Is Integrative Medicine Right for You?

Len Canter wrote . . . . . . . .

Any approach that differs from conventional — or Western — medicine is typically considered complementary and alternative, or CAM.

But these practices have become much more mainstream, leading to growth in the health care approach called integrative medicine, which draws on traditional and non-traditional systems tailored to each individual’s needs.

The U.S. National Institutes of Health agency that reports on CAM therapies has even changed its name to the National Center for Complementary and Integrative Health, to better reflect this shift in philosophy. Getting familiar with integrative health will help you decide if it’s the approach you want.

Integrative medicine focuses on your well-being and considers all aspects of your health: physical, emotional, mental, social, spiritual and environmental. It draws on whatever medical approaches — traditional or alternative — will serve you best.

Integrative medicine centers are now part of many leading institutions across the United States, such as the University of Arizona, Duke, Scripps, Vanderbilt and the University of California, San Francisco. Board certification for practitioners from the American Board of Integrative Medicine was introduced in 2014. These advances have made it easier to find integrative doctors and medical centers.

Key Tenets of Integrative Medicine:

  • Creating a partnership between patient and practitioner.
  • Using conventional and alternative methods as needed, and less-invasive yet effective interventions when possible.
  • Focusing on prevention and promoting good health as well as treating illnesses.
  • Training practitioners to be models of health and healing.

Prevention is a hallmark of integrative care because it’s easier, less expensive and better for people to avoid an illness rather than have to treat and manage one. Integrative medicine also recognizes that physical illnesses can affect you emotionally and vice versa, so all aspects of your well-being are addressed.

This, too, means a better outcome for you.

Source: HealthDay

Poached Cod with Vinaigrette Made with Fresh Orange Juice and Salty Black Olives

Ingredients

4 (6-ounce) cod fillets
2 cups dry white wine
1 Tbsp fennel seeds
1/4 cup orange juice (about 1 orange)
3 Tbsp lemon juice (about 1 lemon)
2 bay leaves
pinch of kosher salt

Vinaigrette

1 Tbsp minced shallots
1/2 cup pitted kalamata olives, sliced in half
1/4 cup orange juice (about 1 orange)
3 Tbsp olive oil
Kosher salt and pepper to taste

Method

  1. To make vinaigrette, in a medium bowl, combine shallots, olives, and orange juice. Mix well. Slowly stir in olive oil. Season with salt and pepper, if desired. Set aside.
  2. In a large, deep skillet, combine 1 cup water, wine, fennel seeds, orange juice, lemon juice, and bay leaves. Bring to a boil, reduce heat, and simmer 15 minutes.
  3. Add fish and sprinkle with salt. Poach just until opaque, about 7 minutes.
  4. Remove fish with a slotted spatula and transfer to a serving platter. Drizzle with vinaigrette before serving.

Makes 4 servings.

Source: The O Magazine

In Pictures: Food of Amber Restaurant in Hong Kong, China

Contemporary Twist of Classic French Cuisine

The Restaurant – Two Michelin stars and No. 7 of the Asia’s 50 Best Restaurants 2018

Oxalate (Oxalic Acid) and Its Relation with Nutrition and Health

From the World’s Healthiest Foods . . . . . . . .

Introduction

While many people think about oxalates as some rare and undesirable component of food, oxalates are naturally-occurring substances found in a wide variety of foods and they play a supportive role in the metabolism of many plants and animals and in our human metabolism as well. So in terms of our overall health and diet, oxalates are neither rare nor undesirable. (For persons interested in the chemical nature of oxalates, these substances are strong acids constructed out of two carboxylic acids, usually abbreviated in biochemistry as COOH groups.) It is also worth noting here that in a practical and non-technical sense, “oxalate” and “oxalic acid” are two different terms for the same substance.

Oxalates can sometimes become problematic, however, if they overaccumulate inside our body. The key site for problems with overaccumulation is our kidneys. If the concentration of oxalates in our urine becomes too high, simultaneous with an overly high concentration of calcium, our kidneys are at risk of calcium oxalate kidney stone formation due to supersaturation of our urine with calcium oxalate salts. Worldwide, 5-15% of all persons are estimated to develop some form of kidney stones, with calcium oxalate stones accounting for about 80% of all stones formed.

Non-food sources of oxalates

Even if we did not eat oxalate-containing foods, we would still have oxalates in our body since we are able to make them in a variety of ways. (In fact, only 20-40% of the oxalates in our blood come from the foods we eat.) Our “internal” ways of making oxalates include:

(1) creating them from amino acids like hydroxyproline in our liver;
(2) taking vitamin C and transforming it into oxalate; and
(3) having our red blood cells synthesize oxalates from glyoxylate.

Because oxalates can be created from amino acids in our liver, and because proteins are constructed out of amino acids, the total amount of protein that we eat may sometimes be related to the amount of oxalates that are formed using this amino acid pathway.

However, in research studies on healthy persons not at special risk of kidney stone formation, high levels of protein intake nearing 150 grams per day have failed to consistently show increased levels of urinary oxalates or increased risk of kidney stone formation. It is persons already known to have problems with kidney stone formation who have been shown to be affected by high protein intake, with about one-third of “stone formers” getting unwanted increases in their urinary oxalate levels in conjunction with a high protein diet. We mention this protein issue not to try and provide treatment recommendations for persons with kidney stone problems—that step is one that should be taken with a healthcare provider—but to give an example of the way that oxalates can be made inside of our body and why dietary sources of pre-formed oxalate only tell one part of the story here.

It’s worth noting that studies on vitamin C supplementation have shown mixed results in terms of their impact on risk of kidney stone formation. Several studies show increased oxalate excretion following vitamin C supplementation. However, some of these same studies show decreased urinary calcium oxalate supersaturation and decreased risk of stone formation. So, the jury is still out on the exact set of relationships here.

Food sources of oxalates

As mentioned earlier, about 20-40% of the oxalates in our bloodstream come from preformed oxalates in our food. While oxalates are found in both plant and animal foods, plant foods have long been the research focus here since some plants have especially high concentrations. Among foods that we do not profile on our website, rhubarb is the most concentrated source of preformed oxalates and contains between 450-650 milligrams in about 3-1/2 ounces. Chocolate can also be a concentrated source, with the oxalate content increasing along with the percentage of cocoa contained in the chocolate. An average for 76% cocoa chocolate bars is approximately 250 milligrams per 3-1/2 ounces. But this amount can nearly double in a chocolate bar that is 100% cocoa.

Among foods that we profile on our website, the most concentrated oxalate sources (all listed in terms of milligrams per 3-1/2 ounces) include spinach (750-800 mg), beet greens (600-950 mg), almonds (380-470 mg), Swiss chard (200-640 mg), cashews (230-260 mg), and peanuts (140-184 mg). It is important to note that you will often find very different results in plant oxalate content due to differences in varieties, planting conditions, harvesting conditions, and measurement technique. It is also worth pointing out that the leaves of plants almost always contain higher oxalate levels than the roots, stems, and stalks.

Other oxalate-containing foods (listed in milligrams of oxalate per 3-1/2 ounces) include:

  • other green leafy vegetables not found in the high-oxalate examples above (5-150 mg)
  • berries, which typically contain between 10-50 mg (with the important exception of gooseberries which can contain 60-90 mg)
  • lemon and lime peel (80-110 mg)
  • nuts besides the high-oxalate nuts listed earlier (40-350 mg)
  • legumes (10-75 mg): with legumes, it is also worth noting that lentils, split peas, black-eyed peas, and garbanzo beans tend to fall at the lower end of this already-low spectrum with 10 mg or sometimes even less, while black beans, navy beans and soybeans tend to fall at the upper end of this low spectrum with 50 mg or more)
  • grain flours (40-250 mg): with grains and grain products, it is worth noting that brown rice flour and brown rice pastas are among the lowest in oxalate content
  • pasta noodles (made from grains) (20-30 mg)

In addition to this highlighted list above, it is worth nothing that most fruits and vegetables contain measurable amounts of oxalates in the small-to-moderate range. We’ve seen studies on grapes, for example, showing 3-5 mg; pineapple 5 mg; plums 10 mg; collards 5-75 mg; celery 11-20 mg; and green beans 15 mg. Okra is a vegetable that usually shows up higher on the oxalate scale at 140-150 mg. Parsley is also worth mentioning here at about 100 mg.

One final note about the oxalate content of lemons and limes: as indicated above, the peels of these fruits have been analyzed as high in oxalate content. However, the juice of these fruits (e.g., lemon and lime juice) is not only low in oxalates, but also high in other organic acids called citrates. Research suggests that the high citrate content in lemon and lime juice might actually help lower risk of calcium oxalate kidney stone formation. By binding together with calcium in place of oxalates, citrates can help reduce risk of urine supersaturation with calcium oxalate.

Oxalates and health

Two aspects of oxalates have been extensively studied from a health perspective: their relationship to kidney stone formation and their relationship to calcium absorption and metabolism.

Kidney Stone Formation

In research studies, some individuals have been shown to be “hyperabsorbers” of oxalate from the intestinal tract. In other words, their bodies uptake more oxalate than would normally be expected. In principle, the greater the amount of oxalate that gets absorbed into the body, the greater the amount that will reach the kidneys and raise the level of urinary oxalates. When combined with high levels of urinary calcium, there can be increased risk of calcium oxalate kidney stone formation.

Unfortunately, this general description oversimplifies what turns out to be a fascinating and more complicated set of bodily circumstances. First, oxalate only gets absorbed from our digestive tract when it is in soluble form. Sodium oxalate and potassium oxalate are the predominant soluble forms. By contract, calcium oxalate is insoluble, and magnesium oxalate is poorly soluble. So the form of the oxalate is important in the absorption process.

Second, our gut bacteria turn out to play a critical role in the amount of oxalate available for absorption since numerous species of gut bacteria are able to break down oxalate. These species include Oxalobacter formigenes, numerous species of Lactobacillus, and several species of Bifidobacteria. In fact, a good number of studies are underway to investigate the role of oral probiotic supplements and their impact on oxalate absorption.

Third, research has shown that the overall combination of foods that we eat during a meal (including both oxalate-containing and non-oxalate-containing foods) can significantly impact the amount of soluble oxalates available for absorption from our digestive tract. We’ve seen a study on Indian cuisine, for example, in which multiple-ingredient dishes like spinach (palak) also containing Indian cottage cheese (paneer) lowered the amount of soluble oxalates available for absorption by about 15-20%. So, as you can see, the relationship between dietary intake of oxalates and oxalate absorption is complicated. In general, since only 20-40% of blood oxalates originate from food, and since 85-95% of individual show no tendency to form calcium oxalate kidney stones, we don’t expect most people to have kidney stone-related problems from routine enjoyment of the foods that we profile at WHFoods.

Calcium Metabolism

An ongoing controversy in oxalate research involves the degree to which food oxalates interfere with calcium absorption from those foods. In general, calcium can be a somewhat difficult mineral to absorb from food. Even at very low levels of dietary intake—in which case you might expect the absorption rate to increase—calcium only tends to be absorbed at a rate of about 35%. But this generalized rate of absorption can vary dramatically from food to food, and the presence of oxalates in food is definitely a dietary factor that lowers calcium absorption (through the formation of insoluble calcium oxalate salts).

However, two further considerations cause us not to be worried in a broad sense about interference with calcium absorption from oxalates. First is the nature of the public health recommendations for calcium. These recommendations—like all nutrient recommendations—take the realities of absorption into account. At WHFoods, for example, our recommended daily intake level for calcium is 1,000 milligrams. This recommended level factors in the amount of calcium absorption from different foods, including foods like spinach that contain high levels of oxalates.

Second is the research on different populations or population subgroups that eat different mixtures of plant and animal foods. Studies show individuals who eat largely plant-based diets (i.e., vegetarians) do not have greater calcium deficiency or increased risk of osteoporosis, which you might predict if substances like oxalates were impairing calcium absorption in a way that would create a health risk. Calcium is definitely not absorbed as well from oxalate-containing versus non-oxalate-containing foods, but from our perspective this difference does not make intake of oxalate-containing foods either irrelevant or counter-productive in terms of their impact on calcium status. We therefore continue to recommend enjoyment of all WHFoods fruits and vegetables as worthwhile contributors to calcium intake, including those with higher oxalate concentrations.

Uncommon conditions that require strict oxalate restriction

There are some relatively rare health conditions that do require strict oxalate restriction. These conditions include absorptive hypercalciuria type II, enteric hyperoxaluria, and primary hyperoxaluria. Dietary oxalates are usually restricted to 50 milligrams per day under these circumstances.

The effect of cooking on oxalates

Cooking has a relatively small impact on the oxalate content of foods. In fact, we’ve seen one recent study examining oxalate changes in 20 different green leafy vegetables in cooked versus raw form which found no significant changes for any of the 20 vegetables. We’ve also seen studies that have focused on the blanching or boiling of green leafy vegetables and these studies show little to no decrease in oxalate content. At the very most, you should not expect more than a 5-15% decrease in oxalate content from the cooking of a high-oxalate food. For all of the above reasons, it does not make sense to us for you to consider overcooking an oxalate-rich food for the purpose of reducing its oxalate content. Research studies have made it clear that overcooking results in the loss of many different vitamins and minerals, and so the end result of overcooking is very likely to be a much less nutritious diet that is only minimally lower in oxalates.

Practical take-away

For the vast majority of individuals who are not at special risk of calcium oxalate kidney stone formation—or do not have any of the rare health conditions that require strict oxalate restriction—oxalate-containing foods should not be a health concern. Under most circumstances, high oxalate foods like spinach (including both baby and larger leafed mature spinach) can be enjoyed either raw or cooked and incorporated into a weekly or daily meal plan. For persons with health histories that make kidney stones a health concern, we recommend consultation with a healthcare provider to develop a diet plan and take other steps that can lower individual health risks.

Source: The World’s Healthiest Foods



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New Guideline for Prostate Cancer Screening

Dennis Thompson wrote . . . . . . . .

More men could receive PSA blood tests for prostate cancer under revised guidelines released Tuesday by the nation’s leading panel on preventive medicine.

The U.S. Preventive Services Task Force (USPSTF) now recommends that men aged 55 to 69 decide for themselves whether to undergo a prostate-specific antigen (PSA) test, after talking it over with their doctor.

This blood test looks for a protein produced by the prostate, a small walnut-shaped gland that produces seminal fluid. Cancerous prostate tissue produces higher levels of PSA.

Until now, the task force has taken a hardline stance that no men receive PSA screening for prostate cancer.

That’s because relatively few men diagnosed with prostate cancer die from the often slow-moving illness. On the other hand, treatment frequently results in erectile dysfunction and urinary incontinence.

However, new data shows that more men are opting for “active surveillance” — not treatment — of their diagnosed prostate cancer, making screening potentially less harmful, said USPSTF Vice Chair Dr. Alex Krist.

Under active surveillance, doctors do not treat the cancer but instead keep a watchful eye on it to make sure it doesn’t become aggressive — sparing patients the harms caused by surgery or radiation therapy, said Krist, a professor of family medicine at Virginia Commonwealth University.

“It used to be that only 10 percent of men got active surveillance, and now in 2018 it’s closer to 40 percent,” Krist said.

Fresh results from ongoing clinical trials also firmed up data showing that out of every 1,000 men who get a PSA test, 1.3 may avoid death from prostate cancer and three may avoid cancer spreading to other organs, the panel’s evidence review concluded.

“It’s a small increase, but it was one that gave us some confidence that some men might not die from prostate cancer if they get screened,” Krist said.

USPSTF recommendations are very influential, in that the Affordable Care Act requires that insurers cover the full costs of any screenings the task force recommends.

The USPSTF still recommends against PSA screening for men aged 70 or older.

The new recommendation means that the USPSTF and leading medical societies are “all saying the same thing now,” said Dr. Otis Brawley, chief medical and scientific officer for the American Cancer Society.

The cancer society and the American Urological Association (AUA) already have guidelines saying that middle-aged men should have the option of receiving a PSA screening after talking with their doctor.

The cancer society guideline calls for men to have the option starting at age 50, while the AUA sets 55 as the earliest age for routine screening. Both recommend against screening for men 70 and older.

Brawley said the USPSTF has provided a valuable service by making sure that clinical trials produced quality data.

“What happened along the way is the task force is really the entity that forced the development of data, forced the studies to be completed,” Brawley said. “No one is saying ‘I think’ anymore about the benefits and harms of prostate cancer screening. Everybody is saying, ‘This is what the data says.'”

The USPSTF evidence review shows that out of every 1,000 men who receive PSA screening:

  • 240 will get a positive result, but only 100 will have cancer confirmed.
  • 80 of those 100 with confirmed prostate cancer will have surgery or radiation treatment, either immediately or after a period of active surveillance.
  • Of those 80 who receive treatment, 50 will suffer erectile dysfunction and 15 will suffer urinary incontinence.

“About two of three men treated will have erectile dysfunction, and about one out of three men will have some degree of incontinence. These are significant harms,” Krist said.

Krist added that about 40 percent of the men with confirmed prostate cancer will never be affected by their cancer, and will wind up dying from something else.

Brawley agreed that the increased use of active surveillance has made prostate cancer screening much less potentially harmful.

“Men are actually being told, your treatment is watching. Observation is a form of treatment. You do not need aggressive treatment with surgery or radiation,” Brawley said.

Although the clinical data have provided some clarity regarding who should be screened, Krist said, they also show the need for a better screening test for prostate cancer and improved treatments.

The task force also calls for more research in this area, including ongoing studies looking at the potential for MRI and genetic testing to better detect aggressive prostate cancers, Krist added.

The panel is also asking for more research into high-risk groups, such as black Americans and men with a family history of prostate cancer.

The new guidelines were published in the Journal of the American Medical Association.

Source: HealthDay


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