Physical Activity and Metabolic Syndrome
Long periods of sedentary behavior – so common in this era of watching television, viewing computer screens, and desk work – increase metabolic risk. In a 2011 study, Andrea Bankoski, MPH, and colleagues used accelerometers to measure sedentary behavior in 1367 men and women, aged 60 years and older. Measurements were taken during waking hours for four or more days. Nearly half of this group (48.6%; n = 665) had metabolic syndrome, as defined by the Adult Treatment Panel (ATP) III criteria. The researchers defined a sedentary bout as any period that lasted 5 or more minutes during which the accelerometer recorded less than 100 counts per minute. Although accelerometers provide objective data, the researchers state that these instruments are not sensitive enough to record upper-body movement, biking, or standing.
   
The group with metabolic syndrome was more sedentary than the healthy group. Those with metabolic syndrome spent a higher percentage of their waking hours as well as more total hours in sedentary (resting energy expenditure) mode. In addition, their sedentary bouts lasted longer and breaks in sedentary behavior were less frequent. Also, activity intensity during the sedentary bouts (according to the accelerometer counts) was lower in the metabolic syndrome group compared with the healthy group. Including more activity breaks during sedentary periods as well as reducing total sedentary time may be beneficial for older people, according to Bankoski and colleagues.
   
Another 2011 study followed physical activity of 50,339 Norwegians, dividing them into two age groups: younger than 65 years, and 65 years and older. None of the volunteers had a reported history of stroke, heart attack, or angina. Of the total participants, 13,449 had metabolic syndrome at baseline. Researcher Dorthe Stensvold and colleagues asked the participants to rate their physical activity at baseline. Participants could rate their activity level as inactive; low (less than the recommended amount); moderate (meets the minimum recommended amount of exercise); or high (exceeding minimum exercise recommendations). The recommended activity level is three hours or more of light physical activity (PA) or less than three hours of light PA when combined with less than an hour of moderate or vigorous PA. The research team assessed "cause-specific mortality" rates among the subjects about 10 years after enrollment. The researchers adjusted their results for possible confounding effects: gender, marital status, education level, alcohol consumption, smoking status, and occupational physical activity level
   
"Highly active people younger than 65 years of age had a strong risk reduction in all-cause mortality (HR 0.52, 95% CI 0.37 to 0.73) compared to inactive people," the authors report. "In the older age group (≥65 years), the corresponding comparison showed a similar risk reduction (HR 0.59, 95% CI 0.47 to 0.74)." In the younger group, people with metabolic syndrome at baseline had a higher risk of death from cardiovascular disease (HR 1.78, 95% CI 1.39 to 2.29) and from all causes (HR 1.35, 95% CI 1.20 to 1.52) than those without metabolic syndrome. Mortality risk in younger people with metabolic syndrome decreased as their reported level of physical activity rose. In fact, mortality risk was only slightly higher (adjusted HR: 1.13, 95% CI: 0.87 to 1.49) in the younger metabolic syndrome group with the highest activity level compared with their peers.
   
The researchers did not find the same pattern in the 65 and older group; mortality risk was about the same in the metabolic syndrome cohort compared with those without a diagnosis of metabolic syndrome. Both groups, however, benefited from physical activity; the higher the activity level, the lower the mortality risk. Regardless of age or presence/absence of metabolic syndrome, " … even a low level of PA was associated with a substantial mortality reduction compared to those who reported that they were physically inactive," say the authors.
   
Stensvold and colleagues recognize that self-reports can be inaccurate, but people tend to overreport the amount of time they spend exercising, rather than underreport. As a result, the researchers believe that the effect of physical activity on mortality may be stronger than their data show.
   
The Norwegian study looked only at the amount of exercise, not the type of exercise; but Mitchell H. Katz, MD, argues that practitioners need to be more specific in their activity recommendations for their patients. While all aerobic exercise benefits cardiovascular health, walking and running (unlike swimming and biking) have the added benefit of increasing bone mineral density. Tai chi improves cardiovascular health and balance. Yoga increases flexibility and relieves stress. Katz points out that the most effective exercise program for people with diabetes uses a combination of resistance (weight) training and aerobic exercise (brisk walking, running, swimming, bicycling). "Although any form of exercise [movement] is better than a sedentary lifestyle," he foresees a time when "prescriptions for exercise regimens [can be] as specific as our prescriptions for hypertension medications. … "

Bankoski A, Harris TB, McClain JJ, et al. Sedentary activity associated with metabolic syndrome independent of physical activity. Diabetes Care. February 2011;34:497–503. Available at http://care.diabetesjournals.org/content/34/2/497.full.pdf+html. Accessed July 30, 2012.

Katz MH. Writing more specific exercise prescriptions. Arch Intern Med. August 6, 2012. Available at http://archinte.jamanetwork.com. Accessed August 16, 2012.

Stensvold D, Nauman J, Nilsen TI, et al. Even low level of physical activity is associated with reduced mortality among people with metabolic syndrome, a population based study (the HUNT 2 study, Norway). BMC Medicine. 2011;9:109. Available at www.biomedcentral.com/content/pdf/1741-7015-9-109.pdf. Accessed July 30, 2012.

Ayurveda, Diabetes, and Metabolic Syndrome
Ayurvedic medicine, founded in India, has a long history of looking at each patient as an individual. It has produced a system for promoting health and managing disease that works for people of differing psychophysiological constitutions. Metabolic syndrome and diabetes correlate to Prameha, a set of clinical disorders described in classical Ayurvedic texts. " … Prameha is one of the significant pathologic conditions brought on by unhealthy diet and lifestyle," according to Hari Sharma, MD, at Ohio State University's Center for Integrative Medicine and Department of Pathology (Columbus, Ohio), and H.M. Chandola MD (AY), PhD, at Gujarat Ayurved University (Jamnagar, India). Sharma and Chandola wrote three articles, published in the Journal of Alternative and Complementary Medicine, about Prameha and the dietary and lifestyle factors used to treat it.
   
For any illness, Ayurvedic doctors prescribe dietary and lifestyle measures as well as herbal combinations using a person's Prakriti as a guide. Prakriti, the psychophysiologic constitution "determined at a person's time of birth," is a unique ratio of the doshas. The three doshas are psychophysiologic principles that regulate the body. Kapha relates to structure and cohesion (e.g., strength, stability, weight). Vata relates to movement and communication (e.g., blood flow, nerve conduction, intestinal motility). Pitta relates to metabolism and transformation (e.g., appetite, endocrine functions).
   
As inmetabolic syndrome and diabetes, prevention and treatment of Prameha are tied to diet and lifestyle. Prameha arises from excessive consumption of yogurt, milk, new (not aged) grains, sugary foods and drinks, cold foods, sweet foods, sour foods, oily foods, and foods that are hard to digest, according to Ayurvedic texts. Physical activity and lifestyle factors that contribute to Prameha differ according to dosha. Kapha-dominantpeople increase their risk of Prameha when they spend too much time sitting and sleeping and don't exercise. For pitta-dominant people, intense heat and overexertion are risk factors. Vata-dominant people need to avoid excessive physical exercise, fasting, and staying awake at night. (People with type 1 diabetes tend to be vata dominant, according to the authors.) Ayurveda also links Prameha to psychological depression and bipolar disorder.
   
"Patients with Prameha must eat a diet that pacifies the disease," Sharma and Chandola write. "The best foods to eat are those that are not sweet [e.g., avoid dairy, ice cream, sugar products, alcoholic beverages], not too oily [e.g., avoid fried food], … and are nourishing." They report that barley, particularly barley soaked overnight in a decoction of Triphala, is useful for people with Prameha. Triphala is an herbal mixture that present-day research has shown lowers blood glucose levels. Itconsists of Phyllanthus emblica Linn., Terminalia bellirica (Gaertn.) Roxb., and Terminalia chebula (Gaertn.) Retz. Several spices – turmeric, cinnamon, cumin, coriander, ginger, fenugreek, and garlic – have antidiabetic effects as well.

The amount of food that a person eats also contributes to Prameha. Eating before the previous meal has been digested, as well as overeating, burdens the digestive system and contributes to the illness. "The proper amount of food for the individual will not produce undue pressure on the stomach; will not result in discomfort during activities such as walking, standing, sleeping, talking, and so on; and will satisfy the individual's hunger and thirst," the authors write.

In addition to following dietary guidelines, people with Prameha benefit from regular exercise, meditation, pranayama (breathing exercises), and yoga. Depending upon an individual's symptoms, Ayurvedic doctors may also prescribe medicinal herbs.

Although most Western practitioners do not have the time to become proficient in Ayurvedic medicine, articles like these can give them very practical dietary and lifestyle information that can help their patients.

Sharma H, Chandola HM. Ayurvedic concept of obesity, metabolic syndrome, and diabetes mellitus. J Altern Complement Med. 2011;17(6):549–552. Available at http://online.liebertpub.com/doi/full/10.1089/acm.2010.0690. Accessed July 30, 2012.

–––. Prameha in Ayurveda: correlation with obesity, metabolic syndrome, and diabetes mellitus. Part 1 – etiology, classification, and pathogenesis. J Altern Complement Med. 2011;17(6):491–496. Available at CINAHL Plus with Full Text. Accessed August 1, 2012.

–––. Prameha in Ayurveda: correlation with obesity, metabolic syndrome, and diabetes mellitus. Part 2 – management of Prameha. J Altern Complement Med. 2011;17(7):589–599. Available at CINAHL Plus with Full Text. Accessed August 1, 2012.

Dairy and Metabolic Syndrome
Consumption of dairy products, particularly whey protein powder, may reduce obesity and metabolic syndrome risk, according to recent studies.

Renée A Stancliffe and colleagues conducted a 2011 study involving 40 overweight and obese adults with metabolic syndrome (19 men and 21 women). None of the participants consumed dairy foods on a regular basis. Researchers randomly assigned participants to a low-dairy (<0.5 dairy serving/day and <600 mg calcium/day) or an adequate-dairy (>3.5 dairy servings/day, ≥1200 mg calcium/day) weight-maintenance diet for 84 days. Plasma glucose, insulin, fasting lipid profiles, inflammatory markers and cytokines, and oxidative stress markers were measured at baseline, day 7, day 28, and day 84. Body composition was also tracked using dual-energy X-ray absorptiometry at baseline, day 28, and day 84.

People in the adequate-dairy group had significant reduction in plasma insulin and improved insulin sensitivity, compared with baseline, beginning with day 7 measurement. The improvement continued to day 84, although the final measurements were not as low as those at day 7. In addition, oxidative stress markers decreased in the adequate-dairy group, particularly in participants who were obese (as opposed to overweight). Inflammatory markers (tumor necrosis factor-a, monocyte chemoattractant protein 1, interleukin-6, and C-reactive protein) all decreased in the adequate-dairy group. C-reactive protein levels fell by 47% by day 84. Adiponectin, a hormone secreted by fat cells that regulates glucose and fat metabolism, increased about 25% by day 7 in the adequate-dairy diet and to about 50% over baseline by day 84. Adiponectin levels declined in the low-dairy group.

"Data from this study show that an increase in dairy intake from suboptimal to adequate levels (~3.5 servings/day) significantly attenuates both oxidative and inflammatory stress in metabolic syndrome," the authors conclude. They view the study's short length (12 weeks) and reliance on participants' self-reports about diet adherence as study weaknesses. The authors suggest that the effects of dairy may stem from milk proteins, particularly whey, which affects insulin.

A 2012 review, conducted by Gabriela T.D. Sousa and colleagues, presents evidence that whey protein, usually derived from cow's milk, reduces risk factors associated with metabolic diseases. Animal and clinical studies indicate that whey protein, as part of a healthful diet, reduces body weight, maintains muscle mass, and improves insulin sensitivity. Whey protein consumption can also reduce blood pressure, inflammation, and oxidative stress. Sousa and colleagues report that reviewed studies gave 5.0 grams to 54.0 grams – quite a wide dosage range – to human adults for about 12 weeks' duration. Longer studies are needed to determine long-term effects of whey protein supplementation as well as the most effective dosage. Isolated whey protein is not a natural food.
  
I was frankly surprised at all the research indicating that dairy and whey are beneficial for preventing and treating metabolic disorders. Dairy intolerance is a big issue in the "natural foods" world, and Ayurveda says that excessive dairy consumption contributes to diabetes and metabolic diseases. An additional complication is the evolving research about b-casein fraction A1, found in some cow's milk. Unlike A2 b-casein, A1 b-casein has been linked to diabetes in animal research and human epidemiological studies. It may also contribute to heart disease, according to Keith Woodford, a New Zealand professor of agribusiness. During intestinal digestion, the amino acid sequence of A1 (and B) b-caseins produce b-casomorphin-7, an opioid without a painkilling effect that crosses the blood–brain barrier. Cows from Europe and North American produce milk with higher levels of A1 and B b-caseins. Human milk, goat milk, sheep milk, and African and Asian cow milk primarily contain A2.

A 2000 study, led by Inga Thorsdottir, showed a relationship between type-1 diabetes and cow's milk with A1 and B fractions. The incidence of insulin-dependent diabetes in Iceland's children is far less than in Scandinavian countries with the same genetic heritage. The cows in Iceland produce milk with lower levels of A1 and B fractions than cows in Scandinavian countries.

Dairy groups in affected countries dispute the idea that A1 causes diabetes and heart disease. (Woodford also believes that A1 is a factor in autistic syndromes.) It will be interesting to see how the use of dairy products to prevent and treat metabolic syndrome plays out.

Sousa GTD, Lira FS, Rosa JC, et al. Dietary whey protein lessens several risk factors for metabolic diseases: a review. Lipids Health Dis. 2012;11(67). Available at www.biomedcentral.com/content/pdf/1476-511X-11-67.pdf. Accessed July 30, 2012.

Stancliffe RA, Thorpe T, Zemel MB. Dairy attenuates oxidative and inflammatory stress in metabolic syndrome. Am J. Clin Nutr. 2011;94:422-30. Available at www.ncbi.nlm.nih.gov/pmc/articles/PMC3142721/pdf/ajcn9420422.pdf. Accessed July 30, 2012.

Thorsdottir I, Birgisdottir BE, Johannsdottir IM, et al. Different b-casein fractions in Icelandic versus Scandinavian cow's milk may influence diabetogenicity of cow's milk in infancy and explain low incidence of insulin-dependent diabetes mellitus in Iceland. Pediatrics. October 2000;106(4);719–724.

Woodford K [interview]. The devil in the milk: A1 or A2? how beta-caseins are changing the dairy industry. Acres U.S.A. December 2009. Available at www.acresusa.com/toolbox/reprints/Dec09_Woodford.pdf. Accessed August 29, 2012.

Diabetes and Environmental Chemicals
For decades, government agencies have assessed chemicals' ability to cause cancer and birth defects in their safety tests. Then, in the early 1990s, scientists began circulating the idea that some synthetic chemicals in the environment disrupt hormones in living beings, including humans. Hormones govern all kinds of metabolic processes, including weight and blood sugar. In 2002, P. F. Baille-Hamilton linked increased obesity rates to increased synthetic chemical production after World War II. Since then, researchers have identified some environmental pollutants that increase weight and body fat, according to an article by Brian A. Neel and Robert M. Sargis. Their article for Diabetes highlights laboratory and epidemiological evidence that common human-produced chemicals – such as bisphenol A (BPA), organochlorine pesticides, and dioxins – disrupt insulin and contribute to diabetes and obesity.

BPA, a component in some plastic bottles and white plastic linings of food cans, has produced several effects associated with diabetes. A laboratory experiment with male mice found that 4-day treatment with BPA (100 µg/kg of body weight per day) impaired glucose tolerance and reduced insulin sensitivity, resulting in hyperinsulinemia (Alonso-Magdalena et al. 2006). In another experiment, human fat cells exposed to BPA increased their secretion of inflammatory cytokines IL-6 and TNF-a and reduced their release of insulin-regulating adiponectin (Ben-Jonathan et al. 2009). BPA is not the only endocrine-disrupting chemical in plastic. Diethylhexyl phthalate has increased blood glucose levels and lowered insulin in rats (Gayathri et al. 2004).

Identifying endocrine-disrupting chemicals is a daunting task. Thousands of chemicals are used in industry, and chemicals are not isolated agents in the environment. A chemical that is benign on its own in a laboratory test may augment, null, or work synergistically with other chemicals in the real world, producing unexpected and unwanted biological effects. Another complication is bioindividual responses to chemical exposure. A number of factors affect biological response, including genetics, gender-specific circulating hormones, and amount of exposure. Many chemicals are lipophilic; so people who eat foods that are high in fat, particularly animal fats, may have greater exposure. Testing chemicals on people with low susceptibility will produce far different results than tests on a cohort of sensitive individuals.

"While the revolution in synthetic chemistry has facilitated vast improvement in our quality of life," write Neel and Sargis, "these benefits increasingly appear to have come with a hidden cost. This paradox of progress now mandates a reassessment of how our consumption habits negatively impact our metabolic health in order to devise effective strategies to limit the significant individual and societal toll of diabetes."

Alonso-Magdalena et al. The estrogenic effect of bisphenol a disrupts pancreatic b-cell function in vivo and induces insulin resistance. Environ Health Perspect. 2006;114:106–112.

Baillie-Hamilton PF. Chemical toxins: a hypothesis to explain the global obesity epidemic. J Altern Complement Med. 2002;8:185–192.

Ben-Jonathan N, Hugo ER, Brandebourg TD. Effects of bisphenol A on adipokine release from human adipose tissue: Implications for the metabolic syndrome. Mol Cell Endocrinol. 2009;304:49–54.

Gayathri NS, Dhanya CR, Indu AR, Kurup PA. Changes in some hormones by low doses of di (2-ethyl hexyl) phthalate (DEHP), a commonly used plasticizer in PVC blood storage bags & medical tubing. Indian J Med Res. 2004;119:139–144)

Neel BA, Sargis RM. The paradox of progress: environmental disruption of metabolism and the diabetes epidemic. Diabetes. July 2011. 60:1838-1848. Available at http://diabetes.diabetesjournals.org/content/60/7/1838.full.pdf. Accessed August 1, 2012.

Diet Type Affects Energy Expenditure
In a JAMA Preliminary Communication, Cara B. Ebbeling, PhD, and colleagues "challenge the notion that a calorie is a calorie from a metabolic perspective." They found that dietary composition affects energy expenditure and a person's ability to maintain weight loss. Twenty-one study participants, 18 to 40 years old, engaged in 4 weeks of weight monitoring, 12 weeks of a weight-loss diet, and 4 weeks of weight stabilization. No changes were made in physical activity, just caloric intake. All of the participants had a body mass index of 27 kg or higher at baseline and lost 10% to 15% of their weight before commencing the 4-week weight stabilization period.

After stabilization, participants entered the test phase, during which they followed menus for one of three diets for 4 weeks: a low-fat diet, a low-glycemic-index diet, or a very-low-carbohydrate diet. This 4-week test phase was repeated two more times so that each person followed all three diets in a random order. Although the composition of each 4-week diet plan differed, the caloric intake remained the same. Researchers measured resting energy expenditure (primary outcome) as well as total energy expenditure, hormone levels, and metabolic syndrome components.

Each diet has been recommended for people with obesity. The low-fat diet emphasizes whole grains with vegetables and fruit. It has a high glycemic index (raises blood sugar level quickly), with 60% of energy coming from carbohydrates, 20% from fat, and 20% from protein. The low-glycemic-index diet replaces some whole grains and starchy (high-glycemic) vegetables with "healthful" fat and low-glycemic-index vegetables, legumes, and fruits. It consists of 40% carbohydrate, 40% fat, and 20% protein. The low-carbohydrate diet, based on the Atkins diet, severely restricts carbohydrates; only 10% of the energy comes from carbohydrate, with 60% from fat and 30% from protein.

Both resting and total energy expenditure followed the diets' glycemic levels. Participants' metabolism (total energy expenditure) was lowest while eating the low-fat diet. In addition, leptin was higher with this diet compared with the other two, making weight gain likely. (Leptin is associated with appetite suppression; high levels, typically found in people with obesity, are believed to be a sign of leptin insensitivity.) The low-fat diet, which has long been recommended conventionally, produced the lowest measures of insulin sensitivity and highest triglyceride levels – both of which are linked to metabolic syndrome. In comparison, the very-low-carbohydrate (Atkins-type) diet had the best effect on energy expenditure: "[Total energy expenditure] differed by approximately 300 kcal/d between [the low-fat and the very-low-carbohydrate diets], an effect corresponding with the amount of energy typically expended in 1 hour of moderate-intensity physical activity."

The Atkins-like diet also produced the healthiest leptin, insulin sensitivity, and triglyceride levels. However, it also produced the highest measures of urinary cortisol and C reactive protein (CRP), indicating greater stress. High cortisol excretion has been linked to a higher risk of a cardiovascular death (Vogelzangs et al. 2010). The low-glycemic-index diet produced the same benefits as the very-low-carbohydrate diet – although not as marked; and this diet did not increase stress markers. In fact, the authors comment that other studies have reported "reductions in measures of chronic inflammation, including CRP with a low-glycemic index diet."

"In conclusion, our study demonstrates that commonly consumed diets can affect metabolism and components of the metabolic syndrome in markedly different ways during weight-loss maintenance, independent of energy content," say the authors. "These findings suggest that a strategy to reduce glycemic load rather than dietary fat may be advantageous for weight-loss maintenance and cardiovascular disease prevention."

Ebbeling CB, Swain JF, Feldman HA, et al. Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance. JAMA. June 27, 2012;307(24):262–2634.

Vogelzangs N et al. Urinary cortisol and six-year risk of all-cause and cardiovascular mortality. J Clin Endocrinol Metab. 2010;95(11):4959–4964.

Functional Medicine Approach to Metabolic Syndrome
Early signs of metabolic syndrome are high triglycerides, low HDL cholesterol, excessive abdominal fat, and high blood pressure. Functional medicine sees these as symptoms of dysfunction in the insulin signaling pathways, according to Robert Rountree, MD. If these symptoms are addressed but the underlying dysfunction at a cellular level is not, metabolic syndrome proceeds to diabetes and/or cardiovascular disease. In a two-part article for Alternative and Complementary Therapies, Rountree explains some of the underlying factors in metabolic syndrome and gives five lifestyle interventions to prevent and treat it.

Advanced glycosylation end-products (AGEs) are one significant contributor to metabolic syndrome. AGEs produce inflammation. "When those inflammatory pathways are activated," Rountree explains, "intracellular signaling pathways activated by insulin go awry, contributing ... to insulin resistance." Cooking carbohydrate and protein foods at high temperatures (i.e., grilling and microwaving) produces AGEs, according to research by Helen Vlassara, PhD. Another source of AGEs is refined carbohydrates, which increase blood glucose levels. If glucose levels are high for too long, the glucose "spontaneously auto-oxidizes and forms AGEs." More AGEs mean more inflammation and more disruption to the insulin pathways. When insulin pathways are disrupted, glycogen storage is inhibited; and fat accumulates in cells. As cellular fat increases, mitochondria become less efficient in their ability to burn glucose. The cell then becomes resistant to insulin's transport of glucose from the bloodstream.

In Part 2 of the article, Rountree writes about five important lifestyle changes for people with or developing metabolic syndrome. An individualized diet with a distribution of macronutrients (carbohydrates, fats, and proteins) that agrees with a person's inherited metabolism and adequate calories tops the list. People may burn fats or burn carbohydrates more efficiently, depending on their genes. A person's diet needs to emphasize the fuel source that is easiest to burn.

Attention to micronutrients, especially phytochemicals found in colorful vegetables and fruits, is the second recommendation. The Mediterranean diet – consisting of lean meats, mostly unrefined carbohydrates, and an abundance of colorful vegetables and good-quality olive oil – is high in phytochemicals. "Extra-virgin olive oil contains an especially rich mixture of phytochemicals that have beneficial effects on human genes and cellular regulatory energy networks," Rountree writes. Third, he recommends that people avoid refined, processed foods because of the chemical additives that they contain and eat organic whole foods to reduce pesticide exposure whenever possible.

Exercise is the fourth lifestyle intervention on Rountree's list. "Exercise is the single most efficient way to burn visceral fat, which is a significant indicator for insulin resistance," he says. Ideally, people engage in both aerobic and resistance exercise on a regular basis; but as he says, " … any exercise is better than no exercise at all. … " Rountree suggests that practitioners routinely question patients about their physical activity and exercise practice. If dietary and exercise interventions do not produce results, Rountree suggests adding nutraceuticals and botanicals to the program. Several nutraceuticals – such as a-lipoic acid, magnesium, chromium, vitamin D, and conjugated linoleic acid (CLA) – can influence insulin regulation and metabolism. Rountree has also found that a low-calorie partial meal replacement, consisting of whey protein or rice and pea proteins with little sweetening, is useful for some patients. Botanicals that benefit people with metabolic syndrome include green tea (or green tea extract), curcumin, cinnamon, garlic, fenugreek, ginseng, bitter melon, and bilberry.

Western medical culture has encouraged people to look for a magic pill that "fixes" high blood pressure and other signs of metabolic syndrome. But treating symptoms without addressing underlying dysfunction is a disservice. "Clinicians need to be more proactive and assertive in educating their patients about the value of basic lifestyle interventions for metabolic syndrome," writes Rountree, "and then take things to the next level by encouraging patients to follow individually tailored diets and exercise programs."

Rountree R. A functional medicine approach to metabolic syndrome: Part 1 – metabolic syndrome explained. Altern Complement Ther. December 2010;16(6):319–323. Available at CINAHL Plus with Full Text database. Accessed July 30, 2012.

———. A functional medicine approach to metabolic syndrome: Part 2 – the top 5 lifestyle interventions. Altern Complement Ther. February 2011; 17(1):14–20. Available at CINAHL Plus with Full Text database. Accessed July 30, 2012.

Homeopathic Treatment for Addictions
Clinical experience and a few studies indicate that homeopathy can be helpful in treating drug and alcohol addictions. Homeopathic remedies can be used to manage withdrawal symptoms, while constitutional remedies support the physical and mental constitution of the patient. Homeopath Manish Bhatia presents two studies that show homeopathy's value in managing withdrawal symptoms. In 1990, the Indian government conducted a double-blind, placebo-controlled study involving 60 heroin addicts. Half were given individualized homeopathic medicine, and the rest took a placebo. The number of withdrawal symptoms and the symptoms' intensity were significantly less in the homeopathic group. It also took less time for this group's symptoms to resolve. Furthermore, 35% of the people in the placebo group quit the study early "due to lack of therapeutic effect" compared with 5% in the homeopathic group.

A 1994 study, conducted by India's Central Council for Research in Homoeopathy (CCRH), involved 261 drug-dependent patients, aged 12 to 52 years, from a drug treatment center in Varanasi, Uttar Pradesh, India. "Treatment was started only after motivating the patients and also after seeking their family support," according to the study abstract. Twenty patients dropped out of the program. The remaining patients were given homeopathic medicines based on the "totality of [their individual] symptoms" – typical of constitutional homeopathy – and were instructed to take the medicine when withdrawal symptoms became obvious (about 8 to 12 hours after abstaining from the addictive substance). During the follow-up period (September 1988 to March 1994), 209 of 241 patients "showed improvement in withdrawal symptoms." The remedy that benefited the most patients (n = 85) was Rhus toxicodendron (10M potency). Mother-tincture of Avena sativa aided 43 patients. Nux vomica (200C potency) helped 34 patients, Arsenic album (10M) aided 26, Bryonia alba (200C) helped 8, and Chamomilla (10M) aided 7.

Homeopathy can also help with addiction to prescription drugs. Classical homeopath Dr. Claudia De Rosa conducted a randomized single-blind study at Eolas-Irish Homeopathic Research Centre (Cork City, Ireland) involving 122 people (aged 22 to 45 years) who were addicted to benzodiazepines (tranquilizers). The volunteers also displayed extreme mood and energy changes, increased sleeping patterns, weight change, persistent coughs or sniffles, and "repeated unexplained outings, often with a sense of urgency." Sixty-one received a constitutional homeopathic remedy. (Natrum muriaticum, Nux vomica, and Sulphur, given in LM potency daily, were the most common.) The remaining participants received Listaril (hydroxyzine), an antianxiety medication. All patients were evaluated at 30 days, 60 days, 90 days, and 6 months (March 2010 to September 2010). At 60 days, 79% of the homeopathic group and 75% of the Listaril group "proved equivalent amelioration of muscles and joints stiffness and sleep patterns." After 6 months of treatment, 86% of the homeopathic group and 64% of the Listaril group "were conventionally diagnosed 'completely cured' from addictions (relapsing conditions)" (my emphasis).

Although homeopathic therapy can relieve withdrawal symptoms, people who want to end their addictions need support; for example, from family (as in India's CCHR study), groups such as Alcoholics Anonymous, and/or a counselor.

Bhatia M. Homeopathy for drug and alcohol abuse [online article]. Hpathy Ezine. November 2009. http://hpathy.com/scientific-research/homeopathy-for-drug-and-alcohol-abuse. Accessed August 31, 2012.

DeRosa C. The role of homeopathy in the treatment of drug addictions. Am Homeopath. 2011;47–53. Available at AltHealthWatch database. Accessed August 1, 2012.

Rai Y. Clinical evaluation of homoeopathic medicines in the management of withdrawal symptoms of drug dependents [online abstract]. Central Council for Research in Homoeopathy. www.ccrhindia.org/abstracts/cr/drugdependents.htm. Accessed August 1, 2012.

Raw Milk
The risk vs. benefit of consuming raw (unpasteurized) milk and dairy products is a hot debate. Federal law forbids the sale of raw milk across state lines. The federal government banned interstate sales in 1987, stating that raw milk is unsafe; it needs to be pasteurized to kill pathogens. Raw dairy proponents object, saying that pasteurized milk is less nutritious and pasteurization does not guarantee that milk is safe. US consumers in at least 29 states had access to raw milk in 2010, according to an article by Erin Volheim.

Nutritional effects of pasteurization were researched decades ago. A 2001 referenced report, submitted to the Los Angeles County Board of Supervisors, explains that the heating process of pasteurization distorts and/or destroys beneficial enzymes, hormones, bacteria, fatty acids, some vitamins, and other valuable components found in raw milk such as phosphatase (needed for calcium absorption), the Wulzen factor (prevents stiffness and arthritis), vitamin A, and an antiviral agent. ("Report in Favor of Raw Milk Expert Report and Recommendation," by Aajonus Vonderplanitz, PhD, and William Campbell Douglass Jr., MD, is available at www.rawmilk.org.)

Logically, a reduction in nutrient content would produce negative health effects on consumers over the long term. The 2001 report contains numerous references to medical journal articles that reported beneficial health effects when patients were given raw instead of pasteurized milk – but these articles appeared in the 1920s and 1930s, before pasteurizing milk became an institutionalized practice. Recent human studies involving raw milk are rare. Volheim reports, "So far, one European study suggests that early consumption of raw milk helps prevent allergies in children."

Can raw milk cause food poisoning? Yes, and so can pasteurized milk. Volheim reports, "Spring 1985: "Salmonella-contaminated pasteurized milk from a suburban Chicago, Illinois dairy poisoned [at least] 16,284 people … " and was linked to at least two deaths. Two months later, Mexican-style raw-milk soft cheese was blamed for 142 reported cases of food poisoning due to Listeria in Southern California. The 142 cases included 19 stillbirths, 10 infant deaths, and 18 other deaths, says Volheim. Listeria, a common bacterium, can be deadly to newborns, fetuses, and immunocompromised people. The problem, however, was not the milk. Professor Verner Wheelock said that the processing plant was to blame: " … the presence of any listeria organism could not be found in dairy herds that supplied raw milk to the manufacturing plant."

Proponents of raw milk say that beneficial microbes in raw milk compete with harmful ones, keeping the pathogen levels in check; but there is no guarantee that the good guys will always win. Factors such as milk temperature, bacterial strains, and the animal's nutrition (green grass, fodder, grains) affect milk's quality.

Volheim urges people who choose to drink raw milk to know the supplier. Is the milking area clean? How does the farmer prevent contamination of the milk? How is the milk stored? Is the herd small? "A farmer with a small herd has more interactions with each individual animal, than a confined animal feeding operation worker," Volheim explains. " … If an animal is sick, its abnormal behavior is going to stand out; especially during the milking season, when each animal is received in the milking parlor once or twice a day." Healthy animals and good sanitation practices during milk collection and processing ensure that raw milk can be enjoyed safely.

Volheim E. Raw and personal. In Good Tilth. January/February 2011;21(6):16–18.
Vonderplanitz A, Douglass WC Jr. Report in Favor of Raw Milk Expert Report and Recommendations. 2001. Available at www.rawmilk.org/pdf/report-in-favor-of-raw-milk-final-06-07.pdf. Access September 7, 2011.

Wheelock V. Raw Milk and cheese production – a critical evaluation of scientific research [online article]. September 1997. www.rawmilk.org/pdf/raw-milk-critical-evaluation.pdf.

Jule Klotter
jule@townsendletter.com