Wednesday, July 7, 2010

Cancer Diet Redux: When is the "Cancer Diet" not recommended?

When should the "cancer diet" not be fed to veterinary cancer patients?

We should begin by determining when the "cancer diet" *should* be fed to cancer patients. It is fairly universally recognized now that cancer cells exhibit increased glucose utilization compared to normal cells, and this metabolic defect is the basis for research to determine whether lowering glucose concentrations (by limiting simple carbohydrates in the diet) can improve cancer survival.

Clinical proof that a low carbohydrate diet is clinically beneficial remains a little lean. A single clinical trial in dogs suggested that a low carbohydrate, high fat diet containing fish oil and arginine accelerated time to remission in lymphoma patients and may extend the disease-free interval. Every cancer is different, and test tube studies on human cancer cells suggest that different cancers respond differently to various nutritional profiles in their media.

While a few million dollars has likely been spent on canine research in this area, billions have been spent in human nutritional oncology. And we still don't have definitive proof as to the best diet for cancer patients. In dogs and the cats, the usual recommendation is to feed a low carb diet simply because there is a physiologic rationale for it. In people, it is recommended that they eat the diet that helps prevent cancer - low in animal fat, high in vegetables, full of variety - and people should continue to get exercise. And while there is plenty of evidence in people that excess weight *loss* during cancer treatment worsens the prognosis, there is now emerging evidence that being obese while undergoing cancer treatment also worsens prognosis.

The dietary key to influencing cancer proliferation is that the diet be high in fat - tumor cells are unable to use fat as an energy source, whereas dogs and cats can do this very efficiently. So the "low carb diet" for cancer patients is usually quite high in meat (which contains a lot of fat), low in starches and sugars, and contains added fat. A logical conclusion is that for pets with cancer only - no pancreatitis, no advanced renal disease, no obesity, etc - a low carb, moderate protein, high fat food makes sense. But for patients with these other disorders, the diet can not only worsen the prognosis but even make death from the other disease more imminent than death from cancer.

I'd like to focus here on managing obesity in a cancer patient. Here's the thing - obesity leads to hyperglycemia - high blood glucose - and insulin resistance. This hyperglycemia is much more persistent than the elevated glucose load that occurs after any meal of any composition. In addition, surgery, radiation and chemotherapy can cause changes in endocrine functions that could increase the likelihood of development of metabolic syndrome (de Haas, 2010).Cancer itself is commonly associated with hyperglycemia (Heber, 2006). Whether this persistent hyperglycemia and insulin resistance leads to worse outcomes in veterinary patients is unknown, but glycemic control is routinely recommended in human patients when hyperglycemia is identified (Heber, 2006). This is both to control episodes of infection (made more likely through the use of immunesuppressive therapies) but also to prevent progression to metabolic syndrome and diabetes which is a risk factor for the development of other cancers.

Obesity is also an 'inflammatory disease', as is cancer. Fat is now considered an organ that releases excess infl ammatory cytokines, such as tumor-necrosis-factor-α (TNFα) and interleukin 6 (IL-6) (de Haas, 2010). These cytokines are considered growth factors that can activate genes that control angiogenesis, invasion and metastasis of cancer cells.

The obese cancer patient then gets a double dose of simple sugar in the blood, and more inflammatory chemicals already being produced by the tumor itself. These patients just have to be 'sicker' - whether or not they show it - than patients of normal weight. Hence the new evidence that some obese human cancer patients have worse outcomes than people of normal weight. This has been shown most frequently in breast, prostate and colon cancer (Ramos 2010, Sinicrope 2010, Komaru 2010, Siegel 2010, de Azambuja 2010, Lange 2008, Nitori 2009). Additionally, some recent trials suggest that overweight patients undergoing controlled weight loss during cancer treatment experienced improved prognosis (Freedland 2009).

A diet that is low in simple carbohydrates and higher in meat protein will be fairly calorie-dense, depending on the proportion of meat to other ingredients. A homemade version of the low carb diet can be made to resemble an Atkins-style diet. This can work for weight loss in some patients but not necessarily for others, because meat comes with fat - even the lower fat meats. If I formulate a diet for an obese patient, I use a lower fat protein, such as tofu, often along with a small amount of a starch, and plenty of vegetables. These proportions are customized to the individual dog, and the vitamin/mineral levels are also changed as needed. The starch and sugar content is still quite low, and weight loss can be facilitated.

I see many people who request the 'cancer diet' for their pet with cancer, and a few who refuse to believe that it is inappropriate for their particular pet. We have an increasing number of studies in people to suggest that customizing the diet for an obese patient improves survival, and only 1 study in dogs suggesting that the high fat low carb diet makes a difference in survival. The veterinary oncologist that investigated the low carbohydrate diet for veterinary cancer patients has repeatedly written "no one diet is right for every cancer patient". You can't believe that his research is right 100% of the time but that this opinion of his is wrong 100% of the time.


References

de Azambuja E, McCaskill-Stevens W, Francis P, Quinaux E, Crown JP, Vicente M, Giuliani R, Nordenskjöld B, Gutiérez J, Andersson M, Vila MM, Jakesz R, Demol J, Dewar J, Santoro A, Lluch A, Olsen S, Gelber RD, Di Leo A, Piccart-Gebhart M.The effect of body mass index on overall and disease-free survival in node-positive breast cancer patients treated with docetaxel and doxorubicin-containing adjuvant chemotherapy: the experience of the BIG 02-98 trial. Breast Cancer Res Treat. 2010 Jan;119(1):145-53.

de Haas EC, Oosting SF, Lefrandt JD, Wolffenbuttel BH, Sleijfer DT, Gietema JA. The metabolic syndrome in cancer survivors. Lancet Oncol. 2010 Feb;11(2):193-203.

Freedland SJ, Aronson WJ. Dietary intervention strategies to modulate prostate cancer risk and prognosis. Curr Opin Urol. 2009 May;19(3):263-7.

Heber, D. Assessing Endocrine Effects of Cancer and Ectopic Hormone Syndromes. Nutritional oncology. Elsevier, St Louis, 2006; p. 695

Komaru A, Kamiya N, Suzuki H, Endo T, Takano M, Yano M, Kawamura K, Imamoto T, Ichikawa T. Implications of body mass index in Japanese patients with prostate cancer who had undergone radical prostatectomy. Jpn J Clin Oncol. 2010 Apr;40(4):353-9. Epub 2010 Jan 10.

Lange BJ, Smith FO, Feusner J, Barnard DR, Dinndorf P, Feig S, Heerema NA, Arndt C, Arceci RJ, Seibel N, Weiman M, Dusenbery K, Shannon K, Luna-Fineman S, Gerbing RB, Alonzo TA. Outcomes in CCG-2961, a children's oncology group phase 3 trial for untreated pediatric acute myeloid leukemia: a report from the children's oncology group. Blood. 2008 Feb 1;111(3):1044-53. Epub 2007 Nov 13.

Nitori N, Hasegawa H, Ishii Y, Endo T, Kitagawa Y. Impact of visceral obesity on short-term outcome after laparoscopic surgery for colorectal cancer: a single Japanese center study. Surg Laparosc Endosc Percutan Tech. 2009 Aug;19(4):324-7.

Ramos Chaves M, Boléo-Tomé C, Monteiro-Grillo I, Camilo M, Ravasco P. The diversity of nutritional status in cancer: new insights. The Oncologist 2010; 15(5):523 -530

Siegel EM, Ulrich CM, Poole EM, Holmes RS, Jacobsen PB, Shibata D. The effects of obesity and obesity-related conditions on colorectacl cancer prognosis. Cancer Control 2010; 17(1):52-57.

Sinicrope FA, Foster NR, Sargent DJ, O'Connell MJ, Rankin C. Obesity is an independent prognostic variable in colon cancer survivors. Clin Cancer Res. 2010 Mar 15;16(6):1884-93. Epub 2010 Mar 9.

Wednesday, June 9, 2010

How to choose a pet food

As a nutritionist and integrative practitioner, I’m asked almost every day what pet food I recommend. It’s an interesting thought – that I recommend one pet food.

At the same time, my nutrition training has led me to question authority. While the holistic folks like to vilify the big over the counter and prescription brands of food, my training has shown me that they employ some of the best – and some of the worst- company philosophies. And this is what I’m about today – choosing a company, and not a food.

Before I tell you what personal philosophies drive *my* company choices, I’ll paint a picture of the problem for you.

Over the past decade, I’ve had occasion to ask for more detailed information about a food based on my patients’ needs. You see, the guaranteed analysis on the food label provides only the barest guide as to the nutrient profile of the food. And while I care about *ingredients*, I also care that my patients are being provided with essential *nutrients* they require for continued normal functioning.


I’ve needed to know if the protein content was able to meet the minimum needs for animals who required caloric restriction of a high fat diet. I’ve needed to know if amino acid profiles were adequate in a vegetarian diet with a suspicious ingredient listing. And I’ve been disturbed by the digital equivalent of a blank stare I got when asking for this information from some of the most popular makers of ‘holistic’ and ‘natural’ diets. The ones you are feeding your pets right now, and the ones your local pet store employee is pushing as new and improved.

Here is a sampling of the problems I’ve encountered when trying to obtain nutrition information from the ‘holistic’ pet food companies:

  1. Labels with egregious mistakes showing either inaccurate information or terrible formulating errors.
  2. Company leaders who do not know what a nutrient profile* is, much less how to provide one to a nutritionist.
  3. Refusal by a company to provide nutrient profiles, stating that it is proprietary information (ok, but you will never hear me recommending your diet, especially if it is a certain new vegetarian diet). Honestly, the largest companies post their profiles on the web – do you really think it has cut into their profits?
  4. Diets (raw and processed) that are not complete or balanced when nutrient profiles are submitted to detailed analysis.
  5. A company that refuses to deal fairly with a veterinarian who discovers a major problem with its food.
  6. Companies that refuse to provide the names or credentials of their food formulators
  7. Naïve representatives making dangerous claims because they don’t understand the simplest feed concepts, such as dry matter conversions
  8. Company heads that misuse their meager knowledge of nutritional biochemistry and microbiology to make unfounded health claims and spread misinformation across the web.
  9. Advertising claims that tout health benefits that were disproven years before.
  10. Companies that for decades refuse to acknowledge new information and adjust their formulas, simply because people continue to buy their foods.

So how do you choose a pet food?

You don’t- you choose a company. So here are my criteria for recommending a food manufacturer:
  1. The company needs a track record. Even if it’s your best friend whom you consider knowledgeable, the company she owns or recommends needs to prove its ability to produce consistently safe formulations, hold onto the best employees, and is using profits to improve (and not just expand) the company.
  2. There should be a board certified veterinary nutritionist on staff. Not just a veterinarian – a veterinary nutritionist. I’ve seen some very questionable formulations even from companies owned by veterinarians. The only way the formulations can improve over time is if a nutritionist is constantly feeding updated knowledge into those formulations.
  3. The company philosophy fits with my clients’ standards** and my patients needs.

Once we settle on a few companies, I have these additional recommendations for my clients:
  1. Choose foods that carry an AAFCO feeding claim to be complete and balanced for the appropriate life stage of your pet. Some smaller pet food companies do not produce balanced diets, and others produce pure meat diets “intended for supplemental or intermittent feeding”. Nutritional deficiencies could result if any of these are fed long term.
  2. Rotate between various companies (i.e. use various flavors , but also from different companies)
  3. Avoid exotic ingredients like duck, rabbit, emu, pheasant, and venison. They aren’t necessary for healthy pets and we may need for them to be completely new to your pet when diagnosing or treating certain conditions later. There is plenty of variety to be had with chicken, lamb, beef, pork, turkey, fish, egg and vegetarian foods. It’s also easier to find organic versions of these ingredients.
  4. Feed your dog veggies and fruits as snacks or to beef up the amount of food in his bowl. It is may help prevent cancer, and they are low in fat. Avoid grapes, raisins and onions, which can be toxic to pets. Choose all colors, including carrots, broccoli, cauliflower, bell peppers, squash, apples, melon, berries, etc). Feeding more meats and starches is rarely necessarily, especially if you are already feeding a premium or Paleolithic diet.
  5. Don’t buy large bags of food for small animals- food should be used up within a month, especially if it is stabilized with natural preservatives instead of chemical preservatives.
  6. Avoid dry foods in cats and if your cat is currently eating dry, make an appointment to talk to a nutritionist about why this may no longer be recommended and how to switch stubborn kitties to canned or homemade food. At the very least, for heavens’ sake, do not leave free choice dry food down – for dogs OR cats. Most just get fat on it!
Seems like a lot to remember, but here is the simple version: feed balanced foods, with healthy ingredients, from different companies. Give veggies and fruits instead of junky treats, and maintain a lean body weight. If you prefer homemade, get the recipe balanced, and stick to the plan. And of course, check in with your vet for regular physical and biochemical exams to find emerging problems early.

Notes

*A nutrient profile shows the levels or concentrations of all essential nutrients in a food . This profile is compared to the nutrient requirements of a dog or cat to determine whether it is marginal, deficient, or replete for a particular life stage or condition.

**Philosophies and standards are unique to each pet owner. Some won’t tolerate commercial diets at all, while others don’t care if they are commercial as long as they are (pick one – raw, natural, organic, made of human grade ingredients, etc). Some trust larger companies and care only that the correct *nutrients* are provided, while others don’t care about nutrients and consider *ingredients* most important, absolutely prohibiting by-products. A few clients believe that locally sourced ingredients are best (necessitating a homemade diet unless you happen to live near a company that uses ingredients local to *you*). If you really want to know, my philosophy necessitates a complete and balanced nutrient profile, identifiable ingredients (although by-products of some types are just fine with me considering the true natural diet of dogs and cats), a veterinary nutritionist on staff, and a company that balances the need for economy with the need to document the safety of their raw ingredients (usually requiring domestically sourced ingredients). The company should be transparent in its operations (some have allowed the WDJ editor to visit their plants, and some regularly invite veterinarians for tours, while others won’t answer phone calls). And of course, I think homemade diets are superior as long as they are balanced. I’ve seen some awful sick animals eating weird homemade recipes, and I’ve seen so many improve if we just balance while incorporating the owners’ preferences!

Monday, May 24, 2010

A corollary to discovering fraud: finding information on the web

A corollary to the problem above is that of how to evaluate pet-related information. Those who rely on the internet are particularly at risk. There are two main types of sites - noncommercial (such as that from teaching hospitals, government agencies and foundations) and commercial (generally someone who wants you to buy their product). In health care, it is best to avoid commercial sites if possible, but some do contain good information. It takes some training to recognize the difference. Here is what to look for:

  1. Scientific references - these come from scientific journals such as the Annals of Internal Medicine, The Cochrane Database, the Journal of the American Veterinary Medical Association, the Journal of the International Veterinary Emergency and Critical Care Society, Journal of Nutrition, etc. Scientific references do not come from newspapers, Time magazine, or Cat Fancy.
  2. The references and information should be relevant to your pet – test tube studies and those in laboratory mice are probably meaningless to a dog in the real world. Human studies are somewhat more useful, but dog studies are best. (And cats are a completely different issue because they are metabolically very different from humans, dogs, mice and most other species we can think of). Testimonials are not useful at all – they can be ignored!
  3. The people who write articles and formulate nutritional supplements should be clearly identified, along with their training and credentials. Contact information should be easily available.
  4. If information on the site seems extremely optimistic or promises to cure chronic and terminal illnesses, please refer back to #1 - 3.
  5. If the site promotes and sells brand name products, refer back to #1-4.
  6. If the ingredients and amounts are not available, avoid purchasing from the company. “Proprietary ingredients” are secret ingredients, and there is no way to tell whether they may be toxic to your pet.
  7. If the site sells veterinary products, the company should be a member of the National Animal Supplement Council (www.nasc.cc), an industry group that insures high standards of quality control and maintains an adverse event reporting system. We do use human products for animals as well, but the dose should be recommended ONLY by a veterinarian familiar with the supplement, and not by the company if they employ no veterinarians.
  8. The site should have links to other sites, and these links should provide multiple ‘points of view’ about the issue or condition. Beware of sites that link ONLY to other alternative medicine sites, or conversely, those that link only to quackbuster sites. Use these other sites to verify that the information you are gathering is fairly well accepted and not the opinion of one well spoken company representative or lone practitioner who only sees a few patients a year!
  9. The site should clearly indicate when it was last updated. Medical information is generally old after only a year!

Finally, please do NOT assume that consumers and pet owners have access to the same information that veterinarians do. Our professional networks keep us informed of research before it is published, and of breaking news never seen in the newspapers or internet. Please verify your information with your veterinarian, or just skip all of the work above, and ask her first!

I can recommend these websites to start your research:
  1. Veterinary Partner (www.vspn.org) - database of in-depth articles on veterinary conditions and the conventional diagnostics and treatments recommended. Usually kept very well updated.
  2. Healthnotes (http://www.pccnaturalmarkets.com/health/ and click on the link “Health Conditions A-Z” as well the links “Vitamins, Minerals and Herbs A-Z”). Information about human health conditions and the supplements commonly used for them.
  3. The National Library of Medicine (www.pubmed.org). The scientific database of peer-reviewed journal articles published from about 1960-present. You can retrieve abstracts of the studies and occasionally, the full scientific article.

Friday, May 21, 2010

How to Identify and Avoid Phony Practitioners

How to Identify and Avoid Phony Practitioners

Seems like everyone who wants to can be a doctor these days, no schooling required. A dictionary definition of a doctoral degree is:
• any of several academic degrees of the highest rank, as the Ph.D. or Ed.D., awarded by universities and some colleges for completing advanced work in graduate school or a professional school
• an honorary degree conferring the title of doctor upon the recipient
• a degree awarded to a graduate of a school of medicine, dentistry, or veterinary science

It’s that second definition that is most troublesome, because it means that anyone can open up a virtual school and award doctoral degrees for whatever level of work – or dollars- they think sufficient.

The field of naturopathic medicine is shot through with such fraud. Only 16 states license naturopathic doctors. The licensing process requires graduation from a 4 year naturopathic school with virtually the same curriculum as that of a medical school, with natural treatments substituted for drugs and surgery.

These institutions have been accredited or are in candidate status for accreditation by one of the regional accrediting agencies approved by the US Department of Education. In addition, all of the naturopathic medicine programs of the member schools have been accredited (or are candidates for accreditation) by the Council on Naturopathic Medical Education (CNME).

On the other hand, the naturopathic schools that offer long distance education say that their courses are approved by the American Naturopathic Certification Board (ANCB). These graduates are not eligible for professional licenses. Strangely, the ANCB's website states "Due to ANCB's stringent application and certification requirements, ANCB is the certification organization preferred and recommended by the leading schools of Traditional Naturopathy, including Clayton College of Natural Health and Trinity College of Natural Health" [both are online diploma mills]. Does this seem a little incestuous?

Now naturopathy has come to veterinary medicine. One online diploma mill requires a “recognized Master's degree in a natural health field” to enter ‘doctoral’ programs offered there, but no definition of what this means. The accreditation for this school is through the American Association of Drugless Practitioners (Texas). That’s all.

We even need to worry about people making up certifications on their own. I once taught a course online on herbal medicine that was open to veterinarians and veterinary technicians. A technician, after finishing the course, granted herself a “Dip.Vet.Bot.Med” on her website, where she was offering animal health consultations. This was new to me as the instructor of the course. Presto – certified in herbal medicine after a 4 week introductory course!

So how do we judge the quality of the educational experience for practitioners of animal medicine? Let’s compare the curriculum and experience of the diploma mill to that of a veterinarian who is familiar with naturopathic principles:

Veterinary education (in the U.S.):
• Requires an undergraduate (college) degree from a university or college accredited by the US Department of Education, with a concentration on chemistry, biology and physics.
• 3 years of full time, in residence schooling that includes about 6 hours daily of didactic lectures, labs and contact with instructors who hold advanced degrees or certifications in their fields
• Required textbooks are comprehensive specialized reviews of medical science
• 1 year of full time clinical experience under direct supervision of faculty who are specialists in their fields
• Regular competency exams culminating in national and state board examinations that must be passed in order to obtain a license to practice.
• Further education on herbal medicine, acupuncture, homeopathy and other natural modalities requires well over 100 hours of study for certification each. A recent survey of 300 veterinarians who practice natural or integrative medicine revealed that 61% of veterinarians with at least 6 years of integrative practice experience have accumulated at least 250 classroom hours in integrative medicine. Of these practitioners, more than 30% have taken more than 500 hours of class room training.

Diploma mill doctoral degree:
• 200-300 hours (claimed) of self study
• Faculty - just a few of the school’s own graduates - available by phone or email
• Required textbooks are simple compilations for pet owners, typically available at your local book store
• Final exam is 3-5 questions, open book

Graduates holding a “VND” or “Doctor of Veterinary Naturopathy” degree have been taught that it is illegal for them to diagnose or prescribe in order to treat animal disease, so they position themselves as educators. Of course, the fact that they suggest treatment recommendations after learning symptoms, and the fact that they often sell just the natural remedies needed certainly could not be viewed as prescriptions (please know that I have on my most ironic smile right now). In addition, they make these recommendations without seeing the animal, which could vitally change the prescriber’s overall assessment. Yes, some veterinarians also do this, but most have medical records or direct communications from a veterinarian who has seen the animal, which solves that problem.

Any veterinarian understands the pet owner’s desire for second opinions and to have a team behind their pet’s medical care. But you can do better by your pet if you stock that team with professionals who have received comprehensive and well rounded veterinary and natural medicine education. Look for the initials below:

Veterinary degree: VMD, DVM, BVSc, MVB, VetMB or BVetMed, BVM&S or BVMS, Dr.Med.Vet
Natural medicine certifications (post graduate training offered only to veterinarians):
Acupuncture: CVA, FAAVA
Herbal Medicine: CVCH (Chinese herbal medicine), CVHM (Western herbal medicine)
Homeopathy: CVH, VetMFHom, CertIAVH
Chiropractic: cAVCA, IVCA, CVSMT
Physical therapy/rehabilitation: CCRT, CCRP
Chinese massage (tui na): CVTP

Nonveterinarians holding the “VND degree” and those who follow them may well wonder why we can’t all just get along. The argument would be that they offer only information that is complementary to that of veterinarians, and that they are only educating pet owners on how to better care for their pets. The situation feels to me much like medical practice in the US in the early 1900s. There were many private medical schools and many different educational experiences, and people had many different types of practitioners to choose from.

In the course of determining which type of practice and schools should be the recipient of grant money, the Rockefeller Foundation hired Abraham Flexner to thoroughly investigate all medical schools in the country for the first time. The report is eye-opening. Most of the naturopathic and homeopathic schools presented their students with very poor experiences – most did not require a college degree; none of the faculty was full time, and few of the students had access to actual patients in a mentoring atmosphere. Some of the schools were described as filthy, with libraries of only a few old books. By contrast, the schools that offered the best education required college degrees and 4 years of didactic and bedside education. If your mother developed a serious medical condition in the 1920’s, which type of graduate would you have wanted to see her?

These are not complementary veterinary professions. And I can already hear the defense - 'those veterinarians are just worried about competition'. No we're not. We're worried about what happens to sick pets whose owners don't know the difference between in-depth veterinary and natural medicine knowledge and a fake. If they know the difference and choose a "VND", the pet still suffers, but the owner is making an informed choice. The trouble is - most owners don't. So if that internet expert with a Dr. in front of her name offers consultations and sells supplements, it's a good idea to look for those letters, then make your decision.

Wednesday, March 17, 2010

Can anyone tell me why the new generation of "vet skeptics" are so insistent on remaining anonymous? I've been reading "skeptvet" and "skeptivet" but cannot determine from their "about" why they are qualified to question the experience and recommendations of specialists with more scientific training. Can someone help me here?

semantics

It's "veterinary medicine" or "veterinary practice". That's a noun with a descriptive adjective, telling you what we do.

"Veterinarian medicine" and "veterinarian practice" are incorrect. On so many levels. Don't do that.

Kthx.

Signed,
Grammar nazi

Tuesday, March 9, 2010

Grains #2 - not as allergenic as you thought

Grainless foods are popular these days. And sometimes rightfully so – I know many have seen a difference when they switch an ailing dog or cat from a standard grain-based food to one that is lower in "carbohydrates" (presumably starch). It’s wrong to blame the grains, though, in many cases (I’ve talked about this here before).

Quick tutorial: Carbohydrates are essentially fibers, sugars and starches. Some (starches and sugars, mostly) are digestible, and are degraded from large molecules on ingestion to small molecules that are absorbed in the small intestine for energy. Grains like barley, wheat, corn, and oats contain digestible and indigestible carbohydrates in addition to fatty acids and proteins – they are more complex than a simple carbohydrate such as starch. Digestible carbohydrates are also contained in root vegetables like potatoes and yams, yuca (or tapioca), taro root, etc.

My biggest quibble with companies that tout a ‘grainless’ label on a dry food is that they are not carbohydrate-less, which is in reality what most pet owners think they are getting when they search for a Paleolithic, low carb (i.e. low starch) diet. I’m just saying, pet owner beware, because you cannot make a dry food without some carbohydrate, and these companies will simply substitute a starch from potato, sweet potato, tapioca or the like to do it. That’s not necessairly a 'low carb’ food.

But I want to talk about today is why some animals do better when switched from a high starch, or even moderate starch food, to a low starch food.

Many people go looking for alternative pet foods because they are forced to – they have a chronically ill animal (“chronically ill” pretty much defining a condition not amenable to conventional therapy). You would almost have to live under a rock to avoid the advice you’d get from fellow pet owners, pet store employees and websites that grain-free diets fix everything from skin disease to GI disorders to cancer.

In the case of animals with chronic conditions of many types, the central problem may be a sick gut. We used to (and still do) call this a leaky gut, but more recently gastroenterologists have come to agree that the condition exists, and call it a hyperpermeable gut. Chronic inflammation of the gut may appear due to food allergy or less well understood inflammatory processes like inflammatory bowel disease. Even a transient gastroenteritis or antibiotic therapy can lead to inflammation of the gut lining.

There are probably many arthritic dogs on long term therapy with nonsteroidal anti-inflammatory agents such as Metacam®, Previcox®, Deramax®, and Rimadyl® walking around with leaky guts, as well. The syndrome even has a name – NSAID enteropathy. For your edification, a review from the Journal of Pharmacy and Pharmaceutical Science in 1999 stated unequivocally that in people, “NSAIDs produce inflammation of the small intestine in 40 to 70% in long-term users” (Davies 2000). And if you’re really interested, “Exposure of the small bowel mucosa to NSAIDs is thought to lead to the loss of intracellular integrity and increased permeability because the NSAIDs damage surface membrane phospholipids and cause an uncoupling of oxidative phosphorylation” (Feagins 2010). Interestingly, NSAID use is also associated with lower numbers of Lactobacillus in the bowel (the good bacteria) which are known to improve gut mucosal integrity. (Mäkivuokko, 2009)

So chronic inflammation in the gut begins to erode the most superficial layers of the mucosal lining. The microstructure of the gut consists of tiny folds called villi, and the villi themselves have surfaces composed of enterocytes (cells of the gut mucosa) that have microvilli on the end that is exposed to the gut lumen. These cells actively secrete enzymes and other products that aid in normal digestion, absorption, and even immunity, and these products become more active as they mature, moving from the deeper layers of the gut to the tips of the microvilli. So what happens when the most superficial layer of the gut is eroded away due to inflammation?

One of the earliest theories from holistic medicine writers was that the gut immune system is exposed to abnormally intact molecules of food, and the animal (or person) subsequently develops food allergy or gluten enteropathy. Since the immune system can potentially become sensitized to any protein ingested, the poor patient experiences signs of food allergy constantly, including skin inflammation and diarrhea, and if you read the more esoteric literature, arthritis and a wide variety of autoimmune diseases.

But another circumstance suggests a simpler explanation for the inconsistent stool we see in some of these animals that eventually improve on a ‘grain free’ or low carb diet. In the ‘stressed’ enterocyte, mature digestive enzymes – disaccharidases that digest starches and sugars – are lost because of erosion of the luminal end – the part that is exposed to the GI contents, NSAIDs, etc. Examples of disaccharidases include lactase, maltase, sucrase, trehalase, isomaltase, and others.

So, disaccharides that result from digestion of more complex carbohydrates in the stomach and upper intestine flow down into the small intestine where disaccharidase enzymes would further digest them into a form that is easily absorbed. If they remain in disaccharide form, they are not absorbed and in fact pull water into the intestine. The result is loose stool, or diarrhea.

The problem is compounded the longer it exists. Carbohydrate malabsorption will lead to increased bacterial fermentation, which will cause gas and discomfort. Bacterial overgrowth (due to a surfeit of nutrition for them) can itself lead diarrhea.

So the neighbor comes along and recommends a grain-free diet, and the dog or cat gets better, and once again, the grains get the blame, when in actuality, the *starch* should get the blame. While allergy may or may not be a component of the reaction seen when grains are fed to these animals, the carbohydrate overload seems to be a bigger problem. And as I said before, carbohydrates are certainly common in ‘grain free’ diets - grain free does not mean low starch.

The good news is this – and I can verify that clinically this is extremely common – these ‘allergies’ aren’t permanent, unless the patient has a genetic disaccharidase deficiency (which is vanishingly uncommon in dogs and cats). In general, balancing the bacterial populations with probiotics, changing the diet so that it contains lower carbohydrate levels and sometimes different proteins, and addressing the cause of the initial bowel inflammation is all that is needed. Whether or not the owner wants to go back to feeding a diet higher in carbohydrates depends on other factors, like owner philosophy, financial capacity to buy the more expensive meat products, and whether the dog or cat has a weight problem (carbohydrates are used in weight loss diets to ‘cut’ the fat while still giving some bulk to the diet).

I just had to get this out there. Temporary carbohydrate intolerance is different from real food allergies. It's a much better diagnosis for your pet though, as there are no permanent food restrictions.

References
Davies NM, Saleh JY. Detection and Prevention of NSAID-Induced Enteropathy.J Pharm Pharmaceut Sci 3(1):137-155, 2000

Feagins LA, Cryer BL. Do Non-steroidal Anti-inflammatory Drugs Cause Exacerbations of Inflammatory Bowel Disease? Digestive Diseases and Sciences 2010;55(2):226

Mäkivuokko H, Tiihonen K, Tynkkynen S, Paulin L, Rautonen N. The effect of age and non-steroidal anti-inflammatory drugs on human intestinal microbiota composition. Br J Nutr. 2010 Jan;103(2):227-34. Epub 2009 Aug 25.

Tuesday, February 16, 2010

Teaching your dog to walk on a treadmill

We do alot of obesity management in my practice. With many dogs (and cats), there comes a point where calorie restriction isn't enough. We need to institute exercise programs both to burn calories and also to increase the ratio of lean body mass to fat mass (lean body mass has a higher metabolic rate and therefore burns more calories). The animals with orthopedic problems need special handling and we usually recommend underwater treadmills or swimming for them. For dogs with good joints and no pain, the owner's own treadmill can do a world of good.

I was looking recently for information on how to train a dog to use a treadmill and found alot of them on YouTube. One was absolutely terrible - a guy simply gets on the treadmill and plops his dog on it, forcing the frantic dog to stay on it. In response to the variability of recommendations out there, I asked my technician, Vera, to research the issue. She wrote this and I think it's good:

How to Train Your Dog to Walk on a Treadmill

1) Purchase a treadmill. Many owners use a human treadmill but special animal treadmills are also available. You can find animal treadmills on these and other websites: www.hammacher.com, www.frontgate.com, and www.dogtrotter.net.

2) Allow your dog to get familiar with the treadmill in the room for a few days. Do not turn it on.

3) Allow your dog to smell the treadmill. Reward your dog’s behavior if s/he goes up to the treadmill by offering small treats. Placing small treats along the length of the treadmill is also recommended so that s/he gets comfortable stepping onto the treadmill.

4) After a few days, turn on the treadmill. Let your dog get familiar with the sound of the treadmill. Reward your dog’s behavior by offering small treats beside the treadmill while it is running. Do not place your dog on the treadmill at this time. Let your dog see you having a slow pleasant walk on the treadmill if using your own.

5) Once your dog is comfortable with the sight and sound of the treadmill, it is time to get him on the treadmill. Ask the dog to step onto the treadmill and while giving a stream of treats, turn it on to the lowest speed. Start the treadmill at the slowest speed. Offer small treats to keep him on the treadmill. You may want to stand in front of the treadmill so that your dog stays in position.

6) You can use your dog’s leash as an aid, but NEVER tie your dog to the treadmill.

7) Once your dog is comfortable walking on the treadmill, you can slowly increase to the recommended speed for your dog.

You may be able to find instructional videos using a google search. Use search terms such as “teach train treadmill dog.” The following youtube videos may be helpful in your training:

http://www.youtube.com/watch?v=I25QXJLXHNg
http://www.youtube.com/watch?v=1eXNOMkcFGc

These trainers used various methods but what they have in common is a slow introduction to the treadmill, avoidance of force, and lots of treats.

What do you think? Do you have a favorite method or success stories to tell?

Monday, February 15, 2010

Thanks for the kudos to Bark Magazine!

I'm honored! Bark Magazine gave me an honorable mention after their Top 100 best and brightest in the Feb/Mar 2010 issue.

I'm in some really heady company - see them here: http://thebark.com/content/barks-best-brightest-honorable-mentions

But look at the Top 100 - Bark Magazine, I think you got it right! (http://thebark.com/media/BestBrightest_58.pdf)

Thanks!

Monday, February 8, 2010

Diversion: 50 sushi tips for beginners

This great article was posted on the MRI Technician Schools website (http://www.mritechnicianschools.org/50-sushi-tips-for-beginners/).

'Cause where else would you expect to find the definitive guide to sushi etiquette?

Seriously - answers some of my long standing questions like, here are the out-takes from the article:

50 sushi tips for beginners

3. Use the pickled ginger (gari) as a palate cleanser.

Almost all Japanese dishes come accompanied by both a wad of wasabi and a small pile of lively pink or ecru gari. Eat a slice between sushi pieces to keep the palate feeling fresh and clean. Doing so imbues diners with the ability to taste the full complex flavor of every different roll, wrap, nigiri, or other sushi style.

[Article does not mention that pickled ginger has been studied for its ability to kill metazoan parasites. Not that they stop me from eating sushi - I'm just pointing this out for your edification).


8. Order sake with sashimi. Sushi tastes best with beer or tea.

Because sake is made from fermented rice, most sushi connoisseurs consider drinking it with sushi a redundancy. It complements sashimi fine, but those hoping for a beverage best suited to accompany nigiri, maki, or other sushi dishes would do best to drink hot tea or beer instead. Try to avoid rice beers, of course.


10. Chopsticks are optional when it comes to sushi.

Sashimi should be eaten with chopsticks, but it is not considered rude to consume nigiri or maki sushi without any utensils whatsoever. There are several different accepted techniques to hold the pieces and keep them together with the fingers.

11. Dip pieces of nigiri sushi into soy sauce (shoyu) topping side first.

Rice soaks up shoyu quickly, overpowering the delicate vinegar flavoring. While it may be awkward at first, turn nigiri pieces upside-down so that the sauce covers the topping instead. This allows diners better control of their condiments and does not compromise taste.

12. Eat nigiri pieces upside-down.

Doing so brings out the complex, carefully balanced flavors in the sushi best. Eating nigiri rice-first may cause palates to predominately taste the light, starchy vinegar over the topping.

13. Eat nigiri pieces in one or two bites.

Most nigiri comes with a subtle smear of wasabi between the topping and the pillow of rice. One to two bites ensures that the diner consumes the piece as it was meant to be tasted – with all ingredients painstakingly playing off one another. Three or more bites may mean missing out on all the itamae’s carefully constructed crafting.


15. Pour shoyu sparingly.

Again, prudently utilizing condiments minimizes waste, but cultural implications are also at play here. Pouring too much soy sauce may be interpreted as an insult to the sushi chef’s abilities, implying that his skills at balancing flavor are sub-par and require masking with liberal amounts of shoyu.

23. Buy the itamae a sake or beer to show appreciation.

Doing so does not take the place of a tip, of course, but many enjoy establishing a rapport with the sushi chef and treating him or her to a sake or beer as a way of showing appreciation for an exquisite meal.

24. If drinking from a carafe, dining companions should refill each other.

This typically holds for alcoholic beverages, but it also a nice, polite gesture when consuming tea from a shared container as well. Individuals must serve others before serving themselves, and wait patiently for their dining companions to follow suit when in need of more drink. Alternately, if serving oneself, be sure to offer others a refill first.

26. Be sure to tip both the waitron and the itamae.

At sushi establishments, it is advisable to leave tips for the waiter or waitress as well as the chef. If there is not a tip jar available at the bar, simply add it to the bill and indicate the split.

30. Do not eat raw freshwater fish.

Far more parasites are present in freshwater fish than those residing in saltwater because the majority cannot handle the high salinity of the latter’s environment. In fact, certain breeds of tapeworms explicitly thrive in the muscles of some freshwater species. Because of this very high risk of infection, it is never safe to eat raw fish from freshwater habitats.

32. If offered a hot towel (oshibori), practice proper protocol.

Some sushi bars and restaurants proffer hot towels to patrons before or after a meal. Clean hands, perhaps lightly and subtly pat around the mouth, then fold the towel neatly before returning it to the waitron.

33. Chopsticks should be set down in the preferred manner when not in use.

There are generally a few different ways to put chopsticks down when going unused. Some may elect to set them on their small saucer for shoyu, though sometimes special chopstick rests are available as well. At some bars or restaurants, the waiter, waitress, or sushi chef will create lovely origami knots from the paper chopstick holders for use as a rest.

39. Feel free to slurp noodles.

Some diners may appreciate a side of soba or udon noodles to accompany their sushi meal. Slurping them is not considered taboo in Japanese etiquette protocol – in fact, it helpfully sucks in air to cool off the usually piping hot dishes. Soup, however, is generally enjoyed in a far quieter fashion.

40. Miso soup may be eaten without a spoon.

Occasionally, sushi bars and Japanese restaurants will serve their soups without a spoon. This may seem unfamiliar to American diners, but it is actually not a mistake on the part of the waitron. If handed a bowl of soup that lacks any sort of utensil, simply lift it up and drink it directly from the bowl. This is not considered an etiquette violation in Japan, nor will it in an explicitly Japanese environment.


47. Order pieces of nigiri in pairs.

The tradition of serving sushi two at once comes from a time when diners would have to cut their pieces in half to eat them without choking. Beyond that, ordering one piece of nigiri or ordering four of something have unfortunate etymologies attached to them in Japanese. It is generally recommended to order in pairs to avoid awkwardness.

50. The only steadfast rule is practice common courtesy and politeness.

In the end, though, just about the only thing that truly matters in the sushi experience is whether or not patrons treat themselves and everyone around them with respect and courtesy. Being awkward with chopsticks or using too much soy sauce or flubbing pronunciations are window dressing, really – it will not carry any truly inescapable or demonizing stigmas. Relaxing, being polite, being nice, and having a great time is truly the spirit of eating sushi and eating it well.

Who knew MRI technician school had a liberal arts component?

Sunday, January 31, 2010

Is Centrum toxic?

Is Centrum Toxic?
By Susan G. Wynn, DVM and Heather Vogl, DVM

I formulate a lot of homemade diets and a source of vitamins and minerals, usually as a multivitamin, is critical to prevent deficiencies. My default multi is Centrum for two reasons: 1. it has a nice balance of vitamins and minerals without too much of any and 2. it is obtainable all over the country in small towns and large ones.

Occasionally I get complaints because someone wants a 'healthier' multi and while it usually results in a much more complicated diet, I can do use those. I can't argue with this inclination as I, too, prefer a whole food-extracted multi rather than a synthetic, but there is no proof that one is better than the other. The synthetic vitamins and minerals are well absorbed and can fulfill the needs for these essential nutrients. The complaints I've gotten are apparently based on one website:

www.centrumistoxic.com

The author of the website (which was apparently written in 2006 and has not been updated since) uses a few techniques to scare readers. For every ingredient, the manufacture is described in detail, apparently to scare readers with unfamiliar chemical names. The author consistently claims that inorganic forms of minerals are toxic and inappropriately active in the body, but these claims are not referenced. The toxicity studies cited in general describe trials where very high doses were used, rather than normal dietary doses. The circumstances are often different as well, quoting epidemiologic studies reporting widespread environmental contamination.

It also is not a critical review, as references cited are selected to show the author's bias, and do not analyze the literature as a whole or even fairly describe study conclusions (look at calcium carbonate, below, for instance). Finally, the site is completely anonymous - even the "about us" page lends no clue as to who the author is and whether they work for other companies or have some similar conflict of interest, or even knowledge enough to interpret the data quoted.

Below are specific analyses of the author's claims.

Magnesium Oxide is claimed to be "biologically inactive, and is not found in this form in foods". Magnesium Oxide can cause a pronounced laxative effect in higher amounts...(how does it have a laxative effect if it is biologically inactive?). The Hazardous Substances Data Bank (HSDB) cited refers almost entirely to toxicity from inhaling particles of magnesium oxide. The toxic dose for an adult human is stated by the Hazardous Substances Dtabase as "0.5-5 G/KG, BETWEEN 1 OZ OR 1 PINT (OR 1 LB) FOR 70 KG PERSON (150 LB)". That's a minimum of 35,000mg. Centrum contains 50mg. Our conclusion: logical inconsistency, lack of supporting references, dishonest representation of toxicity study.

Potassium chloride is stated to have "one of the highest salt index ratings (116) among commercial fertilizers and can cause injury to plants which is known as "burning." (so does table salt and dog urine). The site says "Potassium toxicity involves the following symptoms: gastrointestinal distress, e.g. nausea, vomiting, abdmoninal discomfort and diarrhea." (prunes can have the same effect). People with kidney problems should be especially careful when ingesting potassium that is not from a food source.(actually, Noni juice has caused toxicity in this group of people as well). Come on people - potassium chloride is *salt substitute* which is sold as a condiment. People can eat 2000-3000 mg/day of this stuff. Centrum contains 80mg. Our conclusion: logical inconsistency, lack of supporting references.

Microcrystalline cellulose - this is what the website has to say “The safety of ingesting this synthetically produced chemical has not yet been unequivocally determined. We do not yet know if it is a carcinogen, ground water contaminant, has developmental or reproductive toxicity, or is an endocrine disruptor. Nonetheless, evidence exists that it is toxic in mammals.(intravenous application of microcrystalline cellulose (MCC), in a dose of 5 mg/kg twice weekly for 10 weeks,1979)”. The study quoted is the only one apparently published, and the experimental design was based on administering microcrystalline cellulose intravenously at a high dose. The equivalent dose for a human of normal weight is 350 mg. There is no listed amount on Centrum, but it cannot contain more than about 30mg if you calculate the weights of the other components in each tablet. Our conclusion: logical inconsistency, lack of supporting references, dishonest representation of toxicity study.

Ascorbic Acid: The site says “although not known to be directly toxic, there is growing evidence that ascorbic acid causes a mild physical dependency, whereby removal of this chemical causes vitamin c levels in the blood to drop below baseline. Its use has also been correlated with increased incidence of kidney stones, and may be indicated in other problems caused by calcification of soft tissue.” (no references given). The development of oxalate stones may be increased with ANY form of vitamin C. I don’t even know how to evaluate the ‘mild physical dependency claim’ since no reference is given. Our conclusion: logical inconsistency, lack of supporting references.

Ferrous fumarate is inorganic iron. The website claims that it is “pro-oxidative, stimulating the damaging effects in the body of substances known as free radicals.(1) There is evidence linking high inorganic iron intake to cardiovascular disease and cancer. Excessive iron accumulates in the liver, and may feed bacterial and viral infection.”. The studies cited used 120 mg of ferrous fumarate in people with Crohn’s disease and inflammatory bowel disease. The Crohn’s paper actually states in the discussion that these patients probably absorb more iron due to their deficiency status and possibly the state of the gut itself. Centrum contains less than half the amount used in those studies. From the Wikipedia link on page: Humans experience iron toxicity above 20 milligrams of iron for every kilogram of mass (that would be 1400 mg daily), and 60 milligrams per kilogram is considered a lethal dose. Overconsumption of iron in children is usually due to eating large quantities of ferrous sulfate tablets intended for adult consumption, which is a preventable toxicity. The Dietary Reference Intake (DRI) lists the Tolerable Upper Intake Level (UL) for adults as 45 mg/day. For children under fourteen years old the UL is 40 mg/day. Centrum appears to contain exactly the amount of elemental iron required by menstruating women (L Hallberg and L Rossander-Hulten. Iron requirements in menstruating women. American Journal of Clinical Nutrition, Vol 54, 1047-1058). Our conclusion: logical inconsistency, lack of supporting references, dishonest representation of toxicity study.

Calcium carbonate - the site claims “risk factors associated with inorganic calcium ingestion, i.e. calcification of soft tissue, osteoarthritis, constipation, kidney stones, hypertension and various other side effects of poorly utilized calcium. Lancet and the British Medical Journal, recently published the results of two extensive clinical trails [sic] which concluded that calcium plus Vitamin D does nothing to prevent bone loss”. Actually, these studies note that calcium/D3 DOES benefit bone mineral density and that other studies show that it does prevent fractures.... both new studies had significant compliance concerns, with only 60 percent of respondents taking their supplements more than 80 percent of the time by the two-year mark. Our conclusion: logical inconsistency, lack of supporting references, dishonest representation of toxicity study.

dl-Tocopherol is biologically unprecedented and may have adverse side effects. New research demonstrates that taking only 1 member of the E family, which includes 4 tocopherols (alpha, beta, gamma, delta tocopherols) and 4 tocotrienols (alpha, beta, delta, gamma tocotrienols), may cause a deficiency of the other members. It is believed that the ingestion of dl-alpha tocopheryl in isolation may cause a deficiency of the heart-protective form known as gamma tocopheryl, hence adversely effecting the functioning of the heart.” Our conclusion: lack of supporting references.

Ascorbyl Palmitate - The site’s evidence for toxicity includes a link to one in-vitro study (enhanced uv damage in keratinocytes) and a lab animal study on bladder stones and retarded growth. (For every in vitro study suggesting damage, there are multiples of that number suggesting a benefit from the antioxidant activity.). Our conclusion: logical inconsistency, dishonest representation of toxicity study.

BHT is claimed by the site to be “suspected to be mutagenic and carcinogenic. BHT has been banned for use in food in Japan (1958), Romania, Sweden and Australia. The US has barred it from being used in infant foods”. In a comprehensive review of toxicity studies done over the years, (Lanigan RS, Yamarik TA. Final report on the safety assessment of BHT(1). Int J Toxicol. 2002;21 Suppl 2:19-94), doses used on rats and mice ranged from 50mg/kg of BW to 1500mg/kg BW. Interestingly in some of those studies, the test animals lived longer than control animals. At any rate, the dose of BHT in centrum is a tiny fraction of 1 mg/kg BW. Our conclusion: lack of supporting references, dishonest reprentation of toxicity studies.

Chromic chloride – from the site: “Although trivalent chromium like Chromic Chloride is far less poisonous than the hexavalent form, it is definitely a toxic substance, known to exhibit genotoxic, mutagenic, teratrogenic (reproductive hazard) and is on the Hazardous Substance list. ( no reference given). Centrum contains 120 mcg (.12 millgrams) of chromic chloride, which according to Federal Drinking Water standards is above the 100 mcg per Liter limit for safe consumption”. The reference here is not given, so I don’t know if it refers to 100mcg of chromic chloride or 100mcg of elemental chromium (I suspect the latter). Human beings are supposed to drink 2 liters per day, resulting in a top dose of 200 mcg daily of elemental chromium. Centrum contains 35 mcg of elemental chromium, right in line with recommendations for adequate daily intake. Our conclusion: lack of supporting references.

Calcium stearate is stated as "may be toxic" with the following justification - "It is entirely synthetic, and does not occur in nature. No toxicological studies have been carried out on this substance to date." Our conclusion: lack of supporting references, completely made up ‘toxicity’ claim.

Crospovidone – “Very little research has been done on the toxicity of this biologically unprecedented synthetic, however, animal studies showed this substance was carcinogenic, caused inflammation, pneumonia, and other adverse effects”. I was unable to studies of oral toxicity on this compound – most reports were when surgical antiseptic solutions were used to lavage body cavities. Our conclusion: lack of supporting references.

Cupric oxide is said to be “ generally considered a toxic substance in its unbound form. Virtually all copper in the body is present as a component of copper proteins. Unbound or inorganic copper produces oxidative stress in the body, catalyzing highly reactive hydroxyl radicals. Centrum contains 2mg of cupric oxide, supposedly 100% of the RDA. And yet, Federal EPA drinking water standards consider anything above 1.3 mg per Liter to be a health risk” The site does not define whether they think Centrum contains 2 mg of cupric oxide or elemental copper, but Centrum actually contains 0.5 mg of elemental copper. The human water requirement is about 2 liters per day, making the safe upper limit for an adult human 2.6 mg/day. Our conclusion: logical inconsistency

Cyanocobalamin – “ human studies have reported allergic reactions to skin testing, and mice given 1.5-3 mg/kg body weight experienced convulsions, followed by cardiac and respiratory failure”. It is important to keep some perspective here – FOOD causes allergic reactions in many, many people, and the lab animal study used a low dose of 1.5 - 3 mg/kg of cobalamin, - the usual human dose is 0.006 mg/kg). The site also says that because “some people lack the proper enzyme to actively detoxify and convert cyanocobalamin, or are overwhelmed by the ingestion of too much cyanide, it can accumulate in the body resulting in toxicity”. This occurs at very high doses and in people with congenital abnormalities – and certainly not at the dose provided in Centrum. Our conclusion: logical inconsistency, dishonest representation of toxicity study.

FD&C Yellow 6 (Sunset Yellow) according to the site “has the capacity for inducing an allergic reaction. It is associated with ADD and ADHD. (no reference given) This colourant is prohibited as a food additive in Finland and Norway. According to Dr. Andrew Weil, ‘The chemicals used to create colour are energetic molecules, many of which are capable of interacting with and damaging DNA. Anything that deranges DNA can injure the immune system, accelerate aging, and increase the risk of cancer. Indeed, many synthetic food dyes once considered safe have turned out to be carcinogenic’." Remember, natural food items cause allergies. References were not provided here, but it is true that the European Food Safety agency is concerned about reports of Sunset Yellow causing hyperactivity in people. The recommended top daily dose is 1 mg/kg of body weight. The dose in Centrum is something less than 0.1mg/kg of body weight.

Hydroxylpropryl Methylcellulose is “used as an excipient in drugs and supplements like Centrum.There are no long term toxicological studies available on this synthetic substance”. And yet this site labels it as “may be toxic”. Our conclusion: lack of supporting references, completely made up ‘toxicity’ claim

Magnesium Borate is “may have adverse antibiotic action vis-a-vis intestinal flora”. Link given about ‘borates and their uses and toxicity’ is dead. Our conclusion: lack of supporting references.

Magnesium Stearate is “used to make large scale production tableting of supplements and drugs possible, this chemical excipient is produced through reacting sodium stearate with magnesium sulfate, in a way similar to the production of other hydrogenated oils (a component of the diet of most people). potentially dangerous substance whose Hazardous Substance Databank Number is: 664”. The link to non-human toxicity studies does not function. According to the MSDS form: Chronic Health Effects: This product has no known chronic effects. Repeated or prolong exposure to this compound is not known to aggravate medical conditions. Acute Health Effects: This product is not listed by NTP, IARC or regulated as a Carcinogen by OSHA. Our conclusion: lack of supporting references.

Manganese Sulfate/MnSO4H2O - According to this site: “Toxicological data indicates it is tumorigenic, mutagenic and teratogenic”. The conclusion of the study cited was actually: Under the conditions of these 2-year feed studies, there was no evidence of carcinogenic activity of manganese (II) sulfate monohydrate in male or female F344/N rats receiving 1,500, 5,000, or 15,000 ppm. There was equivocal evidence of carcinogenic activity of manganese (II) sulfate monohydrate in male and female B6C3F1 mice, based on the marginally increased incidences of thyroid gland follicular cell adenoma and the significantly increased incidences of follicular cell hyperplasia. The doses given to the test animals ranged from 60-7400mg/kg of body weight. Centrum contains a total of 2.3 mg of manganese, or about 0.03 mg/kg BW. Our conclusion: lack of supporting references, dishonest representation of toxicity study.

Nicotinic Acid (Niacinamide) - According to this site: “large doses are known to cause liver problems as severe as liver failure.“ Nicotine has a half-life of about 60 minutes, and the liver is equipped to break down remaining amounts of nicotine. The toxic dose of niacinamide is 3000mg/day (M. Knip, I. F. Douek, W. P. T. Moore, H. A. Gillmor, A. E. M. McLean, P. J. Bingley, E. A. M. Gale and for the ENDIT Group. Safety of high-dose nicotinamide: a review. Diabetologia 2000; 43 (11): 1337–45.). The dose in Centrum is 20mg. Our conclusion: lack of supporting references, dishonest representation of toxicity study.

Nickelous Sulfate is described thusly: “classified within the National LIbrary of Medicine's "Hazardous Substances Data Base" (HSDB) as an animal and human carcinogen. It is classified by the National Institute for
Occupational Safety and Health (NIOSH) as "immediately dangerous to Life and Health," and a potential occupational carcinogen.” One link cited does not work, and the other supplied link states: An increase in mortality was not observed in chronic studies in rats or dogs fed nickel sulfate in the diet at doses up to 188 mg/kg/day for rats and 62.5 mg/kg/day for dogs (Ambrose et al. 1976). Centrum contains 5 micrograms (0.005 mg) per tablet per their website. Our conclusion: lack of supporting references, dishonest representation of toxicity study.

Polysorbate 80: “Polysorbate 80 is produced using ethylene oxide (which is known to cause cancer in rats). “ The issue here is the polysorbate, not the ethylene oxide. Polysorbate is used in ice cream to maintain its consistency, and IV medications such as amiodarone to keep them in proper form for administration. According to a study in the periodical Reproductive Toxicity, In Europe and America people eat about 0.1 grams of polysorbate 80 in foods per day. The study cited is a test tube study, which has no relevance to a living system. Our conclusion: lack of supporting references, dishonest representation of toxicity study.

Potassium Iodide “Chronic overexposure can have adverse effects on the thyroid”. The very study cited concludes : The results of our studies suggest that excess KI has a thyroid tumor-promoting effect, but KI per se does not induce thyroid tumors in rats. In this study, the intake of potassium bromide was 55 mg/kg of body weight daily. The dose in Centrum is about 0.3 mg (providing 0.15 mg iodine), or 0.004 mg/kg of body weight. Our conclusion: lack of supporting references, dishonest representation of toxicity study.

Pyridoxidine Hydrochloride (B6). Site states: “Extremely large doses in range of 2 to 6 g/kg (2000-6000 mg/kg) produce convulsions & death in rats and mice. Lower doses (50mg injections) have interfered with the endocrine system of rats by suppressing pituitary secretions.” The lowest dose here is about 25-30 mg/ kg of body weight. The total dose in Centrum is 2 mg, or 0.03 mg/kg of body weight in a person. Our conclusion: lack of supporting references, dishonest representation of toxicity study.

Silicon Dioxide - Site states: “ Although this chemical is known to have extensive acute, subchronic and chronic toxicities in animal studies, silicon dioxide is considered an acceptable food additive by the FDA.” Silicon is a vital trace mineral found in many foods. The author states This is primarily because of a lack of understanding the difference between silica found in food, or mammalian tissues, and inorganic forms. The qualitative difference is profound, and though theelemental silica content may be the same in a chard of glass and a piece of celery, the biological difference is as profound as the difference between life and death.” There isn’t a single supporting bit of science for this claim. Our conclusion: lack of supporting references.

Sodium Aluminum Silicate. Site claims “known to be a neurotoxin for over 100 years, and today it is known to be a major causative factor in diseases like Alzheimers.” No source is cited. Nobody knows what causes Alzheimer's. The Material Safety Data Sheet states that this chemical is only a mild skin irritant and if inhaled fresh air should be breathed.

Sodium ascorbate – the site states: “sodium ascorbate may affect genetic material (mutagenic) based on animal tests”. The link provided on the site clearly states: Ascorbic Acid and Sodium Ascorbate were not genotoxic in several bacterial and mammalian test systems, consistent with the antioxidant properties of these chemicals. Our conclusion: lack of supporting references, dishonest representation of toxicity study.

Sodium Benzoate – the site states: “Sodium benzoate is a synthetic preservative which has been shown to have an antibiotic effect on the essential friendly gut flora. The link provided on the site states: Benzoic acid is produced by many plants as an intermediate in the formation of other compounds (Goodwin, 1976). High concentrations are found in certain berries (see section 6.1). Benzoic acid has also been detected in animals. Benzoic acid (chemically equivalent) therefore occurs naturally in many foods, including milk products (Sieber et al., 1989, 1990). Sodium benzoate IS toxic to cats, at doses of at least 50mg/kg. It is AAFCO-approved at 14mg/kg (0.1% of the diet). The dose in Centrum is less than 10mg total, or 2mg/kg for a cat (0.15mg/kg for people). Our conclusion: lack of supporting references, dishonest representation of toxicity study.

Sodium Borate - the site states: “Definitely toxic” but does not supply a reference. MSDS information: Acute oral toxicity (LD50): 2.66 mg/kg [Rat.]. Acute Toxic Effects on Humans: Ingestion of 5-10 grams has produced severe vomiting, diarrhea, shock and death. Chronic Effects on Humans: Not available. That is a huge amount compared to the amount in Centrum (<2% of tablet per label). And I cannot find it in the ingredient listing in Centrum anyway. Our conclusion: lack of supporting references, dishonest representation of toxicity study.

Sodium Citrate – the site states: May be toxic with no source cited. “an unhealthy liver may have difficulty with this substance potentially resulting in an accumulation of bicarbonate (the metabolic derivative of citrate) which can cause metabolic alkalosis.” The MSDS states that topical contact is only slightly hazardous and to wash hands. Ingestion of large doses may well cause metabolic alkalosis, but Centrum contains less than 10mg total which is far from a dangerous dose. Our conclusion: lack of supporting references.

Sodium Metavanadate is stated to be “a form of vanadium with known toxicity when ingested or inhaled. It is a skin, eye and respiratory irritant.” In the study cited, the lowest dose given to geese and ducks was 10mg/kg of body weight. My calculations suggest (based on sodium metavanadate containing 42% elemental vanadium) is that Centrum contains 0.023 mg of sodium metavanadate, for heavens’ sake! Our conclusion: lack of supporting references, dishonest representation of toxicity study.

You know, I’m tired of doing this. I’ve spent 1 ½ days debunking the claims made here, and the author of this website is so consistently wrong that I’m not going to finish with the rest of the list.

So would I take Centrum? Yes, if I felt I really needed a basic multi and nothing else was available. But is Centrum toxic? Resoundingly no. Just another example of why you need to learn what constitute good information, and to check out claims made by Internet sites, your chiropractor and if you are really skeptical, your doctor or veterinarian.

Wednesday, January 27, 2010

low protein diets and long term well being

OK, this is making me crazy.

I'm getting questions from both veterinarians and pet owners based on bad information from the 'holistic' websites. Essentially, the rumor is that low protein diets used for kidney disease lead to muscle atrophy long term.

These diets (examples are Hill's K/D, Royal Canin LP, and Purina NF)contain protein levels that are more than adequate for maintenance and can even sustain growth. (Not that you would want to try that on your puppy or kitten). That's PLENTY of protein to maintain muscle mass when all else is normal, like calorie intake and exercise.

The reason chronic renal patients lose weight and muscle long term is that *they are not eating enough*. They are starving. When they don't get adequate food, they don't get adequate calories or protein. Starvation leads to fat and muscle loss.

If your kidney patient is losing muscle mass, the thing to do is find out why he or she isn't eating well enough, and correct that problem.

Really - the low protein diets are not the problem!

Not that some would believe a veterinarian trained in nutrition above a random self taught expert on the internet, but that's another issue. Rant over. Thanks for listening.

Friday, January 15, 2010

U.S. Opens Inquiry Into Monsanto - Wall Street Journal

Antitrust Enforcers Probe Business Practices Surrounding Biotech Soybean Seed
By SCOTT KILMAN And THOMAS CATAN

The U.S. Justice Department has opened a formal antitrust investigation into crop-biotechnology giant Monsanto Co. as it contends with the loss of patent protection on its blockbuster soybean in 2014.

Monsanto on Thursday received a formal demand from the Justice Department for information about the St. Louis company’s business practices surrounding its Roundup Ready soybean, the nation’s most popular genetically-modified crop.

Roughly 90% of all the soybeans grown in the U.S. contain a Monsanto gene that helps the plant survive dousing by Monsanto’s Roundup weedkiller. Introduced in 1996, the Roundup Ready soybean seed allows farmers to chemically remove weeds from their fields without damaging crops.

With that seed losing patent protection in four years, Monsanto is trying to get farmers to switch to a second generation of Roundup Ready seed that still will be protected.

Justice Department spokeswoman Gina Talamona confirmed Thursday that antitrust regulators have begun a formal investigation of the seed industry. She refused to identify the investigation’s target or provide specific details.

In the wake of Monsanto’s disclosure, the company’s shares fell $1.16, or 1.4%, to $82.79 in 4 p.m. composite trading on the New York Stock Exchange.

Controversy over Monsanto’s plans for Roundup Ready soybeans grew so heated across the Farm Belt last year that the company declared that it wouldn’t stand in the way of farmers using off-patent seeds.

“We’re confident that a thorough review will show that all of our business practices are fair, pro-competitive and in compliance with the law,” Monsanto spokesman Lee Quarles saidThursday.

Monsanto has been in regulators’ sights since the Justice Department said in August it would take a hard look at economic concentration in agriculture as part on an increased emphasis on antitrust enforcement.

Farmers and seed companies that license genes from Monsanto have long complained about the prices it can command. The price of a bag of soybean seed has roughly quadrupled since the biotech-era dawned in 1996.

The Justice Department’s inquiry appears to mirror complaints filed this month by Monsanto’s archrival, the Pioneer Hi-Bred seed unit of DuPont Co., for a nationwide series of hearings the Justice and Agriculture departments plan to hold on farmers’ competitive concerns. DuPont, which pays to use Monsanto’s first-generation Roundup Ready technology in the seed it sells to farmers, has complained that Monsanto is trying to force seed companies to prematurely switch to the second-generation technology. “The effect of this campaign would be to eliminate any prospect for the emergence of generic competition,” DuPont has said.

DuPont, of Wilmington, Del., several months ago received a demand for information from the Justice Department for information about the seed market. A DuPont spokesman said the company believes the investigation isn’t aimed at DuPont’s behavior.