Issue 39


Procedure Performed at MWA by Emma McGowan, M.D. & Martin Gallagher, M.D.

  Acupuncture and Autogenic Training Benefit Persons with Rheumatoid Arthritis

In a study involving 44 patients with rheumatoid arthritis, treatment with acupuncture (auricular electroacupuncture), once a week for a period of 6 weeks, was found to be more effective than autogenic training (relaxation technique involving visualizations) in reducing pain and reducing erythrocyte sedimentation rate. Patients received either auricular electroacupuncture or autogenic training once a week for six weeks. Statistically significant and clinically meaningful improvements were found among subjects in both groups, both immediately following the 6 week treatment period and at 3 months follow-up. The beneficial effects appeared earlier among patients receiving acupuncture (after the 2nd treatment), and were in general more pronounced. By the 4th treatment, patients receiving acupuncture reported significantly less pain than those undergoing autogenic training. Furthermore, erythrocyte sedimentation rate (ESR) was significantly less and serum tumor necrosis factor-alpha was significantly increased among patients receiving acupuncture, as compared to autogenic training. At the end of the treatment period, patients who received acupuncture assessed their outcome as significantly more improved than those who received autogenic training. Given the safety of such treatments, the results of this study suggest that acupuncture, as well as autogenic training, may be effective in reducing pain and inflammation in patients with rheumatoid arthritis.

"Adjuvant auricular electroacupuncture and autogenic training in rheumatoid arthritis: a randomized controlled trial. Auricular acupuncture and autogenic training in rheumatoid arthritis," Bernateck M, Becker M, et al, Forsch Komplementmed, 2008; 15(4): 187-93. (Address: Department of Anesthesiology, Pain Clinic, Hannover, Germany. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ).


Loss of Smell a Strong Predictor of Death

Posted on Nov. 17, 2015, 6 a.m. in Death and DyingDiagnosticsSensory

A loss of smell is a strong predictor of death within 5-years for older adults.

Research has revealed that olfactory dysfunction – losing the ability to identify scents – is a strong predictor of death in older adults. In the first-wave of the study Jayant M. Pinto, MD, an associate professor of surgery at the University of Chicago, and colleagues enlisted 3,005 participants to take part in a smell-test to identify 5 distinct common odors (peppermint, fish, orange, rose and leather). Results showed that almost 78% of those tested could smell normally(normosmic); with 45.5% correctly identifying 5 out of 5 odors and 29% identifying 4 out of 5. Almost 20% of participants were found to have an impaired sense of smell (hyposmic), and only got 2 or 3 out of 5 correct. The remaining 3.5% had completely or nearly lost their sense of smell (anosmic) and could identify just 1 of the 5 odors (2.4%), or none (1.1%). In the second-wave of the study, 5-years later, the researchers ascertained which participants were still alive. Results showed that 430 (12.5%) of the original 3005 subjects had died and 2,565 were still alive. After adjusting for demographic variables such as age, gender, socioeconomic status, overall health, and race, results showed that participants with smell loss were significantly more likely to have died within the 5-years. 39% of study subjects classed as anosmic died during that period, compared to 19% of those classed as hyposmic and just 10% of those with a healthy sense of smell (normosmic). Further analysis revealed that olfactory dysfunction was better at predicting mortality than a diagnosis of heart failure, cancer or lung disease, and for those already at high risk, anosmia more than doubled the probability of death. The only factor that was a stronger predictor of death was severe liver damage. "It doesn't directly cause death, but it's a harbinger, an early warning that something has gone badly wrong, that damage has been done,” said Dr Pinto. “Our findings could provide a useful clinical test, a quick and inexpensive way to identify patients most at risk."

Pinto JM, Wroblewski KE, Kern DW, Schumm LP, McClintock MK. Olfactory dysfunction predicts 5-year mortality in older adults. PLoS One. 2014 Oct 1;9:e107541.



Super E Plus

Contains Natural Unesterified Mixed Tocopherols and Tocotrienols

Vitamin E is one of the body’s most important antioxidant nutrients. Antioxidants protect healthy cells from oxidative and free radical damage. Free radicals are unstable chemicals formed in the body during metabolism and from exposure to environmental sources, such as pollution and cigarette smoke. Free radicals are necessary for energy metabolism and immune function, but when an excessive number of free radicals are formed, they can attack healthy cells, especially cell membrane lipids and proteins. This, in turn, is thought to contribute to a number of degenerative diseases.

Vitamin E is an especially valuable antioxidant in the cell membranes, where it prevents oxidation of unsaturated fatty acids by trapping free radicals. This helps stabilize and protect cell membranes, especially red blood cells and tissues sensitive to oxidation, such as the lungs, eyes, and arteries. Vitamin E also protects the liver and other tissues from the free-radical damage of toxicants, such as mercury, lead, ozone, nitrous oxide, carbon tetrachloride, benzene, cresol, and various drugs.

Related to its antioxidant properties, vitamin E is important for normal immune function, and many studies show that it prevents lipid peroxidation of blood lipoproteins, such as LDL-cholesterol.

While many think that the term “vitamin E” refers to a single entity, it actually describes a family of eight different compounds known as the tocopherols and the tocotrienols. Both the tocopherols and tocotrienols are further divided into their alpha, beta, gamma and delta isomers. These two groups of compounds are similar with respect to their structure, but do have subtle molecular structure differences.

The d-alpha tocopherol isomer is the most well-known form of vitamin E. However, recent scientific evidence indicates that gamma-tocopherol may possess unique, distinguishable features. This tocopherol is the major form of vitamin E in seeds and in the US diet, though it has not been studied as broadly as alpha-tocopherol. Numerous studies have shown gamma-tocopherol to have excellent antioxidant abilities that complement the antioxidant ability of alpha-tocopherol. Additionally, some studies have shown that high dose supplementation of alpha-tocopherols can deplete both plasma and tissue levels of gamma-tocopherol in the body.

Tocotrienols are found in various foods, but are particularly abundant in rice bran and palm oil. Like tocopherols, tocotrienols function as powerful antioxidants. In certain systems, there is evidence that tocotrienols may even possess greater antioxidant activity compared with tocopherols. In addition to their antioxidant function, tocotrienols have demonstrated the ability to reduce cholesterol synthesis by inhibiting the hepatic enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase, a rate-limiting enzyme in cholesterol biosynthesis. This finding has resulted in research investigating the ability of tocotrienols to affect cholesterol levels as well as other cardiovascular health parameters.

Super E Plus is different from most mixed tocopherols products because it contains natural mixed tocopherols with a minimum guaranteed amount of the d-beta, d-gamma and d-delta tocopherols, as well as a significant amount of natural mixed tocotrienols.





    Lycopene   May Be Beneficial in the Prevention of Platelet Aggregation and Thrombosis

In a study to examine the effects of lycopene in the prevention of platelet aggregation and thrombus formation, results found that lycopene inhibited in vitro platelet aggregation and in vivo thrombus formation, suggesting that tomato-based foods may be especially beneficial in the prevention of platelet aggregation and thrombosis. In the in vitro part of the study, results showed that depending on the concentration of lycopene (2 to 12 micromol/L), lycopene inhibited platelet aggregation in human platelets stimulated by agonists. It was found that 6 and 12 micromol/L of lycopene inhibited phosphoinositide breakdown in platelets labeled with tritiated inositol, inhibited intracellular Ca+2 mobilization in Fura-2 AM-loaded platelets, and inhibited thromboxane B2 formation stimulated by collagen. Additionally, 6 and 12 micromol/L of lycopene significantly increased the formations of cyclic GMP and nitrate, but not cyclic AMP, in human platelets. The phosphorylation of a marker of protein kinase C activation was also markedly inhibited by 12 micromol/L of lycopene. In the in vivo part of the study, thrombus formation was induced in mice by irradiation of mesenteric venules. Results showed that 5, 10, and 20 mg/kg lycopene significantly prolonged the latency period for the induction of platelet-plug formation in the mesenteric venules. These results indicate to the researchers that the antiplatelet activity of lycopene may involve the following pathways - one, where lycopene may inhibit the activation of phospholipase C, and then inhibit phosphoinositide breakdown and thromboxane B2 formation, thereby leading to the inhibition of intracellular Ca+2 mobilization; and two, where lycopene may activate the formations of cyclic GMP/nitrate in human platelets, resulting in the inhibition of platelet aggregation.

"Inhibitory effects of lycopene on in vitro platelet activation and in vivo prevention of thrombus formation," Hsiao G, Wang Y, et al, J Lab Clin Med., 2005; 146(4): 216-26. (Address: Graduate Institute of Pharmacology, Taipei Medical University, Taipei, Taiwan).

CANCER - Sun Protection in Childhood

Excessive sun exposure during the first 10 to 20 years of life increases the risk of skin cancer. Non-melanoma skin cancer such as basal cell and squamous cell carcinoma is associated with cumulative sun exposure, whereas melanoma is associated with short, intense sun exposure or blistering sunburn. Children under normal circumstances receive approximately 3 times the annual sun exposure of adults. So in a child's lifetime most of the sun exposure occurs during that time. Those with fair skin are at highest risk. Sunscreens, clothing and sun avoidance in childhood may significantly reduce the occurrence of melanoma and skin cancer later in life. Regular use of sunscreen with sun protective factor 15 during the first 18 years of life could possibly reduce the incidence of non-melanoma skin cancer by 78%. Pediatricians are encouraged to play an educatory role. It is noticed that long term PABA use can decrease vitamin D stores. It is still questionable whether using sunscreens may result in vitamin D deficiencies in certain cases. The carcinogenicity of some sunscreens has been questioned. There is a nitrosamine compound in very small amounts which probably is a breakdown product of a PABA derivative. It is not known whether this nitrosamine is in sufficient quantities to cause harm. Sunscreens with or without padimate-O, the probable substrate from which the nitrosamine compound comes, are still strongly recommended. Protection against sun exposure should be part of pediatric preventive health care.

"Sun Protection in Childhood", Truhan, Andrew P., M.D., Clinical Pediatrics, July 1991;30(7):412-421.

Chronic Kidney Disease and Salt

Patients with chronic kidney disease are more likely to be salt sensitive than salt resistant. This increase in salt sensitivity is related to reduce nephron mass, increased production of reactive oxygen species in the kidney and a reduction in the ability to excrete salt. When there is reduced nephron mass, there is also an associated disruption of the normal intrarenal hemodynamic vascular responses, with a reduction in preglomerular resistance. In the setting of a salt load, there is in elevation of both systemic and intraglomerular pressure. When there is habitual increased salt intake causing chronic elevated systemic and glomerular pressure, these increases have adverse renal effects, such as proteinuria, loss of nocturnal dip in blood pressure with loss of renal function and, ultimately, end-stage renal disease. There is increasing evidence that salt-induced increases in reactive oxygen species within the vasculature and renal cortex may explain the observations of the associated development of interstitial fibrosis and progressive renal dysfunction. Examining salt consumption patterns by measuring urinary sodium and potassium excretion in patients with chronic kidney disease and tracking their renal outcomes longitudinally would be the ideal way to examine whether the effects of dietary salt in patients with compromised renal function translate into adverse renal outcomes. This may be even more important in patients who have a greater tendency toward salt sensitivity, such as African Americans, older patients and obese individuals, especially if they have chronic kidney disease. In the future, monitoring oxidative stress in either the serum or urine of patients in relation to electrolyte ingestion will be helpful, along with blood pressure measurement, albuminuria, and estimated glomerular filtration rate in monitoring patients and predicting outcomes. There is no real clear cut answer with regard to how much salt is too much. It would be prudent in patients with chronic kidney disease and hypertension to have a modest avoidance of foods rich in salt.

"Salt Intake and Progression of Chronic Kidney Disease: An Overlooked Modifiable Exposure? A Commentary," Weir MR, Fink JC, Am J Kidney Dis, January 2005;45(1):176-188. (Address: Matthew R. Weir, MD, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.)

Is Organic Food Really More Nutritious?

Two large new studies suggests the answer is “yes”, even when it comes to meats

5/4/2016 By Craig Weatherby

 Looking to get biggest nutritional bang for your meat buck?

Two extensive new studies suggest that it makes sense to choose organic.

A British-European team reviewed 263 studies that compared the nutritional content of organic versus conventional meat.

They found clear advantages for organic meat … especially in terms of omega 3 fatty acids, the balance between omega-3s and omega 6 fatty acids, and certain antioxidants.

This matters because Americans need all the omega-3s and antioxidants they can get, and fewer omega-6s.



American diets lack omega-3s

Several years ago, Harvard University researchers came to an alarming conclusion.

They estimated that omega-3 deficiencies may kill 84,000 Americans prematurely every year.

And the new British-European findings show that switching to organic meat would significantly raise people’s omega-3 intakes.

As Professor Chris Seal of Newcastle University said, "Omega-3s are linked to reductions in cardiovascular disease, improved neurological development and function, and better immune function.”

"But getting enough in our diet is difficult. Our study suggests that switching to organic would go some way towards improving intakes of these important nutrients.”

In addition several mother-child studies link organic vegetables to a reduced risk of certain allergies and autoimmune diseases in babies, such as eczema.

Organic meat found superior

Surprisingly, there have been no systematic reviews comparing the nutrient content of organic and conventionally produced meat.

So in one of their two studies, the British-European team analyzed 67 studies comparing the composition of organic and non-organic meat products.

And compared with conventional meats, organic meats looked better:

Organic meats’ advantage in omega-3s matters because, as the authors wrote, "For the majority of North American and European consumers, meat is the main dietary source for long-chain omega-3s, supplying up to an estimated 50% of the recommended adequate intake.”

Prior evidence in favor of organic foods

Two years ago, the same team compared the nutritional composition of organic and conventionally-grown crops.

That analysis found that organic crops are up to 60 percent higher in a number of key antioxidants and contained less of the toxic metal cadmium.


 Epilepsy affects 0.5% of the population. In children the proportion of epilepsy is higher. Ten to 15% of children have seizures which are not controlled with multiple medications. The ketogenic diet is a reasonable alternative for treatment of uncontrolled epilepsy. Supplying the bulk of calories as fat forces the central nervous system to substitute ketone bodies for the brain's preferred fuel which is glucose. It is not known whether ketones themselves are directly antiepileptic or have an indirect action on a particular neurotransmitter system. Atypical absence, tonic and atonic seizures respond best. Other seizure types will sometimes improve. The ketogenic diet consists of 90% fat, calorie restriction to 75% of the RDA, and fluid restriction to 60 cc/kg. This results in ketosis. The ketogenic diet starts with a medically supervised fast until the child spills large ketones in the urine and becomes mildly dehydrated. Once large ketosis is achieved, the child is slowly started on the ketogenic diet over 2 to 3 days. A dietitian helps with this process as well as with numerous meal plans. The diet is deficient in B vitamins, iron and calcium. A carbohydrate-free multivitamin, calcium and mineral supplement is taken daily. All medications need to be low in carbohydrates. Once the child tolerates the full diet and the parents are well educated in home diet management, the child is discharged to home. Parents check the urine for ketones and specific gravity.

"Treatment of Epilepsy in Children," Olson, D. M., et al, Journal of the American College of Nutrition, 1996;15(5):517/Abstract 10.

 DID YOU KNOW.......




 In evaluating 39,876 female health professionals, it was found that current heavy smokers had no significant increase in the frequency of colds but had a significantly increased risk of prolonged colds. There was no difference in the number of days that the subjects were confined to their homes. Nonsmoking females who were passively exposed to cigarette smoke had a slight increase in risk of both more frequent colds and more prolonged colds during the previous year.

"Active and Passive Smoking and Risk of Colds in Women," Bensenor IM, Cook NR, Lee I-M, et al, Ann Epidemiol, 2001;11:225-231

Fibromyalgia - Connection with Bacterial Overgrowth in Small Intestine?

In evaluating 815 individuals using the lactulose hydrogen breath test, 152 individuals had the diagnosis of fibromyalgia, of whom 29 who had concurrent inflammatory bowel disease were excluded. The remaining 123 individuals were used in the analysis. Of these 123 individuals, 63 were referred by a rheumatologist. Of the 63 who were seen by a rheumatologist, 52 tested positive for small intestinal bacterial overgrowth. Twenty-three of the 123 subjects had coexisting connective tissue disease. One hundred and seven of the 123 subjects met the criteria for irritable bowel syndrome. Out of the 123 subjects with fibromyalgia syndrome, 96, or 78%, tested positive for small intestinal bacterial overgrowth as diagnosed by the lactulose hydrogen breath test. In 25 subjects who returned for a follow up lactulose hydrogen breath test, 11 had complete eradication and 14 achieved incomplete eradication of their small intestinal bacterial overgrowth with antibiotics. The antibiotics used were neomycin in 18 subjects, augmentin in 1 subject, ciprofloxacin in 1 subject, flagyl in 1 subject, 1 subject who was treated with both neomycin and ciprofloxacin, another subject who was treated with neomycin, biaxin and amoxicillin, and two subjects who did not remember which antibiotics they took. Twenty-two of these 25 fibromyalgia patients returned for follow-up for a lactulose hydrogen                         breath test and 57% reported global improvement in their symptoms. Three subjects did not provide a percent global improvement. The percent decrease in abdominal pain with 68.8% in the complete eradication group, and 1.5% in the incomplete eradication group. Seventeen subjects noted their abdominal complaints improved the most, 7 patients listed pain, 3 listed fatigue, and 1 reported sleeplessness was most improved. Bloating, gas, diarrhea, constipation and abdominal pain were all improved. There was more improvement with complete eradication. These data suggest that bowel symptoms in fibromyalgia may be caused by small intestinal bacterial overgrowth. There have been associations made between fibromyalgia symptoms and Chlamydia species as well as Borrelia burgdorferi. In animal models, small intestinal bacterial overgrowth can result in bacterial translocation to mesenteric lymph nodes and can produce systemic effects. These systemic effects are believed to be mediated by endotoxins from Gram-negative bacteria. These endotoxin effects may explain the soft tissue hyperalgesia that is seen in fibromyalgia syndrome since injections of the endotoxin into lab animals results in similar hyperalgesia. The authors conclude that the intestinal symptoms of fibromyalgia patients may be related to small intestinal bacterial overgrowth, and treatment of small intestinal bacterial overgrowth can result in overall improvement in intestinal symptoms.

"Small Intestinal Bacterial Overgrowth: A Possible Association With Fibromyalgia," Pimentel M, Chow EJ, Hallegua D, Wallace D, Lin HC, J Musculoskeletal Pain, 2001;9(3):107-113.