|Photo: © Adam Borkowski. |
Not only is gluten found in about 90% of all commercial food products, it's also in a heckuva lot of shampoos, creams, lotions and cosmetics. This can be a major problem for people with celiac disease or other forms of gluten intolerance, said Christine Doherty, ND, at the annual meeting of the New York Association of Naturopathic Physicians.
Gluten from personal care products can pass transdermally, entering the circulation and triggering many of the same symptoms as gluten ingestion. People with gluten intolerance are often unaware of this, and unwittingly expose themselves every time they wash their hair or slather on some moisturizer.
While the spectrum of gluten-free foods has grown prodigiously in the last decade—it is now a $4 billion market in the US alone—the problem has barely hit the radar of the personal care and cosmetics industry. In most cases, people are not even aware that their favorite body products contain gluten.
Dr. Doherty, who has struggled with celiac disease herself, said transdermal gluten exposure may not be a problem for all gluten-intolerant folks, but it will be for some. Suspect it whenever someone remains highly symptomatic despite diligent adherence to a gluten-free diet.
Generic bisphosphonates are not nearly as effective in raising bone mineral density as branded products, according to two studies presented at the recent annual meeting of the American Society of Bone Mineral Research in Montreal.
Johann Ringe, MD, of the University of Cologne, looked at 186 postmenopausal women treated with generic alendronate, branded alendronate (Fosamax), or branded risedronate (Actonel), all at standard doses. The women were on treatment for 1–3 years, and also took 1,200 mg calcium and 800 IU vitamin D.
Those on the generic drug had 40%–50% smaller BMD increases, and nearly double the rate of gastrointestinal side effects. Dr. Ringe believes the two are directly related: more stomach upset means less compliance and, therefore, less benefit.
In a separate study, researchers at MacMaster University, followed 199 postmenopausal women taking branded alendronate prior to a 2005 Canadian government mandated switch to generics. Of the 181 evaluable patients, 53 (29%) quit treatment after switching to the generic drug; 15% stopped because of GI side effects, and 14% due to BMD declines.
In both studies, the authors concluded that generic bisphosphonates are vastly inferior to branded versions.
But guess what? When it comes to preventing fractures—the ultimate goal of therapy—bisphosphonates, whether generic or branded, may not deliver at all.
Dr. Adrianne Feldstein and colleagues at the Kaiser Permanente Center for Health Research compared new fracture rates among 1,829 high-risk osteoporotic women on bisphosphonates, and an equal number of age-matched, untreated controls over a period of nearly 3 years. They found no meaningful difference; actually, those on bisphosphonates had a slightly higher rate (10.8% vs. 9.8%).
Dr. Feldstein acknowledged the possibility that those on treatment could have been somewhat sicker and weaker; and that the lack of fracture reduction may be due to poor adherence. Nonetheless, the finding underscores an important point: data from highly controlled trials using surrogate endpoints (e.g., changes in BMD), don't always translate into actual benefits for patients in the real world.
Low HDL? Think "Couch Potato"
If a patient's HDL is in the 40 mg/dl range, but the rest of the lipid profile says "low-risk," it is usually an indicator of very low physical activity. Over time, that sedentary lifestyle will confer considerably greater risk of heart disease, said Russell Marz, ND, at the annual meeting of the New York Association of Naturopathic Physicians.
"You want to see the HDL in the 60s," said Dr. Marz, medical director of the Tabor Hill Clinic, Portland, OR. A low HDL should prompt you to ask a patient about his or her activity level and to encourage more exercise. Let patients know that even small changes, like taking stairs instead of elevators or parking further from destinations and making up the remainder on foot have big benefits.
Konjac, the Wonder Noodle
Looking for a fun way to include more soluble fiber in your (or your patients') diet? Consider Konjac. The roots of this hearty tropical plant, a popular food source all across Asia, have the highest soluble fiber content of any known edible plant.
Konjac-based foods are especially popular in Japan (konnyaku) and Korea (Gonjac), Konjac flour, which is made into chewy "Shirataki" style noodles, is almost completely fiber (glucomannan), with very few carbohydrate calories, Consequently, konjac noodles have an extremely low glycemic index.
Russell Marz, ND, medical director of the Tabor Hill Clinic, Portland, OR, says he often recommends Konjac noodles to patients struggling with metabolic syndrome, diabetes, obesity or heart disease. Toothsome and satisfying, they're an excellent replacement for high-carb pastas.
Several nutraceutical companies market konjac/glucomannan supplements as weight loss aids. While there's little evidence to support a weight loss claim, Dr. Marz said the supplements can be very helpful in stabilizing blood glucose.
Konjac is not only high in fiber. It is also high in interesting colloquial names, the most evocative being Devil's Tongue, Snake Palm, and our favorite, Voodoo Lilly. Even its Latin genus name, Amorphophallus, is intriguing.