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Dr. Gregory Pais, ND
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Monday, 09 March 2009
March 3 2009 Pediatrics
Many teenagers today, especially black teens, aren't getting enough vitamin D. This is the conclusion of researchers from Weill Cornell Medical College in New York City. Vitamin D deficiency has been linked to many chronic diseases, including breast cancer, heart disease, diabetes, prostate cancer, colon cancer, osteoporosis, and others.

"There is evidence that the levels of vitamin D we have been using in the past may have been too low," said lead researcher Dr. Sandy Saintonge, a fellow in general preventive medicine at Weill Cornell.
Vitamin D is measured by blood levels of 25-hydroxyvitamin D. Several factors can interfere with the amount of vitamin D the body produces, including diet, sun exposure, use of sunscreens, skin color, and possibly statin drugs. Blacks take in less of the sun's rays than whites, causing less vitamin D production, Saintonge noted.

For the study, Saintonge and her colleagues collected data on 2,955 youths, 12 to 19 years old, who participated in the National Health and Nutrition Examination Survey III. The researchers looked specifically at their levels of vitamin D. Using the latest recommended level of vitamin D, the researchers found that, overall, 14% of adolescents in the study were vitamin D deficient. However, black teens were 20 times more likely to be vitamin D deficient than white teens. Vitamin D deficiency among girls was more than double that of boys. In addition, twice as many obese teens were vitamin D deficient as normal-weight teens, Saintonge said. She noted that more recent data puts the prevalence of vitamin D deficiency among teens at 40-50%.

Skin color, the prevalence of obesity and diet among black teens combine to make them more likely to be vitamin D deficient, Saintonge said. "It's a multi-factorial problem," she said. Saintonge recommends that teens have their vitamin D level monitored during regular physical examinations to be sure they are getting enough of the nutrient.

Dr. Michael F. Holick, director of the Vitamin D Laboratory at Boston University, said, "We know the more skin pigment you have, the less efficient is your ability to make vitamin D in your skin." "That's why most African-Americans in the United States are vitamin D deficient."

One thing to realize is that the study's conclusions are based on the outdated reference of what low Vitamin D is. If you were to use the currently accepted reference of 50-80 ng/ml for Vitamin D, the number of teens low in Vit. D greatly increases.

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Saturday, 07 March 2009
Tricoci P, Allen JM, Kramer JM, et al. Scientific Evidence Underlying the ACC/AHA Clinical Practice Guidelines. JAMA 2009 Feb 25;301(8):831-841.
It's common to hear medical practitioners with absolutely no professional nutrition training proclaim that 'supplement use isn't based on scientific research". This report in JAMA suggests the same could be said for the heart guidelines cardiologists use. Actually, almost half of the guidelines issued to cardiologists by the country's leading heart organizations are based on low levels of evidence, according to this study.

Dr. Pierluigi Tricoci and his co-authors reached their conclusion after examining more than 20 years worth of practice guidelines published by the American Heart Association and the American College of Cardiology. They looked at the levels of evidence -- A, B or C, with A being the strongest and C being the weakest. In the 16 lists of guidelines that report levels of evidence, only 314 of 2,711 recommendations -- less than 12% -- are classified as level of evidence A, compared to 1,246, or 48%, that are level of evidence C, they wrote. A recommendation based on evidence C "has no evidence to support it, other than anecdotal," Tricoci said.
In an damning editorial that accompanied the study, Drs. Terence M. Shaneyfelt and Robert M. Centor, said the most widely recognized bias in guidelines is financial. "Guidelines often have become marketing tools for device and pharmaceutical manufacturers," they wrote. "Only when likely biases of industry and specialty societies have been either removed or overcome by countervailing interests can impartial recommendations be achieved."

In other words, when it comes to practice guidelines for cardiologists, science does not dictate practice. In fact, 4 times as many guidelines had the weakest level of evidence vs. those that had the highest level. And we have prominent physicians stating that the pharmaceutical industry has a huge influence on how guidelines come about.

Who's not scientific now?

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Monday, 02 March 2009
February 23 2009 Archives of Internal Medicine
In yet another report on the importance of Vitamin D for health, this large-scale study suggests that Vitamin D has a strong role to play in boosting the immune system.

In looking at the association between Vitamin D and respiratory infections, investigators found that people with the lowest blood vitamin D levels reported having significantly more recent colds or cases of the flu. The risks were even higher for those with chronic respiratory disorders, such as asthma and emphysema.

"The findings of our study support an important role for vitamin D in prevention of common respiratory infections, such as colds and the flu," says Adit Ginde, MD, MPH, UC Denver Division of Emergency Medicine and lead author of the study. "Individuals with common lung diseases, such as asthma or emphysema, may be particularly susceptible to respiratory infections from vitamin D deficiency."

We've learned over the last several years that vitamin D plays a critical role in the function of the immune system. The seasonal spike in colds and flu was correlated with the lack of sunlight in winter. And small studies had suggested an association between low blood levels of vitamin D and a higher risk of respiratory infections.

The current study analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III), conducted by the National Center for Health Statistics. Participants were interviewed in their homes regarding their health and nutrition, and most participants also received a physical examination that included collection of blood and other samples for laboratory analysis.

The research team analyzed blood levels of 25-hydroxyvitamin D (25OHD) - the best measure of vitamin D status - from almost 19,000 adult and adolescent NHANES III participants, selected to be representative of the overall U.S. population.

Study participants with the lowest vitamin D blood levels - less than 10 ng per milliliter of blood - were about 40% more likely to report having a recent respiratory infection than were those with vitamin D levels of 30 or higher. The association was present in all seasons and even stronger among participants with a history of asthma or chronic obstructive pulmonary disease (COPD), including emphysema. Asthma patients with the lowest vitamin D levels were five times more likely to have had a recent respiratory infection; while among COPD patients, respiratory infections were twice as common among those with vitamin D deficiency.
"A respiratory infection in someone with otherwise healthy lungs usually causes a few days of relatively mild symptoms," explains Carlos Camargo, MD, DrPH, MGH Department of Emergency Medicine and senior author of the study. "But respiratory infections in individuals with an underlying lung disease can cause serious attacks of asthma or COPD that may require urgent office visits, emergency department visits or hospitalizations. So the impact of preventing infections in these patients could be very large."

As so many people do not have optimum blood levels of Vitamin D it appears clear that this could play an important factor in prevention of respiratory infections, colds, and flu. This could be a lot cheaper and more specific than the annual flu vaccine.

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Sunday, 15 February 2009
By now you've probably heard about the peanut-based salmonella. But do you really know what products are involved? And do you have confidence in food safeguards? According to a Harvard survey released Friday, February 13, 2009 the answer is No to both questions.

The recall of 1,900 products includes mainly minor-label peanut butter and a range of other items, but not major brand names of jarred peanut butter. Some of the peanut products recalled include snack bars, baked goods, ice cream and dry-roasted peanuts.

"A lot of people have taken some precautions but they're not looking at the ingredients in products not related to peanut butter," said Robert Blendon, the Harvard health policy professor who directed the survey.

The Harvard poll indicated little faith in corporations and the government. Only 33% of Americans said they have a good or great amount of confidence in food manufacturers or government inspectors to keep food safe.

Federal health officials are tracking a salmonella outbreak that has caused at least 636 illnesses in 44 states and has been linked to 9 deaths. The outbreak has been traced to a Virginia-based company, Peanut Corporation of America, that makes some minor-label peanut butter, peanut paste and other products.

The poll found that 37% had a good or great amount of confidence in government food inspections, down from 47% a year ago. About 48% had significant faith in grocery stores to safeguard food, down from 58 percent a year ago. Only 32% had significant confidence in food manufacturers.

This is the FDA web page that lists the peanut products affected by the recall.

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Monday, 09 February 2009
On January 30, government medical advisers recommended a ban on Darvon, a prescription medicine that's been used to treat pain for more than 50 years.

A Food and Drug Administration advisory panel voted 14-12 to recommend withdrawing Darvon after a daylong hearing examining its risks and benefits. Though the FDA is not required to follow the recommendations of its advisers, it often does so.

Darvon was first approved in 1957. It's now mainly marketed as Darvocet, which includes a dose of acetaminophen. The drug remains one of the top 25 most commonly prescribed medications. More than 20 million prescriptions were written in 2007.

Public Citizen, the consumer group, had petitioned the FDA to withdraw Darvon because the drug offers relatively weak pain relief and poses an overdose risk, with the potential to be used in suicides. "With a drug that has almost no evidence of benefit, any risk is unacceptable," said Dr. Sidney Wolfe, a drug safety expert with Public Citizen who first sought a ban in the 1970s. "Hopefully the FDA will follow the vote of its advisers."

In an analysis prepared for the hearing, the FDA's safety office said it found more than 3,000 reports of serious problems. The top three were suicide, drug dependence and overdoses. In a separate analysis, the FDA office that handles painkillers said Darvon is a weak pain reliever. Most studies show that in Darvocet, the widely used combination drug, the Darvon component appears to contribute "little or no" additional pain relief beyond that provided by the acetaminophen component, reviewers said.

Wolfe presented the advisory panel with new data from the government's Drug Abuse Warning Network, which tracks emergency room visits and deaths. It said that Darvon-related deaths rose to 503 in 2007, from 446 in 2006. In both years, about 20% were suicides.

The United Kingdom banned its version of Darvon in 2005.

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