Archives for: August 2003
JOURNAL: Diabetes Care. 2003;26:3215-3218
AUTHORS: Alam Khan, MS, PhD
ABSTRACT: Cinnamon may improve glucose and lipid control in patients with type 2 diabetes.
COMMENTARY: "Botanical products can improve glucose metabolism and the overall condition of individuals with diabetes not only by hypoglycemic effects but also by improving lipid metabolism, antioxidant status, and capillary function," write Alam Khan, MS, PhD, from NWFP Agricultural University in Peshawar, Pakistan, and colleagues.
"Aqueous extracts from cinnamon have been shown to increase in vitro glucose uptake and glycogen synthesis and to increase phosphorylation of the insulin receptor; in addition, these cinnamon extracts are likely to aid in triggering the insulin cascade system."
In this study, 60 subjects with type 2 diabetes were randomized into six groups consuming 1, 3, or 6 g of cinnamon or the corresponding number of placebo capsules for 40 days followed by a 20-day washout period. There were 30 men and 30 women, and average age was 52.2 ± 6.32 years.
All three cinnamon groups had reductions in mean fasting serum glucose (ranging from 18%-29%), triglyceride (23%-30%), low-density lipoprotein (LDL) cholesterol (7%-27%), and total cholesterol (12%-26%) levels. There were no significant changes in high-density lipoprotein cholesterol or in the placebo groups.
Possible mechanisms of the effects of cinnamon include activated glycogen synthase, increased glucose uptake, inhibited glycogen synthase kinase, activated insulin receptor kinase, inhibited dephosphorylation of the insulin receptor, or antioxidant effect.
"The maintenance of lower serum glucose and lipid levels, even when the individuals were not consuming cinnamon for 20 days, denotes sustained effects of cinnamon, indicating that cinnamon would not need to be consumed every day," the authors write. "Because cinnamon would not contribute to caloric intake, those who have type 2 diabetes or those who have elevated glucose, triglyceride, LDL cholesterol, or total cholesterol levels may benefit from the regular inclusion of cinnamon in their daily diet.
In addition, cinnamon may be beneficial for the remainder of the population to prevent and control elevated glucose and blood lipid levels."
JOURNAL: European Neuropsychopharmacology 13 (2003) 267-271.)
AUTHORS: Su KP et al
ABSTRACT: A double-blind study conducted in Taiwan found that administration of omega-3 polyunsaturated fatty acids (omega-3 PUFAs) to a group of depressed individuals provided significant relief compared to those who received a placebo.
COMMENTARY: Twenty-eight patients ages 18 to 60 diagnosed with major depressive disorder were randomized to receive five capsules per day containing 440 milligrams eicosapentanoic acid and 220 milligrams docosahexanoic acid from fish oil, or a placebo for a period of eight weeks.
Prior to the treatment, and at two, four, six and eight weeks, participants rated and were scored on their depressive symptoms. Blood samples were taken before and after the treatment phase.
Following the fourth week of treatment, subjects who were taking the omega-3 supplements showed significant improvement in depressive symptom scores compared to the placebo group. These patients continued to improve through the eighth week of treatment.
The authors provide several possible explanations for omega-3 fatty acids' benefit in depression. One hypothesis is that the fatty acids normalize the altered cell membrane structure and neurotransmission found in depressed patients.
Another explanation if that omega 3 fatty acids target parts of the arachidonic acid cascade, which can effect mood. The authors hope that further clinical trials of omega-3 fatty acids in depressed patients will be undertaken, although they observe that there is not much incentive for pharmaceutical companies to do so since the nutrients aren't patentable.
STUDY: Essential Fatty Acids Crucial for Brain Development
JOURNAL: University of Connecticut
AUTHORS: Dr. Sunita R. Cheruku
ABSTRACT: Newborns whose mothers consumed adequate amounts of a particular fatty acid during the last 3 months of pregnancy exhibit healthier sleep patterns than others.
COMMENTARY: The amount of time babies spend in different stages of sleep may indicate whether they are experiencing normal brain development. Consequently, mothers who get enough of the fatty acid docosahexaenoic acid (DHA) in their diets may also be helping their babies' mental functioning, according to Dr. Sunita R. Cheruku and her colleagues at the University of Connecticut in Storrs.
The results of this study are strongly suggestive of the importance of DHA levels during the last trimester.
The researchers cautioned that even if newborns appear to show disrupted sleep patterns, they may only have a higher risk of--and are not doomed to--less than optimal development.
Risk factors do not mean certainty of outcome.
DHA is a long-chain polyunsaturated acid that appears to boost brain development. Infants accumulate fatty acids in their brains during the last 3 months in the womb and the first few months outside it. The fatty acids are found in cold water fish and fish oils.
JOURNAL: Health Affairs. 2003;22(4):190-197
AUTHORS: Dr. Wynia
ABSTRACT: One third of physicians do not tell their patients about the full range of services that might benefit their medical condition because of perceived insurance coverage restrictions, a new study finds.
COMMENTARY: The study, which surveyed 1,124 U.S. physicians during 1998, did not ask doctors to identify specific categories of medical services for which insurers deny coverage. But complaints about coverage denials in recent years have centered on certain types of prescription drugs and mental health services, as well as expensive procedures such as organ transplantation. Concerns that physicians were being forced by insurers to avoid discussion of noncovered services led to passage in many states of bans on "gag clauses" in managed care contracts.
STUDY: A new study that provides in vivo evidence of vitamin C and E's ability to prevent lipid peroxidation
JOURNAL: American Journal of Clinical Nutrition
ABSTRACT: A new study that provides in vivo evidence of vitamin C and E's ability to prevent lipid peroxidation was published in the September 1 2002 issue of the American Journal of Clinical Nutrition.
COMMENTARY: The researchers, from Johns Hopkins University in Baltimore and the University of Western Australia, sought to prove in humans what has been primarily demonstrated in vitro.
A trial of 184 smokers was conducted over a two month period, during which participants received either 500 milligrams vitamin C, 400 international units vitamin E, both vitamins, or a placebo. Subjects had blood samples and urine samples taken before receiving the supplements and at one and two months. The urine samples were analyzed for levels of 8-isoprostaglandin F2 alpha and MDA + 4-hydroxyalkenals, which are markers of lipid peroxidation.
Blood samples were analyzed for levels of serum ascorbic acid, serum alpha tocopherol, and serum oxygen-radical absorbance capacity (ORAC), which is a measure of the capacity of serum to resist oxidative damage.
Both vitamins were found to lower 8-isoprostaglandin F2 alpha, demonstrating a reduction in lipid peroxidation. Urinary levels of MDA + 4-hydroxyalkenals were not affected. Vitamin C caused an improvement serum ORAC values.
The group taking both vitamins did not have lower values than those taking either vitamin alone. The researchers speculate that the reason for this may be because there is a threshold effect as a result of endogenous processes at which a certain level of oxidative damage is inevitable.
This trial is the largest to date that rigorously assessed the effects of vitamin C and vitamin E on lipid peroxidation in vivo. The finding that vitamin C significantly increased ORAC is consistent with that from in vitro studies.
What we should gather from this is to include lot’s of foods containing vitamin E and A.
The doses used in this study can be obtained from just eating right and including lots of beneficial greens and neutral grain products.
STUDY: Risk low in under 50 age group.
JOURNAL: The New England Journal of Medicine 2002;346:1781-1785
AUTHORS: Dr. Thomas F. Imperiale
ABSTRACT: The number of healthy people without other risk factors who are likely to develop colon cancer before the age of 50 is relatively low compared with older people, new study findings indicate.
COMMENTARY: The findings confirm that one of the current colon cancer screening guidelines--a colonoscopy starting at age 50--is still an appropriate recommendation, according to the researchers.
In colonoscopy, a flexible, lighted tube is used to examine the entire colon for polyps, which can become cancerous. Most average risk patients are advised to undergo colonoscopy every 10 years starting at age 50. Higher-risk patients, including those with a family or personal history of colorectal cancer, are advised to get a colonoscopy more frequently or starting at a younger age.
In the current study, lead author Dr. Thomas F. Imperiale of Indiana University School of Medicine in Indianapolis and colleagues evaluated colonoscopy data for 906 men and women aged 40 to 49 years. None of them had symptoms or a family history of colorectal cancer, according to the report in The New England Journal of Medicine.
Overall, 21% had polyps or other suspicious looking lesions or growths, but none were found to have actual cancer, the authors report. Some of the lesions were located in areas where they could be picked up by a sigmoidoscope, an instrument used to examine the lower part of colon.
Based on the their findings, Imperiale and colleagues write that "if these results are applicable to the general population, at least 250 persons, perhaps 1,000 or more, would need to be screened to detect one cancer in this age group."
The researchers suggest that even though 7% of colorectal cancer cases occur in people under 50, the absolute risk of developing cancer is relatively low in that age group. The incidence of colorectal cancer in those aged 45 to 49 years is 24 cases per 100,000 people, while this jumps to 48 per 100,000 in those aged 50 to 54, according to the report.
"Our findings support the observation that age is a good predictor of risk," said Imperiale in a prepared statement.
In other words, the low risk of colon cancer in people in their 40s doesn't appear to warrant recommending everyone in this age group to get a colonoscopy.
Nonetheless, men and women, regardless of their age, who think they may be at risk or have symptoms such as rectal bleeding speak with their physician about the need for screening or for a diagnostic evaluation.
ABSTRACT: Tumor size may not be an accurate method of predicting lymph node involvement and disease progression in some breast cancers, according to investigators at the Research Institute of the McGill University Health Centre (MUHC).
COMMENTARY: Their findings show that some types of breast tumors do not "play by the rules" and possibly, are more dangerous than previously believed.
"We have identified a group of breast cancer tumors that don't conform to previous observations made in the general population of women with breast cancer," says MUHC geneticist and lead investigator, Dr. William Foulkes. "For these tumors there is only a very weak correlation between tumor size, the local spread of cancer cells and the likely severity of disease."
An associate professor in the Departments of Medicine, Human Genetics and Oncology at McGill University, Foulkes and his colleagues studied over 1500 women with breast cancer.
Women with breast cancer who also had a mutation in particular gene, BRCA1, had unusual tumors. These tumors did not behave as expected - there was no clear correlation between tumor size and associated cancer in the axillary lymph nodes. This was not true for breast cancers in the general population, or those related to another breast cancer susceptibility gene, known as BRCA2.
These results are surprising, because previous studies have indicated that BRCA1-related breast cancers tend to behave aggressively. Thus, the preferred route of spread of BRCA1-related breast cancers may be different from other types of breast cancer. According to Foulkes, these observations have important implications for early diagnosis and treatment of women who carry this gene.
JOURNAL: Mental Health Institute of Victoria (MHIV)
AUTHORS: Dr Rowan Thomas
ABSTRACT: Growing evidence suggests anaesthesia can speed up the onset of dementia in elderly patients.
The new findings present the medical fraternity and patients with a new dilemma.
COMMENTARY: Recent studies by the Mental Health Institute of Victoria (MHIV) show the incidence of post-operative cognitive decline occurs in between 15 and 30 per cent of elderly patients, mostly in those aged over 65 years.
They have found it is more prevalent in patients who already had some dementia.
"Having a major operation can unmask or speed up that process," anaesthetist Dr Rowan Thomas said.
Australian Medical Association (AMA) national vice-president Mukesh Haikerwal says in time, patients could be forced to chose between the benefits of major surgery and its downside.
JOURNAL: The Journal of nutrition.; 2003 Aug;133(8) p4507
AUTHORS: Togna G; Togna A; Franconi M; Marra C; Guiso M;
ABSTRACT: The effects of certain polyphenolic compounds in red wine, such as resveratrol and quercetin, have been widely investigated to determine the relationship between dietary phenolic compounds and the decreased risk of cardiovascular diseases. However, the effects of polyphenolic compounds contained in other foods, such as olive oil, have received less attention and little information exists regarding the biological activities of the phenol fraction in olive oil.
The aim of this study was to evaluate the antiplatelet activity and antioxidant power of two isochromans [1-(3'-methoxy-4'-hydroxy-phenyl)-6,7-dihydroxy-isochroman (encoded L116) and 1-phenyl-6,7-dihydroxy-isochroman (encoded L137)] recently discovered in olive oil and synthesized in our laboratory from hydroxytyrosol.
COMMENTARY: These compounds were effective free radical scavengers and inhibited platelet aggregation and thromboxane release evoked by agonists that induce reactive oxygen species-mediated platelet activation including sodium arachidonate and collagen, but not ADP.
Release of tritiated arachidonic acid from platelets was also impaired by L116 and L137. These results indicate that other Mediterranean diet nutraceuticals also exhibit antioxidant activity that could be beneficial in the prevention of vascular diseases.
JOURNAL: MMWR 2004;53:8-11.
ABSTRACT: The 2003-2004 influenza vaccine seems to offer little protection against the Fujian strain that has dominated this year's flu season in the US.
COMMENTARY: This reduced efficacy is not a complete surprise to the CDC given that the vaccine was not formulated against Fujian, but rather against a closely related strain called Panama (see Reuters report on December 11, 2003).
JOURNAL: Departments of Rheumatology, 1Pain Management/Anesthesiology and 2Research, Hospital for Special Surgery, New York, NY
AUTHORS: C. F. Meng, D. Wang3, J. Ngeow1, L. Lao4, M. adminson2 and S. Paget
ABSTRACT: To determine if acupuncture is an effective, safe adjunctive treatment to standard therapy for chronic low back pain (LBP) in older patients.
COMMENTARY: Fifty-five patients were enrolled, with eight drop-outs. Twenty-four subjects were randomized to the acupuncture group and 23 were randomized to the control group.
Acupuncture subjects had a significant decrease in RDQ score of 4.1 ± 3.9 at week 6, compared with a mean decrease of 0.7 ± 2.8 in the control group (P = 0.001). This effect was maintained for up to 4 weeks after treatment at week 9, with a decrease in RDQ of 3.5 ± 4.4 from baseline, compared with 0.43 ± 2.7 in the control group (P = 0.007).
The mean global transition score was higher in the acupuncture group, 3.7 ± 1.2, indicating greater improvement, compared with the score in the control group, 2.5 ± 0.9 (P < 0.001). Fewer acupuncture subjects had medication-related side-effects compared with the control group.
Conclusions. Acupuncture is an effective, safe adjunctive treatment for chronic LBP in older patients.
JOURNAL: Cell 2003;115:151-162.
AUTHORS: Dr. Mone Zaidi
ABSTRACT: - Despite its name, thyroid-stimulating hormone (TSH) has a number of direct effects on bone cells.
COMMENTARY: "In medical school, I was taught that TSH regulates thyroid hormone secretion," senior author Dr. Mone Zaidi, from Mount Sinai School of Medicine in New York, said in a statement. "Here, we find that genetic manipulation of TSH receptors has a more profound effect on bone loss than on thyroid function," he added. "This finding was totally unexpected and causes one to wonder if the hormone should be renamed to reflect both its biologic functions."
In the new study, the authors found that TSH directly influenced skeletal remodeling by interacting with TSH receptors on osteoblast and osteoclast precursors. By inhibiting the development of both cell types, TSH worked as a negative regulator of bone formation as well as bone breakdown.
In knockout mice, loss of just 50% of the TSH receptors produced marked osteoporosis combined with focal osteosclerosis, the researchers state. Moreover, this effect occurred even though the animals had normal thyroid hormone levels.
Given the powerful effects that TSH has on bone, Dr. Zaidi said that the current findings should "inspire research into new therapeutics that target bone TSH receptors."
STUDY: Benefits of Breast-feeding
JOURNAL: Lancet 2002;359:2003–4
ABSTRACT: Children who were breast-fed during infancy have a reduced risk of becoming obese by age three or four, according to a study published in Lancet (2002;359:2003–4). This new finding adds to the growing list of benefits that have been attributed to breast-feeding, and comes at a time when obesity in both children and adults has reached epidemic proportions in the United States.
COMMENTARY: In the new study, 32,200 Scottish children were observed when they were three to four years old. The prevalence of obesity was 20.8% lower among children who had been breast-fed (7.2%) than among those who had been bottle-fed (9.1%).
When the numbers were adjusted to take into account the effects of birth weight, gender, and socioeconomic status, the risk of obesity was 28% lower in the breast-fed children. It is not known how breast-feeding prevents infants from becoming overweight children, however, as overweight children have an increased risk of becoming obese adults, breast-feeding might help protect against the development of obesity and its complications throughout life.
Obesity has become increasingly prevalent in the United States over the past few decades; by some estimates, more than half of all adults are overweight. Overweight people are at increased risk of suffering from high blood pressure, diabetes, heart disease, gallbladder disease, and osteoarthritis. While lack of physical activity and excessive caloric intake are major factors that contribute to becoming overweight, it is difficult to explain why some people have trouble keeping the weight off.
Some doctors have observed that individuals with food allergies tend to gain weight when they eat the foods to which they are allergic. In those people, avoidance of specific allergens (such as dairy products or wheat) may result in weight reduction that cannot be achieved by other means.
Breast-feeding appears to reduce the risk that someone will develop food allergies. This may be one of the mechanisms whereby breast-feeding helps prevent obesity, although additional research is needed to test that hypothesis.
In addition to reducing the risk of obesity, breast-feeding promotes the development of a healthy immune system.
Children who have been breast-fed have a lower risk of suffering from allergic conditions (such as asthma or eczema), compared with bottle-fed children. In addition, adults who had been breast-fed as infants for more than nine months performed better on intelligence tests, compared with individuals who had been breast-fed for less than nine months or not at all.
The new study adds to the growing body of evidence that human milk is the optimal food for human babies.
STUDY: Latest study adds to confusion over hormone therapy
JOURNAL: Journal of the American Medical Association
AUTHORS: James Lacey
ABSTRACT: In another piece of the increasingly complex hormone-replacement health puzzle, women given estrogen-only therapy after menopause ran a significantly higher risk of ovarian cancer, researchers reported.
COMMENTARY: The report followed two other recently released studies that found estrogen in combination with progestin — a slightly less common replacement therapy than estrogen-only — does not generally protect against heart disease after all and may increase the risk of breast cancer, stroke and blood clots.
Hormone replacement therapy (HRT) of both types is used by an estimated 13.5 million women in the United States alone, nearly 8 million estrogen-only and up to 6 million in combination with progestin.
The therapy is prescribed to treat immediate symptoms such as hot flashes and vaginal dryness, and to protect against bone-thinning osteoporosis.
James Lacey of the National Cancer Institute, lead author of the estrogen study published in this week’s Journal of the American Medical Association, said there was not enough evidence to say if there was also an ovarian cancer risk from estrogen-progestin use.
He offered this advice to women: “Because hormone therapy may influence so many conditions ... after menopause — cardiovascular disease, osteoporosis, breast cancer, uterine cancer, gallbladder disease, blood clots, and now potentially ovarian cancer — we should no longer think of a woman basing her decision to use hormones on the potential risk of just one condition.
Women should continue to talk to their health care providers about whether hormones might be right for them.
Lacey’s research involved 44,241 post-menopausal women whose health histories were tracked for about 20 years as part of a major breast cancer study. Among those women, 329 developed ovarian cancer. The researchers found that compared to similar women not on hormones, those taking estrogen therapy had a 60 percent greater risk of developing ovarian cancer.
The risk increased proportionately with longer duration of hormone use; those who used estrogen therapy for 20 or more years were approximately three times more likely to develop ovarian cancer.
The main finding of the study was that post-menopausal women who used estrogen replacement therapy for 10 or more years were at significantly higher risk of developing ovarian cancer than women who never used hormone replacement therapy.
Estrogen replacement therapy certainly is not the panacea it once appeared. Physicians counseling women about HRT must consider the unique needs of each patients and attempt to weigh the benefits and risks on an individual basis.
AUTHORS: Lars Holmberg
ABSTRACT: Swedish researchers stopped a study examining the impact of hormone replacement therapy (HRT) in women with a history of breast cancer because of an unacceptably high risk of recurrence of the disease.
COMMENTARY: The study, originally planned for five years, was halted after only two because more than three times as many women taking HRT had a recurrence or new breast tumor compared to women who received other treatments to relieve symptoms of the menopause.
"We thought we found an unacceptably high risk for a new breast cancer event in women taking HRT," said lead investigator Lars Holmberg, of the University of Uppsala in Sweden.
"Patient safety must be first. We felt the risk was too high," he added.
After two years of follow-up, 26 women in the group allocated to receive HRT had a recurrence or new cancer, compared to seven in the other group not on hormone treatment.
More than 345 women who had had breast cancer took part in the study. They were randomized to receive either HRT or a non- hormonal treatments.
"Women on active treatment have been advised to discontinue," said Holmberg, whose findings were published online by The Lancet.
Millions of women have used HRT to relieve hot flushes, mood swings and sexual problems linked to the menopause and to stave off osteoporosis, or brittle bone disease.
The Swedish decision followed moves by American and British scientists who also stopped HRT trials after learning HRT may increase the risk of breast cancer, stroke and blood clots.
An analysis of four major studies into the effects of HRT by scientists at the British charity Cancer Research UK supported the U.S. findings.
The review showed that women who took the treatment for five years had a higher risk of breast cancer, stroke and blood clots in the lung but were less likely to suffer from bowel cancer or hip fractures.
JOURNAL: Am J Clin Nutr. 2004;79:183-184, 282-288
AUTHORS: Lital Keinan-Boker
ABSTRACT: High intake of isoflavones does not increase risk of breast cancer, according to the results of a prospective, population cohort study published in the February issue of the American Journal of Clinical Nutrition.
COMMENTARY: "Soy foods are rich in isoflavones, and Asian populations habitually consume large amounts of soy foods. Ecologic observations suggest that the intake of soy foods plays a role in the prevention of breast cancer," write Lital Keinan-Boker, from the University Medical Center in Utrecht, the Netherlands, and colleagues. "Several studies, but not all, showed protective effects of soy in Asian populations. No such associations were suggested for Western subjects."
This study followed 15,555 Dutch women, aged 49 to 70 years, enrolled from 1993 to 1997 in the European Prospective Investigation into Cancer and Nutrition (EPIC). This population has a habitually low phytoestrogen intake.
Using a validated food-frequency questionnaire, the investigators determined habitual dietary intake in the preceding year, and they estimated dietary content of isoflavones and lignans based on a literature search, food-composition tables, and expert opinion. The Comprehensive Cancer Center Middle Netherlands identified 280 newly diagnosed breast cancer cases during follow-up through Jan. 1, 2001.
Median daily intake of isoflavones was 0.4 mg/day (interquartile range [IR], 0.3 - 0.5 mg/day) and of lignans was 0.7 mg/day (IR, 0.5 - 0.8 mg/day). Compared with the lowest intake quartiles, hazard ratios for the highest intake quartiles were 1.0 (95% confidence interval [CI], 0.7 - 1.5) for isoflavones and 0.7 (95% confidence interval, 0.5 to 1.1) for lignans.
"The results of the present study, which focused on Western women whose habitual diet is low in phytoestrogens, showed no protective effects of isoflavones or lignans against breast cancer," the authors write. "Consumption of vegetables, fruit, grain products, and nuts accounted for most of the lignan intake.... Because these food groups are frequently consumed in Western diets, it is reasonable to assume that the intake of lignans is stable over the course of a lifetime and occurs at younger ages also, which is important if lignan intake is relevant only at younger ages, as has been suggested for isoflavones."