Do you really need dairy for strong bones?

The more investigating that I do I wonder where in the world did the notion came about that we need dairy products to have strong bones? The sexy celebrity ad "Got Milk?" would probably be a great place to start. But do Hayden Panettiere, Mischa Barton, or any other celebrity know anything about what it really takes to have "strong bones?" The ad campaign is very successful because 90% of Americans when asked how to have strong bones answer with, "drink milk." When I tell friends and family that I avoid dairy they look at me and always ask, "where do you get your calcium." My response is, "fruits and vegetables." They look at me baffled and then always ask this follow up, "there's calcium in fruits and vegetables?"

The crazy thing is that currently we're consuming more milk, yogurt, and chesse in the U.S. than ever before in history and rates of osteoporosis are on the rise. Osteoporosis costs the American health care system about 38 million dollars per day and that number is growing every year. So who are the experts on strong bones? Osteoporosis was non existent in hunter gatherer populations and there wasn't a single hunter gatherer population that ate dairy. They ate a lot of fruits and vegetables and they did a tremendous amount of weight bearing exercise. But instead of our doctors giving patients more exercise and more fruits and veggies they often give a pill or recommend calcium supplements. This might be one of the most ridiculous things I have heard/seen. Giving people calcium supplements without telling them they need at least 30 minutes of weight bearing exercise every day is the equivalent of telling people to drink protein shakes to get big biceps. It just won't work.

The other science that is coming out about how diet affects bones is the acid/alkaline information. I found the article from the New York Time below to be very interesting:

November 24, 2009
Personal Health
Exploring a Low-Acid Diet for Bone Health
By JANE E. BRODY

The science of osteoporosis and its resultant fractures has long been plagued by some vexing observations. Why, for example, are osteoporotic fractures relatively rare in Asian countries like Japan, where people live as long or longer than Americans and consume almost no calcium-rich dairy products? Why, in Western countries that consume the most dairy foods, are rates of osteoporotic fractures among the highest in the world? And why has no consistent link been found between the amount of calcium people consume and protection against osteoporosis?

An alternative theory of bone health may — or may not — explain these apparent contradictions. It is the theory of low-acid eating, a diet laden with fruits and vegetables but relatively low in acid-producing protein and moderate in cereal grains. Its proponents suggest that this menu plan could lead to stronger bones than the typical American diet rich in dairy products and animal protein, often enhanced by calcium supplements.

These dietary changes might even prevent or delay other chronic conditions that rob far too many people of a wholesome old age.

The low-acid theory was first fully promulgated in 1968 by two American doctors in the leading medical journal The Lancet and has since been the subject of much debate and confusion among bone specialists.

The science behind low-acid eating and the research findings that do, and do not, support it have been spelled out in a new book, “Building Bone Vitality,” by Amy Joy Lanou, an assistant professor of health and wellness at the University of North Carolina at Asheville, and Michael Castleman, a health writer.

At the same time, researchers at the Yale School of Medicine are studying the possible bone benefits of adding protein supplements to the diets of older Americans who habitually consume low levels of protein.

Dr. Karl Insogna, a professor of internal medicine directing the study, said in an interview that the 18-month placebo-controlled study would determine whether raising protein intake to a more normal range could increase bone mineral density and help prevent osteoporosis in people over age 60.

Science of the Skeleton

Bones are not immutable. Rather, they are continually being broken down and rebuilt, and when breakdown exceeds buildup, they get progressively weaker. Vital to the solid framework of the body, bones play an equally important metabolic role hidden from casual observation.

Bones are the storage tank for calcium compounds that regulate the acid-base balance of the blood, which must be maintained within a very narrow range. When the blood becomes even slightly too acid, alkaline calcium compounds — like calcium carbonate, the acid-neutralizer in Tums — are leached from bones to reduce the acidity.

Studies by Dr. Bess Dawson-Hughes, at the Jean Mayer U.S.D.A. Human Nutrition Research Center on Aging at Tufts University, and collaborators have demonstrated the acid-neutralizing ability of fruits and vegetables and the crucial role they can play in maintaining healthy bones.

The researchers note that fruits and vegetables are predominantly metabolized to alkaline bicarbonate, whereas proteins and cereal grains are metabolized to acids. The more protein people consume beyond the body’s true needs, the more acidic their blood can become and the more alkaline compounds are needed to neutralize the acid.

In one study by Dr. Dawson-Hughes and colleagues, published in January in The Journal of Clinical Endocrinology and Metabolism, 171 healthy men and women age 50 and older were treated with either bicarbonate or no bicarbonate. Those receiving bicarbonate, in an amount equivalent to nine servings of fruits and vegetables daily, experienced much lower levels of calcium loss in the urine, as well as a loss of N-telopeptide, the biochemical marker of bone resorption.

(By contrast, Dr. Insogna said that although eating more protein raised the loss of calcium in urine, it also improved intestinal absorption of calcium and thus might not result in bone loss.)

The Dawson-Hughes team concluded that increasing the alkaline content of the diet by eating more fruits and vegetables should be studied as a safe and low-cost approach to preventing osteoporosis and improving bone health in older Americans.

The finding is consistent with current recommendations from several federal health agencies to consume nine servings daily of fruits and vegetables. That amount has been shown to lower blood pressure and has been linked to a reduced risk of developing heart disease, stroke, diabetes, some cancers and Alzheimer’s disease. Now prevention of osteoporosis might be added to the list.

As the book authors point out, “animal foods, especially cheeses and meats, don’t contain much alkaline material” and hardly enough to “neutralize all the acids they introduce into the bloodstream; the body must draw calcium compounds from bone to restore optimal blood pH,” a measure of acidity. On the other hand, the alkaline material in fruits and vegetables, which are low in protein, can buffer that acidity.

Except for hard cheeses, which are acid-producing, most dairy foods, including milk, are “metabolized to compounds that are essentially neutral,” Dr. Dawson-Hughes said.

In their exhaustive review of the scientific literature, Dr. Lanou and Mr. Castleman found that “two-thirds of clinical trials show that milk, dairy foods and calcium supplements do not prevent fractures.” They conclude that the high fracture rate in countries that consume the most milk and dairy products results from the fact that “these affluent Western countries also consume the most meat, poultry and fish.”

Lessons From Research

This does not mean that older people, many of whom chronically consume too little protein, should avoid this essential nutrient, which helps prevent frailty and the falls that result in fractures. Nor must people become vegetarians to maintain strong bones.

But it does suggest that those at the high end of protein consumption may be better off eating less protein in general and less animal protein in particular and replacing it with more fruits and vegetables. Consider adhering to the amount of protein that health experts recommend, which has a built-in safety factor of 45 percent above the minimum daily requirement and is based on ideal (not actual) body weight and age.

For an adult, that amount in grams is 0.36 multiplied by ideal body weight. Thus, a woman who should weigh 120 pounds needs only 44 grams of protein a day, the amount in 3 ounces of flounder, one piece of tofu and a cup of cooked bulgur. A 60-pound 8-year-old (the multiplier is 0.55) would need only 2 ounces of chicken and one-half cup of cottage cheese to get the recommended 32 grams of protein.

U.S. Cholesterol Levels Going Down, Heart Disease Still on The Rise

U.S. cholesterol levels are going down according to a recent study in Journal of the American Medical Association. This should mean that there are less cases of heart disease in the US as well right? Oops that's not happening and in fact there are more diagnosed cases of new heart disease in the US. The scary thing about this journal article is that the authors actually talk about requiring people to take statin drugs based on their age to reduce their "bad" cholesterol and improve their "good" cholesterol. This is insane. Drugs and surgery don't treat lifestyle problems and abdicate all responsibility from the patient. High cholesterol, high blood pressure, heart disease, some cancers, stroke are all examples of chronic preventable diseases that need a lifestyle solution. Eat Well, Move Well, Think Well. We are currently feeding the United States more drugs than we have ever anyone in the history of the world and we are getting sicker. We are in a health crisis and the root cause of this health crisis isn't being talked about. People are more stressed out than ever before, living in toxic environments, eating foods that are totally deficient in the nutrients, and we are more sedentary than ever before.


U.S. cholesterol levels going down
November 17, 2009 | 1:00 pm

Statins

The development of statins, a class of drugs that lower bad cholesterol, have made a big effect. A study published today found that the prevalence of American adults with high levels of LDL cholesterol (that's the bad kind) fell by about one-third from 1999 to 2006. Paradoxically, the study also found that a huge number of people still have excessively high levels of bad cholesterol, are not being treated for it or may even be unaware of their levels.

The study, published in the Journal of the American Medical Assn., examined LDL cholesterol levels among more than 7,000 men and women across four study cycles: 1999-2000, 2001-2002, 2003-2004 and 2005-2006. Rates of high LDL cholesterol decreased from 31.5% in 1999-2000 to 21.2% in 2005-2006.

Yet researchers from the federal government found that many people had elevated rates of bad cholesterol, particularly those at the highest risk for developing heart disease. Fewer than 70% of adults nationwide were screened for cholesterol levels in the 2005-2006 period. During that time period of the study, 64.5% of people received cholesterol screening, 39.6% were screened but were untreated or inadequately treated and 24.9% were not told the results of screening.

In two commentaries accompanying the study, experts noted that cholesterol screening guidelines have become too complex and should be simplified so that more people receive statins. Dr. J. Michael Gaziano and Dr. Thomas A. Gaziano noted in one editorial that the last set of cholesterol guidelines, published in 2002, was 280 pages long. The guidelines are not only complicated, they are far from perfect, sometimes leading doctors to prescribe statins to someone with elevated LDL cholesterol but who has an overall low risk of heart disease and not prescribing drugs to someone with normal LDL cholesterol but who has an overall high risk of developing heart disease.

Another approach to treating cholesterol, said the authors of the other commentary, is to prescribe generic statins to all adults based on age. This approach may be justified, they said, in light of the large number of people who could benefit from statins but are not getting the medication; because statins have been shown to be safe and because generic versions of the medications are inexpensive.

However, that approach may overly simplistic, said Michael Gaziano and Thomas Gaziano. Arbitrary, fixed LDL thresholds for prescribing statins should be abandoned, they said.

"The guideline should begin with simple risk assessment with the goal of classifying patients into only two strata: those for whom lipid-lowering therapy should be considered and those for whom it is not warranted," they wrote. "The use of a simplified risk-based approach could increase the ease of implementation of treatment and increase the number of patients receiving beneficial lipid-lowering therapy."

-- Shari Roan

Obesity is responsible for 100,000 cancer cases annually

This is another example of a lifestyle problem that is putting a major strain on our health care system. Obesity is a lifestyle issue, not a genetic issue and the science is very clear on this. No drug or surgery is going to fix obesity or the problems associated with it. Lifestyle problems need lifestyle solutions, Eat Well Move Well, Think Well.

Obesity responsible for 100,000 cancer cases annually
By Matt Sloane, CNN Medical News
STORY HIGHLIGHTS

* Researchers calculate actual case counts likely to have been caused by obesity
* Endometrial, esophageal, pancreatic, kidney, breast and colorectal cancers affected
* Obesity also negatively affects survival and can make treatment more difficult

(CNN) -- More than 100,000 cases of cancer each year are caused by excess body fat, according to a report released Thursday in Washington.

Researchers with the American Institute for Cancer Research looked at seven cancers with known links to obesity and calculated actual case counts that were likely to have been caused by obesity.

Specifically, the report says that 49 percent of endometrial cancers are caused by excess body fat. That number is followed by 35 percent of esophageal cancer cases; 28 percent of pancreatic cancer cases; 24 percent of kidney cancer cases; 21 percent of gallbladder cancer cases; 17 percent of breast cancer cases; and 9 percent of colorectal cancer cases.

"This is the first time that we've put real, quantifiable case numbers on obesity-related cancers," said Glen Weldon, the American Institute for Cancer Research educational director. In addition, he said, it's not just causing cancer that's an issue.

"Obesity not only raises the risk for getting cancer," Weldon said. "It also has a negative effect on survival and can make treatment more difficult."

Although there is no concrete science on why obesity increases a person's risk for cancer, scientists hypothesize that excess estrogen released by body fat could be the culprit in cancers such as estrogen-receptor positive breast cancers.

Studies have also shown that increased body fat can lead to increased levels of oxidative stress and inflammatory compounds in the blood, which are linked to DNA mutation and diseased cell growth, as is seen in many cancers.

The American Cancer Society applauded the new research, but said the report is only the first step.

"This helps to communicate the magnitude of the problem," said Dr. Michael Thun, vice president emeritus at the American Cancer Society.

"While the study addresses the magnitude of the problem, it does not propose potential solutions. The bottom line for people concerned about this issue is to try to balance the calories you take in with those your body expends every day."

In addition to cancer, obesity is a known cause of heart disease, diabetes, high blood pressure and strokes.

Cheerios, Raisin Bran, and Cornflakes. The breakfast of heart disease and diabetes....not champions. PART 2

Once glycogen stores are full from the increased glucose that resulted from your breakfast bowl of Cheerios, Raisin Bran, or Cornflakes the excess blood sugar is stored as fat (yep you heard that right, FAT) in the form a triglycerides, or fatty acids (for all of you nerds like me think about the Kreb’s cycle). What form are these fatty acids are stored as? Saturated fat! (Palmitic acid specifically) Now what’s funny is we’re eating the low fat, high complex carboydrate diet marketed to us via the USDA and the lovely food companies that produce our cheap “healthy” food to avoid saturated fat because we’ve been lead to believe that eating saturated fat is one of the causes of heart disease (more how this came about later). Do you see the problem with this recommendation? This is nothing but a high sugar, high glucose diet that ends up converting the glucose into the deadly thing we have been told to avoid, saturated fat.

I grew up in Iowa and my family had a farm that raised some cattle. I learned early on that to make your cattle fat to give them that so desired fat marbling craved in steaks you don’t feed them what they’re supposed to eat (grass), but instead feed them grain and don’t let them move around very much. They get fat very quickly and we don't feed them fat. Look at our food pyramid! We're told that we should be eating a lot of grain. Is there any wonder why we currently have an obesity epidemic in the US? At least we’re becoming well marbled Americans.

Think about what else happens because of the insulin that is being produced to reduce your blood sugar after your favorite bowl of cereal every morning. When blood sugar levels are constantly spiking from a diet high in carbohydrates, the amount of insulin required to deal with that will, over time, damage the insulin receptors, blunting their ability to work. Yet the high levels of sugar still need to be lowered, and lowered quickly. So the pancreas pumps out even more insulin, which temporarily forces the insulin receptors into action but ultimately creates still more damage. Now there is so much insulin in the blood that by the time it's all absorbed by the insulin receptors, blood sugar levels will be too low. This cycle, of high blood sugar à too much insulin à low blood sugar, is called hypoglycemia, and it ends when the sufferer, biologically desperate to raise her blood sugar levels, puts another dose of sugar into her mouth with a sweaty, shaking hand. That will help, for an hour or two-until her blood sugar crashes again and the whole process starts over.

Where it really ends is in type II diabetes (which is currently affecting children and adults at pandemic levels, yet we hear more about the swine flu than we do about our children dying from preventable lifestyle diseases, this crushes me inside). The resistant insulin receptors demand too much insulin, more than the pancreas could ever make. The chronic excess sugar destroys the nerves, the arteries, the retinas, the heart. Despite every advance in medical science, a diabetic's life can be shortened by one third. Such are the wages of civilization's dietary sins. No drug or surgery is every going to fix a lifestyle problem. Lifestyle problems need lifestyle solutions (Eat Well, Move Well, Think Well).

Because insulin also controls a number of other basic life functions, high levels of insulin will cause damage throughout the body. Insulin triggers cholesterol synthesis, activating the enzymes that spur cholesterol production. About 80 percent of your cholesterol is made in your body: only 20 percent is dietary, which is one reason why low-fat diets have proven basically useless. Though every one of your cells both makes and needs cholesterol, most of it is produced in the liver. Elevated insulin means elevated cholesterol. It’s these elevated cholesterol levels that have been caused by a lifestyle problem caused by the “healthy” diet that has been marketed to us via companies like Pepsico, Frito Lay, and General Mill that have made the pharmaceutical industry trillions of dollars. My guess is 100% of the people reading this blog know someone who is on a statin drug. But our dependence on cholesterol medications hasn’t reduced the cases of heart disease in the US. In fact heart disease on the rise. Why? Too much insulin triggers the growth of smooth muscle cells that line the arteries, thickening the walls and reducing elasticity. Blood volume of the arteries shrinks, which means the heart has to pump harder, which is another way of saying "high blood pressure. Insulin also triggers the kidneys to retain fluid, which again increases blood pressure. Arteries with less elasticity are more prone to plaque and arterial spasm, which are the causes of heart disease. Insulin also encourages fibrous connective tissue to grow inside the arteries, providing a scaffold for the first layer of plaque. Lifestyle problems need lifestyle solutions (Eat Well, Move Well, Think Well).

Sources:

Keith, Lierre. The Vegetarian Myth: Food, Justice and Sustainability. Kindle Edition. PM Press. March 1, 2009.
Chesnut, James. The Innate Diet and Natural Hygiene. 2004. The Wellness Practice--Global Self Health Corp.

Cheerios, Raisin Bran, and Corflakes the Breakfast of Heart Disease and Diabetes PART 1

Today I was asked the question, “why do you think America is so unhealthy?” The answer is crystal clear to me, we currently eat a diet that is not congruent with our genetic blueprint. We don’t move as much as we were genetically designed to move. And finally our emotional, social, and stress patterns are totally different than we were designed. How did this happen? I’m appalled at the current marketing that takes place when it comes to “healthy” food. The food industry has developed over 100,000 new processed foods since 1990. Understand the implications of the fact that fully a quarter of these foods are "nutritionally enhanced" products that can claim endorsements of health by virtue of being low-fat or cholesterol-free or higher in calcium. Try to comprehend the scale of this: food companies spend $33 billion a year in advertising. What they put their money on is the lowest cost, highest priced items-the unmitigated junk-that they can now market as "heart-healthy" since they're all sugar and no fat. Pepsico alone spends over a billion dollars a year pushing sugar and hydrogenated vegetable oils on the US American public, including children. When I ask my patients if cornflakes, cheerio’s, and raisin bran are healthy foods I get a resounding yes from 90% of them. Then they proceed to tell me about how cornflakes, cheerio’s, and raisin bran are low in fat and good for their cholesterol and then I beat them with a stick until they learn that what they have been lead to believe is wrong. This is totally absurd but we can thank our government for giving us the holy food pyramid that promotes a diet that is literally deadly (which is verified by data: currently 7 out of 10 deaths are caused by a chronic preventable disease). The USDA currently states that we should be eating a diet that is 60% carbohydrate. This is the equivalent of two full cups of sugar and if your body didn’t have a way to deal with all of this sugar you would literally be in a coma or dead. Luckily your body has a mechanism to deal with all of the sugar that we get from our low fat high carbohydrate diet. Elevated sugar levels stimulate the pancreas to produce a hormone called insulin. When most people hear the word insulin they think of diabetes. Well if you didn’t have insulin you would also be dead. Insulin is anabolic, meaning it is very important in nutrient storage. It not only stores sugar but it gets amino acids and fats out of the blood and into your cells. For a species that could not always guarantee a steady food supply this ability to store sugar, fat, and amino acids determined our survival. The problem lies in the fact that we live in a world with excess calories and reduced calorie expenditure. Hence we have a lot of sugar, fats, and amino acids floating around that need to be stored. Where do they get stored? Some get stored in the muscles and liver as glycogen, but the reality is that we fill those stores up very quickly. In fact all of the glycogen stored in your liver and muscles isn’t enough to last you one full active day. So how and where do the rest of the sugars, fats, and amino acids get stored? FIND OUT IN PART 2

A Great Perspective on the H1N1 Flu and Fear Pandemic

The H1N1 Issue: Flu Pandemic, Fear Pandemic, or Both?

James L. Chestnut B.Ed., M.Sc., D.C., C.C.W.P.

The H1N1 issue has become so prevalent that I thought it appropriate to share some factual perspective. I realize that factual perspective is neither newsworthy nor popular when people are in the midst of a mob mentality of fear but I'm willing to risk unpopularity in order to encourage people to be guided by science, reason, and logic.

As you've heard me say so many times the key to finding the truth is asking the right questions. If we don't ask the right questions we will never get the right answers. Irrational fear usually comes from asking the wrong questions or failing to ask the right ones. As I often point out it is not what we don't know that poses the greatest danger, it is what we think we know that is false. We also must be aware of confounding factors creating self fulfilling prophecies. Sometimes fear is rational, sometimes it is not. Regardless, the most important thing is to ACCURATELY assess the threat and then identify an evidence-based, logical, reasonable, and RATIONAL response or course of action.

Let's start with the H1N1 flu virus itself. Clearly this flu virus is a reality and clearly it can lead to illness. The most important question is what kind of illness. The FACT is that the type of illness associated with this virus in over 99.9% of CASES is mild to moderate flu symptoms which include fever, nausea which can include vomiting, and of course general malaise. Not very pleasant to be sure but is this any different than the symptoms associated with the flu viruses that have been the source of the seasonal flu for the past 50 years? No. Although not every seasonal flu virus is associated with vomiting the truth is that vomiting is not considered serious. Seriously uncomfortable - yes, seriously risky in terms of death or severe complications - no.

But what about the deaths from H1N1? We all must admit and understand that even the thought of a child dying is enough to send any parent into hysterics. I can't think of anything more frightening. So let me be clear. I am not suggesting that the threat of harm or death to my child or any child is not something to fear. What I am suggesting is that we RATIONALLY assess the threat and then assess our fear level to see if it is appropriate. Good decisions, decisions that minimize threat and maximize safety, are NOT based on irrational fear. Fear is our worst enemy. Logical interpretation of available facts is our best ally.

Here is what we need to know before we can make a decision about an appropriate fear level associated with risk of death from H1N1. First we need to know how many deaths have been caused by H1N1 in any given population. The next question to ask is whether or not those who have died had underlying illnesses that made them more susceptible or more at risk. In other words we need to know how many of the deaths ASSOCIATED with H1N1 are actually CAUSED by H1N1.

To assess the absolute risk of dying from H1N1 we need to divide the number of deaths in any given population by the number of people in that given population. In Canada as of Oct 17, 2009 there had been a total of 1,604 hospitalizations, and 83 deaths associated with H1N1. By the way by this time H1N1 was already being portrayed as a DEADLY PANDEMIC. So, out of a population of approximately 35 MILLION there were 83 deaths. This means your chance of dying of H1N1 up to this point was 83/35,000,000 which is one in 421,687. This means the chance of death from H1N1 was 0.0002%.

To date these risks are similar in the United States and throughout the rest of the world.

It is not easy to get exact numbers on the number of deaths that are caused by underlying conditions or secondary bacterial infections but estimates are that these would represent at least 99% of all deaths associated with H1N1. So, if you do not have an underlying illness your chance of dying from H1N1 is 1% of 0.0002%. Not exactly worthy of widespread panic.

The chances of dying in a car accident, airplane accident, a fall, from complications of air pollution, from complications from industrial toxins or from medical treatment are EXPONENTIALLY GREATER. What is the difference? The media and the health authorities are not focusing your attention on these risks. You have more chance of dying in a car accident on your way to get an H1N1 vaccine than dying from H1N1. Statistically it could be concluded that it is an undue risk to get into a car and get the vaccine! I could not find any published peer-reviewed data to determine whether the H1N1 vaccine is safe or effective. In other words there is no available information that would be required for any other medical intervention that the H1N1 vaccine works or if it is safe. This does not mean it is not safe or effective, it just means we have no data which would be considered scientifically valid to utilize to form our opinions. Even if we assume the vaccine is safe and effective, statistically there is still more risk of death from the car ride to get the vaccine than from dying from H1N1!

So what is going on in my opinion? Well I think some very well intentioned people are allowing fear rather than science and data to guide public policy. I'm not alone in this opinion by the way. Have a read of the following quotes from a recent article published in The British Medical Journal entitled "Calibrated response to emerging infections" http://www.bmj.com/cgi/content/extract/339/sep03_2/b3471. In fact read this entire article, I think it offers a very good perspective and it is very well referenced.

Pay particular attention to how the health authorities have changed the definition of a flu pandemic!

"Since the emergence of novel A/H1N1, descriptions of pandemic flu (both its causes and its effect) have changed to such a degree that the difference between seasonal flu and pandemic flu is now unclear. WHO, for example, for years defined pandemics as outbreaks causing "enormous numbers of deaths and illness," but in early May, removed this phrase from the definition."

Changing views of pandemic flu, before and after emergence of influenza A/H1N1 virus:

Aspect	Before A/H1N1	Since A/H1N1
One line summary	WHO 2003-9: "An influenza pandemic occurs when a new influenza virus appears against which the human population has no immunity, resulting in epidemics worldwide with enormous numbers of deaths and illness"	WHO: "An influenza pandemic may occur when a new influenza virus appears against which the human population has no immunity"
Virus and immunity	WHO 2005:"Most people will have no immunity to the pandemic virus"	WHO: "The vulnerability of a population to a pandemic virus is related in part to the level of pre-existing immunity to the virus"
	US CDC 1997: "When antigenic shift occurs, the population does not have antibody protection against the virus"	US CDC: "Cross-reactive antibody [to A/H1N1] was detected in 6%-9% of those aged 18-64 years and in 33% of those aged >60 years"
Impact (health, social, economic)	WHO 2005: "Large numbers of deaths will occur . . . WHO has used a relatively conservative estimate - from 2 million to 7.4 million deaths . . . Economic and social disruption will be great"	WHO: "H5N1 has conditioned the public to equate an influenza pandemic with very severe disease and high mortality. Such a disease pattern is by no means inevitable during a pandemic. On the contrary, it is exceptional"
	CDC 1997: "The hallmark of pandemic influenza is excess mortality"	CDC: "There are some pandemics that look very much like a bad flu season"
	Canada 2006: "An influenza pandemic results if many people around the world become ill and die from such a [new form of influenza] virus"	Canada: "An influenza pandemic does not necessarily cause more severe illness than seasonal influenza"

"But the 2009 pandemic, taken as a whole, bears little resemblance to the forecasted pandemic. Pandemic A/H1N1 virus is not a new subtype but the same subtype as seasonal A/H1N1 that has been circulating since 1977."

"Furthermore, a substantial portion of the population may have immunity. The US Centers for Disease Control and Prevention (CDC) found that 33% of those aged over 60 had cross reactive antibody to novel A/H1N1,which may explain why cases have been rare in elderly people." Interestingly a recent report by CBC in Canada indicated that 4 preliminary studies showed that the chance of having immunity to H1N1 is DECREASED if you have regularly been vaccinated for seasonal flu. It will be interesting to see if they pursue this any further and publish the results in a peer-reviewed journal.

"On 26 April, with 20 cases and no deaths in the US, the Department of Health and Human Services declared a nationwide public health emergency."

"The SARS outbreak showed that large numbers of infected people are not necessary to generate concern and fear over disease. The SARS virus is known to have affected only 8096 people globally, but the fear of infection, involuntary quarantine, travel restrictions and subsequent political antagonisms, and at least $18bn in losses were felt by far more. It was not the virus but the response to it that caused these social and economic harms."

So what is my conclusion; is the H1N1 issue a flu pandemic, a fear pandemic, or both?

My conclusion is that at this point it is a pandemic of fear and NOT a flu pandemic. Of course it depends on how you define pandemic! The data available make it clear that we are experiencing an H1N1 seasonal flu BUT that to date this is not associated with significant risk of death or serious illness.

The FACT is that the current level of alarm and fear are NOT supported by data. However, this could change. What we cannot say is that things will not get worse. There is sufficient data to date to strongly suggest that it won't but data can only accurately tell us what has happened not what will happen. Certainly the odds are that H1N1 will pass with the same overblown fear and unactuated threat as SARS. Only time and data with tell.

I do have some concerns about the fact that testing for H1N1 has now been virtually all but discontinued. The authorities are now assuming that any case of the flu is H1N1. This means we will NEVER have any valid data about incidence, prevalence, or death rates. All such assessments without actual confirmation of infection are, in scientific terms, invalid. The term they will use is speculative. Sounds better than saying we are guessing.

Another concern is that deaths associated with H1N1, as with all previous seasonal flu viruses, are vastly overestimated. The annual published death rates for flu are NOT from confirmed deaths due to flu and in fact even CDC published stats reveal that most deaths "associated" with the flu are actually not from the flu at all but almost entirely from pneumonia. Less than one percent of deaths reported as associated with seasonal flu are actually caused by seasonal flu and even in these deaths the vast majority occur in people with underlying conditions.

Another concern is that it is unlikely that we will ever get any data on whether or not those who have been vaccinated have been protected. If one actually reads the primary research studies (not the news or published summaries by health ministries) on the seasonal flu vaccine what one finds is that the data does not support claims that the regular seasonal flu vaccine significantly decreases the incidence of flu or complications from it. Recently there has been some admission that the vaccines do not prevent the flu and that indeed they only guess correct on which virus to vaccinate against less than 30% of the time. However the health authorities still justify recommending the vaccine by claiming it decreases the severity of flu and complications from it. All I am asking for is to have DATA guide policy not DOGMA.

One of the sources of controversy is that vaccine benefits are often reported as relative risk reductions not absolute risk reductions so when one applies the results in real life one quickly realizes that the actual reduction of risk for those vaccinated vs not vaccinated is not statistically significant. They often report that the flu vaccine reduces hospitalizations or deaths but they report the relative difference between vaccinated vs unvaccinated not the absolute difference. In other words there might be 5000 people in each study group and there may be 4 deaths amongst those unvaccinated and 2 deaths among those vaccinated. This relative difference is reported as a "50% reduction in deaths in those vaccinated vs not vaccinated". Of course what this really means is that if you are vaccinated, and you get the flu, you have a 2 in 5000 chance of death. If you are unvaccinated and you get the flu you have a 4 in 5000 chance of death. An absolute difference of 2 in 5000 - not even remotely significant and certainly not worthy of the national vaccination campaigns and the billions of dollars spent on the vaccines. YES, they do report things this way!!

Some good references on this topic are Jackson et al., Evidence of bias in estimates of influenza vaccine effectiveness in seniors, International Journal of Epidemiology 2006; 35: 337-344 and Jefferson, T. Influenza vaccination: policy versus evidence. British Medical Journal 2006; 333: 912-915 and Jefferson et al. Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review. Lancet 2005; 366: 1165-74 and Simonsen et al. Mortality benefits of influenza vaccination in elderly people: an ongoing controversy. Lancet Infectious Disease 2007; 7: xxx-xx.

But doesn't it seem like we have more flu and more associated deaths this year?

Yes is does SEEM that way. However the truth is that although the flu seems to have come early this year it has not come with any greater incidence or seriousness - at least not yet. The real story is that although death rates are not significantly higher than most years there have been some deaths among children and this is just so tragic that it causes great fear and anxiety. HOWEVER, the risk to otherwise healthy children of dying from H1N1 is FAR less than the risk of dying in a car accident. This does not minimize the importance of these tragic losses, it just puts them in perspective in terms of absolute risk.

But aren't more kids away from school and adults away from work this year?

Yes, absolutely. However the frenzy of fear this year has changed things significantly and skewed them toward a self fulfilling prophecy. This year if anyone has even a sniffle they are kept home because we have all been told that we are in the midst of a deadly pandemic and that it is our moral obligation to stay home. In past years we have always gone to work with the flu because for the most part we can work through it. We can't logically use the number of people away from school or work as an accurate indicator of the severity of this year's flu pandemic. We have to use the data about illness rates, severity, and death rates. When we use this data to form our opinions and policies our fear level will certainly move away from hysteria.

What is ironic is that the health authorities have started vaccinating those people who have been identified as most susceptible to serious complications. They have also stated that we should avoid close contact in order to avoid spread. Now we have those identified as being most susceptible congregating in close contact waiting for the vaccine! Remember these people also had to put themselves at GREAT risk (relative to risk of death from H1N1) by traveling on the road to get to the vaccination site. Obviously the minute risk of death from a car accident is not a rational reason to avoid driving to get the vaccine if you think this is a good strategy. This is a valid use of risk analysis to help you put your fears about death from H1N1 into perspective. Fear and anxiety cause the release of stress hormones that down-regulate your immune system!

So what should we do; what is a scientific, logical and reasonable strategy?

1. Be rational, put things in proper perspective and ask the right questions.
2. Be scientific and logical. Get the facts and apply them to your strategy.
3. Don't panic if you or a loved one gets the flu. Keep hydrated, stay home, eat intelligently and REST. If severe complications arise go to your medical doctor or a walk-in clinic.
4. Be preventative. Eating well, exercising, and staying relaxed (Eat Well Move Well Think Well™) are evidence-based ways to optimize your immune defenses, to minimize risk of both becoming ill and of complications, and to maximize your recovery should you become ill.
5. Take Vitamin D - this is absolutely one of the most evidence-based interventions available for reducing incidence and severity of seasonal cold and flu. The data is very very strong. See the upcoming Vitamin D newsletter from Innate Choice www.innatechoice.com for more information and for references.