Red-cell zinc is available separately (£12) or as part of the red-cell mineral profile (£53).

Strontium and osteoporosis. As a potential treatment for osteoporosis, strontium ranelate seems to have the unique property of inhibiting bone resorption and stimulating bone formation. This is discussed in BMJ 2005; 330: 1400-1 The mechanisms are not well defined and problems similar to those seen with the use of fluoride that also blocks bone resorption might occur. My reason for mentioning strontium here is to draw attention to the diagnostic usefulness of measuring strontium in untreated patients. Strontium is strongly associated with mineral calcium sources and accumulates in bone through life. When bone turnover increases, unlike serum calcium that is well controlled, serum, whole blood and urinary strontium increase. This is seen in growing phases in children, post-menopausal bone loss and malignancy with bone metastases. It is also a feature of myeloma. In some patients, it has been the earliest clue to increased bone resorption.

We include strontium in the elements measured in the full toxic metals screen on blood or urine (£100).

Coffee consumption and vascular risk. Charalambos et al. Am J Clin Nutr 2005; 81: 1307 – 12 have shown that chronic coffee consumption increases the stiffness of the aorta and its pulse wave velocity. This implies an increase in cardiovascular risk. This is additional ammunition for those of you who wish to persuade patients to reduce their coffee intake. It is not possible for us to directly plot the aortic pulsatility curve but reductions in femoral pulsatility and femoral:brachial pressure ratio reflect aortic/iliac arterial disease.

We include these measurements is the non-invasive vascular screen (£58)

The metabolic syndrome. This common metabolic disorder results from the increased prevalence of obesity. It involves insulin resistance and inflammatory prostaglandin imbalance with disturbances in essential fatty acid metabolism. There is a clear case for nutritional intervention in the treatment of this syndrome which is not a faddy diagnosis applied by non-conventional doctors. This is main-stream medicine and the disease has well established criteria (WHO and European Group for the Study of Insulin Resistance). You and your main-stream colleagues can find a well referenced discussion of this syndrome in the Lancet. Eckel. RH. Et al. Lancet 2005; 365: 1415-28

Useful Biolab tests include red-cell EFAs (£50 or £58 with absolute values), fractionated cholesterol esters (£61), serum chromium (£12) and tests of zinc and magnesium status [WBC Zn (£27), WBC Mg (£27), RBC Mg (£12)]

Testicular cancer. A news roundup in the BMJ (BMJ 2005; 350: 382) includes the fact that over the past 25 years the number of testicular cancer cases has increased by an average of 60% in 21 populations across five continents. Possible reasons include exposure to endocrine modulators. We have seen a close association between para-dichlorobenzene exposure and testicular cancer and I was able to present provisional data on para-dichlorobenzene-DNA adducts to the American Academy of Environmental Medicine in October 2004. Not that this is an entirely new topic – Stephen and I were involved in discussion of this chemical and other endocrine disrupting chemicals at the International Symposium of Trace Elements, Reproduction and Teratology in Amsterdam in September 1986 before Biolab was able to measure para-dichlorobenzene and long before we began our work on DNA adducts. Those of you with a special concern about Endocrine Disrupting Chemicals may find of interest the Royal Society of Chemistry publication of this name. It is number 12 in the series ‘Issues in Environmental Science and Technology’ and was published in 1999.

Useful Biolab tests include: Volatile Organic Compounds (VOCs) in blood or fat cells (£74), Pesticide screen in serum or fat cells (£74) and DNA adducts (£95)

Trans-Fatty acids and systemic inflammation in heart disease. This is the title of a paper that shows the strong association implied by its title (Mozaffarian D. Et al. Am J Clin Nutr 2004; 80: 1521-5). Trans-fatty acids result from hydogenisation of vegetable oils and are present in some animal fats. High levels are found in some processed foods. Mark Howard, Biolab Manager, is involved in an enormous project updating the computer programs we use. Once this is complete we expect to improve a number of our test reports. We hope to include trans-fatty acid in the essential fatty acids profiles. In the mean time, we already include trans-fatty acid cholesterol esters in the fractionated cholesterol esters profile (£61) and in the Fatty Acids and Related Substances profile on a needle-biopsy fat cell sample (£74).

Insulin. Insulin resistance, insulin and obesity, diabetes, cardiovascular risk and hypoglycaemia are all words that cross our desks and occupy our minds with increasing regularity. They are also highly relevant to the integration of nutrition into clinical medicine. Did you know, for example, that fasting insulin concentrations in healthy people are closely associated with magnesium intake (Fung TT. Et al. Journal of the American College of Nutrition 2003; 22,6: 533-8) and that insulin enters the circulation as a complex with zinc? Are you aware that most of the features and many of the side effects of type 2 diabetes can be explained by inflammatory processes and that the severity of the disease is frequently related to the severity of the inflammatory prostaglandin imbalance? Obviously, the essential nutritional components involved are the subject of a number of Biolab tests. We have also been considering the introduction of Insulin Binding Studies using fluorescence microscopy. The methodology is, as yet, an unpublished research technique and has not been formerly peer-reviewed. The inter-laboratory comparison studies that we are involved in suggest that the test is giving an accurate picture of insulin binding characteristics. Please contact me if you wish to make use of this test.

Zinc supplement doses. While zinc is an essential trace element with a daily requirement because of lack of proven zinc stores it is also known that high level supplementation suppresses immune function and may interfere with copper and iron absorption. Most doctors involved in nutrition recognise that zinc repletion with adult daily doses up to 30mg taken on an empty stomach is highly effective. Supplement levels above 30mg only rarely speed repletion and, in some cases, actually slow the correction of a deficiency. The higher levels will also inhibit normal immune response if continued for long periods of time. Much of this information is derived from anecdotal evidence and simple zinc absorption studies. More recent work that has been carefully done using zinc stable isotope tracer techniques (Cuong DT. Et al. Am J Clin Nutr 2004; 80: 1570-1573) concludes that aqueous zinc doses greater than 20mg result in relatively small and progressively diminishing increases in absorbed zinc.

Useful Biolab tests include Leucocyte Zinc (£27), zinc absorption test (£21 for two point test, £42 for 6 point test).

Symbiogenesis. The human mitochondrion was originally derived from bacteria. 8% of the human genome originates from retroviruses. Half of the human DNA is viral. Symbiosis. In our evolution, the development of the placenta and the presence of helpful gene enhancers may owe much to this but the negative side is that the retroviral components of our make up are linked to serious diseases including cancer, MS and rheumatoid arthritis. There is a lot to learn from the concept of symbiogenesis which has been described as Darwin’s blind spot (Ryan F. Darwin’s Blind Spot: Evolution beyond Natural Selection. London, Texere/Thomson, 2003. [ISBN 1-58799-115-2]) and is summarised in an excellent short article by Robin Fox (J. RSM 2004; 97: 559). Another aspect of symbiosis is our dependence on bacteria in the gut and a whole host of symbiotic mechanisms through the food chain. Neither aspect can be ignored in 21^st century medicine but, as with other areas of medical science, we should not pin all our hopes on genetic breakthroughs. There is much of value in our consideration of the day-to-day effects of symbiosis, dysbiosis, bacterial overgrowth, yeast overgrowth and the destruction of friendly bacteria by drugs or other chemicals.

Biolab tests that may be helpful include Gut Fermentation Products (£42), Breath Hydrogen test (£58) and DNA adducts (£95).

Disease and enviromental factors in children. Many deaths and a lot of childhood illness is attributable to pollution of the indoor and outdoor environment (Valent F. et al. Lancet 2004; 363: 2032-9).

Illness includes respiratory disease, mental retardation and toxic overload as well as the development of sensitivities/allergies and gene suppression or inappropriate gene activation. There seems little doubt that toxic metal exposure is a factor in autism and that toxic chemicals bound to DNA are involved in the etiology of at least some cancers. In addition to the chemical pollution of the environment, we also have to remember the effects of radiation and the powerful electrical fields that none of us can escape and into which children are born. Several tests are available at Biolab for the investigation of toxic exposure and some of these have already been referred to in this newsletter. It is also important to remember the protective mechanisms that include detoxification pathways and antioxidant enzymes.

Biolab tests that might be useful include Toxic Effects Screen (£58), glutathione peroxidase (£19) and superoxide dismutase (£21)

Toxic exposure investigations include Full Toxic Metals screen in urine or blood (£100) and Volatile organic compounds.

Autism. As mentioned above, there is little doubt that toxic metal burden is a factor in many autistic children but we do well to remember that there is also good evidence that increased oxidative stress and poor antioxidant defenses are also major factors in most autistic children. This is well referenced and adequately discussed by Zoroglu SS. Et al. Eur Arch Psychiatry Clin Neurosci 2004; 254: 143-7

Biolab offers a full range of investigations for both the toxic metal investigations and the protective mechanisms.

Preeclampsia. A recent paper (Scholl TO et al. Am J Clin Nutr 2005; 81: 1390-6) concludes that oxidative stress and poor antioxidant protection precede preeclampsia. Most of us would connect that with one of the overriding factors we already know to be involved in the etiology of this condition – magnesium deficiency. Oxidative stress leads to magnesium leakage from cells.

Useful Biolab tests include leucocyte magnesium(£27) and antioxidants such as vitamin C (£15), vitamin E (£15), glutathione peroxidase (£19) and superoxide dismutase (£21).

Thank you for using Biolab in the investigation of your patients. I hope these little ‘news’ items will be of some interest. We welcome your feedback on the issues covered and any suggestions for investigations that we do not currently offer that may prove useful. As always, our first concern is to the care of the patients referred here. We constantly learn from the patients, their test results and your feedback. Thank you.

Best wishes from all of the team.

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