October 28th, 2014

Fecal Capsules vs. Probiotic Supplements for Clostridium difficile

Introduction

Antibiotic use can result in a severe form of diarrhea due to the overgrowth of the bacteria Clostridium difficele. The C. difficele infection is caused because the antibiotics alter the type of bacteria in the colon resulting in killing off the health promoting bacteria that normally keep C. difficele in check. This diarrhea has reached epidemic proportions in the U.S alone, as it is estimated 3 million people develop C. difficele infection annually. Even more serious, is that it is thought that the infection may cause about 300 deaths per day, or almost 110,000 deaths per year.

Probiotic supplementation has been shown to be effective in both preventing and treating antibiotic-induced diarrhea, including C. difficele infections. But for some reason, conventional medicine feels that more drastic measures are required, such as “fecal microbiota transplantation” whereby fecal material is transplanted from a healthy donor to the infected individual via an endoscopic tube. Now, a recent study published in JAMA, the Journal of the American Medical Association, used orally administered capsules of frozen fecal matter to successfully treat C. difficele infection.

The obvious question is why not simply use probiotic supplements versus having people swallow capsules of someone else’s bowel movement? The former is just more appealing than the later.

Background Data:

  1. difficele accounts for 15-25% of all episodes of antibiotic-associated diarrhea. The bloody, watery diarrhea caused by C. difficele is also known as pseudomembranous enterocolitis. The current standard treatment of the infection is giving patients even more powerful antibiotics, such as metronidazole or vancomycin. Even then, about 20% of patients fail to respond or have a recurrence. Fecal transplants from a healthy related donor to the infected individual has been suggested to be a more effective and lower cost approach. A clinical study published in the New England Medical Journal in January 2013 reported a 94% cure rate of pseudomembranous colitis caused by C. difficile with a fecal transplant, compared to just 31% with vancomycin.

New Data:

A new study published in JAMA used frozen encapsulated fecal matter administered orally in the treatment of C. difficele infection. The researchers used frozen fecal matter from thoroughly screened healthy donors who were unrelated to the infected patients. Donors were healthy, non-pregnant adults aged 18-50 years, taking no medications, and with a normal body mass index (BMI).

Twenty patients (median age, 64.5 years; range, 11-89 years) with at least 3 episodes of mild to moderate C. difficile infection and failure of a 6- to 8-week taper with vancomycin or at least 2 episodes of severe C. difficile infection requiring hospitalization were enrolled. The patients received 15 capsules on 2 consecutive days, with monitoring of symptom resolution or occurrence of adverse events for up to 6 months.

Resolution of diarrhea was achieved in 14 patients after the initial treatment. All 6 nonresponders were re-treated and 4 had resolution of diarrhea. So, overall 90% of patients had complete resolution of diarrhea – about the same rate of response seen with fecal transplants via endoscopy. Hence, researchers concluded that oral treatment was equally effective as endoscopic fecal transplant.

The researchers did note that larger studies are needed to confirm the results and to evaluate long-term safety and effectiveness of the capsule.

Commentary:

My initial reaction to this study was “you have got to be kidding me.” I just don’t think it makes sense to be collecting fecal material from the general population, freezing it, putting it into capsules, and then having people take it. Besides the obvious “ick” factor, there is the obvious risk of introducing other pathogens.

It is studies like this one that make me want to scream to the medical profession “hello, have you heard of probiotic supplements?” Probiotics, translated “for life,” refer to bacteria in the intestine considered beneficial to health. The most important healthful bacteria are Lactobacillus acidophilus and Bifidobacterium bifidum.

Probiotics have a protective effect against acute diarrheal disease and have been shown to be successful in the treatment or prevention of various types of infectious diarrhea including C. difficile, rotavirus, and traveler’s diarrhea. There is absolutely no question that probiotic supplementation shortens the duration and reduce stool frequency in acute infectious diarrhea, as numerous clinical studies now document this benefit. Probiotic supplementation is especially important in helping children susceptible to infectious diarrhea. Furthermore, probiotics exert immune-enhancing effects.

Probiotic supplementation is also well documented to prevent as well as promote the recovery from antibiotic induced diarrhea, including C. difficile infection. Although it is commonly believed that probiotics supplements are not effective if taken during antibiotic therapy, the research actually supports usage of probiotics during antibiotic administration.

The recommended dosage is at least 12 to 24 billion organisms during antibiotic therapy and that you take the probiotic supplement as far away from the antibiotic as possible. In people that have developed pseudomembranous enterocolitis, I would also recommend supplementing with Saccharomyces boulardi, a probiotic yeast shown to very helpful in pseudomembranous enterocolitis, unless they are immunocompromised patients (such as those with AIDS or taking immune suppressing drugs).

References:

Youngster I, Russell GH, Pindar C, et al. Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection. JAMA. 2014 Oct 11. doi: 10.1001/jama.2014.13875. [Epub ahead of print]

Dr. Michael Murray
10/28/2014

October 27th, 2014

A Breathing Technique that Triggers the Relaxation Response

A Breathing Technique that Triggers the Relaxation Response

An important step in fighting stress is learning to calm the mind and body. Among the easiest methods to learn are relaxation exercises. The goal of relaxation techniques is to produce a physiological response known as a relaxation response — a response that’s exactly opposite to the stress response.

Although an individual may relax simply by sleeping, watching television, or reading a book, relaxation techniques are designed specifically to produce the relaxation response.

Relaxation response is a term coined in the early 1970s by Harvard professor and cardiologist, Herbert Benson, to describe a physiological response that he found in people who meditate. The relaxation response activates the parasympathetic nervous system, which controls bodily functions such as digestion, breathing, and heart rate during periods of rest, relaxation, visualization, meditation, and sleep.

The Relaxation Response

When the parasympathetic nervous system kicks in, creating the relaxation response, the heart rate is reduced and the heart beats more efficiently. Blood pressure is reduced. Blood is shunted toward internal organs, especially those organs involved in digestion. The rate of breathing decreases as oxygen demand is reduced during periods of rest. Sweat production diminishes, because a person who is calm and relaxed does not experience nervous perspiration. Production of digestive secretions is increased, greatly improving digestion. Blood sugar levels are maintained in the normal range.

While the sympathetic nervous system, triggered by the stress response, is designed to protect against immediate danger, the parasympathetic system is designed for repair, maintenance, and restoration of the body.

An Effective Breathing Technique

Producing deep relaxation with any relaxation technique requires learning how to breathe. Have you ever noticed how a baby breathes? With each breath, the baby’s abdomen rises and falls because the baby is breathing with its diaphragm, a dome-shaped muscle that separates the chest cavity from the abdominal cavity.

If you are like most adults, you tend to fill only your upper chest because you do not utilize the diaphragm. Shallow breathing tends to produce tension and fatigue.

One of the most powerful methods of producing less stress and more energy is by breathing with the diaphragm. By using the diaphragm to breathe, a person dramatically changes their physiology. It literally activates the relaxation centers in the brain.

Here is a 10-step technique for learning diaphragmatic breathing.

1. Find a comfortable and quiet place to lie down or sit.

2. Place your feet slightly apart. Place one hand on your abdomen near your

navel. Place the other hand on your chest.

3. You will be inhaling through your nose and exhaling through your mouth.

4. Concentrate on your breathing. Note which hand is rising and falling with each breath.

5. Gently exhale most of the air in your lungs.

6. Inhale while slowly counting to 4. As you inhale, slightly extend your abdomen, causing it to rise about 1 inch. Make sure that you are not moving your chest or shoulders.

7. As you breathe in, imagine the warmed air flowing in. Imagine this warmth flowing to all parts of your body.

8. Pause for 1 second, then slowly exhale to a count of 4. As you exhale, your abdomen should move inward.

9. As the air flows out, imagine all your tension and stress leaving your body.

10. Repeat the process until you achieve a deep sense of deep relaxation.

October 21st, 2014

Theracurmin First Form of Curcumin to be Shown Effective in Double-Blind Study in Osteoarthritis

Introduction

Curcumin – the yellow pigment of turmeric (Curcuma longa), the spice that is the chief ingredient in curry, has demonstrated significant anti-inflammatory activity in many experimental studies, but its clinical effects have been limited because of poor absorption in humans. Theracurmin, a special, highly bioavailable form of curcumin, represents a major breakthrough in the clinical use of this natural product.

Over a dozen double-blind studies have now shown Theracurmin to produce a wide range of health benefits, including positive results on heart and liver health, muscle fatigue, skin moisture content, mood, and vascular elasticity. Now, a new study with Theracurmin conducted by researchers from the Orthopedics Division at Kyoto Medical Center in Japan, is the first double-blind study confirming the health benefits of curcumin in patients with osteoarthritis.

Background Data:

As of October 2014, more than 5,000 scientific studies have focused on curcumin. Its primary biological effects relate to its action as a broad-spectrum antioxidant and profound anti-inflammatory agent. Its use in clinical trials has been limited due to poor oral absorption in humans.

Theracurmin is the most bioavailable form of curcumin capable of increasing blood levels of curcumin, significantly greater than other forms of curcumin. It is a colloidal mixture produced by reducing the particle size of curcumin by over 100 times and emulsified with a natural vegetable gum.

Detailed studies have shown that Theracurmin is not only better absorbed, but it also stays in the blood far longer than any other commercial form of curcumin. Studies have also shown it to be extremely safe with no significant side effects or drug interactions noted.

New Data:

Osteoarthritis, also referred to as degenerative joint disease, is a slow destructive process of the joints that affects millions of people worldwide. It is usually treated with analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs), but these drugs sometimes cause serious gastrointestinal and cardiovascular adverse events, especially with long-term use. Furthermore, there is concern that these drugs may also impair cartilage formation, thereby leading to greater joint destruction.

Curcumin has been suggested as a natural approach to not only decrease joint pain, but also slow the progression of the condition. To test this hypothesis, researchers at Kyoto Medical Center enrolled 50 patients over 40 years old with knee osteoarthritis confirmed by X-ray. The patients took either Theracurmin providing 180 mg/day of curcumin or a placebo daily for 8 weeks. Blood biochemistry analyses were performed before and after 8 weeks of each intervention to evaluate safety. The patients’ knee symptoms were evaluated at 0, 2, 4, 6, and 8 weeks by the knee scoring system of the Japanese Orthopedic Association and also the Japanese Knee Osteoarthritis Measure, the knee pain visual analog scale (VAS), and the need for nonsteroidal anti-inflammatory drugs.

Results showed that knee pain scores were significantly lower in the Theracurmin group than in the placebo group in those patients with moderate to severe symptoms. Theracurmin also lowered the use of celecoxib (Celebrex) much more significantly than placebo. While 60% of the placebo group still relied on Celebrex for adequate pain relief at the 8-week mark, only 32% of the Theracurmin group still needed the NSAID, and there was a definite strong trend for eventual discontinuation. No major side effects were observed in the patients taking Theracurmin.

These results show that Theracurmin may safely help many people with osteoarthritis improve symptoms and decrease need for NSAIDs.

Commentary:

This study is extremely significant for several reasons. First, it shows that if a highly absorbable form of curcumin is used, meaningful clinical improvement in pain and joint function can be achieved with more significant improvements being noted in those with the greatest degree of discomfort. Second, to show such a significant advantage over a placebo in such a short-term study in osteoarthritis is very impressive. There are published studies with other forms of curcumin in arthritis, but these studies are not double-blind, placebo-controlled studies. Instead, these studies are open trials where both the physician and patient know what is being used as treatment. Open label trials in osteoarthritis are generally not considered meaningful because there is such a high placebo rate with any new treatment in osteoarthritis, e.g., about 60-70% of people in the placebo group experience significant improvement in both objective and subjective measures of joint pain and function.

Double-blind, placebo-controlled studies are designed to show the true treatment effect above and beyond any placebo response. Generally, in osteoarthritis this requires a much larger study group and much longer periods of time. Therefore, for Theracurmin to show such clear benefit in this relatively small, short-term study, bodes really well for people with osteoarthritis gaining immediate and noticeable benefits out in the real world.

Reference:

Nakagawa Y, Mukai S, Yamada S, et al. Short-term effects of highly-bioavailable curcumin for treating knee osteoarthritis: a randomized, double-blind, placebo-controlled prospective study. J Orthop Sci. 2014 Oct 13. [Epub ahead of print]

Dr. Michael Murray
10/21/2014

October 20th, 2014

6 Basic Steps To Get Started Exercising

runnerExercise is an important part of any health plan and an excellent way of keeping your immune system in shape as well. While most people know that staying active is essential if you want to live a healthy life, starting an exercise routine can be daunting for anyone who’s never done it and doesn’t know what to expect.

With that in mind, here’s a six-step plan that can help anyone start exercising, even if you never have before.

1. Realize the importance of physical exercise.

The first step is realizing just how important it is to get regular exercise. Regular exercise is vital to a healthy immune system. You must make regular exercise a top priority, especially as the seasons change and you’re increasingly indoors, where germs are spread easily. Think of small ways to get more exercise into your daily routine. Even small choices, like taking the stairs instead of the elevator, can make a big difference.

2. Consult your physician.

If you aren’t currently on a regular exercise program, get medical clearance if you have health problems or if you’re over 40 years of age. See a physician if you have heart disease or high blood pressure. Also consult your doctor if, when exercising, you experience extreme breathlessness, pain or pressure in the chest, arm, teeth, jaw, or neck, or dizziness, fainting, or abnormal heart action (palpitations or irregular heartbeat).

3. Select an activity you can enjoy.

Next, select an activity that you enjoy — such as bicycling, swimming, or racket sports. Make a commitment to do it daily for at least 20 minutes, preferably an hour. Make enjoyment your goal. Move your body enough to elevate your heart rate above its resting rate.

4. Monitor exercise intensity.

Exercise intensity is determined by measuring your heart rate (the number of times your heart beats per minute). While exercising, place the index and middle finger of one hand on the side of the neck just below the angle of the jaw or on the opposite wrist. Beginning with zero, count the number of heartbeats for six seconds. Simply add a zero to this number, and that’s your pulse.

For example, if you counted 14 beats, your heart rate would be 140. Would this be a good number? It depends upon your “training zone.” Your maximum training heart rate can be found simply by subtracting your age from 185. For example, if you are 40 years old your maximum heart rate would be 145. Your minimum training heart rate would be 20 less. In the case of a 40-year-old this would be 125.

So your training zone would be a heartbeat between 125 and 145 beats per minute. Having a heart rate of 140, then, would be pretty good — you’re working out at the upper end of your training zone. For maximum health benefits, stay in this range and never exceed it.

5. Do it often.

Exercise should be performed on a regular basis. A minimum of 15 to 20 minutes of exercising at your training heart rate at least three times a week is a necessity. Brisk walking (five miles an hour) for approximately 30 minutes may be the best form of exercise for weight loss, and the risks are extremely low.

6. Stay motivated.

Fire up your motivation by setting exercise goals, varying your routine, and keeping a record of your activities and progress. If at some point your enthusiasm wanes, skip one or two workouts. You’ll come back later with an even stronger commitment.

October 13th, 2014

Oral Magnesium Supplementation Improves the Metabolic Profile in Metabolically Obese, Normal-weight Individuals

Introduction:

Some normal weight individuals show obesity-related characteristics such as insulin resistance, elevated fasting blood sugar levels, high triglyceride levels, and high blood pressure. Although eating a high carbohydrate diet is linked to these findings, a new study shows that low magnesium status contributes to this disorder, and that magnesium supplementation can improve the metabolic profile in these subjects.

Background Data:

Magnesium is second only to potassium in terms of concentration within the individual cells of the body. The functions of magnesium primarily revolve around its ability to activate many enzymes. It is an essential cofactor in the enzymatic processes involved in energy production, insulin action, and the regulation of glucose and lipid metabolism, as well as in the regulation of blood pressure.

Magnesium deficiency is extremely common in Americans due to a lack of dietary magnesium. Deficiency is also often secondary to factors that reduce absorption or increase the excretion of magnesium such as: high calcium intake, alcohol, surgery, diuretics, liver disease, kidney disease, and oral contraceptive use.

A large body of clinical evidence derived from double-blind trials shows that oral magnesium supplementation improves insulin sensitivity, triglyceride and cholesterol metabolism, improves glucose metabolism, and helps lower blood pressure in hypertensive individuals

New Data:

A total of 47 subjects defined as metabolically obese, normal-weight (MONW) individuals with low magnesium status were enrolled in a randomized double-blind, placebo-controlled trial. The metabolic abnormalities included the presence of fasting glucose levels ≥100 mg/dL, HOMA-Insulin Resistance index ≥3, triglyceride levels ≥150 mg/dL and/or systolic and diastolic blood pressure ≥140 and 90 mmHg. Low magnesium status was defined by serum magnesium concentration ≤1.8 mg/dL.

The treatment group received an oral supplement providing 382 mg of elemental magnesium per day for 4 months. At the beginning of the study there were no significant differences between groups. At the end of follow-up, the following parameters were significantly lower in the subjects who received magnesium compared with individuals in the placebo group: fasting glucose (-12.3 vs. -1.8% mg/dL, p <0.05); triglyceride levels (-47.4% vs. 10.1% mg/dL); HOMA-IR index (-46.5 vs. -5.4%,; and systolic (-2.1 vs. 3.9% mmHg) and diastolic (-3.8 vs. 7.5% mmHg) blood pressures.

These results show quite clearly that magnesium supplementation provides significant benefits in the regulation of metabolic disturbances and blood pressure whether someone is overweight or not.

Commentary:

Most Americans consume less than 50% of the recommended dietary intake (RDI) for magnesium indicating that a large segment of the population may benefit greatly from magnesium supplementation.

Magnesium supplements are available in several different forms. Absorption studies indicate that magnesium is most easily absorbed orally when it is bound to citrate, and presumably aspartate and other members of the Krebs cycle, such as malate, succinate, and fumarate. Inorganic forms of magnesium such as magnesium chloride, oxide, or carbonate are generally well absorbed, but are more likely to cause diarrhea at higher dosages.

Personally, even though I probably consume adequate amounts of magnesium from my diet, because I work out intensely and live in a hot climate (Arizona) I take a scoop of Magnesium Citrate drink mix (Natural Factors) providing 300 mg of elemental magnesium in a glass of water every night before I go to bed. In addition to providing my brain and body with this easily absorbable form of magnesium, there is data that shows that magnesium supplementation also greatly improves sleep quality.

Reference:

Rodríguez-Moran M, Guerrero-Romero F. Oral magnesium supplementation improves the metabolic profile of metabolically obese, normal-weight individuals: a randomized double-blind placebo-controlled trial. Arch Med Res. 2014 Jul;45(5):388-93. doi: 10.1016/j.arcmed.2014.05.003.

October 7th, 2014

Fish Oils Improve Behavior Issues in Children 8-16 Years Old

Introduction:

The long-chain omega-3 fatty acids EPA and DHA found in fish and fish oil supplements are absolutely critical to optimal brain function. A new study by researchers from the University of Pennsylvania found that supplementation with 1,000 mg of omega 3 fatty acids daily, significantly improved antisocial and aggressive behavior in children between the ages of eight and sixteen.

Background Data:

A large body of research shows that a lack of the long chain omega-3 fatty acids EPA and DHA leads to impaired brain function and plays a major role in attention deficit disorder, depression, and other psychological disturbances in both children and adults. Not surprisingly, supplementation with fish oils rich in EPA+DHA have been shown to improve these very same conditions, as well improve behavioral issues associated with these disorders.

The importance of EPA+DHA to brain function relates to their role in the composition of nerve cell membranes. A relative deficiency of omega-3 fatty acids in cellular membranes substantially impairs brain cell function.

Studies have shown that the EPA+DHA content in cell membranes in the brain directly influences neurotransmitter synthesis, signal transmission, uptake of serotonin and other neurotransmitters, neurotransmitter binding, and the activity of key enzymes that break down neurotransmitters like serotonin, epinephrine, dopamine, and norepinephrine.

EPA+DHA supplementation has also been shown to blunt the stress response.

All of these actions could have significant effects in helping easily stressed or depressed children (and adults) exert more appropriate behavior instead of acting out.

New Data:

In the study, 200 children were randomized into a treatment group or placebo control group. The children in the treatment group were given a fruit drink containing 1,000 mg of omega 3 fatty acids daily (300 mg DHA, 200 mg EPA, 400 mg alpha-linolenic acid [ALA], and 100 mg of docosapentaenoic acid [DPA]). Treatment lasted for 6 months, and all participants were followed for another 6 months after discontinuation of treatment.

Primary outcome measures were externalizing behavior problems that included acting out, being aggressive, and reactive. Secondary outcome measures looked at the impact on internalizing behavior (social withdrawal, feelings of loneliness or guilt, fearfulness, etc.). The children were assessed by the parents and researchers, as well as through a self-assessment questionnaire. The parents also completed a self-assessment questionnaire.

While the children themselves did not report improvement, the parents reported a significant improvement in children’s behavior in the treatment group for all behavioral issues. Specifically, omega-3 supplementation for 6 months resulted in a 41.6% reduction in parent-rated child externalizing behavior compared to the placebo group. This effect persisted 6 months after the treatment period had ended. An even larger reduction of 68.4% was seen for internalizing behavior.

There was also an unexpected finding, the parents whose children took omega-3s also showed significant reductions in their own external behavior. Further analysis of the findings indicated that while the omega-3s definitely had an effect on child behavior, the improvement in parental antisocial behavior accounted for 60% of the improvement in child behavior.

Commentary:

While it may be easy to conclude that the majority of the improvement was related to the change in the parents, I think that is the wrong answer. Here is my thinking: when a child with behavioral issues starts exhibiting improved behavior, it changes the parent-child dynamic. The parents feel less stress and that in turn helps push things in a more positive direction and the child will respond accordingly. It is a classic example of a positive feedback loop. In fact, I think the accurate conclusion from the study is that omega-3 fatty acid supplementation is important in starting the positive feedback cycle that exerts a tremendous effect in not only improving the behavior of the child, but also the family dynamics.

Reference:

Raine A, Portnoy J, Liu J, Mahoomed T, Hibbeln J. Reduction in behavior problems with omega-3 supplementation in children aged 8-16 years: a randomized, double-blind, placebo-controlled, stratified, parallel-group trial. J Child Psychol Psychiatry. 2014 Aug 22. doi: 10.1111/jcpp.12314. [Epub ahead of print]