· Study authors report that gastroenteritis can lead to heartburn or IBS years later.  Infectious gastroenteritis may cause chronic low-grade inflammation of the intestinal track which can lead to symptoms of functional bowels disorders.

· The current study analyzed people from a small community in Canada where there was an outbreak of bacterial gastroenteritis in the year 2000.  Over 2,300 people were infected and seven people died from the infection.

· Researchers studied approximately 1,088 participants from this community six year period.
Over 50% of the study participants who had been infected during the outbreak reported symptoms of dyspepsia which included heart burn, nonspecific abdominal pain and discomfort.  Only 30% of the people who were not infected during the outbreak had dyspepsia symptoms

· Given the higher rate of gastrointestinal complaints in the affected study population, researchers concluded that bacterial gastroenteritis plays a role in the development of chronic functional bowel disorders.

Cristopher Geiler, MD
Gastroenterology 2010

Study authors enrolled 120 patients with lung disease, emphysema or chronic bronchitis in a three year study. All patients completed dietary questionnaires at six month intervals.

Sixty patients were randomized to the intervention arm, in which they were instructed to increase their fresh fruit and vegetable consumption by at least one portion per day. The control group had no diet guidance.

The groups were similar at baseline in demographic factors, smoking or smoking cessation, dietary habits, and spirometry results. They were also similar in terms of their physical activity, alcohol consumption and weight during the study.

At baseline, the groups were similar in their consumption of vegetables and fruits. Throughout the study, diets in the control group remained unchanged, but antioxidant consumption rose significantly in the intervention group.

Study authors report that in the year before the study, the average number of COPD exacerbations were similar in the intervention group and control group. During the study, the average number of COPD exacerbations were significantly lower in the intervention group.

The high-antioxidant diet was also associated with an improvement in lung function.

Although this was a small study, it is likely that diets that are high in antioxidants found in fruits and vegetables is helpful in patients with lung disease

Cristopher Geiler, MD

Reference
Eur Respir J. 2010

Study authors report that “Vitamin D insufficiency, which is prevalent in older individuals, is associated with bone and muscle weakness and falls.” This study examined the effects of a weekly dose of 8400 IU vitamin D3 on balance problems, muscle strength, and safety in older individuals.

Researchers analyzed participants who were 70 years and older with deficient levels of vitamin D and randomly assigned them to receive a weekly dose of 8400 IU of vitamin D3 or placebo.

The main endpoint of the study was to assess improvements in balance and stability along with vitamin D levels.

The study authors reported that patients who were treated with supplemental vitamin D 8400 IU once a week had a significant increase in vitamin D blood levels, increasing from 13.9 to 26.2 ng/mL. Researchers reported that there was no improvement in balance or neuromuscular function according to their tests after 16 weeks of treatment.

Although low levels of vitamin D appear to be associated with imbalance and neuromuscular dysfunction, replacement of vitamin D3 did not appear to help. However, this study did show that weekly vitamin D3 dosing was helpful in raising blood levels of vitamin D.

Cristopher Geiler, MD
Reference
Am J Clin Nutr. February 2010

It is hard to make a smart conclusion from this information.  This type of study (meta-analysis) is difficult to interpret in that data is really coming from previously published articles that were not directly studying the same outcomes; in this case, the risk of diabetes in people who take statins.

There does not appear to be a physiologic relationship between the activity of statin medications and blood glucose or insulin.  This type of study is not very scientific and it is very difficult to make conclusions,  especially when it does not make sense.

Cristopher Geiler, MD

References
Lancet 6736(09)61965-6

According to a new analysis of the ‘Women’s Health Initiative’ study, menopausal women, who took estrogen and progesterone hormone replacement therapy, had a slightly increased risk of coronary heart disease within the first few years of treatment.  The caveat is that the slightly increased risk was not statistically significant.

The study analyzed recently menopausal women and showed a slightly increased but insignificant risk of about 29% during the first two years of hormone use. This risk disappeared after six years of use.  In fact, the researchers showed a possible protective effect against heart disease in women who used hormone replacement therapy for more than six years.

Hormone replacement therapy in postmenopausal women remains controversial and this most recent analysis does not clarify the issues.  The current recommendations by the FDA for women to take hormone replacement therapy, if required, is to relieve symptoms of menopause, but to use it at the lowest dose and for the shortest time possible.

Cristopher Geiler, MD
Arch Intern Med. 2010;170(3):226.

· Researchers began to investigate outbreaks of acute selenium toxicity after reports of cases of Selenium poisoning began in March 2008.

· Selenium is a naturally occurring mineral that is usually obtained from a balanced diet. Selenium is required for good health and the recommended dietary allowance is 55mcg per day for adults.

· The cause of the outbreaks were identified as liquid dietary supplements which were labeled as containing 200mcg of selenium per fluid ounce in the form of sodium selenite, an inorganic form of selenium. The actual Selenium concentration was 200 times the amount on the label. When the US Food and Drug Administration (FDA) tested the supplements, they found the selenium concentration of 40,800mcg/ounce.

· The authors report that about 200 cases of Selenium poisoning were found and one case required hospitalization.

· Symptoms of Selenium poisoning include diarrhea, nausea and vomiting along with fatigue, joint pain, hair loss and foul breath.

· Although 201 cases were found, the actual number of people affected with Selenium toxicity was likely higher because of the associated symptoms. Selenium toxicity can be nonspecific, making the association with the supplement difficult.

· When the affected patients were interviewed by their doctors, they had not suspected the supplement had made them ill nor mentioned the fact that they were taking the dietary supplements.

· This article highlights the importance of patients communicating with their doctors about all dietary supplements, herbs, and over-the-counter medications that they are taking.

Cristopher Geiler, M.D.
Arch Intern Med. 2010;170:256-261, 262-263.

· Researchers have found that higher blood levels of the omega 3 fish oils are associated with a slowing of the cellular time clock. Cells use the redundant DNA at the end of chromosomes as a biologic clock. Every time a cell divides, it loses some of this redundant DNA called a ‘Telomere‘. When the telomere runs out, the cell stops dividing and dies.

· Authors of this study showed that higher levels of omega 3 fish oils were associated with a decrease in the shortening of the telemere over a five year study. Researchers studied over 600 patients who participated in the Heart and Soul Study between the years 2000 and 2002. Researchers measured the telomere length and omega-3 fish oils docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) of the patients at the beginning and the end of the study. The participants were divided into four quartiles based on the amount of omega 3 fish oils in their blood. The group with the lowest levels of Omega 3 fish oils were noted to have the fastest rate of telomere shortening. The group with the highest blood levels of Omega 3 fish oils had the slowest rate of telomere shortening.

Since telomere length is directly related to cellular aging, a longer telomere, or slowing the telomere loss, will increase cellular longevity and, in essence, slow the aging of your cells.

Omega 3 fatty acids are not produced in your body. Omega 3 fatty acids need to be obtained by eating certain fish or a supplement of fish oil capsules or liquid form.

Cristopher Geiler, M.D.

Additionally, recent research studies have shown that vitamin D may protect against cardiovascular disease.  In the current study, researchers showed that low levels of vitamin D are linked to an increase in heart rate and blood pressure.

Study authors examined data from more than 27,000 adults who took part in the National Health and Nutrition Examination Surveys conducted from 1988 to 1994 and from 2001 to 2006.

The participants with Vitamin D blood levels of 10 ng/ml or less had a heart rate that was about two beats per minute faster, and blood pressure readings that was 1.9 points higher, than those with people with vitamin D in the normal range of at least 35 ng/mL.

Why does vitamin D help the heart?  Nobody knows. The primary function of vitamin D is to regulate calcium metabolism.  It is likely that vitamin D has additional and undiscovered functions that affect human metabolism.

This observational study suggests that people with higher vitamin D levels have hearts that work more efficiently.  This is intriguing information and additional research is needed to clarify how vitamin D affects the heart.  Additionally, we do not know the optimal dose of vitamin D nor the best source for obtaining vitamin D. 

Cristopher Geiler, MD

Am J Cardiol 2010.

Additionally, study authors reported that the women participants had no changes in blood pressure, insulin, glucose, lipoprotein(a) levels or evidence of inflammation or clotting related to menopausal transition.

This is the first study to show that menopause is associated with worsening in cholesterol levels.  Although we have been suspicious that postmenopausal women will develop higher cholesterol, this study proves it.
Untreated high levels of bad cholesterol is directly related to heart attacks and strokes.  This is an important finding and should serve as a wakeup call for postmenopausal women to check their cholesterol levels and review the information with their doctor.

Cristopher Geiler, MD
J Am College Cardiol. 2009;54:2366-2373 and 2374-2375

The researchers report that the young adults in this study who had lead levels of 2.11 ?g/dL or more in their blood were 2.3 times more likely to be diagnosed with Major Depression and five times more likely to be diagnosed with Panic Disorder or Anxiety Disorder compared with lead blood levels of 0.7 ?g/dL or less.

Lead exposure is not uncommon.  Exposure to lead can come from contaminated water, pottery, tobacco smoke, leaded gasoline or paint.

Previous medical studies have indicated that lead blood levels above 6.3 ?g/dL were toxic and were associated with depression and anxiety disorders.  This is an important new finding in that it is teaching us that even very low levels of lead can cause disease and we should be very cautious of any exposure to environmental lead.

Cristopher Geiler, MD
Arch Gen Psychiatry. 2009;66:1313-1319.