Recently, the FDA placed 16 pharmaceutical drugs on a “watch list” because of troubling side effects, which are better documented after drugs have been on the market much longer than the limited trials prior to their approval. This may serve as a reminder that one ofIntegrative Health’s main tenants, to “Treat underlying causes rather than solely treating symptoms“ is a worthy goal to pursue. Most of the 16 drugs listed are immune modulators used in arthritic patients. Since they depress the immune system, there is a concern that patients are at a higher risk of contracting serious infections. The other pharmaceuticals are well-known to most people: Omeprazole-like acid blockers, Imodium, Miralax, Quinolones like Cipro, Gabapentin and IV magnesium.
In view of the FDA’s sobering call to be more cautious with these pharmaceuticals, and our epidemic of obesity, a recent article gives us hope that we may yet get better health care if we accept an Integrative view of health: acupuncture combined with Chinese herbs is equal in effectiveness to weight loss drugs, but with practically no side effects. Hugo Rodier, MD
More on “Obesogens” and what to do about them
In previous issues we have discussed the role of environmental chemicals (Obesogens) and the epidemic of obesity. The latest eye-popping studies on this subject are not unexpected: (1) GMO corn fed to rats increased their BMI and their liver weight by 11%, and (2) phthalates (plastic softeners) are now linked to diabetes. But, the obesogen getting the most ink is Bisphenol A, a chemical used to make plastics see-through. BPA is also used as a dental sealant and as a lining agent in cans to keep aluminum from getting into food. BPA also raises the risk of future coronary disease and neonates’ neurobehavior problems.
The FDA won’t ban any of these obesogens in the foreseeable future; but some kind of action on BPA was requested by The Natural Resources Defense Council in back in 2008. As a result, the National Institute of Environmental Health Sciences is conducting a $30 million research study on BPA. The Endocrine Society, President G. W. Bush’s Cancer Panel, The American Pediatric Association, The American Congress of Ob & Gyn, and the American Medical Association have denounced BPA.
Obesogens are metabolized and detoxified in the gut, functions highly dependent on the nature of our gut flora. In other words, the more plant based foods (high in fiber) we eat, the better our gut flora will work, which then optimizes our metabolism and detoxification pathways. The fact that our liver gets fatter with obesogens and refined foods (“Fatty Liver“) points to poor metabolism and detoxification; these problems have been shown to increase our risk of diabetes and pre diabetes. Making patients aware early on that they are becoming Pre Diabetics may help. The Hemoglobin A1c blood test, when it goes above 5.7 signals significant insulin resistance, a.k.a. Pre Diabetes. To boot, this test has been shown to be cost effective.
Ignoring gut function, obesogens and the addicting nature of sugars (see blogs) is the reason why hardly any program designed to curve obesity are succeeding. Nagging does not work either, but doctors and other providers addressing these issues at each visit and being good examples are arguably more likely to succeed in motivating patients to change their lifestyles, which should include more active lives and less sitting around. There is an increased risk of mortality (15%) in people who sit for at least eight hours; the risk is 40% higher for people who sit for 11 or more hours a day. Rushing around, stressed and worried is the opposite extreme of activity, but it also promotes insulin resistance, especially if we end up sleep deprived. Insulin resistance is well documented in people who work night shifts. Now we know that insulin secretion is also compromised in that setting.
But, enough on “the problem;” Let us now add to the list of things (documented in previous issues) we can do to lose weight. I know you are going to love this one: “Association Between More Frequent Chocolate Consumption and Lower Body Mass Index.“ Really?! Yes, really; but, it has to be the high cocoa chocolate (85%+), not the M&Ms you crave. Most “chocoholics” are addicted to the sugar and milk in chocolate, not the chocolate itself, in my opinion. Unprocessed chocolate, just like ground green coffee beans, help lose weight.
Speaking of treats and/or drinks to lose weight, there is also resveratrol, an antioxidant in grapes. It lowers insulin resistance so well that it is scheduled to become a pharmaceutical product. We will need to be aware of the marketing by anyone standing to profit from resveratrol in the future. As always, buyer beware.
Weight problems are intertwined with psychological issues; there is a clear link between mood and food. Beware of comfort foods and try to manage stress in healthier ways: exercise more and strongly consider yoga.
Toxins and Other Health Problems
Most people may not easily accept the concept of “obesogens,” perhaps thinking that environmental toxins are only affecting our lungs. While air pollution is the main toxin associated with lung problems, other pollutants, such as pesticides, heavy metals, chemical solvents, and phthalates are also contributing to airways oxidation and inflammation. Even mouse droppings and odors have been implicated. The list is likely to get longer.
Since the mechanism of lung injury is oxidation and inflammation, it makes sense that asthmatics supplementing antioxidant and anti-inflammatory nutrients get some relief.This is why I recommend asthmatics to strengthen their immune system in the gut with lots of plant based foods (fiber) and probiotics. My antioxidant of choice is glutathione. This “master antioxidant” is best given by injection or sublingual route. There are some reports that oral glutathione is well absorbed, but most of them are associated with companies that promote its sales (Buyer beware.) Taking oral glutathione precursors is a good alternative. In previous issues we have documented that the following items promote the synthesis of glutathione: Alpha lipoic acid (broccoli,) SAMe (B vitamins,) Milk thistle, goat’s whey, curcumin, N-Acetyl Cysteine (amino acid,) seaweed, elagic acid (pomegranate,) asparagus, selenium and polyphenols in fruits and veggies.
Another problem increasingly associated with toxins is Autism and its milder forms, Asperger’s and ADD. How else could we explain the shocking increase in the incidence of these problems? Recently, researchers showed that genetic mutations are part of the problem. Sure, but they did not discuss that nutrition and toxins do affect genetic expression. When I was in Medical School we were told that Autism was a rare condition affecting 1:2,000 boys. Now, according to the CDC, it afflicts 1:88 children and 1:55 boys. My home state, Utah, leads the nation with 1:32 boys, and 1:85 girls. This is an increase of 78% from 2002 to 2008.
We know that obese moms bear children at higher risk for autism, that “Infant Malnutrition Is Associated with Persisting Attention Deficits in Middle Adulthood,” and that junk food affect the brain, even our moods. Add the toxins’ story, obesogens and poor detoxification together and you will understand why Glutathione is found diminished in autistic children. It goes without saying that improving intestinal/detoxification function in these children through better diets and supplementing glutathione precursors may be helpful in some of them. (I wish I could say ALL of them would be improved, but, alas, autism is a very tough problem.) What a terrible problem we have in our society. And how do we cope? By narrowing the definition of Autism and potentially leaving many families without treatment and/or assistance.
Finally, Fibromyalgia: it too has been associated with toxicity and poor diets. Naltrexone 4.5 mg could be tried, along with glutathione and improving gut function. And believe it or not, acne also signals a poor diet. Along with changes therein, try thyme and essential oils.
 “Promoting More Conservative Prescribing.” JAMA 2009;301:865
 J. Obesity Reviews, May 2012
 J. International J. Biological Sciences, March 21st 2012
 J. Diabetes Care, April 12th 2012, Epub
 “Urinary Bisphenol A Concentration and Risk of Future Coronary Artery Disease in Apparently Healthy Men and Women ,” J. Circulation 2012;125:1482
 “Bisphenol A and Infant Neonatal Neurobehavior” J. Environ Health Perspect 2012;120:a102
 “Do Interactions Between Gut Ecology and Environmental Chemicals Contribute to Obesity and Diabetes?” J. Environ Health Perspect 2012;120:a123
 “Combined Influence of Insulin Resistance, Overweight/Obesity, and Fatty Liver as Risk Factors for Type 2 Diabetes,” J. Diabetes Care April 2012 35:717
 Am J. Preventive Medicine 2012;42;374
 “Observed assertive and intrusive maternal feeding behaviors increase child adiposity,” Am J Clin Nutr 2012 95: 640
 J. Obesity Epub March 19th 2012
 “Sitting Time and All-Cause Mortality Risk in 222 497 Australian Adults,”
J. Arch Intern Med. 2012;172(6):494.
 “Coordination of the transcriptome and metabolome by the circadian clock,”
- PNAS 2012 109 (14) 5541
 “Adverse Metabolic Consequences in Humans of Prolonged Sleep Restriction Combined with Circadian Disruption,” J. Science & Translational Med 2012;4:129
 J. Arch Intern Med. 2012;172(6):519
 American Chemical Society’s 243rd National Meeting and Exposition, March 25-29, 2012, San Diego, Calif.
 “Resveratrol improves insulin signaling in a tissue-specific manner under insulin-resistant conditions only: in vitro and in vivo experiments in rodents,” J. Metabolism Clinical and Experimental 2012;61:424
 “Resveratrol: is selectivity opening the key to therapeutic effects?” J. Metabolism Clinical and Experimental 2012;61:289
 Canadian J. Psy 2012;57:85
 “Effect of Exercise Training on Depressive Symptoms Among Patients With Chronic Illness,” J. Arch Int Med 2012;172:101
 “The Effects of Yoga on Anxiety and Stress,” J. Alternative Medicine Review 2012;17:21
 “Do Environmental Toxicants Contribute to Allergy and Asthma?” J. Altern Med Rev 2012;17:6
 “Mouse sensitization as an independent risk factor for asthma morbidity,” J. Annals Allergy Asthma Immunology 2012;108:135
 “Nutritional Supplement Therapy Improves Oxidative Stress, Immune Response, Pulmonary Function, and Quality of Life in Allergic Asthma Patients: An Open-Label Pilot Study,” J. Altern Med Rev 2012;17:42
 J. Altern Med Rev 2012;17:6 & Am J. Resp Crit Care Med 2002;166:346
 “Glutathione-dependent reductive stress triggers mitochondrial oxidation and cytotoxicity,” J. FASEB 2012 26:1442
 “General Heritability and Shared Environmental Factors Among Twin Pairs With Autism,” J. Arch Gen Psy 2011;68:1095
 “De novo mutations revealed by whole-exome sequencing are strongly associated with autism,” J. Nature Epub 4 April 2012
 “Healthy Diet Trumps Genetics?” JAMA 2011;306:1967
 Epub J. Pediatrics April 9th 2012
 J. Nutrition 2012;142:788
 J. Public Health Nutrition 2012;15:424
 Am J. Clinical Nutrition 2004;80:1611
 DSM V, 2012
 “Small intestinal bacterial overgrowth,” JAMA 2004;292:852
 J. Family Practice News April 1st 2012, p29
 “Diet Gains Legitimacy as Potential Factor in Acne,” J. Skin and Allergy news, May 2008, page 9
 Society for General Microbiology’s Spring Conference, March 26-29, 2012, Dublin
 “Application of the Essential Oil from Copaiba (Copaifera langsdorffii Desf.) for Acne Vulgaris: a Double-Blind, Placebo Controlled Clinical Trial,” J. Altern Med Rev 2012;17:69