What to Make of Dr. Oz and his Detox? Not much

Although my exposure to Dr. Oz has been limited, he is not one of my favorite TV doctors. He often offers opinions in areas where he clearly is not an expert.  By presenting himself as a doctor who is knowledgeable in so many areas, he has the potential of undermining the credibility of physicians more broadly.  A recent report provides some welcome pushback and at the same time indicates that “detox” treatments are unlikely to be helpful.

Here’s the link: Detox treatments by DrOz and others lack evidence, benefit  – CBC

An excerpt:

Despite bold promises that the treatments would purify, detoxify and boost energy and optimize organ function, the cleanses lacked any scientific evidence of efficacy, or clear idea of what toxins they would actually diminish…

“In looking at the medical literature on these things, there has never been a properly conducted scientific investigation of any of these treatments that I’ve been able to find,” Dr. George Dresser, a toxicologist, pharmacologist and an internal medicine specialist at London Health Sciences Centre, told Marketplace co-host Tom Harrington. “It’s an intensely popular topic. And it’s popular because people are interested in a quick fix to health ”

A group of sorority sisters from Western University volunteered to help Marketplace test the cleanse. Half of the group participated in the Dr. Oz cleanse, which required that the students observe a strict diet and refrain from alcohol and caffeine, and not eat any food after 7 p.m. They also drank detoxifying teas and took soothing baths as prescribed by the diet, while the other students ate and drank normally.

To test the efficacy of the cleanse, all students had their liver and kidney functions tested both before and after the 48-hour period. At the end of the 48-hour period, however, Dr. Dresser was unable to detect any physiological benefit at all, or even tell which students had participated in the cleanse.

Despite a CV that boasts degrees from Harvard and the University of Pennsylvania medical school, Dr. Oz has been the target of growing criticism from fellow medical and science professionals for his promotion of products and methods that lack evidence.

Bottomline: “Given his education and influence,” wrote Erin May on the Harvard University science research blog Policylab, “there’s no excuse for the unsubstantiated claims and sensational language that is so pervasive on his show.”

Perhaps Dr. Oz can garner additional publicity by placing his detox on the following website:  Quackwatch (He’s already frequently cited on this website.)

Brain Response to Physical Activity different in Obesity

From NY Times (http://nyti.ms/1afnEyJ) review of the following article:

Int J Obes (Lond). 2013 Dec 24. doi: 10.1038/ijo.2013.245. [Epub ahead of print]

Differences in neural activation to depictions of physical exercise and sedentary activity: An fMRI study of overweight and lean chinese women. Jackson T, Gao X, Chen H.

An excerpt:

Overweight women’s brains respond differently to images of exercise than do the brains of leaner women…

The scientists asked their volunteers to complete two questionnaires, one of which probed the extent to which they considered exercise desirable; would they agree, for instance, that, “if I were to be healthy and active, it would help me make friends”? The other set of questions examined whether they expected exercise to be unpleasant; if they were to be physically active on most days, for example, would they expect to wind up feeling sore, or maybe even embarrassed by exercising in public?

The researchers next had each woman lie inside a functional magnetic resonance imaging machine, which scans blood flow to specific areas of the brain, indicating areas of increased activity. Then they started a slide show.

For some time, scientists have known that many overweight people’s brains operate differently than the brains of thinner people when they look at images related to eating. In previous neurological studies, when heavier volunteers viewed pictures of food or food preparation, they typically developed increased activity in portions of the brain involved in reward processing, or an urge to like things, including in an area called the putamen. At the same time, their brains showed relatively blunted activity in areas that are thought to induce satiety, or the ability to know when you are full. These changes generally are reversed in the brains of thinner people shown the same images.

But no brain-scanning studies had examined whether being heavy might also affect people’s brain responses — and presumably their attitudes — toward physical activity.

So, to address that gap, the researchers now flashed a series of photographs before their volunteers. Ninety of the images showed people being joyously active by running, dancing, leaping, playing tennis and such. The women were asked to vividly imagine themselves performing the same actions, using hand gestures and limited bodily contortions, to the extent possible within the confines of the scanner.

Ninety additional images featured relaxed, sedentary behaviors, including stretching out on a sofa and sitting in a desk chair. Again, the women were directed to imagine themselves similarly lounging. The various images of activity and quiet were interspersed with photographs of landscapes.

While the women viewed the pictures, the functional M.R.I. machine monitored their brain activity.

The resulting readouts revealed that overweight women’s brains were put off by exercise. Shown images of people being active, these women developed little activation in the putamen region of the brain, suggesting that they did not enjoy what they were seeing. At the same time, a portion of the brain related to dealing with negative emotions lit up far more when they viewed images of moving than of sitting. Emotionally, the brain scans suggested, they anticipated disliking physical activity much more than they expected to disdain sitting.

Leaner women’s brain activity, by and large, was the opposite, with the putamen lighting up when they watched others work out and envisaged doing the same themselves.

Micronutrient Monitoring in Intestinal Failure

J Pediatr 2013; 163: 1692-6.  This retrospective study of prospectively collected data from 178 children provides data with regard to micronutrient deficiency among intestinal failure patients transitioning to enteral feeds. Figures 1 and 2 along with Table 2 provide the prevalence of micronutrient deficiency while receiving supplemental parenteral nutrition (PN) and while on full enteral nutrition (FEN).  Iron deficiency was most common in both situations with prevalence of 84% and 61% respectively. With the exception of folate (0%), all of the vitamins and micronutrients had fairly high rates of deficiency.  While on FEN,  deficiencies were  the following:

  • Vitamin A        19%
  • Vitamin B12    6.5%
  • Vitamin D        30%
  • Vitamin E          6%
  • Copper            8%
  • Iron                61%
  • Selenium         4%
  • Zinc               23%

The study does not indicate that the deficiency values were adjusted based on CRP values.  Instead, “low serum levels were used to define deficiencies.”  This is likely to lead to numerous errors.  Nevertheless, it is clear that these deficiencies are common.  Another finding of the study was that normal anthropometrics did not reduce the frequency of these deficiencies.  In their patient population, 57 of 136 (42%) with sufficient height and weight data had a height-for-age z-scores of <-2 by the time of FEN; where as 52 of 139 patients (37%) had weight-for-age z-scores of <-2.

A recent post on The Pediatric Nutritionist blog provides a suggested approach to the monitoring of vitamins and micronutrients based on the need for parenteral nutrition and on the need to consider inflammatory markers in the interpretation of these lab values: The Importance of Nutrition Lab Monitoring Protocols Featuring 

Bottomline: Vitamin and micronutrient deficiencies are common among intestinal failure patients.  In addition, a large percentage of these kids are not large at all.

Related blog post:

What happens to micronutrient levels in the hospital setting 

Timing of Solid-Food Introduction

The “DAISY” (diabetes autoimmunity  study in the young) study indicates that the timing of solid-food introduction can influence the likelihood of developing type 1 diabetes (T1DM) (JAMA Pediatr 2013; 167: 808-15).

The participants were 1853 children at increased genetic risk for T1DM who were enrolled in a longitudinal observational cohort study in Denver. Early solid-food exposure was considered <4 months of age and late >6 months of age.

Results:

  • “Both early and late first exposure to any solid food predicted development of T1DM.”  For early exposure, the Hazard Ratio was 1.91 and for late HR was 3.02.
  • Breastfeeding at the time of introduction to wheat/barley conferred protection (HR 0.47)

The study has several limitations, particularly the relatively low numbers of children who developed T1DM (n=53).

A second study (Pediatrics 2013 [doi: 10.1542/peds2012-3692]) –thanks to Ben Gold for this reference –showed that “solid foods were introduced significantly earlier among the infants with allergies, with 35% of them receiving their first solids before and including 16 weeks, compared with 14% of control infants (P=.011).”   (Solid foods before 17 weeks linked to food allergy)

Bottomline: As with celiac disease (GlutenRelated Disorders” (Part 1) | gutsandgrowth), current science suggests the introduction of solid foods between 4-6 months of age may diminish the risk of developing T1DM as well as food allergies.

 

Newest FODMAPs Study for IBS

From AGA twitter feed: http://t.co/vFwhS5YEF4 -Full text article.

From Abstract:

Methods

In a study of 30 patients with IBS and 8 healthy individuals (controls, matched for demographics and diet), we collected dietary data from subjects for 1 habitual week. Participants then randomly were assigned to groups that received 21 days of either a diet low in FODMAPs or a typical Australian diet, followed by a washout period of at least 21 days, before crossing over to the alternate diet. Daily symptoms were rated using a 0- to 100-mm visual analogue scale. Almost all food was provided during the interventional diet periods, with a goal of less than 0.5 g intake of FODMAPs per meal for the low-FODMAP diet. All stools were collected from days 17–21 and assessed for frequency, weight, water content, and King’s Stool Chart rating.

Results

Subjects with IBS had lower overall gastrointestinal symptom scores (22.8; 95% confidence interval, 16.7–28.8 mm) while on a diet low in FODMAPs, compared with the Australian diet (44.9; 95% confidence interval, 36.6–53.1 mm; P < .001) and the subjects’ habitual diet. Bloating, pain, and passage of wind also were reduced while IBS patients were on the low-FODMAP diet. Symptoms were minimal and unaltered by either diet among controls. Patients of all IBS subtypes had greater satisfaction with stool consistency while on the low-FODMAP diet, but diarrhea-predominant IBS was the only subtype with altered fecal frequency and King’s Stool Chart scores.

Conclusions

In a controlled, cross-over study of patients with IBS, a diet low in FODMAPs effectively reduced functional gastrointestinal symptoms. This high-quality evidence supports its use as a first-line therapy.

Related Blog Posts:

What helps kids poop?

While there are a number of answers to the above title, the answer that I’m looking for is physical activity (JPGN 2013; 57: 768-74).

With regard to the referenced study, a large prospective birth-cohort study (n=347 participants) in Rotterdam showed that preschool children with increased physical activity had about 1/3rd less frequency of functional constipation in the fourth year of life.  Activity measurements at the age of 2 years were accomplished by wearing ActiGraph accelerometers during 1 weekday and 1 weekend day.  Additionally, children who had physical activity of 60 min/day at age 4 had about 1/2 the likelihood of having functional constipation.  There are several limitations to the study; reduced activity and constipation could both be present in some individuals as a consequence of personality or psychologic attributes rather than physical activity having a causal relationship in causing constipation.

Bottomline: Another good reason to encourage physical activity –it might help with regular bowel habits.

Also, on a separate note, a recent blog post by Kipp Ellsworth is a useful reference for lab monitoring (micronutrients and vitamins) in children with short bowel syndrome:

Blog | The Pediatric Nutritionist | Covering the world of infant, child 

Related blog entries:

.

Could you recruit your patients to climb a mountain for research?

Amazingly, a group of investigators enrolled 25 healthy climbers to determine how hypoxia affects the expression of iron transporters in the duodenal mucosa (Hepatology 2013; 58: 2135-62).

Methods: In a nonblinded, prospective study, blood and duodenal samples were taken at three timepoints: baseline (446 meters) and at 4559 meters two days later after a rapid ascent and then at day four while remaining at high altitude. 14 subjects received dexamethasone on day 2 to avoid high-altitude sickness. The duodenal biopsies were obtained by unseated transnasal small-caliber duodenoscopy.  Numerous other assays were checked as well.

Key finding: Hypoxemia was associated with a 10-fold increase in duodenal expression of divalent metal-ion transporter 1 and ferroportin 1 which promote iron intake.  In addition, there was decreased serum hepcidin levels.

Take-home message: Hypoxic conditions such as high-altitude quickly lead to an activation of changes that lead to compensatory erythropoeisis.

Related blog post: Help with hepcidin | gutsandgrowth

Healthy Obesity?

From NY Times,  nyti.ms/1diH2d4 –an excerpt:

The idea that there are obese people who are nonetheless healthy may be a myth.

Although some overweight or obese people have normal cholesterol, glucose levels and blood pressure — elements of so-called metabolic health — a new study suggests that obesity by itself increases the risk for heart disease, stroke, diabetes and death.

Researchers analyzed 12 studies that had together followed more than 61,000 adults, most for at least 10 years. About 9 percent of the subjects were obese and metabolically healthy — that is, they had normal LDL, HDL and total cholesterol, along with healthy blood pressure and blood sugar levels. The report was published online last week in Annals of Internal Medicine.

Compared with metabolically healthy people of normal weight, the obese group had a 24 percent increased risk for fatal and nonfatal cardiovascular events like heart attack and stroke, and for death by any cause.

Related blog posts:

Vitamins: often ‘throwing money down the drain’

From USA Today: Medical journal: ‘Case closed’ against vitamin pills

“it’s time for most consumers to stop wasting money on multivitamins and other supplements, because they have no proven benefits and some possible harms.”

That declaration comes in a strongly worded editorial that accompanies two new studies and an expert panel’s report published Monday in the Annals of Internal Medicine.

“The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided,” says the editorial, signed by two researchers from Johns Hopkins University in Baltimore, one British researcher and one of the journal’s senior editors…

The new results from that study will disappoint anyone who hoped a multivitamin might keep them sharp in old age. The study followed male physicians over age 65 for an average of 11 years and found multivitamins had no effect on cognitive decline…

A second, unrelated, new study in Annals found high-dose multivitamins had no effect on the progression of heart disease in heart attack survivors…

there are exceptions. For example, health officials strongly urge women of childbearing age to take folic acid, to prevent birth defects. Some ongoing studies of vitamin D, he says, are justified because some benefits…

most of the 53% of U.S. consumers who use supplements are wasting money, to the tune of $28 billion a year.

Same story from NY Times: http://t.co/kEwrk1mGyQ

Related blog entry:  Live longer -don’t take your vitamins? | gutsandgrowth