Evening primrose oil (EPO) and borage oil (BO) provide little benefit for the relief of atopic eczema compared with placebo, according to a new review published in the April issue of the Cochrane Database of Systematic Reviews.
Joel Bamford, MD, from the University of Minnesota Medical School in Duluth, and colleagues identified 27 studies (19 EPO and 8 BO; 1596 adults and children overall) that evaluated the use of oral EPO or BO for treatment of eczema compared with placebo. The review authors searched the main scientific literature databases up to August 29, 2012.
A meta-analysis of 7 EPO studies showed no significant increase in symptom relief compared with placebo. Studies of BO also failed to show any significant symptom improvement; however, a meta-analysis of studies was not performed because of differences in study reporting.
Adverse effects were mild but similar for EPO and BO, were primarily gastrointestinal in nature, and ranged in frequency from 7% to 15%. One study reported that EPO may increase bleeding risk among patients receiving warfarin.
According to the researchers, 67% of the included studies were judged as having a low risk of bias for random sequence generation, 44% had a low risk of bias for allocation concealment, and 59% had a low risk of bias for blinding.
"[EPO and BO] do not seem to add any benefit to eczema as measured in this systematic review," Dr. Bamford and colleagues write.
"Noting that the confidence intervals between the active and placebo treatments are so narrow to exclude the possibility of any clinically useful difference, we conclude that further studies [of] EPO or BO for eczema would be hard to justify," they write.
Hywel Williams, PhD, FRCP, from the Center of Evidence Based Dermatology, University of Nottingham, United Kingdom, wrote: "Although some of us always suspected that EPO was not especially useful in atopic eczema, this study provides robust evidence from the totality of evidence to suggest that it is of very little value, if any."
Dr. Williams agreed with the review authors that more research in this area is not needed and that "research monies should be spent elsewhere on eczema, such as finding out how best to prevent it."
Welcome to my collection of health articles. Most of them contain little nuggets of health wisdom that we can easily apply to our daily lives. As you can gather, I've been consuming all sorts of supplements over the years, most of them from iherb. They deliver on time (DHL), and prices are good. If you're a first-time buyer, use my code 'pot089' to enjoy up to $10 off.
Friday, 28 June 2013
Vitamin D levels linked to respiratory disease
Having severe vitamin D deficiency may put people aged 65 years and older at more than twice the risk of having self-reported respiratory disease, according to an article published online May 6 in theJournal of the American Geriatrics Society.
However, the question remains as to whether respiratory disease is a cause rather than a consequence of low vitamin D concentrations.
Vasant Hirani, PhD, from the Department of Epidemiology and Public Health, University College London Medical School, United Kingdom, analyzed the records of 2070 people (1120 women) who participated in the 2005 Health Survey for England and who were also interviewed by a nurse and had a blood sample taken.
Dr. Hirani found that after adjusting for age, sex, season, smoking status, and social class, people with less than 35 nmol/L serum 25(OH)D were more than twice as likely to report having respiratory disease as those individuals with a serum level of 64 nmol/L or higher. Individuals with intermediate serum levels also had greater risk compared with those with levels above 64 nmol/L.
Prevalence of respiratory disease among the study population ranged from 8.9% for people with vitamin D levels of 75 nmol/L and greater to 45.5% for people with levels of 25.0 to 49.9 nmol/L. The association was not consistent, however, as only 14.7% of individuals with serum 25(OH)D levels lower than 25 nmol/L reported having respiratory disease.
Although Dr. Hirani found associations in unadjusted analyses between low vitamin D levels and smoking tobacco, lower social class, fair or poor general health, and self-reported heart disease, cancer, and pain, she found no associations between low vitamin D levels and age, sex, body mass index, alcohol consumption, or use of vitamin supplements.
It is "biologically plausible" for vitamin D to be associated with respiratory health, she writes, because of vitamin D's role in the lung's immunity response to virus infection.
"It is also likely that individuals with a respiratory condition are less likely to spend time outdoors and may also limit their activities, resulting in less sunlight exposure and thus vitamin D deficiency," she writes. More research is needed to clarify the cause and effect of the association, she notes.
Although definitive conclusions as to whether low vitamin D is truly linked to respiratory disease, she writes, the study population is nationally representative of people of that age in England.
She concludes, "Regardless of the direction of causation, the higher-than-expected co-occurrence of vitamin D deficiency and respiratory conditions is an important public health question for older populations living in northern latitudes because both are common, and both have substantial adverse health consequences."
Dr. Hirani is currently funded by the National Health Services Information Centre and is an editor and chapter author on the Health Survey for England, funded by the English Department of Health.
However, the question remains as to whether respiratory disease is a cause rather than a consequence of low vitamin D concentrations.
Vasant Hirani, PhD, from the Department of Epidemiology and Public Health, University College London Medical School, United Kingdom, analyzed the records of 2070 people (1120 women) who participated in the 2005 Health Survey for England and who were also interviewed by a nurse and had a blood sample taken.
Dr. Hirani found that after adjusting for age, sex, season, smoking status, and social class, people with less than 35 nmol/L serum 25(OH)D were more than twice as likely to report having respiratory disease as those individuals with a serum level of 64 nmol/L or higher. Individuals with intermediate serum levels also had greater risk compared with those with levels above 64 nmol/L.
Prevalence of respiratory disease among the study population ranged from 8.9% for people with vitamin D levels of 75 nmol/L and greater to 45.5% for people with levels of 25.0 to 49.9 nmol/L. The association was not consistent, however, as only 14.7% of individuals with serum 25(OH)D levels lower than 25 nmol/L reported having respiratory disease.
Although Dr. Hirani found associations in unadjusted analyses between low vitamin D levels and smoking tobacco, lower social class, fair or poor general health, and self-reported heart disease, cancer, and pain, she found no associations between low vitamin D levels and age, sex, body mass index, alcohol consumption, or use of vitamin supplements.
It is "biologically plausible" for vitamin D to be associated with respiratory health, she writes, because of vitamin D's role in the lung's immunity response to virus infection.
"It is also likely that individuals with a respiratory condition are less likely to spend time outdoors and may also limit their activities, resulting in less sunlight exposure and thus vitamin D deficiency," she writes. More research is needed to clarify the cause and effect of the association, she notes.
Although definitive conclusions as to whether low vitamin D is truly linked to respiratory disease, she writes, the study population is nationally representative of people of that age in England.
She concludes, "Regardless of the direction of causation, the higher-than-expected co-occurrence of vitamin D deficiency and respiratory conditions is an important public health question for older populations living in northern latitudes because both are common, and both have substantial adverse health consequences."
Dr. Hirani is currently funded by the National Health Services Information Centre and is an editor and chapter author on the Health Survey for England, funded by the English Department of Health.
Low back pain linked to bacterial infection
New research suggests that some 40% of chronic lower back pain (CLBP) could be caused by bacteria, and that a significant percentage of people with lower back pain following a herniated disc and swelling in the spine could find relief by taking an antibiotic.
Investigators from the Research Department of the Spine Center of Southern Denmark, University of Southern Denmark, Odense, led by Hanne B. Albert, PhD, conclude that antibiotics may be considered as a treatment option for patients with chronic low back pain, but with caution.
The authors suggest that long-term antibiotics should not be prescribed "without due consideration." Low back pain is so common in the community that there could be hazards if used indiscriminately, they write.
"However, as many patients, as in this trial, are on sick leave at risk of losing their jobs and have a high analgesic intake, we suggest that antibiotics, when applied along the lines of this MAST [Modic antibiotic spine therapy] protocol may be appropriate in this subgroup, i.e., CLBP with Modic type 1 changes. We do not support the proposition that all patients with lumbar pain should have a trial course of antibiotics."
Their findings, published in 2 papers, 1 a randomized trial of antibiotics for low back pain, are published in the April issue of the European Spine Journal.
Positive cultures
An estimated 80% of Americans have low back pain at some point in their life, the authors write, and back pain is the most common reason for workplace absence.
The first of 2 studies shows that patients with an anaerobic infected disc are more likely to develop Modic change (MC) (bone edema) in the adjacent vertebrae after disc herniation, suggesting a role of bacteria in developing Modic changes.
The study included 61 adults (mean age, 46.4 years; 27% female) who had MRI-confirmed lumbar disc herniation and were undergoing surgery. All patients were immunocompetent. No patient had received a previous epidural steroid injection or had previous back surgery.
Using stringent antiseptic sterile protocols, researchers collected 5 tissue samples from each patient. In total, microbiological cultures were positive in 46% of the patients. Anaerobic cultures were positive in 43% of patients, and of these, 7% had dual microbial infections, containing 1 aerobic and 1 anaerobic culture. No tissue specimens had more than 2 types of bacteria.
The anaerobic microorganism Propionibacterium acnes was found in 40% of the total cohort and in 86% of those with positive microbiology. These bacteria typically live in human skin and hair follicles and gums.
The results showed that in the discs with a nucleus with anaerobic bacteria, 80% developed new MC in the vertebrae adjacent to the previous disc herniation. In contrast, none of the patients with aerobic bacteria and only 44% of those with negative cultures developed new MC.
The association between an anaerobic culture and new MCs was highly statistically significant.
The authors said that the detected bacteria are unlikely the result of intraoperative skin contamination. They pointed out that the procedures were conducted under the strictest of sterile conditions. As well, if skin contamination was the cause of the infection, a pattern of multiple skin bacteria cultures would be observed, which was not the case.
Why would some patients develop MC when no microorganisms are present in their herniated nuclear tissue? The authors speculate this could be due to a biochemical effect reflecting edema secondary to microfractures and subsequent inflammation, or the result of an inflammatory process from proinflammatory chemicals penetrating through the microfractures from the nucleus pulposus.
Antibiotic randomized trial
The second study, a double-blind, randomized trial, showed that an antibiotic protocol was significantly more effective than placebo in reducing pain and disability. This study included 162 adults who had chronic lower back pain that had developed after a previous disc herniation and had lasted more than 6 months.
These patients also had bone edema, as shown by Modic type 1 changes in the vertebrae adjacent to the previous herniation. Such changes in the vertebrae are present in 6% of the general population and 35% to 40% of those with low back pain.
The patients were randomly assigned to amoxicillin-clavulanate (500 mg/125 mg;Bioclavid) or identical placebo 3 times daily for 100 days and were blindly evaluated at baseline, end of treatment, and 1 year.
The analysis included 144 patients who completed the 1-year follow-up. The antibiotic group improved on all primary outcome measures, including disease-specific score on Roland Morris Disability Questionnaire (RMDQ), and lumbar pain. The improvement continued from the 100-day follow-up until the 1-year follow up.
The improvements in the antibiotic group were highly statistically significant on all outcomes measured, including secondary outcomes of leg pain, number of hours with pain in the last 4 weeks, global perceived health, and days with sick leave, among others.
For example, at baseline, 100 days, and 1 year, the disease-specific disability-RMDQ scores for the antibiotic group were 15.0, 11.5, and 7.0, and for placebo they were 15.0, 14.0, and 14.0 (P = .0001 for the difference between placebo and antibiotic group at 1 year follow up). For back pain, the figures for the antibiotic group were 6.7, 5.0, and 3.7 and for placebo they were 6.3, 6.3, and 6.3. (P = .0001 for difference).
For low back pain, which was experienced by all patients at the beginning of the study, 67.5% of the antibiotic group reported this pain after 1 year compared with 94.0% of the placebo group (P = .0001 for difference). The percentage of those with constant pain was reduced from 73.5% to 19.5% in the antibiotic group and from 73.1% to 67.2% in the placebo group (P = .0001 for difference).
There was a trend toward a dose-response relationship, with double-dose antibiotics being more effective; however, this was not statistically significant because the study was not powered for this comparison.
Adverse events were more common in the antibiotic group (65% of participants) than in the placebo group (23%).
Surgical setting
In an editorial accompanying the publication, Max Aebi, MD, from the MEM Research Center for Orthopaedic Surgery, Institute for Evaluative Research in Orthopedic Surgery, University of Berne, Switzerland, and editor-in-chief of the European Spine Journal, points out that previous studies have shown that MC I occurs 6 times more frequently in the low back pain population than the general population. The relationship may be mechanical, he writes, "but under certain circumstances, low virulent infections may play a key role."
These new papers not only demonstrate that patients infected with herniated nucleus material by anaerobic bacteria in lumbar disc herniation develop new MC I in adjacent vertebrae but also that patients with low back pain and MC I after lumbar disc herniation improved significantly with an antibiotic protocol, Dr. Aebi writes.
"This strongly suggests one cause of low back pain in combination of MC I to be of low-grade infectious nature in case of previous disc herniation," he said.
However, he cautions that it is ethically impossible to take biopsy samples from all of these patients; this could be done only those who have surgery subsequent to disc herniation. The authors ask "the obvious key question" of whether the bacteria found in the nuclear material results from infection or could be due to intraoperative contamination, he writes, and then provide a "plausible" answer as to why such contamination is "highly improbable."
"Nevertheless," Dr. Aebi writes, "further research is necessary to show what exactly happens in patients with disc herniation who develop MC I and low back pain and who have not been operated on. How could we show that in this fraction of patients there could be the same number of anaerobic infections of the nucleus material? By markers of the anaerobic bacteria or of specific infectious tissue, which could be made visible in imaging? By fine needle biopsy?"
Knowing these answers would make the current study results "even more explosive" in terms of better understanding low back pain and corresponding MRI changes, said Dr. Aebi. "We are keen to wait for further innovative research in this field."
Investigators from the Research Department of the Spine Center of Southern Denmark, University of Southern Denmark, Odense, led by Hanne B. Albert, PhD, conclude that antibiotics may be considered as a treatment option for patients with chronic low back pain, but with caution.
The authors suggest that long-term antibiotics should not be prescribed "without due consideration." Low back pain is so common in the community that there could be hazards if used indiscriminately, they write.
"However, as many patients, as in this trial, are on sick leave at risk of losing their jobs and have a high analgesic intake, we suggest that antibiotics, when applied along the lines of this MAST [Modic antibiotic spine therapy] protocol may be appropriate in this subgroup, i.e., CLBP with Modic type 1 changes. We do not support the proposition that all patients with lumbar pain should have a trial course of antibiotics."
Their findings, published in 2 papers, 1 a randomized trial of antibiotics for low back pain, are published in the April issue of the European Spine Journal.
Positive cultures
An estimated 80% of Americans have low back pain at some point in their life, the authors write, and back pain is the most common reason for workplace absence.
The first of 2 studies shows that patients with an anaerobic infected disc are more likely to develop Modic change (MC) (bone edema) in the adjacent vertebrae after disc herniation, suggesting a role of bacteria in developing Modic changes.
The study included 61 adults (mean age, 46.4 years; 27% female) who had MRI-confirmed lumbar disc herniation and were undergoing surgery. All patients were immunocompetent. No patient had received a previous epidural steroid injection or had previous back surgery.
Using stringent antiseptic sterile protocols, researchers collected 5 tissue samples from each patient. In total, microbiological cultures were positive in 46% of the patients. Anaerobic cultures were positive in 43% of patients, and of these, 7% had dual microbial infections, containing 1 aerobic and 1 anaerobic culture. No tissue specimens had more than 2 types of bacteria.
The anaerobic microorganism Propionibacterium acnes was found in 40% of the total cohort and in 86% of those with positive microbiology. These bacteria typically live in human skin and hair follicles and gums.
The results showed that in the discs with a nucleus with anaerobic bacteria, 80% developed new MC in the vertebrae adjacent to the previous disc herniation. In contrast, none of the patients with aerobic bacteria and only 44% of those with negative cultures developed new MC.
The association between an anaerobic culture and new MCs was highly statistically significant.
The authors said that the detected bacteria are unlikely the result of intraoperative skin contamination. They pointed out that the procedures were conducted under the strictest of sterile conditions. As well, if skin contamination was the cause of the infection, a pattern of multiple skin bacteria cultures would be observed, which was not the case.
Why would some patients develop MC when no microorganisms are present in their herniated nuclear tissue? The authors speculate this could be due to a biochemical effect reflecting edema secondary to microfractures and subsequent inflammation, or the result of an inflammatory process from proinflammatory chemicals penetrating through the microfractures from the nucleus pulposus.
Antibiotic randomized trial
The second study, a double-blind, randomized trial, showed that an antibiotic protocol was significantly more effective than placebo in reducing pain and disability. This study included 162 adults who had chronic lower back pain that had developed after a previous disc herniation and had lasted more than 6 months.
These patients also had bone edema, as shown by Modic type 1 changes in the vertebrae adjacent to the previous herniation. Such changes in the vertebrae are present in 6% of the general population and 35% to 40% of those with low back pain.
The patients were randomly assigned to amoxicillin-clavulanate (500 mg/125 mg;Bioclavid) or identical placebo 3 times daily for 100 days and were blindly evaluated at baseline, end of treatment, and 1 year.
The analysis included 144 patients who completed the 1-year follow-up. The antibiotic group improved on all primary outcome measures, including disease-specific score on Roland Morris Disability Questionnaire (RMDQ), and lumbar pain. The improvement continued from the 100-day follow-up until the 1-year follow up.
The improvements in the antibiotic group were highly statistically significant on all outcomes measured, including secondary outcomes of leg pain, number of hours with pain in the last 4 weeks, global perceived health, and days with sick leave, among others.
For example, at baseline, 100 days, and 1 year, the disease-specific disability-RMDQ scores for the antibiotic group were 15.0, 11.5, and 7.0, and for placebo they were 15.0, 14.0, and 14.0 (P = .0001 for the difference between placebo and antibiotic group at 1 year follow up). For back pain, the figures for the antibiotic group were 6.7, 5.0, and 3.7 and for placebo they were 6.3, 6.3, and 6.3. (P = .0001 for difference).
For low back pain, which was experienced by all patients at the beginning of the study, 67.5% of the antibiotic group reported this pain after 1 year compared with 94.0% of the placebo group (P = .0001 for difference). The percentage of those with constant pain was reduced from 73.5% to 19.5% in the antibiotic group and from 73.1% to 67.2% in the placebo group (P = .0001 for difference).
There was a trend toward a dose-response relationship, with double-dose antibiotics being more effective; however, this was not statistically significant because the study was not powered for this comparison.
Adverse events were more common in the antibiotic group (65% of participants) than in the placebo group (23%).
Surgical setting
In an editorial accompanying the publication, Max Aebi, MD, from the MEM Research Center for Orthopaedic Surgery, Institute for Evaluative Research in Orthopedic Surgery, University of Berne, Switzerland, and editor-in-chief of the European Spine Journal, points out that previous studies have shown that MC I occurs 6 times more frequently in the low back pain population than the general population. The relationship may be mechanical, he writes, "but under certain circumstances, low virulent infections may play a key role."
These new papers not only demonstrate that patients infected with herniated nucleus material by anaerobic bacteria in lumbar disc herniation develop new MC I in adjacent vertebrae but also that patients with low back pain and MC I after lumbar disc herniation improved significantly with an antibiotic protocol, Dr. Aebi writes.
"This strongly suggests one cause of low back pain in combination of MC I to be of low-grade infectious nature in case of previous disc herniation," he said.
However, he cautions that it is ethically impossible to take biopsy samples from all of these patients; this could be done only those who have surgery subsequent to disc herniation. The authors ask "the obvious key question" of whether the bacteria found in the nuclear material results from infection or could be due to intraoperative contamination, he writes, and then provide a "plausible" answer as to why such contamination is "highly improbable."
"Nevertheless," Dr. Aebi writes, "further research is necessary to show what exactly happens in patients with disc herniation who develop MC I and low back pain and who have not been operated on. How could we show that in this fraction of patients there could be the same number of anaerobic infections of the nucleus material? By markers of the anaerobic bacteria or of specific infectious tissue, which could be made visible in imaging? By fine needle biopsy?"
Knowing these answers would make the current study results "even more explosive" in terms of better understanding low back pain and corresponding MRI changes, said Dr. Aebi. "We are keen to wait for further innovative research in this field."
Eating peppers may help ward off Parkinson's Disease
Eating foods that contain even a small amount of nicotine, such as peppers, may reduce the risk for Parkinson's disease (PD), new research hints.
Peppers are in the same botanical family as tobacco — the Solanaceae family. In a population-based study, researchers found that increasing consumption of edible forms of Solanaceae plants was associated with a lower risk of developing PD, with peppers displaying the strongest association.
"If our results are confirmed in similar studies, and we also learn more about why peppers might be protective, then the research may be of particular interest to people who want to eat foods that might benefit their health, especially people without PD already," Susan Searles Nielsen, PhD, who led the study, told Medscape Medical News.
"We weren't able to explore whether peppers or other foods slow progression of the disease once you have it, although research to address that question might be a natural extension," added Dr. Searles Nielsen, research scientist in the Department of Environmental and Occupational Health Sciences, University of Washington, Seattle.
The study was published online May 9 in Annals of Neurology
Consistent inverse association with tobacco
Research has consistently shown an inverse association between PD and tobacco use, with people who have ever regularly smoked cigarettes less likely to develop PD than others. Some animal studies indicate that nicotine might help protect neurons. "However, it's unclear whether nicotine or something else in tobacco is actually protective, or whether people predisposed to PD simply don't respond well to tobacco smoke and therefore avoid it," Dr. Searles Nielsen explained.
"A few studies suggest that secondhand smoke might be associated with a reduced risk of PD, so that prompted us to look at another source of a relatively small amount of nicotine — foods in the same plant family as tobacco," she added.
The researchers assessed whether nicotine from edible Solanaceae influences risk for PD in 490 adults with newly diagnosed PD and 644 unrelated, neurologically healthy controls. They used questionnaires to assess participants' lifetime diets and tobacco use.
They report that PD was inversely associated with consumption of all edible Solanaceae combined (relative risk [RR], 0.81; 95% confidence interval [CI], 0.65 - 1.01), but not consumption of all other vegetables combined (RR, 1.00; 95% CI, 0.92 - 1.10).
They found that the trend "strengthened" when they weighted edible Solanaceae by nicotine concentration.
An inverse association was also evident for peppers specifically. Eating peppers 2 to 4 times per week was "consistently" associated with a 30% reduction in risk for PD the researchers report.
The potentially protective effect of peppers was mainly in people who had little or no prior tobacco use, which is "intriguing," Dr. Searles Nielsen said. "That is where you would expect to see the clearest association if something in both tobacco and peppers, such as nicotine, is protective."
"This lends strength to our findings, along with our observations that the association grew stronger with greater consumption of peppers and that there was no association between PD and eating vegetables outside this plant family. However, more research is needed to fully understand whether eating peppers might help prevent PD," Dr. Searles Nielsen said.
Novel approach, new evidence
The observation that smokers have a lower risk for PD has been "consistently reported in more than 60 epidemiological studies," Honglei Chen, MD, PhD, from the National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, who wasn't involved in the study, told Medscape Medical News.
"All previous studies on this topic have focused on analysis of smoking behaviors, while this study took a very different and novel approach by examining nicotine from diet in relation to Parkinson risk. Although this study did not settle the controversies regarding smoking and PD, it offers new evidence that supports a causal explanation," Dr. Chen said.
He cautioned, however, that this is a "preliminary finding that needs to be replicated, particularly from prospective studies that assess dietary habit before PD diagnosis.
"This study, however, is an excellent example of a novel approach for studying the relationship between smoking and PD. Further, if this finding could be confirmed, it adds to the health benefits of eating tomatoes and green peppers," Dr. Chen said.
Peppers are in the same botanical family as tobacco — the Solanaceae family. In a population-based study, researchers found that increasing consumption of edible forms of Solanaceae plants was associated with a lower risk of developing PD, with peppers displaying the strongest association.
"If our results are confirmed in similar studies, and we also learn more about why peppers might be protective, then the research may be of particular interest to people who want to eat foods that might benefit their health, especially people without PD already," Susan Searles Nielsen, PhD, who led the study, told Medscape Medical News.
"We weren't able to explore whether peppers or other foods slow progression of the disease once you have it, although research to address that question might be a natural extension," added Dr. Searles Nielsen, research scientist in the Department of Environmental and Occupational Health Sciences, University of Washington, Seattle.
The study was published online May 9 in Annals of Neurology
Consistent inverse association with tobacco
Research has consistently shown an inverse association between PD and tobacco use, with people who have ever regularly smoked cigarettes less likely to develop PD than others. Some animal studies indicate that nicotine might help protect neurons. "However, it's unclear whether nicotine or something else in tobacco is actually protective, or whether people predisposed to PD simply don't respond well to tobacco smoke and therefore avoid it," Dr. Searles Nielsen explained.
"A few studies suggest that secondhand smoke might be associated with a reduced risk of PD, so that prompted us to look at another source of a relatively small amount of nicotine — foods in the same plant family as tobacco," she added.
The researchers assessed whether nicotine from edible Solanaceae influences risk for PD in 490 adults with newly diagnosed PD and 644 unrelated, neurologically healthy controls. They used questionnaires to assess participants' lifetime diets and tobacco use.
They report that PD was inversely associated with consumption of all edible Solanaceae combined (relative risk [RR], 0.81; 95% confidence interval [CI], 0.65 - 1.01), but not consumption of all other vegetables combined (RR, 1.00; 95% CI, 0.92 - 1.10).
They found that the trend "strengthened" when they weighted edible Solanaceae by nicotine concentration.
An inverse association was also evident for peppers specifically. Eating peppers 2 to 4 times per week was "consistently" associated with a 30% reduction in risk for PD the researchers report.
The potentially protective effect of peppers was mainly in people who had little or no prior tobacco use, which is "intriguing," Dr. Searles Nielsen said. "That is where you would expect to see the clearest association if something in both tobacco and peppers, such as nicotine, is protective."
"This lends strength to our findings, along with our observations that the association grew stronger with greater consumption of peppers and that there was no association between PD and eating vegetables outside this plant family. However, more research is needed to fully understand whether eating peppers might help prevent PD," Dr. Searles Nielsen said.
Novel approach, new evidence
The observation that smokers have a lower risk for PD has been "consistently reported in more than 60 epidemiological studies," Honglei Chen, MD, PhD, from the National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, who wasn't involved in the study, told Medscape Medical News.
"All previous studies on this topic have focused on analysis of smoking behaviors, while this study took a very different and novel approach by examining nicotine from diet in relation to Parkinson risk. Although this study did not settle the controversies regarding smoking and PD, it offers new evidence that supports a causal explanation," Dr. Chen said.
He cautioned, however, that this is a "preliminary finding that needs to be replicated, particularly from prospective studies that assess dietary habit before PD diagnosis.
"This study, however, is an excellent example of a novel approach for studying the relationship between smoking and PD. Further, if this finding could be confirmed, it adds to the health benefits of eating tomatoes and green peppers," Dr. Chen said.
Probiotics affect brain activity
A new study provides the first evidence in humans that probiotics in the diet can modulate brain activity.
In a proof-of-concept study using functional MRI (fMRI), researchers found that women who regularly consumed probiotic-containing yogurt showed altered activity of brain regions that control central processing of emotion and sensation. The study was funded by Danone Research.
"This study is unique because it is the first to show an interaction between a probiotic and the brain in humans," lead author Kirsten Tillisch, MD, associate professor, Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California Los Angeles, toldMedscape Medical News.
"We can't say whether the effects are beneficial; that will take larger studies with more complex designs. One of the areas this will move to is study of disease groups like irritable bowel syndrome and anxiety," she added.
The results appear in the June issue of Gastroenterology.
Modulating brain function
"This is a very important study as up to now most of the evidence that the gut microbiota can influence brain and behavior have emerged from studies in mouse models including our own work," said John Cryan, PhD, professor and head of the Department of Anatomy and Neuroscience, University College Cork, Ireland, who was not involved in the study.
"Tillisch and colleagues now have neatly shown that probiotics can also affect resting brain activity in human subjects using neuroimaging techniques. This gives credence to the idea that we may eventually modulate brain function in disease states using probiotics. That said, it is a small study, only in women, and the mechanism as to how the bacteria are inducing their effects remains unclear," Dr. Cryan said.
The study involved 36 healthy women with no gastrointestinal or psychiatric symptoms. Twice daily for 4 weeks, 12 women ate a fermented yogurt product containing the probiotics Bifidobacterium animalis subsp Lactis, Streptococcus thermophiles, Lactobacillus bulgaricus, and Lactococcus lactis subsp Lactis; 11 women ate a nonfermented milk product (controls), and 13 received no intervention.
The women underwent fMRI before and after the intervention to measure resting brain activity and brain responses to an emotion-recognition task in which they viewed a series of pictures of people with angry or scared faces and matched them to other faces showing the same emotions. The researchers say they chose this task because studies in animals have linked changes in gut flora to changes in affective behaviors.
During the emotional reactivity task, the probiotic group showed significantly reduced activity in a widely distributed functional network containing affective, viscerosensory, and somatosensory cortices.
During resting fMRI, the probiotic group showed greater connectivity between the periaqueductal grey matter of the midbrain and cognition-associated areas of the prefrontal cortex.
These changes were not observed in the group that consumed the nonfermented milk product; "thus the findings appear to be related to the ingested bacteria strains and their effects on the host," the authors say.
Gut-brain interactions
This study, they say, "clearly demonstrates" an effect of probiotic ingestion on evoked brain responses and resting-state networks in women. However, it was not designed to address the mechanisms mediating this effect.
Going forward, they say, "identification of the signaling pathways between the microbiota and the brain in humans is needed to solidify our understanding of microbiota gut-brain interactions. If confirmed, modulation of the gut flora can provide novel targets for the treatment of patients with abnormal pain and stress responses associated with gut dysbiosis."
"The knowledge that signals are sent from the intestine to the brain and that they can be modulated by a dietary change is likely to lead to an expansion of research aimed at finding new strategies to prevent or treat digestive, mental and neurological disorders," Emeran Mayer, MD, professor of medicine, physiology, and psychiatry at the David Geffen School of Medicine at UCLA and the study's senior author, told Medscape Medical News.
In a proof-of-concept study using functional MRI (fMRI), researchers found that women who regularly consumed probiotic-containing yogurt showed altered activity of brain regions that control central processing of emotion and sensation. The study was funded by Danone Research.
"This study is unique because it is the first to show an interaction between a probiotic and the brain in humans," lead author Kirsten Tillisch, MD, associate professor, Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California Los Angeles, toldMedscape Medical News.
"We can't say whether the effects are beneficial; that will take larger studies with more complex designs. One of the areas this will move to is study of disease groups like irritable bowel syndrome and anxiety," she added.
The results appear in the June issue of Gastroenterology.
Modulating brain function
"This is a very important study as up to now most of the evidence that the gut microbiota can influence brain and behavior have emerged from studies in mouse models including our own work," said John Cryan, PhD, professor and head of the Department of Anatomy and Neuroscience, University College Cork, Ireland, who was not involved in the study.
"Tillisch and colleagues now have neatly shown that probiotics can also affect resting brain activity in human subjects using neuroimaging techniques. This gives credence to the idea that we may eventually modulate brain function in disease states using probiotics. That said, it is a small study, only in women, and the mechanism as to how the bacteria are inducing their effects remains unclear," Dr. Cryan said.
The study involved 36 healthy women with no gastrointestinal or psychiatric symptoms. Twice daily for 4 weeks, 12 women ate a fermented yogurt product containing the probiotics Bifidobacterium animalis subsp Lactis, Streptococcus thermophiles, Lactobacillus bulgaricus, and Lactococcus lactis subsp Lactis; 11 women ate a nonfermented milk product (controls), and 13 received no intervention.
The women underwent fMRI before and after the intervention to measure resting brain activity and brain responses to an emotion-recognition task in which they viewed a series of pictures of people with angry or scared faces and matched them to other faces showing the same emotions. The researchers say they chose this task because studies in animals have linked changes in gut flora to changes in affective behaviors.
During the emotional reactivity task, the probiotic group showed significantly reduced activity in a widely distributed functional network containing affective, viscerosensory, and somatosensory cortices.
During resting fMRI, the probiotic group showed greater connectivity between the periaqueductal grey matter of the midbrain and cognition-associated areas of the prefrontal cortex.
These changes were not observed in the group that consumed the nonfermented milk product; "thus the findings appear to be related to the ingested bacteria strains and their effects on the host," the authors say.
Gut-brain interactions
This study, they say, "clearly demonstrates" an effect of probiotic ingestion on evoked brain responses and resting-state networks in women. However, it was not designed to address the mechanisms mediating this effect.
Going forward, they say, "identification of the signaling pathways between the microbiota and the brain in humans is needed to solidify our understanding of microbiota gut-brain interactions. If confirmed, modulation of the gut flora can provide novel targets for the treatment of patients with abnormal pain and stress responses associated with gut dysbiosis."
"The knowledge that signals are sent from the intestine to the brain and that they can be modulated by a dietary change is likely to lead to an expansion of research aimed at finding new strategies to prevent or treat digestive, mental and neurological disorders," Emeran Mayer, MD, professor of medicine, physiology, and psychiatry at the David Geffen School of Medicine at UCLA and the study's senior author, told Medscape Medical News.
Hepatitis B viral levels soar when vitamin D drops
Insufficient serum levels of vitamin D, which ebb and flow with sun exposure, are associated with high levels of hepatitis B virus (HBV) replication in treatment-naive people who suffer from chronic infection.
Harald Farnik, from the Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Germany, and colleagues report the results of their study in an article published online May 22 in Hepatology.
HBV infection remains one of the most significant infectious diseases worldwide. According to the World Health Organization, 2 billion people worldwide have been infected with HBV, and roughly 600,000 die each year. Without antiviral therapy, the virus can attack the liver, and chronic infections progress to liver disease and cirrhosis. An emerging body of evidence has shown that vitamin D plays a role in inflammatory and metabolic liver diseases and that vitamin D can have a therapeutic effect for patients with tuberculosis. Although previous research has failed to demonstrate a correlation between hepatitis C viral load and circulating vitamin D levels, Dr. Farnik and colleagues sought to characterize the relationship between vitamin D metabolism and chronic hepatitis B.
They analyzed serum samples from treatment-naive patients with chronic hepatitis who visited the outpatient liver clinic of the Johann Wolfgang Goethe University Hospital in Frankfurt, Germany from January 2009 to December 2012. Two hundred and three patients were enrolled in the study. Every 3 HBV-infected patients enrolled in the study were randomly matched, according to age and sex, with 2 HCV-infected patients. Sixty-nine of the patients had severe vitamin D deficiency (25(OH)D3 levels < 10 ng/mL), 95 had vitamin D insufficiency (25(OH)D3 ≥ 10 ng/mL and < 20 ng/mL), and 39 had normal vitamin D levels (25(OH)D3 ≥ 20 ng/mL), Dr. Farnik and colleagues write.
"25(OH)D3 and HBV DNA serum levels showed a significant, inverse correlation (P=0.0003)," the authors write. "In both uni- and multivariate analyses, HBV DNA was the strongest determinant of low 25(OH)D3 serum concentration in our cohort (P=0.0007 and P=0.000048), respectively.
Additional studies will be needed to establish a causal relationship between vitamin D metabolism and HBV replication, the researchers write, as well as to explore the effect of adding supplemental vitamin D to existing therapies to improve the durability of treatment.
"In conclusion, we demonstrate a significant association between low 25(OH)D3 serum levels and high levels of HBV replication in chronically infected patients," they authors write. "Future studies to evaluate a therapeutic value of vitamin D and its analogs in HBV infection may be justified."
Source:
Harald Farnik, from the Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Germany, and colleagues report the results of their study in an article published online May 22 in Hepatology.
HBV infection remains one of the most significant infectious diseases worldwide. According to the World Health Organization, 2 billion people worldwide have been infected with HBV, and roughly 600,000 die each year. Without antiviral therapy, the virus can attack the liver, and chronic infections progress to liver disease and cirrhosis. An emerging body of evidence has shown that vitamin D plays a role in inflammatory and metabolic liver diseases and that vitamin D can have a therapeutic effect for patients with tuberculosis. Although previous research has failed to demonstrate a correlation between hepatitis C viral load and circulating vitamin D levels, Dr. Farnik and colleagues sought to characterize the relationship between vitamin D metabolism and chronic hepatitis B.
They analyzed serum samples from treatment-naive patients with chronic hepatitis who visited the outpatient liver clinic of the Johann Wolfgang Goethe University Hospital in Frankfurt, Germany from January 2009 to December 2012. Two hundred and three patients were enrolled in the study. Every 3 HBV-infected patients enrolled in the study were randomly matched, according to age and sex, with 2 HCV-infected patients. Sixty-nine of the patients had severe vitamin D deficiency (25(OH)D3 levels < 10 ng/mL), 95 had vitamin D insufficiency (25(OH)D3 ≥ 10 ng/mL and < 20 ng/mL), and 39 had normal vitamin D levels (25(OH)D3 ≥ 20 ng/mL), Dr. Farnik and colleagues write.
"25(OH)D3 and HBV DNA serum levels showed a significant, inverse correlation (P=0.0003)," the authors write. "In both uni- and multivariate analyses, HBV DNA was the strongest determinant of low 25(OH)D3 serum concentration in our cohort (P=0.0007 and P=0.000048), respectively.
Additional studies will be needed to establish a causal relationship between vitamin D metabolism and HBV replication, the researchers write, as well as to explore the effect of adding supplemental vitamin D to existing therapies to improve the durability of treatment.
"In conclusion, we demonstrate a significant association between low 25(OH)D3 serum levels and high levels of HBV replication in chronically infected patients," they authors write. "Future studies to evaluate a therapeutic value of vitamin D and its analogs in HBV infection may be justified."
Source:
Food supplement linked to lower PSA in prostate cancer
A commercially available food supplement that contains pomegranate, broccoli, green tea, and turmeric significantly lowers prostate-specific antigen (PSA) levels, compared with placebo, in patients with prostate cancer, a double-blind placebo-controlled randomized trial has shown.
The study results, presented here at the 2013 Annual Meeting of the American Society of Clinical Oncology, made headlines around the world and caused the polyphenol-rich supplement, known as Pomi-T (nature Medical Products), to sell out within hours.
This is a "promising new therapy," said Tomasz Beer, MD, professor of medicine and director of the prostate cancer research program at the Oregon Health and Science University in Portland, during a "highlights of the day" session.
"We have been staggered by the level of interest...from medical professionals and the public," Marcus Williams, owner and director of natureMedical Products, told Medscape Medical News. As soon as the results of this study were released, the company, based in Porthcawl, South Wales, United Kingdom, received a rush of orders from customers in Australia, Canada, the United Kingdom, and the United States.
"It's awesome," the study's lead investigator, Robert Thomas, MD, a consultant oncologist at Bedford Hospital and Addenbrooke's Hospital, in the United Kingdom, told Medscape Medical News.
"We didn't expect such a big response. People are seeing that this can change practice...because men and their doctors do look at their PSA as a deciding factor in whether to stop active management," he explained.
Significantly different than placebo
The study involved 203 men (average age, 74 years) with a PSA relapse after radiotherapy or surgery for localized prostate cancer. The men, who were being managed with active surveillance, were randomized to receive the supplement 3 times a day for 6 months or placebo.
At 6-month follow-up, the median increase in PSA was 63.8% lower in the supplement groups than in the placebo group (14.7% vs 78.5; P =.0008). In addition, PSA levels were stable or lower than baseline more often in the supplement group (46% vs 14%;P = .00001).
Fewer men in the supplement group than in the placebo group went on to receive brachytherapy, radiotherapy, surgery, or androgen-deprivation therapy (7.4% vs 26.0%; P = 0.01).
At the end of the study, more men in the supplement group than in the placebo group continued on active surveillance (92.6% vs 74.0%). "This is an end point we feel is important: more men were choosing to stay on treatments with less toxicity," Dr. Thomas noted.
There were no differences between the supplement and placebo groups for baseline and serial measurements of cholesterol, blood pressure, serum glucose, C-reactive protein, or adverse events.
"Pomi-T was well tolerated," he said. "More men experienced nonsignificant bloating or diarrhea, but 15% of men reported beneficial effects, including better digestion and improvement of urinary symptoms."
Previous research has shown that the polyphenols and antioxidants in pomegranate, broccoli, green tea, and turmeric have individual anticancer properties, but "we believe there's a synergistic effect in the supplement," said Dr. Thomas.
In addition, the fact that each ingredient originates from a separate food category (fruit, vegetable, herb, and spice) might prevent potential adverse effects from the overconsumption of one particular type of polyphenol, he noted.
In the lab, polyphenols have been shown to have antiproliferative, antiangiogenic, proadhesion, antimetastatic, and proapoptotic properties, and notably, they have no phytoestrogenic or hormonal effects. "We specifically chose to steer away from anything that might have a hormonal effect."
Because of the supplement's effect is likely not hormonal, future trials will involve men with different stages of prostate cancer and those receiving androgen-deprivation therapy, he said. In addition, the researchers hope to look at the impact of the supplement on other slow-growing cancers and even on cancer prevention.
The study received no funding from the manufacturer of the supplement; however, the company worked very closely with the research team to develop the product, said Williams. "Unlike other nutritional supplement products, the manufacture of this supplement was significantly more time-consuming because Dr. Thomas and colleagues, for whom this was initially made, insisted on a great deal of quality assurance, over and above that normally required by the US Food and Drug Administration or European Commission, particularly in terms of purity and authenticity."
He said the study signals "a new era for the nutritional supplement industry, which has previously relied on advertising and marketing rather than evidence of benefit. Clearly, it's the latter that the public wants."
Dr. Beer noted that the product's significant effect on adherence to active surveillance is "potentially clinically meaningful... If this can be confirmed, this is really interesting," he said, although he added that "these patients were more severe than the sort of patients that we would follow [with active surveillance] here in the United States."
Prostate Cancer UK reacted more cautiously to the news, releasing a statment saying that "there is not yet enough evidence that Pomi-T food supplements have a significant impact."
Kate Holmes, MD, head of research at Prostate Cancer UK, said in a statement that "there is increasing evidence showing that men who have a healthy lifestyle, including a balanced diet and regular exercise, have better prostate cancer outcomes than those who do not. At this stage, however, we simply do not have enough evidence to suggest that any particular foods or supplements have a significant impact and these should certainly not be substituted for conventional treatments."
Source: http://www.medscape.com/viewarticle/805549?nlid=31706_1301&src=wnl_edit_dail&uac=129655SZ
The study results, presented here at the 2013 Annual Meeting of the American Society of Clinical Oncology, made headlines around the world and caused the polyphenol-rich supplement, known as Pomi-T (nature Medical Products), to sell out within hours.
This is a "promising new therapy," said Tomasz Beer, MD, professor of medicine and director of the prostate cancer research program at the Oregon Health and Science University in Portland, during a "highlights of the day" session.
"We have been staggered by the level of interest...from medical professionals and the public," Marcus Williams, owner and director of natureMedical Products, told Medscape Medical News. As soon as the results of this study were released, the company, based in Porthcawl, South Wales, United Kingdom, received a rush of orders from customers in Australia, Canada, the United Kingdom, and the United States.
"It's awesome," the study's lead investigator, Robert Thomas, MD, a consultant oncologist at Bedford Hospital and Addenbrooke's Hospital, in the United Kingdom, told Medscape Medical News.
"We didn't expect such a big response. People are seeing that this can change practice...because men and their doctors do look at their PSA as a deciding factor in whether to stop active management," he explained.
Significantly different than placebo
The study involved 203 men (average age, 74 years) with a PSA relapse after radiotherapy or surgery for localized prostate cancer. The men, who were being managed with active surveillance, were randomized to receive the supplement 3 times a day for 6 months or placebo.
At 6-month follow-up, the median increase in PSA was 63.8% lower in the supplement groups than in the placebo group (14.7% vs 78.5; P =.0008). In addition, PSA levels were stable or lower than baseline more often in the supplement group (46% vs 14%;P = .00001).
Fewer men in the supplement group than in the placebo group went on to receive brachytherapy, radiotherapy, surgery, or androgen-deprivation therapy (7.4% vs 26.0%; P = 0.01).
At the end of the study, more men in the supplement group than in the placebo group continued on active surveillance (92.6% vs 74.0%). "This is an end point we feel is important: more men were choosing to stay on treatments with less toxicity," Dr. Thomas noted.
There were no differences between the supplement and placebo groups for baseline and serial measurements of cholesterol, blood pressure, serum glucose, C-reactive protein, or adverse events.
"Pomi-T was well tolerated," he said. "More men experienced nonsignificant bloating or diarrhea, but 15% of men reported beneficial effects, including better digestion and improvement of urinary symptoms."
Previous research has shown that the polyphenols and antioxidants in pomegranate, broccoli, green tea, and turmeric have individual anticancer properties, but "we believe there's a synergistic effect in the supplement," said Dr. Thomas.
In addition, the fact that each ingredient originates from a separate food category (fruit, vegetable, herb, and spice) might prevent potential adverse effects from the overconsumption of one particular type of polyphenol, he noted.
In the lab, polyphenols have been shown to have antiproliferative, antiangiogenic, proadhesion, antimetastatic, and proapoptotic properties, and notably, they have no phytoestrogenic or hormonal effects. "We specifically chose to steer away from anything that might have a hormonal effect."
Because of the supplement's effect is likely not hormonal, future trials will involve men with different stages of prostate cancer and those receiving androgen-deprivation therapy, he said. In addition, the researchers hope to look at the impact of the supplement on other slow-growing cancers and even on cancer prevention.
The study received no funding from the manufacturer of the supplement; however, the company worked very closely with the research team to develop the product, said Williams. "Unlike other nutritional supplement products, the manufacture of this supplement was significantly more time-consuming because Dr. Thomas and colleagues, for whom this was initially made, insisted on a great deal of quality assurance, over and above that normally required by the US Food and Drug Administration or European Commission, particularly in terms of purity and authenticity."
He said the study signals "a new era for the nutritional supplement industry, which has previously relied on advertising and marketing rather than evidence of benefit. Clearly, it's the latter that the public wants."
Dr. Beer noted that the product's significant effect on adherence to active surveillance is "potentially clinically meaningful... If this can be confirmed, this is really interesting," he said, although he added that "these patients were more severe than the sort of patients that we would follow [with active surveillance] here in the United States."
Prostate Cancer UK reacted more cautiously to the news, releasing a statment saying that "there is not yet enough evidence that Pomi-T food supplements have a significant impact."
Kate Holmes, MD, head of research at Prostate Cancer UK, said in a statement that "there is increasing evidence showing that men who have a healthy lifestyle, including a balanced diet and regular exercise, have better prostate cancer outcomes than those who do not. At this stage, however, we simply do not have enough evidence to suggest that any particular foods or supplements have a significant impact and these should certainly not be substituted for conventional treatments."
Source: http://www.medscape.com/viewarticle/805549?nlid=31706_1301&src=wnl_edit_dail&uac=129655SZ
Tea and coffee lower blood pressure
A large French retrospective analysis provides good news for caffeine lovers: investigators showed that drinking tea or coffee was associated with a small but statistically significant reduction in systolic and diastolic blood pressure. In addition, drinking tea and coffee was also associated with a significant reduction in pulse pressure and heart rate, although the heart-rate reductions were greater with tea.
Presenting the results at the European Society of Hypertension (ESH) 2013 Scientific Sessions, Dr Bruno Pannier (Centre d'Investigations Préventives et Cliniques, Paris, France) said that other studies have suggested a relationship between coffee and tea consumption and blood pressure, but these analyses haven't been conclusive. Some have suggested a benefit, while others found no relationship between tea/coffee consumption and blood pressure.
Presenting the data on 176 437 subjects aged 16 to 95 years of age who had a checkup at their center between 2001 and 2011, Pannier explained that the analysis was simply based on a questionnaire asking participants how much coffee or tea they drank per day. Individuals were classified into three groups: those who drank no coffee/tea, those who drank one to four cups, and those who drank more than four cups.
Overall, coffee is consumed more frequently than tea, although there were differences between the sexes, said Pannier. Men were more likely to drink coffee, while women were more commonly tea drinkers. Coffee consumption was also significantly associated with tobacco consumption, higher cholesterol levels, and higher scores on stress and depression indexes. Tea consumption, on the other hand, was associated with lower cholesterol levels but similarly high scores on the stress and depression measurements.
After adjustments that included these and other potential confounding variables, both coffee and tea consumption was associated with a significant reduction in systolic and diastolic blood pressure, as well as other variables.
Speaking during the session, Pannier explained that the group did not differentiate between green, black, or herbal tea consumption, which is one of the limitations of the analysis. In addition, the questionnaire is not sophisticated enough to address estimates in the caffeine content of the coffee consumed in France.
That said, Pannier believes that tea is a major source of flavonoids in the diet, and these compounds can improve vasodilation. "The vasorelaxing compounds included in these beverages might be involved in these results, something that has been suggested by the experimental data," he said.
Source: http://www.medscape.com/viewarticle/806516?nlid=31779_1301&src=wnl_edit_dail&uac=129655SZ
Presenting the results at the European Society of Hypertension (ESH) 2013 Scientific Sessions, Dr Bruno Pannier (Centre d'Investigations Préventives et Cliniques, Paris, France) said that other studies have suggested a relationship between coffee and tea consumption and blood pressure, but these analyses haven't been conclusive. Some have suggested a benefit, while others found no relationship between tea/coffee consumption and blood pressure.
Presenting the data on 176 437 subjects aged 16 to 95 years of age who had a checkup at their center between 2001 and 2011, Pannier explained that the analysis was simply based on a questionnaire asking participants how much coffee or tea they drank per day. Individuals were classified into three groups: those who drank no coffee/tea, those who drank one to four cups, and those who drank more than four cups.
Overall, coffee is consumed more frequently than tea, although there were differences between the sexes, said Pannier. Men were more likely to drink coffee, while women were more commonly tea drinkers. Coffee consumption was also significantly associated with tobacco consumption, higher cholesterol levels, and higher scores on stress and depression indexes. Tea consumption, on the other hand, was associated with lower cholesterol levels but similarly high scores on the stress and depression measurements.
After adjustments that included these and other potential confounding variables, both coffee and tea consumption was associated with a significant reduction in systolic and diastolic blood pressure, as well as other variables.
Blood Pressure Among Coffee Drinkers
| Variable | None | 1 to 4 cups | >4 cups | p (for trend) |
| Systolic blood pressure (mm Hg) | 127.9 | 126.7 | 125.5 | <0.0001 |
| Diastolic blood pressure (mm Hg) | 76.0 | 76.0 | 75.7 | 0.02 |
| Pulse pressure (mm Hg) | 51.9 | 50.7 | 49.8 | <0.0001 |
| Heart rate (beats/min) | 63.2 | 62.9 | 63.2 | 0.001 |
Blood Pressure Among Tea Drinkers
| Variable | None | 1 to 4 cups | >4 cups | p (for trend) |
| Systolic blood pressure (mm Hg) | 127.3 | 126.3 | 125.3 | <0.0001 |
| Diastolic blood pressure (mm Hg) | 76.2 | 75.6 | 75.0 | <0.0001 |
| Pulse pressure (mmHg) | 51.1 | 50.7 | 50.3 | <0.0001 |
| Heart rate (beats/min) | 63.5 | 62.7 | 62.0 | <0.0001 |
Speaking during the session, Pannier explained that the group did not differentiate between green, black, or herbal tea consumption, which is one of the limitations of the analysis. In addition, the questionnaire is not sophisticated enough to address estimates in the caffeine content of the coffee consumed in France.
That said, Pannier believes that tea is a major source of flavonoids in the diet, and these compounds can improve vasodilation. "The vasorelaxing compounds included in these beverages might be involved in these results, something that has been suggested by the experimental data," he said.
Source: http://www.medscape.com/viewarticle/806516?nlid=31779_1301&src=wnl_edit_dail&uac=129655SZ
Mindful meditation has antianxiety effects
Individuals with no experience in meditation who participate in mindful meditation training sessions for as little as 4 days show changes in specific brain mechanisms that correlate with a reduction in anxiety, a new imaging study shows.
"There is plenty of evidence that meditation can improve a host of issues, such as pain and cognitive function, and anxiety is perhaps at the top of the list," explained lead author Fadel Zeidan, PhD, a postdoctoral research fellow in neurobiology and anatomy at Wake Forest School of Medicine, in Winston-Salem, North Carolina.
"But what we've been able to do is to correlate, through imaging, changes in specific brain regions that are related to anxiety, even in a cohort of people with no anxiety or depression."
The findings were published online April 24 in Social Cognitive and Affective Neuroscience.
Buffer to anxiety
For the study, Dr. Zeidan and his colleagues recruited 15 healthy volunteers with normal levels of anxiety and no experience in meditation to participate in four 20-minute training sessions to learn the technique for mindful meditation.
This involves a focus on breathing and a conscious acknowledging of distracting thoughts and emotions, combined with a decision not to react to them.
"You're trained to focus on keeping a very straight posture and the sensations of the rise and fall of your chest and abdomen as you breathe," Dr. Zeidan explained.
"If your mind becomes distracted, you acknowledge the distraction, let it go, and focus back on the breathing. You are regulating your emotional responses."
Before and after each meditation training session, the participants, who included graduate students and faculty, received brain activity imaging with pulsed arterial spin labeling magnetic resonance imaging (MRI).
The participants also were administered the State Anxiety Inventory, a 20-item subscale of the State Trait Anxiety Inventory, before and after the brain imaging.
While the participants reported meditation-related reductions in anxiety ratings by as much as 22%, the MRIs showed anxiety relief to be associated with activation of the anterior cingulate cortex and ventromedial prefrontal cortex (vmPFC), which show decreases in activity when anxiety is present.
The vmPFC is also implicated in the alteration of contextual evaluation of affective processes, the authors write.
"Activation in the vmPFC is associated with modulating higher-order affective appraisals, including cognitive regulation of negative emotions."
In addition, reports of greater anxiety correlated with greater default-related activity (ie, posterior cingulate cortex) on MRI, "possibly reflecting an inability to control self-referential thoughts," the authors write.
The brain mechanisms related to the reduction of anxiety through mindful meditation in healthy people have never been identified, so the findings help confirm that the changes do occur, said Dr. Zeidan.
"It shows that mindful meditation can be sort of this buffer to anxiety. After just a brief training, you can reduce this ruminative thought process, change your attention, and change the context in how you respond to things," he said.
Potential payoff
Amit Sood, MD, director of research and practice in the Mayo Complementary and Integrative Medicine Program at Mayo Clinic, in Rochester, Minnesota, said that such changes are not unexpected over such a short period.
"I'm not surprised to see the correlations with reductions of anxiety in 4 days — other studies looking at brain structure have reported seeing these changes after just 4 to 6 hours of training," said Dr. Sood.
"What I would be surprised to see, however, is if they were still doing it on their own after 6 months," he noted.
"People can learn it quickly, but then they forget. A change in habit requires a lot of effort. People have to carve out the time in their busy days, and what tends to happen is will power depletion."
The study demonstrates, however, the potential payoff, he added.
"I wouldn't call this a landmark study, but it does validate the overall theme we're seeing in this field," Dr. Sood said.
"It adds another bullet point of how we can understand emotional and brain states, and eventually this may help us better classify people based on what is actually happening in the brain, beyond their displayed symptoms."
"There is plenty of evidence that meditation can improve a host of issues, such as pain and cognitive function, and anxiety is perhaps at the top of the list," explained lead author Fadel Zeidan, PhD, a postdoctoral research fellow in neurobiology and anatomy at Wake Forest School of Medicine, in Winston-Salem, North Carolina.
"But what we've been able to do is to correlate, through imaging, changes in specific brain regions that are related to anxiety, even in a cohort of people with no anxiety or depression."
The findings were published online April 24 in Social Cognitive and Affective Neuroscience.
Buffer to anxiety
For the study, Dr. Zeidan and his colleagues recruited 15 healthy volunteers with normal levels of anxiety and no experience in meditation to participate in four 20-minute training sessions to learn the technique for mindful meditation.
This involves a focus on breathing and a conscious acknowledging of distracting thoughts and emotions, combined with a decision not to react to them.
"You're trained to focus on keeping a very straight posture and the sensations of the rise and fall of your chest and abdomen as you breathe," Dr. Zeidan explained.
"If your mind becomes distracted, you acknowledge the distraction, let it go, and focus back on the breathing. You are regulating your emotional responses."
Before and after each meditation training session, the participants, who included graduate students and faculty, received brain activity imaging with pulsed arterial spin labeling magnetic resonance imaging (MRI).
The participants also were administered the State Anxiety Inventory, a 20-item subscale of the State Trait Anxiety Inventory, before and after the brain imaging.
While the participants reported meditation-related reductions in anxiety ratings by as much as 22%, the MRIs showed anxiety relief to be associated with activation of the anterior cingulate cortex and ventromedial prefrontal cortex (vmPFC), which show decreases in activity when anxiety is present.
The vmPFC is also implicated in the alteration of contextual evaluation of affective processes, the authors write.
"Activation in the vmPFC is associated with modulating higher-order affective appraisals, including cognitive regulation of negative emotions."
In addition, reports of greater anxiety correlated with greater default-related activity (ie, posterior cingulate cortex) on MRI, "possibly reflecting an inability to control self-referential thoughts," the authors write.
The brain mechanisms related to the reduction of anxiety through mindful meditation in healthy people have never been identified, so the findings help confirm that the changes do occur, said Dr. Zeidan.
"It shows that mindful meditation can be sort of this buffer to anxiety. After just a brief training, you can reduce this ruminative thought process, change your attention, and change the context in how you respond to things," he said.
Potential payoff
Amit Sood, MD, director of research and practice in the Mayo Complementary and Integrative Medicine Program at Mayo Clinic, in Rochester, Minnesota, said that such changes are not unexpected over such a short period.
"I'm not surprised to see the correlations with reductions of anxiety in 4 days — other studies looking at brain structure have reported seeing these changes after just 4 to 6 hours of training," said Dr. Sood.
"What I would be surprised to see, however, is if they were still doing it on their own after 6 months," he noted.
"People can learn it quickly, but then they forget. A change in habit requires a lot of effort. People have to carve out the time in their busy days, and what tends to happen is will power depletion."
The study demonstrates, however, the potential payoff, he added.
"I wouldn't call this a landmark study, but it does validate the overall theme we're seeing in this field," Dr. Sood said.
"It adds another bullet point of how we can understand emotional and brain states, and eventually this may help us better classify people based on what is actually happening in the brain, beyond their displayed symptoms."
Source: http://www.medscape.com/viewarticle/806288?nlid=31771_1301&src=wnl_edit_dail&uac=129655SZ
Diclofenac poses similar risks as COX-2 Inhibitors
The Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) has completed its review of diclofenac and concluded that the drug poses similar risks as selective COX-2 inhibitors, particularly when used in high doses (150 mg) or when used long term [1].
Still, committee says the benefits of diclofenac exceed the risks and that physicians should take the same precautions to minimize thromboembolic events as they do with patients treated with selective COX-2 inhibitors.
"Patients who have serious underlying heart or circulatory conditions, such as heart failure, heart disease, circulatory problems, or a previous heart attack or stroke, should not use diclofenac," according to PRAC. "Patients with certain cardiovascular risk factors (such as high blood pressure, raised blood cholesterol, diabetes, or smoking) should only use diclofenac after careful consideration. Healthcare professionals will also be advised to periodically reassess the need for patients to continue taking the medicine."
The review conducted by PRAC was launched in October 2012 after the EMA completed a report on published information assessing the cardiovascular safety of nonsteroidal anti-inflammatory drugs (NSAIDs). Like PRAC, the EMA concluded that there was a consistent but small increase in the risk of cardiovascular side effects with diclofenac compared with other NSAIDs and that this risk was on par with that observed with COX-2 inhibitors.
The current PRAC conclusions are based on all published and unpublished data. Its recommendations will now be forwarded to the Coordination Group for Mutual Recognition and Decentralized Procedures--Human (CMDh), a regulatory body representing member European Union states, which will adopt a final position.
Still, committee says the benefits of diclofenac exceed the risks and that physicians should take the same precautions to minimize thromboembolic events as they do with patients treated with selective COX-2 inhibitors.
"Patients who have serious underlying heart or circulatory conditions, such as heart failure, heart disease, circulatory problems, or a previous heart attack or stroke, should not use diclofenac," according to PRAC. "Patients with certain cardiovascular risk factors (such as high blood pressure, raised blood cholesterol, diabetes, or smoking) should only use diclofenac after careful consideration. Healthcare professionals will also be advised to periodically reassess the need for patients to continue taking the medicine."
The review conducted by PRAC was launched in October 2012 after the EMA completed a report on published information assessing the cardiovascular safety of nonsteroidal anti-inflammatory drugs (NSAIDs). Like PRAC, the EMA concluded that there was a consistent but small increase in the risk of cardiovascular side effects with diclofenac compared with other NSAIDs and that this risk was on par with that observed with COX-2 inhibitors.
The current PRAC conclusions are based on all published and unpublished data. Its recommendations will now be forwarded to the Coordination Group for Mutual Recognition and Decentralized Procedures--Human (CMDh), a regulatory body representing member European Union states, which will adopt a final position.
Source: http://www.medscape.com/viewarticle/806308?nlid=31771_1301&src=wnl_edit_dail&uac=129655SZ
Silver enhances antibiotic activity against gram-negative bacteria in mice
The use of silver in medicine is as old as western medicine itself. Hippocrates is known to have used it to treat ulcers and wounds, the Romans almost certainly knew of its healing properties, its use continued through the middle ages and up to the present day. In the antibiotic age, interest in silver may have waned a little. But with urgent need to fight antibiotic-resistant bacteria, there is resurgence in its uses.
The reason is that silver can kill bacteria selectively and, more importantly, bacteria are unable to develop resistance against it. Despite silver’s long medical history, we do not know how it operates. A paper published last Thursday in the journal Science Translational Medicine sheds some light on silver’s success against bacteria. The most important find is that silver – unlike most antibiotics – works in more than one way. This is perhaps why bacteria are not able to build resistance to silver.
Here is silver’s multi-pronged approach: first, silver sticks very strongly to sulfur, found in parts of proteins. These sulfur groups normally bond to each other in proteins, holding them together and keeping the protein folded up in its correct shape. But if silver interacts with sulfur then the protein cannot fold correctly, and thus it cannot do its job. Next silver interferes with how bacteria use iron. Iron is often held in the places it is needed by binding to sulfur. And since silver also interacts with sulfur it stops the iron doing so. Finally, silver causes bacteria to produce extremely toxic substances called reactive oxygen species. These go on to cause damage inside the cell, harming the DNA, proteins and even the membranes that surround cells.
The net result of this silver onslaught is bacteria with severely damaged defences. Most importantly the membranes and walls that surround it are leakier after the silver treatment. Once weakened, they are much more susceptible to conventional antibiotics. James Collins, at Boston University, who led the research showed that with added silver, less antibiotic drug is needed to kill the bugs. A great result in itself, but it gets better. Silver also reverses antibiotic resistance of E. coli bacteria making them, once more, susceptible to tetracycline.
These experiments not only worked in a Petri dish. When silver was added to standard antibiotics such as gentamicin and vancomycin, Collins could treat E. coli infections in the bladder and abdomens of mice. Normally these drugs have little effect on E. coli infections because they are designed to attack a completely separate class of bacteria.
Bacteria are broadly classified into two groups called Gram-negative or Gram-positive. Gram-negatives have an extra cell membrane that protects the bacteria, which means that it is much more difficult for some antibiotics, such as gentamicin and vancomycin, to penetrate the cell. It seems that silver negates this advantage and allows even weaker drugs to do their jobs. Finally, Collins showed that the mice themselves remain unharmed by silver. If he is able to repeat this work in humans, then he may actually have a “silver bullet” for antibiotic resistance.
The reason is that silver can kill bacteria selectively and, more importantly, bacteria are unable to develop resistance against it. Despite silver’s long medical history, we do not know how it operates. A paper published last Thursday in the journal Science Translational Medicine sheds some light on silver’s success against bacteria. The most important find is that silver – unlike most antibiotics – works in more than one way. This is perhaps why bacteria are not able to build resistance to silver.
Here is silver’s multi-pronged approach: first, silver sticks very strongly to sulfur, found in parts of proteins. These sulfur groups normally bond to each other in proteins, holding them together and keeping the protein folded up in its correct shape. But if silver interacts with sulfur then the protein cannot fold correctly, and thus it cannot do its job. Next silver interferes with how bacteria use iron. Iron is often held in the places it is needed by binding to sulfur. And since silver also interacts with sulfur it stops the iron doing so. Finally, silver causes bacteria to produce extremely toxic substances called reactive oxygen species. These go on to cause damage inside the cell, harming the DNA, proteins and even the membranes that surround cells.
The net result of this silver onslaught is bacteria with severely damaged defences. Most importantly the membranes and walls that surround it are leakier after the silver treatment. Once weakened, they are much more susceptible to conventional antibiotics. James Collins, at Boston University, who led the research showed that with added silver, less antibiotic drug is needed to kill the bugs. A great result in itself, but it gets better. Silver also reverses antibiotic resistance of E. coli bacteria making them, once more, susceptible to tetracycline.
These experiments not only worked in a Petri dish. When silver was added to standard antibiotics such as gentamicin and vancomycin, Collins could treat E. coli infections in the bladder and abdomens of mice. Normally these drugs have little effect on E. coli infections because they are designed to attack a completely separate class of bacteria.
Bacteria are broadly classified into two groups called Gram-negative or Gram-positive. Gram-negatives have an extra cell membrane that protects the bacteria, which means that it is much more difficult for some antibiotics, such as gentamicin and vancomycin, to penetrate the cell. It seems that silver negates this advantage and allows even weaker drugs to do their jobs. Finally, Collins showed that the mice themselves remain unharmed by silver. If he is able to repeat this work in humans, then he may actually have a “silver bullet” for antibiotic resistance.
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