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Inflammatory Bowel Disease Linked to Prevalence of Neurological Disorder

January 21st, 2011

Inflammatory bowel disease (IBD) has been linked to an increased risk for subsequent neurological disorders, new research suggests.

Initial 2-year results from an ongoing study that will be presented May 1 at the American Academy of Neurology’s 59th Annual Meeting, in Boston, Massachusetts, showed individuals with IBD were 4 times more likely to develop neuromuscular conditions (including carpal tunnel syndrome and small fiber neuropathy) and 6 times more likely to have sensorimotor polyneuropathy (PN) compared with individuals with other types of gastric conditions.

“Based on these initial results, we believe IBD itself is directly related to the neuropathy and that neuropathy in these patients is much more common than we previously thought,” the study’s principal investigator, Francisco De Assis Gondim, MD, PhD, from the Federal University in Ceara, Brazil, told Medscape.

Women at Greater Risk for Neuromuscular Complications

Although the link between IBD and neurologic disease has been reported before, most of the studies have been small, retrospective case series. In 2005 (Gondim FA et al. Brain. 2005;128:867-879), Dr. Gondim and colleagues also reported the association in a case series of 33 patients with IBD and PN as well as a literature analysis, At the time, this was the largest study and provided the most convincing evidence of the link between IBD and peripheral neuropathy to date.

The initial aim of the current cohort study, said Dr. Gondim, was to determine the prevalence of IBD-associated neurologic disease. To do this, investigators compared 103 individuals with IBD

37 with Crohn’s disease (CD) and 66 with ulcerative colitis (UC)

with 51 control subjects who had other gastric disorders, including dyspepsia, gastritis, and irritable bowel syndrome (IBS).

All subjects received a standard neurological evaluation, including vibration assessment, electromyography, screening for common causes of neuropathy, including possible vitamin B12 deficiency, diabetes, glucose intolerance, and hypothyroidism. They also underwent a neurological workup that included neuroimaging.

Headache was the most commonly reported neurological complaint and had a similar prevalence in all 3 study groups

48.6% in CD patients, 56.9% in the UC group, and 56.9% among controls.

However, the investigators report neuromuscular diseases, including parasthesias and SFN, were much more likely to occur in UC and CD patients compared with the control group.

Carpal tunnel syndrome was 4 times more prevalent in the UC group, and SP was more than 6 times more common in IBD patients, affecting 21% of subjects in the UC and CD groups.

In addition, said Dr. Gondim, the study also showed that neuromuscular complications in general and carpal tunnel syndrome in particular were much more common in women.

A Good Start

“Compared with the control group, the IBD group had a much higher prevalence of neuropathy. In spite of the fact that some of the IBD patients had [neuropathy] risk factors, there were a substantial number who did not, which leads us to conclude there is a direct relationship between IBD and neuropathy,” said Dr. Gondim.

Whether this is due to an immune-mediated phenomenon, an undetected vitamin deficiency, or some other mechanism is not clear, he said. However, the link between IBD and neuropathy is something clinicians need to be aware of, since neuromuscular disease is a common IBD complication that is frequently misdiagnosed as a rheumatological disorder.

The investigators intend to follow study participants for at least another 3 years, with the aim of gaining a better understanding of the natural history of neurological complications in IBD patients.

In the future, Dr. Gondim also hopes to launch a larger, long-term, multicenter cohort study in IBD patients who are neurologically competent at study outset to confirm the link between IBD and neuropathy and better characterize patients who are at risk for neurological complications.

“There’s a lot of work still to do, but this is a good start,” he said.

American Academy of Neurology 59th Annual Meeting: Abstract S16.005. April 28

May 5, 2007

Dr. Perlmutter’s comment:

This is breathtaking that this would be considered breaking news. Please see

BrainRecovery.com which I published 7 years ago. Complementary based physicians have long recognized that inflammation, like that in inflammatory bowel disease, is systemic and therefore affects other organ systems like the nervous system. It’s time for gastroenterologists to talk to neurologists.

Researcher sees link between vitamin D, autism

December 1st, 2010

From AutismToday.com:

The growing prevalence of autism is one of the biggest scientific whodunits in the medical world, with few clues for its rising incidence.

But a U.S. researcher is advancing a controversial hypothesis: that autism is related to vitamin D deficiency during fetal development and early childhood.
Dr. John Cannell, a psychiatrist and prominent vitamin D advocate, says flagging levels of the vitamin in pregnant women and young children could be the elusive factor explaining the rising rate of autism.

The evidence for such a link is circumstantial, and autism experts describe the hypothesis as speculative. But Dr. Cannell, founder of the Vitamin D Council, a non-profit advocacy group, says autism rates have skyrocketed in lockstep with medical advice given to the public since the late 1980s to avoid all exposure to bright sunshine.

“If it’s true, I can’t think of another situation where medical advice was so damaging to such a large number of people,” says Dr. Cannell, who practises at Atascadero State Hospital in California.

The vitamin D link “is an interesting speculation,” says Dr. Wendy Roberts, a professor of pediatrics at the University of Toronto and one of Canada’s leading autism experts.

Because the cause of autism is such an enigma, Dr. Roberts says researchers should investigate vitamin D, but the public should treat the idea more cautiously.

“You like to be able to have something that is firm and clear before you get parents all excited and doing something and then, once again, being disappointed,” she said.

Although Dr. Cannell is something of a maverick in research circles, he has credentials. Last year, he published an important peer-reviewed paper linking low vitamin D levels to an increased susceptibility to influenza, based on research at his hospital.

But for his autism hypothesis, he is now jeopardizing his chances of publication in a scientific journal by e-mailing the Vitamin D Council newsletter outlining the idea to thousands of U.S. autism activists – a possible violation of the rules of publication.

Dr. Cannell said he decided to disseminate his hypothesis now to encourage the public to increase its sun exposure during the warmer part of the year.

“If only 10 pregnant women go outside and sunbathe a little bit, they may be saved a lifetime of misery,” he said.

The idea that vitamin D deficiency may have a link to autism isn’t as farfetched as it once might have seemed because the deficiency is also emerging as a possible cause of many diverse illnesses, ranging from multiple sclerosis to cancer.

Last month, the Canadian Cancer Society recommended adults start taking the sunshine vitamin to reduce their risk of cancer.

Autism refers to a spectrum of conditions that involve repetitive behaviours and difficulty communicating and interacting socially. Autism manifests itself in the first few years of life and is thought to be some kind of neurological disorder affecting brain function.

One discredited theory is that the mercury-containing preservative thimerosal once used in childhood vaccines causes autism. Studies have failed to find any link.

The cause of autism is further clouded because some scientists speculate that part of the apparent increase in incidence – in the United States it is being diagnosed about 10 times more frequently now than in the early 1990s – may reflect improved reporting by doctors more aware of the condition.

The current Canadian estimate is that about 60 children out of every 10,000, or about 1 in 165, have autism and related conditions. Up until the 1990s, the prevalence was thought to be far lower, at only 4 or 5 children in 10,000.

If there is a vitamin D link, incidence rates around the world would probably vary by latitude. Rates would be lower in equatorial areas, where sun exposure is higher, than in northern latitudes, but studies investigating geographical differences in diagnosis haven’t been done.

Dr. Cannell says some of the strongest evidence vitamin D may have a hand in the disorder is that the vitamin is converted in the body to a steroid hormone, which in animal experimentation has been found to influence brain development. If vitamin levels are low, whatever brain development it is linked to will be skewed.

Startling trend
The occurrence of autism spectrum disorders (the most sever of which is autism) has risen sharply during recent years.
Rate per 10,000
UNITED STATES
1980s: 4-5
1990s: 30-60
2000A: 67
CANADA
2001B: 60
SOURCES: ENVIRONMENTAL HEALTH PERSPECTIVES
A- CENTRES FOR DISEASE CONTROL
B-CAIRN

Obesity and Brain Function

November 19th, 2010

Research scientists have long suspected that a relationship existed between

obesity and a decline in brain power. New studies now confirm the contention

that being overweight is detrimental to the brain. Researchers at the University of California

in an article published in the Archives of Neurology demonstrated a strong

correlation between central obesity (that is, being fat around the middle) and

shrinkage of a part of the brain ( the hippocampus) fundamental for memory (as

measured on MRI scans).

(abstract available online at: http://archneur.ama-assn.org).

In fact, other researchers have shown that excess body fat is strongly related to the

actual brain changes associated with Alzheimer’s disease. (http://www.neurology.org).

Why this relationship? Several reasons, First, excess body fat increases

the production of the chemical mediators of inflammation and damaging free

radicals, both fundamental to Alzheimer’s (and Parkinson’s I might add) Second,

body fat stores environmental toxins. Third, obesity is associated with

increased risk of other problems bad for the brain like hypertension anddiabetes.

So slim down and save your brain. Remember (and hopefully you can),

Alzheimer’s is preventable.

Riboflavin Benefits Parkinson’s Patients

November 4th, 2010

From

International Health News Database

One of the key features of Parkinson’s disease (PD) is loss of motor control, that is, difficulty in walking and moving muscles as instructed by the brain; even turning over in bed can become increasingly difficult as PD progresses. The degree of motor function in a PD patient is often evaluated using the Hoehn and Yahr scale where 0% means that the patient requires assistance just to stand up while 100% means that the patient has full, normal motor control.

Researchers at the University of Sao Paulo now report that supplementing with riboflavin (vitamin-B2) and avoiding all red meat can markedly improve motor function in PD patients. Their study involved 31 PD patients and 10 dementia patients with no PD symptoms. Blood analysis showed that all 31 PD patients were deficient in riboflavin while only 3 of the 10 dementia patients exhibited a deficiency. The researchers also observed that the intake of red meat among the PD patients (2044 grams/week) was almost 3 times higher than that of 19 healthy random controls matched for age and similar social and cultural backgrounds (789 grams/week).

Other research has shown that a low riboflavin status is found in about 10-15% of the population and is associated with low activities of two important enzymes, erythrocyte glutathione reductase (EGR) and pyridoxin(pyridoxamine)-phosphate oxidase. Low EGR activity may be associated with the glutathione depletion and impaired antioxidant defense observed in PD patients even before their disease becomes clinically evident. Glutathione depletion would be particularly deleterious if accompanied by a high heme iron intake from red meat.

Based on the above theoretical considerations the researchers decided to supplement the PD patients with 30 mg of riboflavin every 8 hours while at the same time removing all red meat from their diet. The results were quite astounding. After just 3 months motor function had improved markedly and after 6 months the average motor capacity (Hoehn and Yahr scale) had increased from 44% to 71%. The treated patients also reported better sleep at night, improved reasoning, higher motivation, and reduced depression after as little as 2 weeks of treatment. Some very disabled patients were able to change body positions in bed as early as on the third day of treatment.

The riboflavin level in the treated patients increased from 106 ng/mL prior to treatment to 179 ng/mL after 1 month. Withholding riboflavin supplementation for a few days did not reverse the observed improvements indicating that some beneficial permanent changes had occurred due to the supplementation and total avoidance of red meat. The researchers conclude that riboflavin supplementation and red meat avoidance may be highly effective in halting and even reversing the progression of Parkinson’s disease.

Dr. Perlmutter’s comment:

This is important research. So often my patients seem perplexed when I tell them that their Requip, Mirapex, or Sinemet medications are not treating their Parkinson’s disease. In reality, these drugs only treat the symptoms. That is, they treat the smoke, not the fire. Here is more evidence that there are indeed ways to treat the underlying disease, and put the fire out.

Repeal of helmet laws a proven mistake

September 24th, 2010

From NHTSA

U.S. Department of Transportation, National Highway Traffic Safety Administration

Effective July 1, 2000, Florida eliminated the legal requirement that all motorcycle riders wear helmets. State law now requires helmet use only by riders under the age of 21, or older riders who do not carry at least $10,000 of medical insurance. Observational surveys and crash reports indicated that helmet use dropped substantially following the law change. Motorcyclist fatalities increased by 81 percent comparing 2001-2003 to 1997-1999, compared to +48 percent nationally. Non-fatal serious injuries began increasing in the first six months of 2000, increased by 32 percent in the first year following law repeal. There was a 40 percent increase in the number of injured motorcyclists who were admitted to hospitals. Admissions for head injuries increased by 82 percent. The average head injury treatment cost increased by almost $10,000, to $45,602. In 1998 and 1999, the acute care hospital charges for head-brain-skull principal injury cases per 10,000 registered motorcycles were $311,549 and $428,347 respectively. The comparable figures for 2001 and 2002 were $605,854 and $610,386, adjusted for inflation. Time series analysis showed a statistically significant increase in fatalities while controlling for changes in motorcycle registrations. Similar analyses also showed significant increases for Kentucky, Louisiana and Texas. Florida crash reports also indicated that helmet use declined markedly among riders under age 21, who were still covered by the law. Fatalities in this age group nearly tripled in the three years after the law change. Comparing the 30 months before and after the law change, there was an increase of 55 percent in the average annual number of motorcyclists killed (181 to 280, respectively). Registrations increased an average 33.7 percent in this time period. Some of the increases in fatalities and other injuries in Florida were probably due to this increased ridership. The expected number of motorcycle fatalities as a result of the increase in registrations was 242. The actual number who died in 2002 was 301, 56 (+24 percent) more motorcycle fatalities than expected as a result of increased registrations alone. Nationally in 2001 and 2002, motorcycle miles of travel declined compared to earlier years.

Dr. Perlmutter’s comment:

This was obviously the wrong thing to do. The only ones benefiting from this are people waiting for organs for transplantation.