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Drug (Pharmaceutical!) Crime
Pattern of
Abuse
Inflammatory
Bowel Disease (IBD)
Natural Remedies
for IBD
Other Supplements
for IBD
Ask Dr. J:
Insomnia
References
In the Health
News
Diet and Disease
Recipe of the
Month: Cold Cucumber-Yogurt-Dill
Soup
Dear Friends,
I was surprisingly shocked by a recent news
article about the fraud and deception on the
part of a large drug company, AstraZeneca. Surprising
because I am quite aware of promotion schemes
that drug companies have been involved in over
the years, and the overwhelming financial power
of these companies to influence medical education
and doctors’ prescribing habits.
The criminal actions were this: the drug reps
would give free samples of the prostate cancer
drug, Zoladex, to physicians, and encourage
them to bill Medicare for reimbursement when
they administered the drugs. (The prosecutors
could never prove that the company officials
were aware of or directing this practice, but
absence of evidence is not the same as evidence
of absence.) The company settled with over $350
million dollars (a mere drop in the bucket for
them), and admission of guilt!
Although the drug companies are no longer able
to directly pay physicians with free trips and
other benefits, they always seem to find new
ways to influence the pocketbooks and capture
the sympathies of doctors when it comes to prescribing
their drugs.
In addition, the company agreed to settle another
charge without admitting guilt. They were accused
of inducing doctors to buy Zoladex by offering
to set and report to Medicare falsely high prices
for the drug. In this way, prescribing doctors
who went along with the scheme could collect
higher fees when billing Medicare. Astonishingly,
many doctors defended the fraudulent practice
by saying they needed the money to cover their
incredibly high operational costs for treating
cancer.
This is not the first time that drug companies
have tampered with prescribing practices using
financial inducements to doctors. Another prostate
drug, Lupron, was similarly promoted by TAP
Pharmaceuticals, and they settled for $875 million.
It makes you wonder whether doctors are prescribing
for medical or financial reasons. Doctors often
prescribe through habit, and drug companies
try to influence these habits early on.
Witness the incredible promotion of Nexium
to both the public and to doctors. This “purple
pill” is a modified version of Prilosec,
for treatment of acid indigestion, ulcers, and
related digestive disorders. Nexium’s
only apparent advance is that it is newly patented,
whereas Prilosec is now off patent (and much
less profitable).
Scientifically validated benefits are good
reasons for a doctor to prescribe a medicine.
Financial incentives and fraud are, or should
be, much less convincing.
Inflammation of the bowel usually takes one
of two forms–ulcerative colitis, confined
to the large intestine (colon), or Crohn’s
disease, which is usually in the small intestine,
but may extend into the colon, as well. This
is a serious medical condition. Irritable bowel
syndrome is also a serious health problem, although
not life threatening or requiring surgery or
drugs, and this condition never causes bloody
diarrhea.
The usual symptoms of Crohn’s disease
include cramping, bloating, abdominal pain,
fever, and diarrhea, with or without blood.
With time, ulcerations and fissures may form
around the rectum and anus. The symptoms of
ulcerative colitis are almost identical, and
both conditions feature inflammation and ulceration.
To make the diagnosis, it is important to be
tested, but the natural treatments for both
are quite similar.
It is not known precisely what causes either
condition, but autoimmunity is a component of
both diseases and food allergies are thought
to contribute in some cases. Some doctors suggest
that yeast overgrowth in the intestinal tract
is another contributing factor.
Conventional treatments include anti-inflammatory
drugs, drugs for diarrhea, and steroids (prednisone)
for more intense symptoms. In many cases, patients
go on to have surgery to remove diseased sections
of bowel, and sometimes they have to have a
permanent colostomy or ileostomy with a bag.
Some patients are also treated with immune suppressant
drugs.
You may not need any of these treatments with
the right diet and supplement program, plus
some exercise and stress management. However,
these approaches also may work well combined
with conventional treatment, reducing the necessary
doses of medications.
A diet that is low in land-animal fat (as opposed
to fish) and hydrogenated oils may help reduce
the tendency to inflammation. A 1997 review
revealed an increased risk of IBD in people
who consumed higher levels of fat, especially
animal fat, cholesterol, and sucrose. A lower
risk was seen in people who consumed more fluids,
fruit, magnesium, and vitamin C.
A Japanese reveiw in 1996 showed similar correlations.
In this study, the risks were increased by total
fat (including conventional vegetable oil),
animal fat, animal protein, and milk protein
consumption. While the strongest correlation
with increased risk was with animal protein,
the lowest risk was associated with vegetable
protein intake.
For general health, it is wise to include a
wide variety of fresh vegetables and fruits
in the diet. Also, you should not be afraid
of fiber. It is more important to avoid junk
and highly processed sugary and fatty fast foods.
Also include whole grains and beans to your
diet.
Unlike land-animal fat, flaxseed and fish oil
contain fatty acids that reduce inflammation.
Flaxseed (which has not been studied as much
as fish oil) can be taken either as freshly
ground seeds (in juice or smoothies), or as
organic oil in capsules, or as liquid in salads
or on cooked vegetables or potatoes. (Keep it
frozen until it is opened, and then in the refrigerator
to slow the oxidation until it is used up.)
Fish oils contain the fatty acids EPA and DHA,
and are usually taken in capsule form, up to
10 to 12 per day to get the effective dose.
Sometimes a lower dose is adequate. These fatty
acids also help with other autoimmune disorders,
including rheumatoid arthritis, lupus, and others.
Vitamn C is depleted by inflammatory disease.
Intestinal mucosal membranes are damaged by
free radicals during inflammation and their
vitamin C status declines, so supplements can
help provide protection. I usually recommend
at least 4 to 6 gms daily, although intravenous
doses are often helpful as vitamin C has anti-inflammatory
effects.
L-glutamine is an important dietary supplement
in any bowel disorder. This amino acid supports
normal immune function and white blood cell
production, recovery from surgery, burns, and
trauma, protection of tissues exposed to radiation,
and improving function in patients undergoing
cancer treatment.
Typical glutamine supplements are 4000 to 8000
mg daily, but some severe inflammatory bowel
disease might require even higher doses.
In animal studies with experimental colitis,
curcumin, one of the spices in curry, helps
as an anti-inflammatory and an antioxidant.
These studies from India and Japan suggest that
curcumin, with its high level of safety, should
be considered as part of a comprehensive treatment
program for IBD.
Probiotic supplements, or “friendly bacteria”
help to repopulate the intestinal tract with
beneficial organisms (“normal flora”).
These supplements include Lactobacillus acidophilus,
and Lactobacillus bifidus (bifidobacteria).
They support immune function, protect against
infections, help treat diarrhea, and control
ulcerative colitis.
High-quality probiotics have about 10 billion
organisms per gram. Typical supplement doses
are 10 to 40 billion organisms. I usually recommend
a mixture of L. acidophilus and L. bifidus in
equal amounts. These supplements help restore
normal organisms after antibiotic therapy.
Nutritional status tends to be depleted in
IBD. Taking a good multivitamin/mineral is essential
to maintain basic health, immune status, and
recovery ability. Common one-per-day supplements
are never adequate in a variety of nutrients,
beyond prevention of serious deficiency diseases.
A higher potency supplement, usually requiring
4 to 6 pills a day is better (One example is
Ultra Vitality, from QCI Nutritionals.)
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Q. I have difficulty getting
enough sleep at night. Are there any drug-free
treatments for this?
-- HS, Tokyo, Japan, by Email
A. Insomnia is a common health
problem. Lack of adequate sleep leads to depression,
fatigue, poor concentration, and poor physical
stamina. Some people can’t fall asleep,
while others are able to fall asleep easily,
but they wake early and cannot go back to sleep.
Psychological problems, stress, poor diet,
lack of exercise, obesity, low back pain and
other pain syndromes, smoking, caffeine, and
even food allergies, can all contribute to insomnia.
Alcohol consumption can also disturb sleep patterns.
Of course, when people have sleep problems,
and can’t stay awake for their work, they
tend to take more caffeine to maintain their
alertness, and this can perpetuate the problem.
Most sedative or anti-anxiety drugs used to
treat the problem, such as Valium, Restoril,
Serax, or Ambien, may have side effects, including
fatigue, headaches, dizziness, and nausea. They
also lose effectiveness if taken consistently.
The best approach is to eat a healthy diet.
Avoid sugary/fatty foods foods, caffeine, alcohol,
and any known food allergens. It is also important
to address the underlying physical or psychological
problems, and to get more regular exercise.
Supplements may also help with insomnia, without
the side effects of medications. Magnesium is
a relaxant, and is commonly deficient in the
diet. I often suggest 200 to 400 mg at bedtime.
The amino acid, 5-hydroxytryptophan (50 to 100
mg) is also helpful as a precursor to serotonin,
which reduces anxiety.
Melatonin, is a hormone from the pineal gland
that controls the body clock, and supplements
(3 to 6 mg) often improve sleep. Valerian (400
to 600 mg of standardized extract) is as effective
as the medications, but without side effects.
Numerous studies still show the advantage of
a high-complex-carbohydrate, mostly-vegetarian
diet for health, longevity, and less obesity,
cancer, diabetes, and heart disease mortality.
Reuters, June 20, 2003 AstraZeneca
to Pay Cancer Drug Fine
Simopoulos AP, Omega-3 fatty
acids in inflammation and autoimmune diseases.
J Am Coll Nutr 2002 Dec;21(6):495-505.
Ergas D, et al., n-3 fatty
acids and the immune system in autoimmunity.
Isr Med Assoc J 2002 Jan;4(1):34-8.
Reif S, et al., Pre-illness
dietary factors in inflammatory bowel disease.
Gut 1997 Jun;40(6):754-60.
Buffinton GD, Doe WF, Altered
ascorbic acid status in...inflammatory bowel
disease patients. Free Radic Res 1995 Feb;22(2):131-43.
Biondo-Simoes Mde L, et al.,
...inflammatory colitis treated with an elemental
diet, glutamine and 5-ASA. An experimental study
in rats. Arq Gastroenterol 1998 Apr-Jun;35(2):116-25.
(Portugese)
Lacey JM, Wilmore DW, Is
glutamine a conditionally essential amino acid?
Nutr Rev 1990 Aug;48(8):297-309.
Ameho CK, et al., ...glutamine
supplementation on interleukin 8 and tumour
necrosis factor alpha...in...colitis. Gut 1997
Oct;41(4):487-93.
Paulo FL, Effects of oral
supplement of L-glutamine on diverted colon
wall. J Cell Mol Med 2002 Jul-Sep;6(3):377-82.
Klimberg VS, Souba WW, The
importance of intestinal glutamine metabolism
in maintaining a healthy gastrointestinal tract...
Surg Annu 1990;22:61-76.
Souba WW, et al., Oral glutamine
reduces bacterial translocation following abdominal
radiation. J Surg Res 1990 Jan;48(1):1-5.
Ukil A, et al., Curcumin...reduces
mucosal injury in...colitis. Br J Pharmacol
2003 May;139(2):209-18.
Fujiwara M, et al., Inhibitory
Effects of Bifidobacterium longum on Experimental
Ulcerative Colitis... Digestion 2003;67(1-2):90-5.
Macfarlane GT, Cummings JH,
Probiotics, infection and immunity. Curr Opin
Infect Dis 2002 Oct;15(5):501-6.
Janson C, et al., Insomnia
in men-a 10-year prospective population based
study. Sleep 2001 Jun 15;24(4):425-30.
Ziegler G, et al., ...valerian...in
the treatment of non-organic insomnia... study.
Eur J Med Res 2002 Nov 25;7(11):480-6.
Whether or not you have diabetes, it appears
that laughter reduces the usual rise in blood
sugar after meals (poorly controlled sugar increases
risks for heart disease, blindness, and kidney
disease). Laughter has many benefits, improving
immunity, circulation, and mood. (Hayashi
K, et al., Laughter lowered the increase in
postprandial blood glucose. Diabetes Care. 2003
May;26(5):1651-2; reported in Reuters Health,
May 22, 2003.) Watching funny movies
or listening to humorous CD’s are good
meal accompaniments.
Stress reduction and positive attitudes really
do make people happy. Buddhists studied in India
had brain scans indicating that they were tranquil
and happy (Flanagan
O, The colour of happiness. New Scientist, 2003
May 24;178(2396):44). This and other
studies indicate that mindful meditation is
associated with positive emotions, and can reduce
fear and anger. Meditation appears to be effective
not only during the practice, but also throughout
the day. Treating depression with drugs does
not make people happy.
Women in Japan who consumed the most soy isoflavones
(genistein) and miso (fermented soy) had the
lowest risk of breast cancer. Yamamoto
S, et al., Soy,isoflavones, and breast cancer
risk in Japan. JNCI, 2003 Jun 18;95(12):906-13.
The highest consumption led to a 50 percent
reduction in risk. Women with the lowest soy
intake consumed 250 times more genistein than
Western white women, their breast cancer rates
were lower than in US women. Be careful, though,miso
is high in salt. Dietary soy is particularly
protective when consumed during adolescence.
Studies of adults have been inconsistent. An
earlier study showed that soy intake halved
the risk of death from gastric cancer (Nagata
C, et al., ...soy product intake and stomach
cancer death. Br J Cancer 2002 Jul 1;87(1):31-6).
Although I was eager for the warm weather to
arrive, now I want to cook as little as possible
(but still enjoy delicious foods). This recipe
is a variation of a Mediterranean staple. I
use English cucumbers, as they are seedless
and usually unwaxed. Shred the cucumbers, and
add them to an equal amount of non-fat plain
yogurt, with a little water and fresh lemon
juice to make it a soupy consistency. Add some
crushed garlic, a small amount of flaxseed oil
or extra virgin olive oil, a dash of cumin,
ground pepper, and chopped fresh dill. Stir
all this together, and garnish with sliced fresh
scallion greens and crushed walnuts. You can
use almost any fresh herb (oregano or mint are
both great). If you prefer, you can substitute
plain soy yogurt for the dairy.
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