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Agave Health Claim Doesn't Match Its Hype

March 11, 2010

Relief from IBS Naturally

Sometimes old-fashioned remedies work best, and for the millions of people with one very hard-to-treat condition -- irritable bowel syndrome (IBS) -- an old remedy beats everything modern science has dreamed up. If you or someone you know has IBS, please read on.

As many as one in five Americans suffer from IBS, a miserable disorder that can bring an endless progression of constipation, diarrhea, gas, bloating and stomach cramps. Where expensive new IBS drugs have been disappointing, it turns out that a classic stomachache remedy, peppermint oil, can often get the job done more effectively.

In with the Old, Out with the New

At McMaster University in Ontario, Alexander C. Ford, MD, and his colleagues analyzed the results of many previously published studies on adults with IBS, including 12 comparing fiber with placebo, 22 comparing antispasmodics with placebo, and four comparing peppermint oil with placebo. Peppermint oil was surprisingly effective, bringing relief to 74% of patients. This compares very favorably with antispasmodics, which helped only 61%, and fiber, which was beneficial to just 48%.

Peppermint oil may be most helpful in soothing the abdominal pain and cramping that are common IBS symptoms and, over time, it may also help ease diarrhea or constipation. Scientists believe it works by blocking the movement of calcium into muscle cells in the gastrointestinal tract, thereby reducing muscle contractions, discomfort and bloating.

How to Make Your IBS Better

Look for "enteric coated" peppermint oil capsules at your health food store, since taking peppermint oil straight can produce reflux symptoms, suggests Daily Health News contributing medical editor Andrew L. Rubman, ND. Dr. Rubman often prescribes doses of 200 mg to 300 mg to be taken once, twice or three times daily -- but not more often, as larger doses can be toxic. He says most patients find it helpful to take a dose just before eating a meal.

Several factors should be weighed in identifying the right treatment for an IBS patient, including whether symptoms are dominated by diarrhea or constipation or whether both occur about equally. If your doctor seems quick to recommend newer pharmaceuticals, consider seeing a specialist in natural medicine to discuss the older remedies and over-the-counter medicines. As Dr. Ford pointed out to me, even though peppermint oil helped the most people in his analysis, the other two treatments -- fiber and antispasmodics (which lessen spasms in the GI tract) -- were effective for many, and they are safe, inexpensive and readily available over the counter at most pharmacies. Also, Dr. Rubman pointed out that there are many other useful botanical extracts that are antispasmodic as well, including valerian, skullcap, viburnum, juniper berry, hyoscamus niger, gentian and gelsemium. "Their effects may vary from minor to profound, so it’s best to use these only under physician care," he added.

Dr. Ford has also been exploring another "new old" remedy for IBS --probiotics -- and results are promising.

Pros and Cons of Prostate Surgery

Men facing radical prostatectomy (surgical removal of the prostate gland) may like the idea of having it done with state-of-the-art robotic technology. And indeed, minimally invasive prostatectomies typically result in smaller incisions, less blood loss and quicker recovery. But -- get ready, this is a big one -- it also carries a higher risk for very unappealing complications, including erectile dysfunction. Any man considering this procedure should be aware that the trade-off can be considerable, especially since the newest version of the high-tech procedure is being aggressively marketed by hospitals eager to bring in patients -- and the ads aren’t offering these details.

What Goes Wrong?

The disconcerting finding that minimally invasive radical prostatectomies (particularly when performed with a robot) have higher rates of genitourinary complications, including infection, incontinence and erectile dysfunction, was published in Journal of the American Medical Association. Comparing the minimally invasive procedure with open prostatectomy (in which a much larger incision is made to reach the prostate), researchers at Brigham and Women’s Hospital drew data from tumor registries and Medicare, evaluating surgical outcomes of 8,837 men with prostate cancer. Of these patients, 1,938 had minimally invasive prostatectomy and 6,899 had their prostates removed the traditional way. The researchers found that the minimally invasive prostatectomies resulted in...

Shorter hospital stays (two versus three days, on average)

Fewer patients requiring blood transfusion (3% versus 21%)

Fewer postoperative respiratory complications (4% versus 7%)

Less risk that problematic strictures or scar tissue will develop (6% versus 14%).

However, these men also had...

A higher rate of infection (5% versus 2%)

Greater likelihood of incontinence (16% versus 12%)

Higher rates of erectile dysfunction after the operation (27% versus 19%).

The need for additional cancer treatment was similar in both groups.

Do They Know What They’re Doing?

Jim Hu, MD, MPH, genitourinary surgeon at Brigham and Women’s Hospital, assistant professor at Harvard Medical School and lead author of the study, told me that he believes these important differences in outcomes occurred because many surgeons using the new techniques and technology haven’t yet developed expertise with it. Compared with the traditional open procedure, which has been used for 30 years, minimally invasive radical prostatectomy has been available just eight years. It’s exploding in popularity -- where a minimally invasive approach was used for just 9% of all prostatectomies in 2003, use grew to 43% in 2007. Typically, surgeons performing open radical prostatectomy were either trained during their residencies or had more than 20 years of experience. In comparison, many of the minimally invasive radical prostatectomy surgeons in the study were learning "on the fly" during the study period. Dr. Hu said the laparoscopic practitioners start to perform procedures after a two-day course and being proctored for a few cases, rather than learning it more intensively in a residency or fellowship setting.

Ironically, this trend is being driven by consumer demand. Ads tout the advantages the robotic technology offers, which promises less blood loss, less pain and a quicker recovery compared with minimally invasive radical prostatectomy without robotic assistance. In this study, researchers were unable to differentiate between the minimally invasive procedures performed with robot assistance and those done without, but according to Dr. Hu, it is the robotic procedures that people are asking for. In his words, requests from patients have "grown beyond the general surgical expertise of the surgeons at this time of rapid, unbridled adoption." So it is especially important to be on the alert when this technology is new to a hospital -- don’t just assume the training and experience are in place before the procedures are being done.

Ask Your Doctor

If you are considering robot-assisted minimally invasive radical prostatectomy, be sure to ask your surgeon:

How were you trained to do this procedure? Did you learn to do this during your residency or fellowship? A fellowship is an additional course of study for one or two years, where surgeons subspecialize. In contrast, said Dr. Hu, robot certification can be obtained after a two-day course.

How many procedures have you performed with this technology? Dr. Hu recommends at least 250 surgeries, and that a surgeon is performing at least four/week.

The good news, said Dr. Hu, is that as more surgeons become skilled in minimally invasive radical prostatectomy, with or without robotic assistance, the benefits of this approach will eventually outweigh the risks. Until then, proceed with caution.

March 9, 2010

The Brain-Shrinking Diet

Not only can the foods you eat affect the size of your body, they also can affect the size of your brain. That’s what researchers discovered when searching for a connection between food and Alzheimer’s disease. Researchers in the US, Canada, Australia and the UK recently conducted a mouse study investigating four types of diet to see if any of them triggered brain plaque formation, the hallmark sign of Alzheimer’s that also leads to brain shrinkage. What they discovered came as quite a surprise.

The mice, which had been bred with a vulnerability for developing Alzheimer’s, were divided into four groups, and each fed one of the following four diets...

Standard commercial mouse chow (58% carbs, 29% protein, 13% fat)

A high-fat/low-carb version of the chow that was standardized at 60% fat, 30% protein, 10% carbs

High-protein/low-carb chow (60% protein, 30% fat, 10% carbs)

High-carb/low-fat chow (60% carbs, 30% protein, 10% fat)

Brain Food

After 14 weeks, researchers studied the brains of the mice. Previous research had shown that a high-fat diet increases the amount of amyloid beta protein (the main constituent of Alzheimer’s plaques) in the brain, and this study found that, too -- but interestingly, this did not translate to an increase in plaque itself. Another finding was that the high-protein/low-carb diet was associated with a tendency to lose nerve cells from the hippocampus, the area of the brain where memory resides. That’s interesting in itself -- but what really astonished the scientists was that in the course of the 14-week study, the brains of the same high-protein/low-carb group of mice had shrunk. They weighed 5% less than the brains in all other groups.

The lead author on this study is Sam Gandy, MD, professor at Mount Sinai School of Medicine in New York City and a neurologist at the James J. Peters VA Medical Center in the Bronx. Dr. Gandy told me that it isn’t unusual for people’s brains to shrink very slightly (less than 1%) as they age, but the 5% brain shrinkage as seen in this group of mice is a considerable decrease. Dr. Gandy told me that how problematic this is depends on what part of the brain was diminished. He said that his team plans to study these findings further -- including whether the type of protein eaten makes a difference. In the meaintime, keep your diet properly balanced. Weight loss at the cost of brain volume is not a good trade-off.

Are You a Type D Personality?

You’re probably aware of whether you tend toward a type A or type B personality, since those labels are part of our lexicon. What you may not know, however, is that there is a third type -- type D -- and it’s not a great category to find yourself in. The D stands for distress, and a growing body of research links this personality type with a variety of health risks and even early death -- so it may be especially important for these inhibited and gloomy folks to do everything they can to lighten up.

Remember Eeyore -- the sad, self-conscious donkey character in Winnie-the-Pooh? To my mind, he is a perfect illustration of the type D personality. He always expected the worst and therefore, that’s what he usually got. Traits associated with this personality type include social inhibition, a negative self-image, depressed mood, hostility, tension, chronic anger and a tendency to overreact to stressful events.

Type D & Death Risk

It’s already known that having this type D personality elevates risk for people who have had heart attacks, cardiac bypass surgery and/or stent implants. In new research from the University of Tilburg in the Netherlands, scientists set out to determine the impact of these characteristics on people with a common condition called peripheral artery disease (PAD), a circulatory problem in which narrowed arteries reduce blood flow to the limbs. People who have PAD have four to five times greater risk for heart attack and stroke.

Researchers asked 184 patients (average age 65) diagnosed with PAD to fill out a 14-item personality questionnaire to assess character traits, such as negativity and social inhibition. They rated statements such as "I would rather keep people at a distance" and "I often find myself worrying about something" as false or true on a scale of zero to four. During the next four years, 16 patients (9%) died -- six of cardiovascular disease, seven of cancer and one each from emphysema, pneumonia and acute pancreatitis. After factoring in other variables such as age, gender, diabetes and kidney disease, investigators learned that those with type D personalities were more than three times as likely to have died as those who were Type A or B.

How Distress Raises Risk

There are numerous pathways linking this particular personality type with poor health outcomes, I learned from study coauthor Johan Denollet, PhD, a professor of medical psychology at Tilburg University. Some are physical, other behavioral. For instance, Type D individuals tend to...

Experience chronic anxiety and negativity. Living in such a state has a variety of physical effects on your body, none beneficial. Chronic stress drives up levels of inflammatory proteins called cytokines, which leads to increased oxidative stress and contributes to disease. The adrenal glands respond to stress by pumping out cortisol, the hormone that helps us meet perceived threats. Having high and prolonged levels of cortisol in the bloodstream causes serious problems, including blood sugar imbalances, reduced immunity, slower wound healing and increased abdominal fat.

Have poor health habits. Research has shown that people with type D personalities often neglect their health by eating improperly, not having medical checkups and being sedentary.

Are unlikely to be proactive in seeking medical care. Perhaps because they are unable to express their emotions and are tense, insecure and uncomfortable in social situations, type D individuals are often slow to seek the medical help they need. In one study, type D patients with chronic heart failure experienced more cardiac symptoms and worried more about them than other people but, paradoxically, were less likely to discuss them with health-care professionals. Other research demonstrates that heart failure patients with "inadequate consultation behavior" face a six-fold increased risk for impaired health.

What Can Help

Generally speaking, you can’t change your personality -- but if you recognize these traits in yourself or a loved one, there are plenty of things you can do to address the issues and minimize the impact on your health. For example, Dr. Denollet notes that type D personalities are more likely to experience anxiety and depression -- and points out that these can be managed to a significant degree with counseling and/or medication. Other strategies include...

Adopting healthier lifestyle behaviors, such as better diet and regular exercise.

Participating in programs or counseling to conquer addictions, such as smoking or alcohol abuse, or to improve social skills and learn to relax.

Using techniques such as guided imagery, breathing exercises, meditation, tai chi and yoga to help manage stress and mood and learn to control anger and hostility.

While you can’t change who you are, if you have a type D personality, you can take these concrete steps to make yourself healthier and, I’llbet, happier.

March 8, 2010

New Marker for Heart Health

In the ongoing search for "the" important marker of cardiac risk, some scientists are now focusing on one you may not have heard of -- and your doctor may not be evaluating. It’s a measurement called Apo B, which reveals the number of cholesterol particles in your bloodstream that can clog arteries and lead to a heart attack or stroke. This may be a more useful predictor of risk than the total cholesterol, which is what's commonly measured.

According to cardiologist Michael Ozner, MD, medical director for the Cardiovascular Prevention Institute of South Florida and author of The Great American Heart Hoax, doctors in Canada routinely test Apo B, but in this country we are just starting to recognize its value.

Apo B stands for apolipoprotein B, a protein that is attached to the particles that transport cholesterol throughout the body. The number of Apo B-containing particles is a crucial measure because they are able to migrate out of the bloodstream and enter blood vessel walls. Once there, they can be retained and oxidized, creating an inflammatory response that can lead to atherosclerotic plaque, which is like a pimple in the artery wall. That, in turn, can rupture and result in a heart attack or sudden cardiac death. So, the more Apo B-containing particles you have, the greater your risk for heart attack and stroke.

Dr. Ozner suggested picturing these particles as cars carrying the cholesterol molecules within like passengers. It’s the number of cars on the highway (not the number of passengers riding in them) that leads to a traffic jam -- and the number of particles is what’s important in predicting risk for atherosclerosis. An elevated Apo B level means that you have too many bad particles which put you at risk for heart attack or stroke, irrespective of how much cholesterol those particles contain. A desirable Apo B level is 80 mg/dl or below, Dr. Ozner told me, noting that high-risk patients, such as those who have had heart attacks or strokes, may need to aim for an even lower count.

Dr. Ozner pointed out that in addition to being a better predictor of heart attack risk than the conventional cholesterol blood work-up, the Apo B test is inexpensive and usually covered by insurance. It is widely available. "It is valuable in helping your physician to determine the optimum medical therapy to prevent cardiovascular disease," he said.

Agave Health Claim Doesn't Match Its Hype

From the same cactus that gives us tequila, we now have a sweetener that is making health-food fanciers kick up their heels in delight -- it is a syrup made from agave, a succulent native to Mexico. Even my supermarket is now selling a variety of products proudly proclaiming that they are "sweetened with agave nectar," the implication being that this is healthier than regular sugar or high-fructose corn syrup (HFCS).

It’s easy to understand how agave syrup got its great reputation. The cactus has been cultivated for thousands of years. Even its name, "agave," has a fine pedigree, coming from the Greek word for noble. Fresh extracts from the agave plant have been shown to have anti-inflammatory and some antioxidant properties -- but unfortunately, there’s zero evidence that any of those compounds are present in the commercially made syrup.

Agave Claims

Agave nectar is an amber-colored liquid that pours more easily than honey and is sweeter than white table sugar, according to Jeannette Bessinger, author of Simple Food for Busy Families. Among the health claims are that it’s gluten-free (but so are all other refined sugars) and suitable for vegan diets (again, just like the rest of the sweeteners) -- and, most especially, that it has a relatively low glycemic index. A large body of research shows that foods with low glycemic indexes, such as vegetables, beans and high-fiber foods in general, tend to be healthier for us than foods that quickly raise our blood sugar. But in the case of agave nectar, you have to ask, why does this sugar have a low-glycemic index? And the answer is that agave nectar is made largely of fructose, which, even though it has a low glycemic index, is being implicated in many long-term health problems. With the exception of pure liquid fructose, agave nectar has the highest fructose content of any commercial sweetener.

It’s worth knowing that all sugars, from white table sugar to high-fructose corn syrup and even honey, include some mixture of fructose and glucose. For example, table sugar is 50% fructose/50% glucose and HFCS is 55/45. Agave nectar is a whopping 70% to 90% fructose.

"Fructose, which is basically the sugar found in fruit, is perfectly fine when it is ingested in whole foods like apples," said nutritionist Jonny Bowden, CNS, author of The 150 Healthiest Foods on Earth. "That’s because it also comes with a host of vitamins, antioxidants and fiber, so you are getting good stuff along with it. But, when fructose is extracted from fruit, concentrated and made into a sweetener, it plays havoc with the metabolism."

Research shows that fructose, more than other kinds of sugars, contributes to insulin resistance and often significantly raises blood levels of triglycerides (a risk factor for heart disease) in both obese and healthy people. It also has a greater propensity than other sugars to increase fat around the middle, which elevates risk for diabetes, heart disease and metabolic syndrome. And it’s the sweetener most often linked to nonalcoholic fatty liver disease.

Spun Sugar

So, in the end, it’s all spin. "Agave nectar syrup ends up being a triumph of marketing over science," said Bowden.

Agave nectar is not poison -- it’s okay to enjoy it from time to time, says Bowden. But don’t believe the hype that it’s a health food -- that’s just food-industry sweet talk.