Vitamin D is known as the sunshine vitamin, and is well known for its role in bone health. However its role in the body extends well beyond simply bone health. Vitamin D deficiency is linked with a variety of conditions including autoimmune disease, various types of infections, type 2 diabetes, as well as cardiovascular diseases. It has also been shown that vitamin D is necessary for certain kinds of immune cells to be activated and be able to effectively fight infections.⁽¹⁾ Recent research published in the American Journal of Clinical Nutrition has brought to light a serious health issue that may be preventable to some degree with something simple as adequate vitamin D levels. They found that sufficient levels of vitamin D prior to being hospitalized may prevent development of “hospital acquired blood stream infections” (HABSI).⁽²⁾ After adjusting for a number of other possible variables, their results showed that the odds of acquiring HABSI were highest in those with vitamin D levels below 10ng/mL (25nmol/L), while those with elevated levels had significantly decreased risk. Sufficient levels are considered to be at least 30-32ng/mL (75-80nmol/L), or higher. Incidence of HABSI in the United States was nearly 80000 in 2009 among patients hospitalized in intensive care (ICU), with roughly 28000 deaths;⁽³⁾ and these numbers are likely proportionate here in Canada. If these statistics can be lowered by something simple and inexpensive as vitamin D, it would be not only be saving many lives but also the healthcare system a significant amount of associated costs. Next time you visit your doctor make sure you get your vitamin D levels checked and supplement as needed based on your levels.

Hibiscus has a long history of traditional use amongst various cultures, consumed mainly as a tea for general enjoyment as well as for specific ailments. Historically, folk medicine has used it for the treatment of high blood pressure, liver disease and fevers. Scientific interest has grown over the past decade, with a number of human studies published showing benefits for cholesterol, blood pressure and metabolic syndrome. A study published in the journal Nutrition Research showed hibiscus extract was able to decrease serum cholesterol by between 8.3-14.4% in just one month, depending on the dose given.⁽¹⁾ Interestingly it was not the highest dose that offered the most benefit; ideal dose was found to be at 1000mg 3x/day. Another study published a few years later found Hibiscus at 2 cups/day taken as a brewed tea for one month significantly increased HDL while also significantly decreasing total cholesterol, LDL and triglyceride levels in those with type 2 diabetes.⁽²⁾ Its hypotensive effect has also been reproduced in several studies, with hibiscus tea taken twice daily reducing systolic blood pressure levels; in one study this was reduced by over 20 points (3, 4). With no known side effects this little herb is gaining intrigue, with a number of potential therapeutic uses.

Bisphenol A (BPA) is a man-made chemical used in the production of polycarbonate water bottles, epoxy-lined metal cans and is even found in dental sealants. This toxic substance has known endocrine disrupting effects, which in general terms means that it can act like the body’s own hormones. In 2008 Health Canada seemed to have acknowledged it as being a health issue, particularly in the young, and banned it from plastic baby bottles; however efforts seem to have stopped there. In June 2009 Health Canada completed and published a study that found trace levels of BPA still present in most the commonly used plastic baby bottles and liners, even though they were labeled as being BPA free!⁽¹⁾ They justify this by saying levels were in trace amounts and as such do not pose a health risk. Another government resource however admits that safe levels of BPA exposure are unknown, and that the level associated with adverse health effects in humans is as yet unknown.⁽²⁾ This disturbing contradiction raises concerns about this latest finding of BPA still present in many common products.

The most recent research presented at the joint meeting of the International Federation of Fertility Societies and the American Society for Reproductive Medicine showcased several studies that suggest harmful effects from BPA on human health. One study looking at a group of pregnant women found that those that had a miscarriage in the first trimester had higher BPA levels at the start of the study compared to those that had live births.⁽³⁾ Another study found that high BPA levels in the follicular fluid may be a potential cause of hyperandrogenism in PCOS patients.⁽⁴⁾ Other associated health implications include: impaired neuropsychological function in children,⁽⁵⁾ and heart disease and diabetes to name a just a few. BPA and other similar endocrine disruptors in our environment are a real threat to our health that deserves to be addressed. France, for example, has taken the initiative to ban BPA from all forms of food packaging. It’s time Canada stepped up to the plate.

Thalassemia is one of the most common genetic disorders worldwide. Iron supplementation or blood transfusions can treat the underlying anemia but may lead to iron toxicity. Iron overload can result in damage to major organs including the heart and the liver. Safe and non-invasive strategies for iron reduction are an important target for clinical management of thalassemia major.

This study assessed the iron-chelating activity of silymarin, a flavonolignan isolated from milk thistle (Silybum marianum) in patients with β-thalassemia major. A total of 97 patients were treated with the combination of desferrioxamine (pharmaceutical iron chelator) in combination with a placebo, or desferrioxamine in combination with silymarin for 9 months. Patients had their liver enzymes and their iron parameters tested before and after therapy.

After nine months, a marker of iron levels (called ferritin) decreased significantly in the silymarin group (3028.8 vs. 1972.2 ng/mL) but not in the placebo group (2249.0 vs. 2015.6 ng/mL). Moreover, serum iron and total iron binding capacity (TIBC) levels were significantly reduced in silymarin group compared with placebo. Also important was the improvement in liver function tests observed in silymarin group in comparison with placebo.

This study shows that silymarin is effective at reducing iron overload in patients when used in conjunction with desferrioxamine. Silymarin may also have a role in protecting liver function in patients with iron overload.

Uterine fibroids, also known as uterine leiomyomas, are benign tumors of the uterine tissue that are thought to affect about one third of women. Uterine fibroid growth occurs in response to estrogen stimulation. For this reason, they typically affect women of reproductive age, and diminish in size after menopause. Small uterine fibroids are generally not problematic and do not give rise to serious symptoms; on the other hand, large fibroids can lead to subfertility, heavy bleeding, iron deficiency anemia, and may require surgical treatment.

Vitamin D is known for its role in a host of conditions, including immune health, cancer, respiratory illness such as asthma, and bone health to name a few. Its potential role in women’s reproductive health is less known. Laboratory studies have shown that the active metabolite of vitamin D can inhibit cell proliferation and extracellular matrix production in fibroid tissue culture, and can reduce fibroid volume in animals .⁽²⁾ This case-control study compared vitamin D status in women with and without uterine fibroids to identify a potential role for vitamin D in this condition in humans .⁽¹⁾

Subjects were women referred to two infertility clinics in Italy. “Cases” were 128 women who had to have at least one fibroid of at least 1cm diameter. “Controls” were 256 women of the same age with no uterine fibroids upon ultrasound.

Vitamin D levels were significantly lower in women with fibroids compared to healthy women. A total of 15% of women in the fibroid group had vitamin D deficiency, compared to only 7% of women in the control group, meaning that women with fibroids were at 2.4-fold greater odds of having vitamin D deficiency .⁽¹⁾ These findings are consistent with previous studies, which found that women with sufficient levels of vitamin D had 32% lower odds of having fibroids compared with women who had insufficient vitamin D insufficiency .⁽²⁾

Vitamin D is an emerging regulator of uterine leiomyoma development. Randomized controlled trials are need to assess whether vitamin D supplementation may be an effective therapy for uterine fibroids. Women with fibroids should have their vitamin D levels tested and supplement to achieve sufficient blood levels.

Food allergies and intolerances have far reaching effects on kids’ health. Some common allergens include peanuts, dairy, and eggs. A recent study examines the impact of a lesser known food allergen, peach. According to the authors, peach allergy is the main cause of fruit or vegetable-based food allergy in the Mediterranean area. The protein called Pru p3 is the major allergen, and it is mainly found in the peach peel.

This study assessed whether children with peach allergies are able to tolerate peach pulp (peeled peach). The study assessed the frequency of tolerance to peach pulp in children suffering from allergic reactions after eating or having contact with peach. Fifty-seven children with average age 7.4 years were included in the study. Skin prick tests were performed with peach peel and pulp, as well as isolated peach proteins. Oral food challenges (OFCs) with peach pulp were performed on all but one child.

Eighty-eight percent of the children had positive prick tests with peach peel, 35% with peach pulp, and 88% with the peach protein LTP. The presence of IgE antibodies (IgE) to peach was demonstrated in 100% of the patients, with rPru p3-specific IgE in 96%. The study found that more than 90% of the children with peach allergy were able to tolerate peeled peach.

Peach allergy has been linked to oral allergy syndrome as well as systemic reactions such as hives and chronic urticarial in children.^(2,3) It appears that a large number of these children may be able to tolerate peeled peach.

In addition to updated guidelines for cholesterol management, this past month has seen the release of new guidelines from the American Heart Association on the role of lifestyle management for the reduction of cardiovascular disease risk. The guideline group sought to answer three topics: 1) the role of dietary patterns and/ or macronutrient composition; 2) the role of sodium intake or restriction; 3) the role of exercise in managing blood pressure and cholesterol.

For patients that would benefit from LDL cholesterol lowering, the guidelines recommend the following dietary pattern: emphasis on intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils and nuts; and limits intake of sweets, sugar-sweetened beverages and red meats. This diet should aim for between 5% to 6% of calories from saturated fat, and reduce the percent of calories from trans fat.

For patients that would benefit from lowering blood pressure, the same dietary recommendations apply, with the addition of sodium restriction. Sodium should be limited to no more than 2,400 mg of sodium/day, with 1500 mg being a more ideal target; for those who do not consume this amount but still have high blood pressure, a further reduction by at least another 1000 mg/d sodium will further lower blood pressure.

Both groups of patients should be advised to engage in aerobic exercise as a way to lower cholesterol and blood pressure. Exercise frequency should be 3 to 4 times a week, lasting on average 40 minutes per session, and involving moderate-to-vigorous intensity physical activity.

The American Heart Association recently released its updated 2013 guidelines on management of cholesterol levels. The new guideline identifies four groups that are targeted for risk reduction of atherosclerotic cardiovascular disease (ASCVD) through use of cholesterol lowering medications. Two large categories of ASCVD are heart disease and stroke. This new guideline recommends that statin medications may be beneficial for lowering disease risk in individuals with 1) established ASCVD such as angina, history of a heart attack, stroke, etc; 2) otherwise healthy individuals with LDL cholesterol levels above 190 mg/dL, or 4.9 mmol/L in Canadian units; 3) patients with diabetes aged 40 to 75 years who have LDL–cholesterol between 70 to 189 mg/dL (1.8- 4.9 mmol/L, Canadian units) and without clinical ASCVD, or 4) otherwise healthy individuals without established ASCVD or diabetes who have LDL–C between 70 to189 mg/dL (1.8- 4.9 mmol/L, Canadian units) and estimated 10-year ASCVD risk >7.5% (Framingham risk score). The Framingham risk score is a well-recognized scoring system used to estimate an individual’s risk of developing heart disease within the next 10 years, based on demographic data such as age and sex, as well as the presence of risk factors such as being a smoker, having diabetes, blood pressure, and blood cholesterol.

The most surprising of these four groups is the last. The benefit of statins for patients with established disease such as a previous heart attack is relatively uncontested. However, the new guidelines suggest that anyone with modestly elevated risk of cardiovascular disease should be on medication. As an example, using this model, a man with no history of disease but over the age of 40 and “normal” cholesterol (total cholesterol 5.2 mmol/L and good cholesterol, HDL 1.0 mmol/L) and borderline blood pressure 130/80, would be considered to have 7.9% risk, and as such would be recommended cholesterol lowering medication .⁽²⁾

There are some recognized side effects of statin therapy, including muscle damage and pain, liver toxicity, as well as increases in blood glucose levels and possibly increased risk of developing diabetes .⁽¹⁾ The guideline does recommend that all patients on statin therapy should be asked at each visit, both before and after initiation of statin therapy, about muscle symptoms such as muscle weakness or fatigue, aching, pain, tenderness, cramps, or stiffness. In addition, all patients should be screened for onset of new diabetes while on therapy, and have liver enzyme levels checked regularly.

The guideline also stated that “All individuals receiving statins should be counseled on healthy lifestyle habits” .⁽¹⁾ The guideline emphasized that “lifestyle modification (i.e., adhering to a heart healthy diet, regular exercise habits, avoidance of tobacco products, and maintenance of a healthy weight) remains a critical component of health promotion and ASCVD risk reduction, both prior to and in concert with the use of cholesterol lowering drug therapies.” Authors referred to the 2010 guidelines on lifestyle modification, which we will examine next…

Most people are well aware of the benefits of maintaining a healthy weight and regular exercise in general terms, however most are not aware of its impact with respect to cancer. For instance, few people are aware that regular physical activity lowers the risk of recurrence after breast cancer diagnosis and treatment. ⁽¹⁾ Newer evidence is showing that cancer therapies such as radiation of the breast may result in damage to the heart underneath, leading to increased risk of heart disease down the road in patients who are breast cancer survivors. ⁽²⁾ Reducing risk factors for heart disease, such as being overweight and being inactive, are especially important in these women. Finally, physical activity may also be related to quality of life in patients who are breast cancer survivors.

A new study examined the impact of obesity and physical activity on the health and wellbeing of patients with breast cancer who had completed adjuvant therapy. ⁽³⁾ A total of 537 women aged 35 to 68 years with newly-diagnosed breast cancer were enrolled into an exercise intervention study. Researchers investigated the effect of exercise on patients’ physical performance (2-km walking test), cardiovascular risk factors, quality of life, co-morbidities and body-mass index (BMI). Overall, 191 (39%) patients were overweight and 85 (17%) obese, defined as BMI equal to or greater than 30. The study found that higher BMI (ie. being overweight) increased the women’s risk of having poor ability for physical performance (walking 2 km), poor quality of life, and increased risk factors for heart disease, including cholesterol, blood pressure, and blood sugar. Researchers concluded that obesity and a sedentary lifestyle are important factors to be addressed in breast cancer survivors, since they lead to impaired quality of life, impaired ability to exercise, and increased risk of cardiovascular disease in these women. ⁽³⁾

Amyotrophic lateral sclerosis (ALS) is a chronic, degenerative condition resulting in gradual loss of normal body function leading to disability and death. The cause of ALS is not known, and there is no established treatment available. An area currently under investigation is whether nutrients that improve cellular function and energy production might be able to slow down the progression of this disease.

The current study is one of the first to assess the effects of acetyl-L-carnitine (ALC) in combination with the drug riluzole on disability and mortality in patients with amyotrophic lateral sclerosis (ALS). Patients diagnosed with either “definite” or “probable” ALS, who had had ALS for between 6-24 months, were self-sufficient in their ability to perform activities of daily living (ie. able to swallow, cut food/handle utensils, and walk), and who still had good lung function were included in this study. All patients were given riluzole 100mg/d, and were then randomized to receive either acetyl-L-carnitine 3g/d or placebo or placebo for 48 weeks. A total of 42 patients received acetyl-L-carnitine and 40 received placebo.

Treatment with acetyl-L-carnitine was shown to help preserve function for longer than placebo: after 48 weeks, 34 (80.9%) patients receiving acetyl-L-carnitine and 39 (97.5%) receiving placebo became non-self-sufficient. In addition, scores for questionnaires assessing function were significantly better in the group receiving acetyl-L-carnitine. Lung function remained stable in the acetyl-L-carnitine group but declined markedly in the placebo group. Finally, patient taking acetyl-L-carnitine had a survival time of 45 months until death, whereas the control group had a survival time of only 22 months. Investigators concluded that acetyl-L-carnitine may be an effective, well-tolerated and safe therapy in ALS, and a larger study is planned to confirm these results.

Polycystic ovary syndrome (PCOS) is a condition that occurs in women of reproductive age, causing imbalances in the hormones estrogen, progesterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and results in poor quality or infrequent ovulation. This can result in problems becoming pregnant in some women.

To goal of this study was to investigate the role of the herb black cohosh, or Cimicifuga racimosa, in stimulating ovulation in women with polycystic ovary syndrome (PCOS). A total of 100 women with PCOS were randomized to receive either the fertility drug clomiphene citrate 100mg daily for 5 days, or black cohosh 20mg daily for 10 days. Both groups took the drug or black cohosh starting from the second day of their menstrual cycle and continuing for three consecutive cycles. During this time, changes in the hormones follicle-stimulating hormone (FSH), luteinizing hormone (LH), FSH/LH ratio, and progesterone were tested. In addition, researchers measured the thickness of the uterine lining (endometrial thickness) and assessed the pregnancy rate in both groups.

After treatment, significant favourable changes in LH level and FSH/LH ratio were seen among women taking black cohosh. In these women, the progesterone level was higher from the first treatment cycle, indicating better ovulation, and endometrial thickness was greater. The pregnancy rate was also higher in the black cohosh group, but this difference was not significant when compared to patients receiving the fertility drug clomid. The researchers concluded that black cohosh may be an effective alternative to the drug clomiphene citrate in stimulating ovulation among women with polycystic ovarian syndrome.

High blood pressure, or hypertension, is a well recognized risk factor for the development of heart disease, stroke, eye disease, or other circulatory problems. Hypertension is defined as a blood pressure equal to or above 140/90 on two separate readings. Hypertension is usually treated with one or more medications belonging to the class of: diuretics, beta blockers, or angiotensin receptor antagonists. High blood pressure increases the risk of developing peripheral vascular disease, a condition that limits blood flow to the extremities, especially among patients with diabetes, or smokers. Peripheral vascular disease leads to the development of skin ulcers or purplish discoloration, as well as pain, weakness, and muscle cramps.

Flaxseed, also known as linseed, contains omega-3 fatty acids, hormone-modulating compounds called lignans, and fiber. Together, these components are thought to provide benefits to patients with cardiovascular disease. The purpose of this study was to examine the effects of daily ingestion of flaxseed on blood pressure in patients with peripheral vascular disease and high blood pressure. A total of 110 patients were randomized to receive a diet containing 30g of ground flaxseed or placebo each day for 6 months. As expected, blood levels of the omega-3 fatty acid α-linolenic acid and lignans increased 2- to 50-fold in the flaxseed-fed group, but did not increase significantly in the placebo group. There was no change in body weight. However, the patients who consumed flaxseed had an approximate 10 point reduction in their systolic blood pressure (the top number in 120/80 for instance), and a 7 point reduction in their diastolic blood pressure (bottom number), compared to patients who got placebo. This study suggests that consumption of 30g ground flaxseed can have an important blood pressure lowering effect.

The first trimester is known to be a delicate time in fetal development, when it is most susceptible to damage from substances such as alcohol, drugs, medications as well as some infections. Many women make the incorrect assumption that certain over the counter medications, such as decongestants for cold and hay fever, are without risk. New research has found a link between first trimester use of some oral and intranasal decongestants and risk of certain birth defects.⁽¹⁾ Although the authors state the risks are considered small, in combination with previously published research,^{(2, 3, 4)} there is enough evidence to suggest these drugs should be avoided during pregnancy. The associated risks found in this study were: phenylephrine with an increased risk of endocardial cushion defect, phenylpropanolamine with ear defects, phenylpropanolamine with pyloric stenosis, intranasal decongestants with pyloric stenosis, intranasal imidazolines with trachoesophageal defects and oxymetazoline with kidney anomalies. Interestingly these decongestants all cause blood vessel constriction which may explain how these drugs may affect fetal development. There are many other options to relieving symptoms of allergies and the common cold that are not associated with such devastating risk. Pregnant women should always seek the advice of a health professional before taking any medications or supplements.

A recently published, and widely publicized, paper on omega 3 Fatty acids sent a very strong and incorrect message to the public; that use of these fatty acids is potentially harmful to human health and their use should be reconsidered in some. The study published in the Journal of the National Cancer Institute came to the conclusion that omega 3 fatty acids increase the risk of prostate cancer and are somehow involved in tumor development.⁽¹⁾ The reality is this study is laden with flaws and limitations and it is crucial that the public understands that the information presented was misconstrued.

First, although the article implies that the study was designed to assess prostate cancer risk in men consuming omega 3 fatty acids/fish oil supplements, it in fact was not. The data used in this paper was collected from the SELECT trial which was originally designed to look at vitamin E and selenium in a group of men followed for several years to determine prostate cancer incidence. Dietary fish consumption and/or fish oil supplement use was never assessed in this study! Additionally, the fatty acid levels reported were from a single blood draw taken at the start of the study while the cancer diagnosis was made years later! Not to mention the fact that the difference in fatty acid blood levels between the groups of men wasn’t even clinically significant. The numerous studies that actual look at the relationship between dietary fish consumption and/or fish oil supplementation and prostate cancer show reduced risk of developing prostate cancer^{(2, 3, 4)} as well as decreased prostate-specific mortality.^{(5, 6)} in those with increased consumption. The take home message is that there is no evidence to support the claim that omega 3 fatty acids cause prostate cancer. These fats are safe and extremely beneficial for a number of health concerns including prostate cancer.