and take advantage of surplus by feasting and celebrating. The party aspect of human behavior links us strongly with carnivorous predators who gorge when they have made a kill and then rest. All overweight people would become slimmer if they hibernated over the winter and did not eat food for 4 months. All overweight people would become lean people if they as trained hard and long as an endurance cyclist. Long-distance athletes are the leanest people in town because sustained exertion causes muscle cells to use fat as fuel. If you train long enough and hard enough, most of your stored body fat is burned as fuel.

Diets Don't Work

Most therapists who have worked with overweight patients have stories of spectacular initial successes, with equally spectacular relapses weeks or months later. Obviously, there are unsolved problems in the weight-loss business. Carbohydrates are often blamed for weight gain and high fat, high protein diets have been promoted for 50 years and books proclaiming weight loss success are re-issued year after year without any reassurance that these diets are healthy or safe. Research in the 20th century showed that diets rich in plant foods and low in animal fat and proteins are the best diets for health from all points of view. The long-term consequences of high protein, high fat diets are well known; you get all the bad diseases that characterize modern civilization such as cancer, heart disease, strokes, diabetes and obesity.

This is not to argue that you could not lose weight on a high protein, high fat diet. You can lose weight by any method of reducing caloric intake, but that weight loss is not be relevant to your long-term success. It is to argue that you would be making a mistake if you lived on a high protein, high fat diet for many years. Pittas et al, for example, compared a high glycemic index, high-carbohydrate diet with a low-GI/low-carbohydrate diet resulted in comparable weight loss and increase in insulin sensitivity in 34 overweight participants. Both diets in the randomized, double-blind trial were designed to achieve 30% calorie restriction and followed recommendations for "healthy eating." The high carbohydrate diet was 60% carbohydrates, 20% protein, and 20% fat. The low-carbohydrate diet was 40% carbohydrates, 30% protein, and 30% fat. Both groups achieved a 10% reduction in BMI and 20% increase in insulin sensitivity. Dansinger et al. compared 4 popular diets (Atkins, Zone, Weight Watchers, and Ornish) for weight loss and cardiac risk factor reduction. and found that each diet modestly reduced body weight and several cardiac risk factors at 1 year. Overall dietary adherence rates were low. Increased adherence was associated with greater weight loss and cardiac risk factor reductions for each diet group.

Appetite and weight regulation are complex and vary from person to person. While there are some general rules, there are many exceptions to the rules. The solution to obesity, diabetes, high blood pressure, coronary artery disease lies more in the choice what foods you eat, how they are cooked, and how much you eat. The idea that you can predict the outcome of eating specific foods by the knowing the carbohydrate, fat, protein ratios is wrong. No matter what other argument seems appealing, the single enduring fact of healthy nutrition is that a diet rich in plant foods works best. Some plant foods such as wheat, however, may cause severe disease in people who are susceptible (as I am), so that no generalization will work for everyone.

Read More in Eating and Weight Management by Stephen Gislason MD