Health Newsletter:October 2004

From WebHealth

Hamburger Disease - A Sizzling Problem

One of the many strains of the bacterium E. coli (type 0157:H7) became famous after a 1982 outbreak of bloody diarrhea across the U.S. The infection could be traced back to contaminated hamburgers sold by a fast food chain. Canada also had some smaller food-related outbreaks, but a large disastrous outbreak occurred in Walkerton, Ontario. In this case the culprit was cow manure that was washed into surface water. The water was not optimally treated at the local water works and then consumed by the local community. It is important to know, that infection with E. coli bacteria can be spread in various ways as shown in this table.

The symptoms of infection usually present themselves after an incubation period of 3 to 8 days in the form of abdominal cramps, diarrhea that can also be bloody, and vomiting.

Unfortunately, a more severe form can occur in 2 to 10% of patients due to the toxic substances of the bacterium. The dreaded form of "hamburger disease", is medically known as hemolytic uremic syndrome, and children are at the highest risk, along with older adults or those with immune suppression (AIDS patients, cancer patients). The disease is life threatening, requires blood transfusions, dialysis and life-support therapy in an intensive-care unit setting. Prevention is of utmost importance, and fortunately a lot of it is common sense about food safety and safe food-handling practices:

Besides prevention, vigilance is important: if any case of E. coli infection has been found, the local health units have to be notified, so the source of infection can be found and further spread can be prevented.

The Canadian Journal of Continuing Medical Education, September 2004, Vol.16, Nr.9, pg.49.

Herbal Medicine To Control Menopausal Symptoms

Hot flashes have been plaguing menopausal women, and some patients have resorted to hormone replacement therapy. However, quite a few concerns have arisen over deleterious effects of hormone replacement lately. It is not surprising, that many women turn to herbal remedies for relief.

Of the commonly used alternatives, the most useful one seems to be black cohosh (the botanical name is Actaea racemosa, or the older name Cimicifuga racemosa). Three trials out of four showed that black cohosh was beneficial for patients suffering of hot flashes. Another review showed that in nine out of ten studies black cohosh relieved menopausal symptoms. At this point the safety of long-term use is not known, as none of the trials lasted longer than 6 months. A recently published review involved 2800 women, and all forms of black cohosh were taken into account. The incidence of adverse effects was low at 5.4 % and most effects were mild, like stomach upsets.

As there are isolated reports of adverse effects to the liver, it may be necessary to monitor liver function on patients who take black cohosh preparations. Dosage is also of importance: of the crude drug amounts between 40 and 80 mg per day should be taken. If the dried rhizome or root is taken, dosage should be 40 mg, but not exceeding 200 mg (or 5 to 30 drops of the fluid extract) per day.

The Canadian Journal Of Diagnosis, September 2004,Vol 21,Nr.9, pg.43

What Went Wrong With VIOXX

Merck &. Co., Inc. announced on Sept. 30, 2004 that VIOXX® (rofecoxib), an arthritis and acute pain medication, would be withdrawn voluntarily worldwide.

VIOXX was FDA approved as a new anti-inflammatory drug for osteoarthritis in 1999. Later it was also cleared for rheumatoid arthritis. As a Cox-2 inhibitor it was different from aspirin and the conventional anti-inflammatory drugs such as Naproxen, Motrin or Voltaren.

In a study called VIGOR , which is detailed more under this link, VIOXX was compared to Naproxen in terms of gastrointestinal side-effects.

It was found that the risks of bleeding ulcers, perforation and bowel obstruction were 50% reduced (frequency of cases with naproxen 1.22% versus VIOXX with a frequency of 0.52%). Surprisingly, in this study of 4000 patients over 1 year the cardiovascular risks such as heart attacks, strokes, blood clots for VIOXX was 1.8%, 3-fold higher than Naproxen, which had only 0.6% such complications. In addition it was noted that high blood pressure was more common in rheumatoid patients. The FDA made Merck add a warning on the drug label regarding these added risks, but this went more or less unnoticed by the public.

It has been known for some time that aspirin (ASA) has polyp preventative action on the colon and thus reduces the risk of colon cancer. A specific study, called APPROVe (Adenomatous Polyp Prevention on VIOXX) trial, was designed to show that VIOXX could do the same as aspirin, but with less toxic side effects. In 2000 Merck started enrolling patients into this 3 year long trial. After 18 months into the trial cardiovascular side-effects started to show up that were statistically significant when compared to controls. This is what prompted the recent press release that VIOXX would be taken off the market altogether.

Comments

One of the potential problems with receptor specific medications is that they can be so specific that the metabolism in the human body is changed. What's good for the gut may not be good for the circulation, blood pressure and the heart. Merck did the right thing to withraw the medication altogether. It is not known at this time whether other similar medications such as Celebrex, which has a different molecular configuration, will stand up in the future to post-marketing testing.

Related links:

Studies Show Ginseng Works

As early as 25 A.D. a medical journal praised ginseng "the imperial herb" because of its nontoxic and rejuvenating properties. In the meantime 16-31% of Americans have consumed ginseng in the hope to increase their health and wellness. It is mostly the root of ginseng, which is used for medical purposes, and it is sold either whole, as a powder, or as a water- or alcohol based extract.

Among the many medically active ingredients, the ginsenosides are the most intensely studied substances. There are well designed clinical studies which have tested ginseng's ability to modulate diabetes, heart disease, mental function and physical performance. In the meantime there is enough evidence, which shows that Panax quinquefolius (its botanical name) can reduce blood glucose in individuals with and without type 2 diabetes. Another study examined ginseng and its influence on blood pressure readings. Patients with type 2 diabetes (adult onset diabetes) who received a dosage of 3 grams daily over a period of 8 weeks achieved a reduction in their blood pressure readings, making it safe to take and also as an adjunct in the management of blood pressure.

Cognitive performance may be influenced positively by ginseng, however it is dependent on the dose, which is used. A lower dose of 200 mg reduced the mental performance, whereas a dose of 400 mg significantly improved accuracy in a demanding test.

Ginseng has not found to be effective to improve physical performance or be a weapon against fatigue. In a 12- week trial patients received ginseng as a general supplement together with multivitamins or multivitamins alone. Ginseng significantly improved the quality of life, which could not be achieved with multivitamins alone.

Taking all the findings together, it is evident, that ginseng has beneficial properties for patients with diabetes, and it is also useful to improve cognitive function. Ginseng may reduce blood pressure readings, but more studies are needed. The blood pressure reducing effect seems marginal and ginseng, if taken for this purpose, should be used only as an adjunctive treatment along with the regular medication. As far as physical performance is concerned, it seems to be of little use. It does not show any interaction with prescription drugs, and for this reason it can be considered safe for general use.

Comments: As this reference shows red and white ginseng powder caused a 55% reduction of a variety of cancers in a population of 905 patients that were studied (liver, lung, stomach, throat, cervix, breast, thyroid and others). The effective ingredients are a mixture of saponins. These have long been known to have prostate cancer preventative effects. All in all there seem to be beneficial effects of ginseng on the cardiovascular system, the nervous system and regarding cancer prevention. The end result is that ginseng is perceived as an anti-aging substance as those people who take it live longer .

The Whitehall-Robins Report, September 2004, Vol.13,No.3

Gum Disease Increases Stroke Risk

Gum disease is common, particularly in the Western civilization. It has been known for a number of years that heart attacks are associated with chronic gum infections, but whether or not strokes would also be more common in these patients was not known for certain.

Stroke risk in patients with gum disease compared to controls without gum disease (see text for more details)

The purpose of a University of Helsinki study by Dr. Pussinen was to see whether patients with periodontal gum disease were objectively more at risk to develop a stroke over a period of time. Blood samples of 6950 people aged 45 to 64 were collected between 1973 to 1976. The patients were followed for 13 years and 173 developed a stroke. Blood samples for antibody studies had been taken at the beginning of the study. Two types of antibody tests were done in order to check out whether or not the body's immune system had reacted to two of the typical pathogens that are associated with bad and chronic gum disease.

Other studies had shown earlier that the pathogens Actinobacillus actinomycetemcomitans (in the illustration above called "type 1") and Porphyromonas gingivalis (above called "type 2") are associated with the initiation of hardening of arteries (atheromatous plaque formation).

Dr. Pussinen and his group looked at indiviuals that were free of stroke or heart disease at the baseline. Among those individuals who were positive for the type 1 antibody and after adjusting for heart disease risk factors, there was a 1.7-fold risk of developing a stroke (shown as dark blue bar above). When type 2 antibody titers were tested among these stroke patients, the probability of finding a positive type 2 test was 2.6-fold higher than in appropriate controls. The authors concluded that aggressive forms of periodontitis (=bad gum disease) are an independent risk factor to develop a stroke.

Comments: It has been known, based on the original research from Switzerland several decades ago, that tooth decay can be prevented or slowed down by brushing our teeth following meals and in particular after sugar consumption.

Regular flossing once per day has been shown in more recent years to counteract gum disease (periodontitis). Only recently has it been shown that heart disease is directly related to infection of atheromatous plaques with Chlamydia pneumoniae and the other two pathogens mentioned above. It is here that we can make a big difference to our health. How do we prevent periodontal disease? By brushing and flossing our teeth daily. It is that simple. Well, not quite. There is one other thing: We need to cut down the amounts of sugar and starch we consume every day as this provides the micro-chemical climate in the mouth for these bacteria to multiply and this is what we want to change. This will tip the balance in our favor: healthy teeth, healthy gums, healthy blood vessels, hearts and intact brains.

To learn more about this topic, here are more links regarding gingivitis .
Dr. Pussinen et al., September issue of Stroke (Stroke 2004;35:2020-2023).