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Content 7


The Doctor and the Pharmacist

Radio Show Articles:
August 4, 2012

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New Diet Drugs Approved
When Does Alzheimer Disease Start?
Endocrine Cocktails for Advanced Breast Cancer
Breast Cancer Treatment Targeting Estrogen Production, Receptors Prolongs Survival
Benzocaine Teething Remedies Can Be Dangerous in Children
Shifting Causes of Peptic Ulcer Disease
Cataract Surgery Might Lower Hip Fracture Risk in Older Patients
Aerobic Exercise Modestly Reduces Depressive Symptoms in Heart Failure Patients
Extreme Obesity in Adolescents Linked with Idiopathic Intracranial Hypertension
The Impact of New York City's Trans Fat Content Regulation
Proton-Pump Inhibitors Raise Risk for C. difficile Infections
'Spray-On' Cells Associated with Improved Healing of Venous Leg Ulcers
Autologous Fibroblasts Can Reduce Wrinkles
Weight Changes Vary After Smoking Cessation
FDA Approves Three New Treatments
Breast-Feeding May Lower Risk for Maternal Obesity in Later Life
Soy Oil Mistaken as Healthful

MM: My staff members are taking bets as to how many months it will take before these products will be recalled from the market. Qsymia can’t even be pronounced and its effects on weight loss are even more obscure. In studies using this product, mean wweight loss was less than 1 pound each month. Combine that with the known side effects and restrictions associated with these drug components and one has to wonder how it got through the FDA approval process. Topiramate Severe side effects: sudden vision loss, pain around or behind your eyes; dry mouth, increased thirst, confusion, drowsiness, decreased sweating, increased body temperature, and hot, dry skin, nausea, vomiting, increased urination, muscle pain or weakness, fast heart rate, feeling light-headed, fainting, or seizure (convulsions); or severe pain in your side or lower back, painful or difficult urination. Less serious side effects may include: slowed thinking, memory problems, trouble concentrating; problems with speech or balance; numbness or tingling; sleep problems (insomnia); tired feeling; headache, dizziness.
New Diet Drugs Approved
There is an interesting history of diet drugs as shown in the table below:

Diet Drugs Over the Years

Years on the U.S. Market

Drug (Brand Name)




Discontinued due to potential for abuse


Phentermine and other anorectics

Appetite suppressants; approved for short-term use only


'Rainbow pills' Amphetamine, digitalis, diuretics combined;

discontinued after links to several deaths


Fenfluramine (Pondimin)

Often combined with phentermine in 'fen-phen'; withdrawn after links to heart valve problems


Dexfenfluramine (Redux)

Similar to fenfluramine; withdrawn after links to heart valve problems


Sibutramine (Merida)

Withdrawn due to risk of heart attack, stroke


Orlistat (Xenical, Alli)

Blocks fat absorption

2007 (rejected)

Rimonabant (Acomplia)

Suspected link to suicidal thoughts

2011 (rejected)


Combines an antidepressant and an alcoholism drug; now undergoing more trials


Qsymia, Belviq

Approved after additional data submitted


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MM: Many of us have a desire to know as much as possible about our bodies. Unfortunately, without a means of treatment or strategy for prevention this knowledge may serve to only torment. Once we have these latter tools, then it is more meaningful to know whether one is a carrier of the AD gene. The data presented in this article is a baby step in the direction of knowledge and eventual treatment or prevention of AD. Let’s hope that it will be used as a tool for progress and disease prevention; not a tool for obstruction of care or insurance coverage.
N Engl J Med 2012 Jul 12
When Does Alzheimer Disease Start?
A study of familial AD suggests the disease starts more than 20 years before clinical symptoms develop.
The pathological process of Alzheimer disease (AD) begins before the clinical symptoms manifest. To identify the timing and stages of this process, researchers examined biological markers of AD in 128 individuals who had a parent with dominantly inherited AD (carriers of the APP, PSEN1, or PSEN2 gene mutation). The researchers tested the participants for carrier status of the relevant gene. Using the affected parent's age at onset and the participant's age at assessment, the researchers estimated the years to symptom onset and identified correlations with biological and clinical AD parameters.
Of the 128 participants, 88 were AD gene carriers (mean age at assessment, 39). Levels of amyloid-beta (Aβ)42 in the cerebrospinal fluid (CSF) appeared to decline in carriers compared with noncarriers 25 years before estimated symptom onset and were significantly different starting 10 years before estimated onset. Compared with noncarriers, carriers had significantly greater Aβ deposition in the precuneus (measured by positron emission tomography), significantly higher CSF tau levels, and hippocampal atrophy 15 years before estimated onset. Carriers also had cerebral hypometabolism in the precuneus 10 years before estimated onset and significantly more global cognitive impairment and logical memory impairment than noncarriers 5 years before estimated onset. The diagnosis of AD was made in 44 participants (43 carriers) an average of 3 years after estimated onset.
Comment: This study shows that AD, including amnestic mild cognitive impairment, may be diagnosed up to 2 decades after the biological process has begun. It is unsurprising that treatments have been unimpressive. The findings suggest that our standards for diagnosing clinical dementia must be refined substantially, so that future disease-modifying therapies can target neuropathology early.
Developing new treatments would have high financial and psychological costs. We would need to screen numerous asymptomatic individuals in their 30s and 40s, to establish a theoretical risk and expose them to potential disease-modifying drugs. As the authors note, longitudinal data are needed to validate this model in dominantly inherited AD, and it may not apply to the more common "sporadic" AD. At present, this information does not warrant a significant change to routine clinical practice, but it highlights the importance of obtaining an accurate family history and encouraging research participation by patients with neurodegenerative illnesses.
Brandy R. Matthews, MD, and Jonathan Silver, MD Published in Journal Watch Neurology July 31, 2012
Citation(s): Bateman RJ et al. Clinical and biomarker changes in dominantly inherited Alzheimer's disease. N Engl J Med 2012 Jul 12; [e-pub ahead of print].
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MM: This is very exciting news for practitioners and patients who understand the interaction between hormones. I am frequently asked (or more often told) by patients whether they can use hormones if there is a history of breast cancer personally or familially. The traditional response by those who have a little bit of knowledge is a resounding NO across the board. Well, thie is simply erroneous. There are a variety of anti-hormonal cancer treatments that fall into the category of “Aromatase Inhibitors”. Bio-identical Progesterone is also an Aromatase Inhibitor. It does not perpetuets estrogen receptor sensitive cancers. It inhibits them.
N Engl J Med 2012 Aug 2; 367:435
Endocrine Cocktails for Advanced Breast Cancer
Patients with hormone receptor–positive disease achieved survival benefits with combination versus sequential single-agent therapy.
Prior studies have provided little evidence that combination endocrine therapy — for example, with tamoxifen plus older-generation aromatase inhibitors such as aminoglutethimide — improves outcomes over more common sequential endocrine therapy for patients with metastatic, hormone receptor–positive breast cancer. However, with the introduction of more-selective aromatase inhibitors (anastrozole, letrozole, and exemestane) and the novel estrogen-receptor agonist fulvestrant, the concept of combination endocrine therapy has been revisited.
Investigators have now compared the efficacy of single-agent therapy with anastrozole (1 mg/day) versus combination therapy with anastrozole and intramuscular fulvestrant (500 mg on day 1, 250 mg on days 14 and 28 and monthly thereafter) in postmenopausal women with previously untreated hormone receptor–positive metastatic disease. A total of 707 patients were randomized to the two treatment groups, and 694 were included in intention-to-treat analysis. Patients taking anastrozole alone who experienced disease progression were encouraged to cross over to also receive fulvestrant. The primary endpoint was progression-free survival (PFS); overall survival (OS) was a prespecified secondary outcome.
Median PFS was superior with combination versus single-agent therapy (15.0 vs. 13.5 months; hazard ratio, 0.80; P=0.007); the PFS advantage for combination therapy was observed across all subgroups. Median OS was also superior with combination therapy (median 47.7 vs. 41.3 months; HR, 0.81; P=0.05); the OS advantage for combination therapy was observed even though 41% of the single-agent group crossed over to receive fulvestrant at disease progression. No significant difference in toxicity was observed between the two groups.
Comment: These results suggest that combination endocrine therapy might be more effective than either agent alone, but a couple of caveats are worth mentioning. First, a similar trial (FACT) failed to demonstrate the superiority of anastrozole and fulvestrant over anastrozole alone (J Clin Oncol 2012 Jun 1; 30:1919), although potential differences in patient and disease characteristics between the FACT trial and this study could explain the discordant findings. Second, similar outcomes might have been achieved with fulvestrant (with optimal loading and monthly dosing at 500 mg) whether used alone or in combination with anastrozole. The authors' suggestion that adjuvant clinical trials explore combination versus single-agent strategies further are worthy of consideration, although treatment involving monthly intramuscular injections of fulvestrant over many years might prove prohibitive.
William J. Gradishar, MD Published in Journal Watch Oncology and Hematology August 1, 2012
Citation(s): Mehta RS et al. Combination anastrozole and fulvestrant in metastatic breast cancer. N Engl J Med 2012 Aug 2; 367:435
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Breast Cancer Treatment Targeting Estrogen Production
Receptors Prolongs Survival

Hormone-receptor-positive metastatic breast cancer responds better to a regimen of drugs, fulvestrant and anastrozole given concurrently, than to anastrozole given alone or to both drugs given in sequence, according to a phase III study in the New England Journal of Medicine.
Roughly 700 women with metastatic hormone-receptor-positive disease underwent randomization either to a combination of fulvestrant (Faslodex, which disrupts estrogen receptors) and anastrozole (Arimidex, an estrogen-production inhibitor), or to anastrozole alone. In the anastrozole-alone group, patients whose disease progressed were encouraged to switch to fulvestrant alone.
The median progression-free survival (the study's primary outcome) was 13.5 months in the anastrozole-alone group and 15.0 months in the combination group. Median overall survival rates were, respectively, 41.3 and 47.7 months.
The authors suggest further trials comparing combinations of an aromatase inhibitor and fulvestrant should be undertaken in patients with estrogen-receptor-positive tumors.
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Benzocaine Teething Remedies Can Be Dangerous in Children
Benzocaine products to relieve teething pain in babies should only be used under the advice and supervision of a healthcare professional, the FDA says. The products involved include Anbesol, Orajel, Baby Orajel, Orabase, and Hurricane. These benzocaine gels and liquids to relieve gum and mouth pain can lead to methemoglobinemia; children under 2 years old are at particular risk for the condition.
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Aliment Pharmacol Ther 2012 Jul; 36:48
Shifting Causes of Peptic Ulcer Disease
An observational study supports prior findings of less PUD attributed to H. pylori infection and more attributed to use of NSAIDs, particularly aspirin.
The main causes of peptic ulcer disease (PUD) are Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs), including low-dose aspirin (LDA). As the prevalence of H. pylori decreases in developed countries, the percentage of PUD attributable to NSAIDs or other (often idiopathic) causes is increasing.
To further investigate this trend, researchers identified patients with PUD diagnosed by endoscopy between 2005 and 2010 at a tertiary referral hospital in the U.K. They collected data on their pre-endoscopy use of NSAIDs and LDA (≤325 mg/day) via patient interviews and hospital records. H. pylori infection status was determined from biopsy testing, if available, or serology testing.
Of 386 patients with PUD, 220 (57%) had used NSAIDs, with 112 (51%) using LDA only. The frequency of H. pylori infection was 57% overall, but was higher among patients with duodenal ulcers versus gastric ulcers (66% vs. 47) and among LDA users than users of any NSAID (61% vs. 52%). The prevalence of non-NSAID, non-H. pylori PUD was 12%. Patients using LDA were older than patients using other NSAIDs.
Comment: The authors conclude that these results are consistent with studies showing the declining role of H. pylori and ascendant role of NSAIDs in the etiology of PUD in developed countries. However, interpretation of these results is limited by the observational study design and use of comparison data from >10 years ago. Moreover, the independent contributions of LDA and H. pylori could not be assessed because of the high prevalence of H. pylori in the LDA group. The higher rate of H. pylori in LDA users than other NSAID users may represent a cohort effect, as both LDA use and prevalence of H. pylori increase with age. The overall prevalence of H. pylori (57%) is lower than in previous studies, but is still higher than in other countries, such as the U.S. The high number of patients taking LDA confirms prior findings that even low doses of aspirin carry a risk for PUD (JW Gastroenterol Jan 31 2006).
David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) Published in Journal Watch Gastroenterology August 3, 2012
Citation(s): Musumba C et al. The relative contribution of NSAIDs and Helicobacter pylori to the aetiology of endoscopically-diagnosed peptic ulcer disease: Observations from a tertiary referral hospital in the UK between 2005 and 2010. Aliment Pharmacol Ther 2012 Jul; 36:48.
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Cataract Surgery Might Lower Hip Fracture Risk in Older Patients
Cataract surgery seems to reduce the risk for hip fracture among older patients, according to a retrospective study in JAMA.
Researchers examined a sample of 1.1 million Medicare beneficiaries with a diagnosis of cataract. Those undergoing surgery for the condition were followed for a year after surgery; those not undergoing surgery were followed for a year after diagnosis. Fracture rates between the two groups were compared.
After adjustment for comorbidities, the odds ratio for hip fracture among those who underwent surgery was 0.84, relative to those who did not have surgery (absolute risk difference, 0.2%). Patients with severe cataract showed the highest benefit.
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Aerobic Exercise Modestly Reduces Depressive Symptoms in
Heart Failure Patients

Aerobic exercise reduces depressive symptoms among patients with heart failure, according to a JAMA study.
Researchers randomized some 2300 patients with stable HF to exercise training or usual care. Exercise training involved supervised aerobic exercise for 3 months, followed by home-based exercise for 9 months. At baseline, 28% of the patients had clinically significant depression.
The mean depression score was significantly lower with exercise than with usual care at month 3 (8.95 vs. 9.70) and month 12. In analyses limited to patients with clinical depression at baseline, depression scores again favored exercise. The incidence of death or hospitalization over roughly 30 months' follow-up was also significantly lower in the exercise group — by 2 percentage points.
The authors call exercise's effect on depression "modest," with unknown clinical significance. And in Journal Watch Psychiatry, Peter Roy-Byrne points out: "It is just as likely that more-depressed patients exercised less as [it is] that exercise improved depression."
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J Pediatr 2012 May 26
Extreme Obesity in Adolescents Linked with Idiopathic Intracranial Hypertension
IIH should be considered in obese adolescent girls with headaches or blurred vision.
Idiopathic intracranial hypertension (IIH) in children is uncommon and has been associated with use of expired tetracyclines and retinoids. In adults, increased intracranial pressure has been associated with extreme obesity. To examine the association between obesity and IIH in children, researchers reviewed the medical records of 913,178 children in the Kaiser Permanente Southern California Children's Health Study diagnosed with IIH between 2006 and 2009.
Among the 78 children with confirmed IIH, defined as the presence of papilledema and elevated opening cerebrospinal fluid pressure documented by lumbar puncture, 85% were girls, 85% were older than 11 years, 47% were non-Hispanic whites, and 73% were overweight or obese. Compared with underweight and normal weight children, risk for IIH increased with increasing weight (adjusted odds ratios, 3.56 for overweight, 6.45 for moderately obese, and 16.14 for extremely obese). The association between IIH and obesity in girls was strongest among those older than 11 years. Normal-weight children with IIH were more likely than overweight or obese children to have been exposed to known risk factors for IIH. Overweight and obese children with IIH were significantly more likely to have headache, blurred vision, and sixth nerve palsy than normal-weight children with IIH.
Comment: Although this study does not provide insight into the pathogenetic mechanism for increased intracranial pressure in obese children, the association between obesity and IIH in children is an important new finding. IIH should be considered in obese adolescent girls with headaches or blurred vision. IIH can lead to visual loss and severe headaches.
F. Bruder Stapleton, MD Published in Journal Watch Pediatrics and Adolescent Medicine August 1, 2012
Citation(s): Brara SM et al. Pediatric idiopathic intracranial hypertension and extreme childhood obesity. J Pediatr 2012 May 26; [e-pub ahead of print].
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Ann Intern Med 2012 Jul 17; 157:81
The Impact of New York City's Trans Fat Content Regulation
A significant decrease in the amount of trans fat in purchased fast-food meals bodes well for associated reductions in cardiovascular events.
Trans fat consumption increases cardiovascular risk. In 2006, New York City passed a regulation restricting both chain and non-chain restaurants from using, storing, or serving food containing partially hydrogenated vegetable oil with a total of 0.5 g or more of trans fat per serving. Lunchtime receipt surveys were conducted at fast-food chain restaurants just before and about 1 year after the regulation went into effect. A total of 14,854 purchases (6969 from 2007 and 7885 from 2009) were analyzed.
Participants were evenly divided between men and women. The distribution of customers by restaurant chain type was similar before and after the regulation (hamburger, 53%; sandwich, 28%; fried chicken, 12%; pizza and Mexican food, 4% each). From 2007 to 2009, trans fat content per purchase decreased significantly at three of the five chain types and increased slightly (but significantly) at sandwich chains, resulting in a significant overall mean decrease of 2.4 g per purchase. The maximum trans fat content per purchase decreased from 28 g to 5 g; the absolute trans fat decrease per purchase was greatest at hamburger chains (3.8 g). After adjustment for total calories purchased, restaurant chain, customer sex, and restaurant location, neighborhood poverty rate was not significantly associated with change in trans fat content per purchase.
Comment: This population-wide initiative demonstrates that public health measures aimed at dietary factors can produce substantial beneficial effects. Similar to the ban on public smoking, national adoption of broad-based policies such New York City's could lead to a substantial reduction in cardiovascular morbidity and mortality.
Joel M. Gore, MD Published in Journal Watch Cardiology August 1, 2012
Citation(s): Angell SY et al. Change in trans fatty acid content of fast-food purchases associated with New York City's restaurant regulation. Ann Intern Med 2012 Jul 17; 157:81.
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Am J Gastroenterol 2012 Jul; 107:1001
Proton-Pump Inhibitors Raise Risk for C. difficile Infections
In two meta-analyses, PPI use was associated with a 1.7-fold higher risk for Clostridium difficile infection.
In February 2012, the FDA issued a safety alert regarding an association between proton-pump inhibitors (PPIs) and Clostridium difficile infection. In new meta-analyses, two groups of researchers used slightly different criteria to select studies in which this association could be evaluated; all included studies (23 and 42, respectively) were observational (cohort or case-control). Each meta-analysis involved roughly 300,000 patients.
In both meta-analyses, risk for C. difficile infection was significantly higher in PPI users than in nonusers (risk ratio, about 1.7). Although results across individual studies were heterogeneous, nearly all trended toward higher risk. Most of the included studies were adjusted for confounding variables, including antibiotic use. Concomitant use of both PPIs and antibiotics — examined in one meta-analysis — was associated with greater risk for C. difficile infection than was use of PPIs alone or antibiotics alone. Risk for C. difficile infection was higher with histamine (H)2-receptor antagonists than with no acid-suppressive therapy, but lower with H2-receptor antagonists than with PPIs.
Comment: The opportunity for residual confounding in these studies is substantial, because sicker patients are more likely both to receive PPIs and to be vulnerable to C. difficile infection. Still, these worrisome findings should remind clinicians to initiate PPIs only for valid indications and to stop PPIs in patients who take them for unclear reasons.
Allan S. Brett, MD Published in Journal Watch General Medicine July 31, 2012
Citation(s): Janarthanan S et al. Clostridium difficile-associated diarrhea and proton pump inhibitor therapy: A meta-analysis. Am J Gastroenterol 2012 Jul; 107:1001.
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'Spray-On' Cells Associated with Improved Healing of Venous Leg Ulcers
Treating venous leg ulcers by spray-on application of allogeneic skin cells is associated with more rapid healing, according to a Lancet study designed and partially conducted by the developing company.
The treatment uses foreskin-derived neonatal keratinocytes and fibroblasts suspended in a fibrinogen solution, which serves as the spray vehicle. In the double-blind, phase II trial, some 200 patients with leg ulcers were randomized to various active treatment regimens of sprayed-on cells or to vehicle alone for 12 weeks.
Patients in the most effective active-treatment group showed faster wound closure than controls, with median time to complete wound closure of 21 days earlier.
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Dermatol Surg 2012 Jul; 38:1234
Autologous Fibroblasts Can Reduce Wrinkles
Autologous cell therapy marks the beginning of a new phase in aesthetic therapy
Age-related loss of collagen and elastin can produce folds and wrinkles. These investigators conducted a randomized, placebo-controlled, multi-center trial in 272 patients with very severe nasolabial folds to try the benefits of injectable cultured autologous fibroblasts.
The patients received a series of three treatments 5 weeks apart. Results were assessed on a validated wrinkle scale by evaluators and patients blinded to treatment assignment. Based on the evaluator assessment, 64% of patients treated with fibroblasts versus 36% placebo recipients showed at least a 1-point improvement on the scale after 6 months. Mild injection-related adverse events were comparable in the experimental and placebo groups.
Comment: Cultured autologous fibroblasts appear to be the first successful cell therapy for treatment of wrinkles. Unlike conventional fillers, they do not work immediately. Instead, they provide gradual improvement after several treatments over several months. However, the end result offers the promise of living cells, which may have greater persistence than inert fillers, although this has not yet been shown. Fibroblasts may be a good alternative for patients who do not want a foreign material injected. It is important to note that fibroblast injections appear to be best suited for fine lines; they are not designed to replenish large atrophic areas. Also, there is a substantial cumulative cost for harvesting, culturing, and reinjection. Given these cautions, it is unclear whether this therapy portends a sea change in filler treatment, as the advent of hyaluronic acid fillers did in 2003, when they brought on the decline of injectable collagens. Strict FDA-mandated procedures protect against misidentification of cells during processing.
Murad Alam, MD, MSCI Published in Journal Watch Dermatology August 3, 2012
Citation(s): Smith SR et al. A multicenter, double-blind, placebo-controlled trial of autologous fibroblast therapy for the treatment of nasolabial fold wrinkles. Dermatol Surg 2012 Jul; 38:1234.
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BMJ 2012 Jul 10; 345:e4439
Weight Changes Vary After Smoking Cessation
At 12 months, about half of smoking abstainers gained >5 kg, but 16% of abstainers lost weight.
Smoking cessation can be associated with weight gain. In this meta-analysis of 62 clinical trials, investigators determined weight changes among smokers who quit and abstained from smoking for as long as 12 months.
Among quitters who did not receive cessation-support drugs, mean weight gains at 1, 2, 3, 6, and 12 months after cessation were 1.1 kg, 2.3 kg, 2.9 kg, 4.2 kg, and 4.7 kg, respectively. At 12 months after cessation, 16% of quitters had lost weight, 37% had gained <5 kg, 34% had gained 5 to 10 kg, and 13% had gained >10 kg. Outcomes were similar for quitters who did receive cessation-support drugs (i.e., nicotine replacement, bupropion, or varenicline).
Comment: Smoking cessation, whether untreated or treated, is associated with mean weight gain of about 5 kg at 12 months after cessation. However, weight change is highly variable — more than half of quitters lose weight or experience minimal gain. These results should reassure smokers who are unwilling to quit because they've always assumed that weight gain was a certainty; however, for smokers who are concerned about a 50:50 chance of gaining at least 5 kg, these results might be less reassuring.
Paul S. Mueller, MD, MPH, FACP Published in Journal Watch General Medicine July 31, 2012
Citation(s):Aubin H-J et al. Weight gain in smokers after quitting cigarettes: Meta-analysis. BMJ 2012 Jul 10; 345:e4439.
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FDA Approves Three New Treatments
The FDA approved new treatments for several conditions last week, including:



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Int J Obes (Lond) 2012 Jul 10
Breast-Feeding May Lower Risk for Maternal Obesity in Later Life
For every 6 months of lactation, mean body-mass index was 1% lower during middle age.
Given the number of obesity-related diseases, identifying behaviors that lower risk for obesity is particularly important. U.K. researchers studied 740,628 eligible participants in the Million Women Study (mean age, 58) who provided information on childbearing, lactation, and height and weight. On average, participants each had two children; among the 70% who breast-fed, mean duration of lactation was 3.1 months per child.
In models adjusted for factors such as age, socioeconomic group, smoking status, physical activity, and parity, mean body-mass index (BMI) was significantly higher in mothers who had not breast-fed than in those who had. At every parity level, mean BMI was lower with longer duration of breast-feeding. The reduction in BMI was also greater in women who had breast-fed for >6 months cumulatively than in those who breastfed for <6 months.
Comment: Although this study did not adjust for women's body-mass index at the time of pregnancy (which can affect both success with lactation and BMI in later life), the results add to a growing body of literature suggesting that lactation has important benefits for maternal health. Other studies have shown that women who have never breast-fed face excess risk for visceral adiposity, diabetes, hypertension, hyperlipidemia, and cardiovascular disease, in addition to higher rates of ovarian and breast cancer.
Eleanor Bimla Schwarz, MD, MS Published in Journal Watch Women's Health August 2, 2012
Citation(s): Bobrow KL et al. Persistent effects of women's parity and breastfeeding patterns on their body mass index: Results from the Million Women Study. Int J Obes (Lond) 2012 Jul 10; [e-pub ahead of print].
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Soy Oil Mistaken as Healthful
Consumers believe soybean oil is healthful … a misapprehension rooted in general ignorance of a dire “omega-imbalance” in the standard American diet 
by Craig Weatherby
We’ve written many times about the unhealthful effects of imbalanced intakes of omega-3 and omega-6 fatty acids … a key feature of the standard American diet. In short, Americans have raised their intake of omega-6 fatty acids radically … thanks to far greater use of vegetable oils in processed foods and in home, takeout, and restaurant foods.
Omega-6 fatty acids predominate in the most commonly used vegetable oils … corn, soy, safflower, cottonseed, and sunflower. The only common exceptions are olive oil, macadamia nut oil, canola oil, and “hi-oleic” sunflower or safflower oils.
 The available evidence indicates that people will thrive best – and reduce their risk of most major diseases – on diets providing about three parts omega-6 fats to one part omega-3 fats. But Americans’ relative intakes of omega-6s to omega-3s shifted dramatically in favor of omega-6 fats over the past 100 years … a trend that accelerates sharply starting in the late 1960’s. As a consequence, the average American’s diet now provides 20 or more parts omega-6s to one part omega-3s … a whopping seven times or more higher than the three-to-one intake ratio shown to deter major diseases and promote optimal health. Dozens of human clinical and epidemiological studies – and many more cell and animal studies – link the omega-imbalance typical of most American’s diets to higher disease risks.
 For an overview of this serious health issue, see “America’s Sickening ‘Omega Imbalance’”, “Using our Omega 3/6 Balance Scores”, and the Omega-3 / Omega-6 Balance section of our news archive.
Last year, a team led by renowned National Institutes of Health psychiatrist and omega-3 expert Joseph Hibbeln, M.D., published a study revealed several disturbing trends (Blasbalg TL et al. 2012):

 Why would a big increase in omega-6 intake reduce Americans’ omega-3 EPA and DHA levels? The body cannot use omega-3 ALA for the essential brain, metabolic, and immune functions performed by omega-3 EPA and DHA. Humans convert just one to five percent of dietary omega-3 ALA into omega-3 EPA … a very small percent of which the body can convert to omega-3 DHA. (Pregnant women may convert as much as 10 percent of ALA to EPA.)

Those very low conversion rates are further reduced when the diet is high in omega-6 LA from vegetable oils … a perfect description of American eating patterns. So it is dismaying to see these results from the 2012 Consumer Attitudes About Nutrition survey – an online poll of 1,000 adults conducted by the United Soybean Board (USB 2012):

The report contains this true but highly misleading statement: “Soybean oil is one of the few non-fish sources of omega-3s, and is the principal source in the U.S. diet.” But the omega-3 ALA in soy oil is not remotely equivalent to the omega-3 EPA and DHA in fish fat, and soy oil contains far more competing omega-6 LA than omega-3 ALA. And as the study by Dr. Hibbeln’s team reveals, soy oil is anything but healthful in the context of American diets that already suffer from an extreme overload of omega-6 fatty acids.

The soy industry has done a great job of giving soy foods – soy milk, tofu, and fake meats made from highly processed soy protein – an overly healthful image, despite a notable lack of evidence. Sadly, most people apply that unearned perception of healthfulness to soy oil … to the detriment of their health.
 Sources: Blasbalg TL, Hibbeln JR, Ramsden CE, Majchrzak SF, Rawlings RR. Changes in consumption of omega-3 and omega-6 fatty acids in the United States during the 20th century. Am J Clin Nutr. 2011 May;93(5):950-62. Epub 2011 Mar 2. United Soybean Board (USB). 2012 National Report: Consumer Attitudes about Nutrition. Accessed at http://www.soyconnection.com/health_nutrition/pdf/ConsumerAttitudes2012.pdf
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