Is Organic Better? Yes, Mostly.

I've addressed the various issues with judging whether organic foods are better than conventional produce on my website.  http://www.maloneymedical.com/id156.html

The short answer continues to be that organic produce does, in fact, have more of some nutrients than its conventional cousin.  It varies from season to season and crop to crop.  Let's acknowledge that, and move on.  Unfortunately, places like the Mayo Clinic like to sound like authorities, and so cite one review (covering the last fifty years?  Don't get me started on soil depletion, changing farming methods, etc.) and say probably there's no difference.  I'd say some researcher needs to take the Twinkie out of his mouth and realize he's just set the debate back to the dark ages of the 1960's. 

Our current discussion needs to focus on the process of becoming locavores.  This term needs to enter the mainstream in the same way that vegetarian is now part of common knowledge.  If you are unfamiliar with this concept, here's a starting point.  Many people here in Maine have been locavores for decades, but have subsidized an otherwise exemplary diet full of fresh and flash frozen vegetables from their giant gardens with deep fried food.  All they need to do to get healthier is stop eating out.

For the crunchies among us, put down that Ecuadorian arugula.  It isn't in season, and you've just consumed a full tank of gasoline along with your "spring veggies."  Oh, I'm guilty as well, and everything in moderation.  But let's all keep humble and have a look at what our neighbors are doing right.  If we focus, necessity and intention meld together to make it more and more obvious that our only possible way out of our issues is to work together on every issue.     

More information on radiation than you should want to read.

Wow, it just keeps getting more scary in Japan.  So here's a whole range of resources for those of you who are busy watching it real time and hearing about it on the news. 

First, take a minute to check the EPA's up-to-date radiation readings for your area.  (When are they going to start adding this to the weather report?)

Then, take a few moments to read what the National Institutes of Health has to say about radiation exposure. 

If you're more of a visual person, here is a fun (in a gallows humor sort of way) way to visualize your relative exposures to radiation. 

As I've pointed out at alternative health answers and at my website, the ionizing radiation you receive from medical testing is likely to far outweigh your exposure from Japan. 

If we take that idea to the next level, there is a whole group that irradiates people for a living.  Radiation oncologists specialize in treating you with radiation.  They just celebrated a century of using radiation as a treatment for cancer.  If you look at the second abstract, in many cases radiation therapy is the only available treatment.  The doses being used to palliate suffering are astronomically higher than anything we see anywhere else. 

If you look at the third abstract, in cases of advanced head and neck cancer the application of radiation in huge doses directly to the area is often not sufficient to cause hypothyroidism.  We're talking about extraordinary exposure, and still the body keeps on ticking.  It's a wonderful thing. 


If you are still panting for more information on radiation,  I've attached links to three books on the subject.  Bring your medical dictionaries and dig in.  Or maybe take a walk outside and breathe easy. 

Nat Rev Cancer. 2004 Sep;4(9):737-47.



Radiation oncology: a century of achievements.

Bernier J, Hall EJ, Giaccia A.

Department of Radio-Oncology, Oncology Institute of Southern Switzerland, CH-6504 Bellinzona, Switzerland. jacques.bernier@hcuge.ch



Abstract

Over the twentieth century the discipline of radiation oncology has developed from an experimental application of X-rays to a highly sophisticated treatment of cancer. Experts from many disciplines - chiefly clinicians, physicists and biologists - have contributed to these advances. Whereas the emphasis in the past was on refining techniques to ensure the accurate delivery of radiation, the future of radiation oncology lies in exploiting the genetics or the microenvironment of the tumour to turn cancer from an acute disease to a chronic disease that can be treated effectively with radiation.

PMID: 15343280


Radiother Oncol. 2011 Mar;98(3):287-91.

Palliative radiotherapy for cervical carcinoma, a systematic review.

van Lonkhuijzen L, Thomas G.

Odette Cancer Centre, ON, Canada.

Abstract

Purpose: Worldwide, particularly in developing countries, many women present with advanced stage cervical cancer for which palliative radiotherapy is the treatment of choice or may be the only available treatment. The purpose of this study was to determine from the literature the optimal palliative radiation scheme for the treatment of advanced cervical cancer. Design: A systematic literature review up to January 2010 was performed in Medline, Embase, the Cochrane database, CinHL and Google Scholar using a combination of synonyms for: cervical cancer, palliative treatment and radiation therapy. No limitations were applied for language or study types. For included papers data were extracted and described. Results: Only eight papers were identified and none compared the results of different fractionation schemes. Most used observational retrospective study design with considerable sources of bias. No studies used validated endpoints for symptom relief nor did they include measures of the quality of life. Several papers described the experience with single or multiple monthly 10Gy doses or with a higher total dose delivered in 2-4 fractions within 48h to 1week. Studies report varying amounts of relief from bleeding. The effect on other symptoms such as pain and discharge is not evaluable. Acute and late toxicity is poorly documented. Conclusion: There is a dearth of information in the current literature to guide selection of an optimal palliative radiation schedule for treatment of patients with advanced cervical cancer. Based on this review and information from other solid tumors, there is no evidence to support the common belief that better and longer palliation is achieved with a high dose delivered in multiple smaller fractions. There is a clear need for comparative studies of different radiation fractionation schedules in order to identify an optimal palliative radiation scheme. These studies require the use of validated endpoints to measure specific symptom relief as well as accompanying quality of life.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

PMID: 21316785

Radiother Oncol. 2011 Apr 1. [Epub ahead of print]

Radiation-induced hypothyroidism in head and neck cancer patients: A systematic review.

Boomsma MJ, Bijl HP, Langendijk JA.

Department of Radiation Oncology, University Medical Center Groningen, The Netherlands.

Abstract

PURPOSE: To review literature on the relationship between the dose distribution in the thyroid gland and the incidence of radiation-induced hypothyroidism in adults.

MATERIAL AND METHODS: Articles were identified through a search in MEDLINE, EMBASE and the Cochrane Library. Approximately 2449 articles were screened and selected by inclusion- and exclusion criteria. Eventually, there were five papers that fulfilled the eligibility criteria to be included in this review.

RESULTS: The sample sizes of the reviewed studies vary from 57 to 390 patients. The incidence of hypothyroidism was much higher (23-53%) than would be expected in a non-irradiated cohort. There was a large heterogeneity between the studies regarding study design, estimation of the dose to the thyroid gland and definition of endpoints. In general, the relationship between thyroid gland volume absorbing 10-70Gy (V10-V70), mean dose (Dmean), minimal dose (Dmin), maximum dose (Dmax) and point doses with hypothyroidism were analysed. An association between dose-volume parameters and hypothyroidism was found in two studies.

CONCLUSIONS: Hypothyroidism is frequently observed after radiation. Although the results suggest that higher radiation doses to the thyroid gland are associated with hypothyroidism, it was not possible to define a clear threshold radiation dose for the thyroid gland.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

PMID: 21459468



 

Hypertension: White Coat Syndrome Medline Studies.

I realized that many of my readers may not wish to search for the literature on the previous post.  Here are the relevant medical studies with the pertinent information bolded.  Please print out and take with you to start a discussion with your prescribing doctor if you are not currently basing treatment on home pressure readings. 

To your health!

Clin Exp Hypertens. 2009 Jun;31(4):306-15.


White coat effect and its clinical implications in the elderly.

Yavuz BB, Yavuz B, Tayfur O, Cankurtaran M, Halil M, Ulger Z, Aytemir K, Kabakci G, Oto A, Ariogul S.

Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey. bbyavuz@hacettepe.edu.tr

The aim of this study was to investigate the frequency and correlated factors of white coat effect (WCE) in the elderly. Geriatric patients who were known as normotensive and office BP exceeding 140/90 mmHg underwent 24-hour ambulatory blood pressure monitoring (ABPM). Correlation of WCE with clinical parameters, geriatric assessment scales, co-existing diseases, and laboratory results were analyzed. Within 61 patients 72.1% were diagnosed as white coat hypertension (WCH). Independent correlates of systolic WCE were activities of daily living, instrumental activities of daily living scores, creatinine; independent correlate of diastolic WCE was Geriatric Depression Scale score. White coat hypertension constitutes a major part of office-detected hypertension in geriatric patients. Ambulatory blood pressure monitoring should be performed on geriatric patients with office-measured hypertension in order to avoid overtreatment.

PMID: 19811359

Rev Port Cardiol. 1999 Oct;18(10):897-906.

[Arterial hypertension difficult to control in the elderly patient. The significance of the "white coat effect"]

[Article in Portuguese]

Amado P, Vasconcelos N, Santos I, Almeida L, Nazaré J, Carmona J.

Serviço de Cardiologia, Hospital Egas Moniz, Lisboa.

OBJECTIVE: Previous studies have revealed a high prevalence of white coat effect among treated hypertensive patients. The difference between clinic and ambulatory blood pressure seems to be more pronounced in older patients. This abnormal rise in blood pressure BP in treated hypertensive patients can lead to a misdiagnosis of refractory hypertension. Clinicians may increase the dosage of antihypertensive drugs or add further medication, increasing costs and producing harmful secondary effects. Our aim was to evaluate the discrepancy between clinic and ambulatory blood pressure in hypertensive patients on adequate antihypertensive treatment and to analyse the magnitude of the white coat effect and its relationship with age, gender, clinic blood pressure and cardiovascular or cerebrovascular events. POPULATION AND METHODS: We included 50 consecutive moderate/severe hypertensive patients, 58% female, mean age 68 +/- 10 years (48-88), clinic blood pressure (3 visits) > 160/90 mm Hg, on antihypertensive adequate treatment > 2 months with good compliance and without pseudohypertension. The patients were submitted to clinical evaluation (risk score), clinic blood pressure and heart rate, electrocardiogram and ambulatory blood pressure monitoring (Spacelabs 90,207). Systolic and diastolic 24 hour, daytime, night-time blood pressure and heart rate were recorded. We considered elderly patients above 60 years of age (80%). We defined white coat effect as the difference between systolic clinic blood pressure and daytime systolic blood pressure BP > 20 mm Hg or the difference between diastolic clinic blood pressure and daytime diastolic blood pressure > 10 mm Hg and severe white coat effect as systolic clinic blood pressure--daytime systolic blood pressure > 40 mm Hg or diastolic clinic blood pressure--daytime diastolic blood pressure > 20 mm Hg. The patients were asked to take blood pressure measurements out of hospital (at home or by a nurse). The majority of them performed an echocardiogram examination. RESULTS: Clinic blood pressure was significantly different from daytime ambulatory blood pressure (189 +/- 19/96 +/- 13 vs 139 +/- 18/78 +/- 10 mm Hg, p < 0.005). The magnitude of white coat effect was 50 +/- 17 (8-84) mm Hg for systolic blood pressure and 18 +/- 11 (-9 +/- 41) mm Hg for diastolic blood pressure. A marked white coat effect (> 40 mm Hg) was observed in 78% of our hypertensive patients. In elderly people (> 60 years), this difference was greater (50 +/- 15 vs 45 +/- 21 mm Hg) though not significantly. We did not find significant differences between sexes (males 54 +/- 16 mm Hg vs 48 +/- 17 mm Hg). In 66% of these patients, ambulatory blood pressure monitoring showed daytime blood pressure values < 140/90 mm Hg, therefore refractory hypertension was excluded. In 8 patients (18%) there was a previous history of ischemic cardiovascular or cerebrovascular disease and all of them had a marked difference between systolic clinic and daytime blood pressure (> 40 mm Hg). Blood pressure measurements performed out of hospital did not help clinicians to identify this phenomena as only 16% were similar (+/- 5 mm Hg) to ambulatory daytime values. CONCLUSIONS: Some hypertensive patients, on adequate antihypertensive treatment, have a significant difference between clinic blood pressure and ambulatory blood pressure measurements. This difference (White Coat Effect) is greater in elderly patients and in men (NS). Although clinic blood pressure values were significantly increased, the majority of these patients have controlled blood pressure on ambulatory monitoring. In this population, ambulatory blood pressure monitoring was of great value to identify a misdiagnosis of refractory hypertension, which could lead to improper decisions in the therapeutic management of elderly patients (increasing treatment) and compromise cerebrovascular or coronary circulation.

PMID: 10590654