Newsletter from Penn Elm Medical Group

Penn Elm Medical Group
488 E. Valley Parkway
Suite 411
Escondido, CA 92025
(760) 745-2000

NEWSLETTER: January 2006

NEWS YOU CAN USE
Ephedra-Free Weight Loss Supplements Still Pose Risks
SAN FRANCISCO, Sept. 12, 2005 — Ephedra-free weight loss dietary supplements may pose some of the same cardiovascular risks that caused ephedra-containing products to be banned, researchers here said. The substance that has replaced ephedra in these products—bitter orange extract—appears to increase heart rate and also raise blood pressure when combined with other stimulants, said Christine A. Haller, M.D., and colleagues at the University of California San Francisco in the September issue of the American Journal of Medicine.

The primary constituents of bitter orange extract are synephrine and octopamine, which are structurally similar to norepinephrine. In pharmaceutical form, synephrine is used to treat low blood pressure and nasal congestion, the investigators said.

The study tested single doses of these supplements in 10 healthy, non-smoking adults. Heart rate and blood pressure were recorded before dosing and at regular hourly intervals afterward. Advantra Z, which contains the higher amount of synephrine, did not raise blood pressure. However, Xenadrine EFX, which contains other stimulants, increased systolic and diastolic blood pressure. The researchers suggested that although synephrine does not appear to increase blood pressure on its own, it may boost the pressure-raising effects of other stimulants such as caffeine.

Further study is needed to determine the long-term effect of these products, the researchers said. "Until such data are available, physicians should caution patients about the use of ephedra-free weight-loss dietary supplements, and monitor blood pressure in those who choose to use these supplements," the researchers said. "Individuals with hypertension, heart disease, or other pre-existing conditions that could be exacerbated by the sympathomimetic effects of botanical stimulants should avoid use of these products," they advised.

Bottled Water May Promote Tooth Decay
TORONTO, Sept. 19, 2005 — Tooth decay is making a comeback, fueled by junk food, spurred by social changes, and abetted by an unusual culprit—bottled water. "I had a three-year-old kid come in the other day," says Toronto dentist Sheldon Rose, D.D.S., "and he had at least two cavities that I could see. I haven't seen that for years." Like most dentists, Dr. Rose blames the usual suspects—snack foods, soft drinks, lack of parental supervision of food. But bottled water also plays a role, he and others suspect. "It's not the water that's causing the decay," said Jack Cottrell, D.D.S., president of the Canadian Dental Association (CDA). "It's the lack of fluoride."

The bottled water issue was raised at the World Dental Congress in Montreal, Dr. Cottrell said, as part of a general discussion about what to do about the sudden rise in tooth decay in children. The American Dental Association says that more and more "health-conscious consumers are sipping bottled water." Indeed, says the International Bottled Water Association, in 2004 Americans drank nearly 6.8 billion gallons, for a per capita consumption level of 23.8 gallons. That's an 8.6% increase over the previous year, the association says. The problem is that people are turning away from tap water—which for over two-thirds of Americans contains all of the fluoride that they need to prevent tooth decay—and most bottled waters don't have enough fluoride.

"If bottled water is your main source of drinking water, you could be missing the decay-preventive benefits of fluoride," the ADA says. (The bottled water association notes that more than 20 U.S. companies do produce fluoridated products. The association has more than 80 bottlers among its members.)

Part of the rise in bottled water is lack of trust in municipal water. In Canada in 2000, for instance, a mismanaged town water system in Walkerton, Ontario, was blamed for killing seven people and making 2,000 others ill. One result of such occurrences is that people think tap water is "not safe," Dr. Cottrell said, and begin drinking and cooking with bottled water, with detrimental outcomes for their kids' teeth.

Ground zero for fluoridation was the city of Grand Rapids, Michigan, which 60 years ago began adding small amounts of fluoride to city water — enough to bring the level to the U.S. Public Health Service recommended level of between 0.7 and 1.2 parts per million. Since then, fluoridation has become recognized as a key intervention. The CDC in December 1999 put fluoridation among the top 10 public health achievements of the 20th Century, along with such things as vaccination and control of infectious diseases. The Task Force on Community Preventive Services, an independent group appointed by the CDC director, found that in studies that measured decay rates before and after water fluoridation, the median decrease in tooth decay among children ages four to 17 years was 29.1%.

"We know the effectiveness of fluoride," says the CDA's Dr. Cottrell. But the chemical is only part of the equation, he adds. "We're seeing changes in the diets of children," says Dr. Cottrell, a combination of more readily available sugary snacks and—because more families are working couples—less parental supervision of the kids' diets. At the same time, he said, the protective element of fluoride is being removed as more parents switch their kids to bottled water and fruit juices. "We're not getting the advantages of it," he said. "When I graduated in 1965," said Dr. Rose, "it was a rarity to see a kid with no decay." Then Toronto's municipal water supply was fluoridated and the rate of cavities plummeted. "It became very unusual to see a kid with any decay," Dr. Rose says. "But in the past 10 years," he says, "it seems we're going back to the way it used to be."

Even One Cigarette a Day Jeopardizes Health
OSLO, Norway, Sept. 21, 2005 -- One to four cigarettes per day, generally considered light smoking, nearly triples the risk of heart disease and lung cancer, researchers here reported. Even one cigarette a day is enough to put a smoker's health in jeopardy, Kjell Bjartveit, M.D. of the National Health Screening Service and colleagues reported in the September issue of Tobacco Control.

The study tracked the health and death rates of nearly 43,000 men and women from the mid 1970s through 2002. At the start of the study, participants were between 35 and 49 and were screened for cardiovascular disease and diabetes. Health information and smoking status were obtained via questionnaire and clinical exam at the beginning of the study. Light smoking was defined as one to four cigarettes per day. Primary outcomes were relative risks of dying, compared with non-smokers, from ischemic heart disease, lung cancer, and all causes after adjusting for age, blood pressure, cholesterol, triglyceride levels, physical activity, body mass index, and height. Light smokers were nearly three times more likely to die from heart disease.

"The results from this and other studies imply that smoking control policy makers and health educators should emphasize more strongly that light smokers are also endangering their health," the researchers concluded.

IMPORTANT ANNOUNCEMENTS
Have You Had Your Flu Shot?
Flu season has arrived, but it’s still not too late to get a flu shot! If you haven’t received the flu vaccine yet, please contact our front desk for a nurse’s appointment.

Notice to Blue Cross and Pacificare PPO members: As of January 1st, Penn Elm is now accepting these insurance plans.

WHAT’S NEW AT PENN ELM?
The Baby Girls Have Arrived — Congratulations!
Congratulations to Dr. Greenberg and to Dr. Buzard’s nurse, Araceli, both of whom had baby girls born to their families this month! We wish them all happiness and good health!

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