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

NEWSLETTER:
September 2005

VISIT NEWSLETTER ARCHIVE

NEWS YOU CAN USE
Nutrients in Foods are Best, with Supplements Filling Narrow Niche
BOSTON, July 20, 2005—Essential nutrients that come from foods are better than pills from bottles, concluded nutrition researchers. Indications for supplements, they added, occupy a narrow niche.

Taking massive or even moderate quantities of pills containing single nutrients may in some instances do more harm than good, cautioned nutrition experts Alice H. Lichtenstein, D.Sc., and Robert M. Russell, M.D., of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts.

"The identification, isolation, and purification of nutrients in the early 20th century raised the possibility that optimal health outcomes could be realized through nutrient supplementation," they wrote in the July 20 issue of the Journal of the American Medical Association. Recent attempts at using this approach for cardiovascular disease and lung cancer have been disappointing, as demonstrated with vitamin E and beta carotene.

Vitamin E supplementation, once touted for its cardiovascular benefits based on results of a few small intervention studies, does not appear to reduce the risk of heart disease, agreed the American College of Cardiology, American Heart Association Nutrition Committee, and the U.S. Preventive Services Task Force. Even more notoriously, in two large-scale intervention studies, beta carotene, an antioxidant thought to protect against the risk of lung cancer (particularly among smokers), was associated with an increased risk of lung cancer among smokers and asbestos-exposed workers.

The authors conceded that for some people supplements can play an important role in maintaining health, such as the use of calcium and vitamin D in people at risk for osteoporosis, fluoride to prevent cavities in children, and omega 3 fatty acids (such as fish oil) to reduce the risk of a major event in patients with coronary heart disease (the latter recommended by the American Heart Association).

"There are insufficient data to justify an alteration in public health policy from one that emphasizes a food-based diet to fulfill nutrient requirements and promote optimal health outcomes to one that emphasizes dietary supplementation. Our conclusion is based on the lack of a complete understanding of nutrient requirements and interactions, disappointing results of intervention studies with single nutrients or nutrient cocktails, and limited understanding of how the message would be interpreted with respect to dietary and lifestyle behaviors," Drs. Lichtenstein and Russell concluded.

Vitamin E May Increase the Risk of Heart Failure
HAMILTON, Ont., March 15, 2005—By Peggy Peck, Senior Editor, MedPage Today. Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco. Also covered by: CNN, MSN, USA Today.

The bad news is that a seven-year study has found no preventive role for vitamin E supplementation in heart disease or cancer. But it gets worse: there seems to be a significantly increased risk of congestive heart failure attached to a daily vitamin E capsule. These data were reported by researchers at McMaster University in the March 16 Journal of the American Medical Association.

The researchers found in the the Heart Outcomes Prevention Evaluation (HOPE-TOO) study that seven years of daily vitamin E supplementation (400 IU/day) did not prevent cancer or cardiovascular disease, but it did increase both congestive heart failure and hospitalization for CHF.

The original four-year HOPE study enrolled 9541 participants at 267 centers. It also had bad news about vitamin E, but critics said the follow-up was too short for meaningful results. For HOPE-TOO, 7030 patients at 174 centers were included for three extra years. Participants were randomized to 400 IU vitamin E daily (3520 people) or placebo. Median duration of follow-up was 7 years.

The HOPE-TOO findings come just a week after investigators with the Women's Health Study reported no benefit for vitamin E as a primary prevention for cardiovascular disease.

Eva Lonn, M.D., of the Population Health Research Institute and McMaster University, Hamilton Health Sciences Corporation, and her co-investigators wrote that "the potential for harm suggested by our findings strongly supports the view that vitamin E supplements should not be used in patients with vascular disease or diabetes mellitus." They added that the study should serve as a cautionary tale to the public which has a "tendency to accept 'natural products' (e.g., vitamins) as being safe, even if they have not been proven to be effective. However, our findings emphasize the need to thoroughly evaluate all vitamins, other natural products, and complementary medicines in appropriately designed trials before they are widely used for presumed health benefits."

In an editorial that accompanies the HOPE-TOO results, B. Greg Brown, M.D., Ph.D., of the University of Washington School of Medicine, and John Crowley, Ph.D., of the University of Washington School of Public Health, wrote that the report is important because it "effectively closes the door on the prospect of a major protective effective of long-term exposure to this supplement." Moreover, they point out that once again evidence from randomized clinical trials trumps observational data. see article

Obesity Can Lead To Dangerous Heartburn
HOUSTON, Aug. 4, 2005—There may be a "dose response" relationship between increasing weight and gastroesophageal reflux disease (GERD)—heartburn that can damage the esophagus—according to multiple studies evaluated by investigators here.

Compared with normal weight persons, overweight individuals (as little as 15 lbs. overweight) were 50% more likely to have GERD, and obese individuals (greater than 35 lbs. overweight) were twice as likely to have the disease, said Hashem B. El-Serag, M.D., M.P.H., and colleagues at the Michael E. DeBakey Veterans Affairs Medical Center.

In addition, the risk for GERD appeared to increase with increasing weight, the researchers said in the Aug. 2 issue of the Annals of Internal Medicine. Of the nine studies, six showed a statistically significant association between overweight and obesity and GERD, including complications of GERD such as erosive inflammation of the esophagus and cancer of the esophagus.

The mechanism or mechanisms underlying the link between obesity and GERD have not been established, the researchers said. However, they noted that obesity has been associated with increased intra-abdominal pressure, impaired stomach-emptying, and weakening of the sphincter that protects stomach acid from backing up into the esophagus, all of which can lead to increased esophageal acid exposure. "Our review suggests that overweight and obesity are risk factors for acid-related esophageal disease," the researchers said.

Another Example of How Smoking Kills
ABC News anchorman Peter Jennings, 67, died last month, just four months after he announced that he was being treated for lung cancer. He was a former smoker. Neither Jennings nor ABC provided details of his diagnosis, but it is known that he received radiation treatment at Memorial Sloan-Kettering Cancer Center. Jennings never returned to the anchor desk in the months since he revealed his condition.

According to the National Cancer Institute (NCI), lung cancer is the number one cause of cancer death among both men and women. The NCI estimates that 172,570 cases of lung cancer will be diagnosed this year and 163,510 lung cancer deaths will occur in 2005.

Roughly 87% of lung cancers are thought to result from smoking or exposure to second hand smoke. When Jennings' diagnosis was made public, friends and colleagues reported that he was a former smoker. After Jennings' death was announced, his colleague, Barbara Walters, made a plea for people not to smoke. According to the American Cancer Society, 10 years after quitting smoking the risk of lung cancer drops to about a third of the risk of current smokers.

Although Jennings' specific diagnosis was not revealed, he did not have surgery, which suggested that he had small cell lung cancer (SCLC). This form is nearly always smoking-related, and accounts for about 13% of all lung cancers.

SCLC is the most aggressive cancer of the lung, with median survival of two to four months from time of diagnosis. Moreover, at time of diagnosis it is more likely to be widely disseminated than other lung cancers, meaning that surgery is rarely an option. This cancer is, however, more responsive to chemotherapy and radiation than other lung cancers. Chemotherapy can achieve a four- to five-fold improvement in median survival, compared with patients who are not treated. With therapy, the median survival is 14 to 20 months for limited stage disease (confined to one side of the thorax) and eight to 13 months for extensive stage disease (disease beyond one side of the chest cavity).

The NCI estimates that 10% of the total population of SCLC patients remains disease-free two years after initiation of therapy, but long-term survival is rare and patients remain at high risk of dying from both SCLC and non-small cell lung cancer (NSCLC). SCLC is almost always diagnosed in current or former smokers. This cancer is also called oat cell Carcinoma.

Another possibility is that Jennings had late stage non-small cell lung cancer (NSCLC) or a very aggressive type of NSCLC, such as large-cell undifferentiated carcinoma, which accounts for 10% to 15% of all NSCLC. This aggressive cancer can be found in any part of the lung and it carries a very poor prognosis. Squamous cell carcinomas, which account for about 25% of NSCLC, and adenocarcinomas, which make up about 40% of cases of NSCLC, are considered more treatable if detected at an early stage.

IMPORTANT ANNOUNCEMENTS
Medicare Prescription Benefits
Autumn marks the beginning of enrollment for Medicare Part D prescription benefits for Medicare-eligible patients. It is expected there will be an onslaught of questions in the coming months. But, thanks to a new online Medicare resource, answering those questions just got easier. The Medicare webpage at http://www.medicare.gov/medicarereform/drugbenefit.asp provides links to:

• Your Medicare Prescription Drug Coverage Options
• Extra Help for People with Limited Income and Resources
• Frequently Asked Questions
• Introducing Medicare’s New Coverage for Prescription Drugs (a four-page brochure)
• Publications: A list of helpful publications that address specific questions and situations
• Partner Resources: A list of resources from the Centers for Medicare and Medicaid Services

If you need more help understanding the new coverage, you can call (800) MEDICARE [633-4227] for a list of local organizations that can answer questions.

WHAT’S NEW AT PENN ELM?
Ohio Avenue Office Closed
We have consolidated the Penn Elm practice now into our main building as of September 1, 2005. Dr. Sheffey will now be seeing his patients at the 488 E. Valley Parkway, suite 411 office. see map

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