Dr. Bray Links

Monday, January 30, 2017

More Support for Gut-Brain Link in Autism

A new study provides more evidence of a gut-brain relationship in autism spectrum disorder (ASD).

In intestinal epithelial tissue from patients with ASD, researchers observed reduced expression of barrier-forming cellular components and higher expression of molecules that increase intestinal permeability. In postmortem brain tissue from patients with ASD, they observed altered expression of genes associated with blood-brain barrier (BBB) integrity and function in association with neuroinflammation.

"Our study is the first to explore mechanistically the molecular signature of defects in the gut epithelial barrier and the BBB in ASD," Maria Rosaria Fiorentino, PhD, of Harvard Medical School and the Mucosal Immunology and Biology Research Center at Massachusetts General Hospital East in Charlestown, told Medscape Medical News.

"Our findings suggest there is a molecular mechanism linking the gut and brain that involves both the intestine and the BBB in the pathophysiology of ASD. Elucidating the molecular basis of gut and BBB impairment in ASD will be the first step toward the design of more targeted and effective therapies. If we can prevent alterations of the function of these barriers, we may be able to treat the GI symptoms and/or autism core symptoms in the ASD population," she added.


Residents Spend More Time on Computer Than With Patients

Medical residents at a Swiss teaching hospital spend almost half of their workday on the computer, which is approximately three times the amount of time they spend with patients, according to a study published online today in the Annals of Internal Medicine.

On average, residents spend 1.7 hours per day with patients, compared with 5.2 hours using computers, and 13 minutes doing both.

The findings, reported by Nathalie Wenger, MD, from the Department of Internal Medicine at Lausanne University Hospital in Switzerland, and colleagues mirror patterns seen among internal medicine residents in the United States.


Global Influenza Vaccine Market 2017 Latest Report

While the country suffers  at the peak of influenza season, it is best to consider the profitability of the influenza vaccine market... 

"The influenza vaccine market in the US is the largest market globally because of its strong dynamics and a great scope of innovation in the region. The growth factors of the market include increase in incidence of H1N1 outbreaks, rising spending on public healthcare programs, growth of the market in emerging economies, escalating ageing population and increase in spending on medicines and healthcare expenditure."


Saturday, January 28, 2017

Neurocognitive Risk From PCSK9 Inhibitors Hinted in Meta-Analysis

However, when they only looked at the two large studies (ODYSSEY LONG TERM and OSLER), which accounted for about 65% of all patients, they found a more than twofold increase in incidence of neurocognitive events (odds ratio 2.81, 95% CI 1.32–5.99; P=0.007). These events included delirium (including confusion), cognitive and attention disorders and disturbances, dementia and amnestic conditions, disturbances in thinking and perception, and mental-impairment disorders.


What causes heart disease

by Dr Malcolm Kendrick

Returning to the central process of cardiovascular disease (CVD), for a moment. If you are going to reduce the risk of cardiovascular disease, you must do, at least, one of three things:

  • Protect the endothelium (lining of blood vessels) from harm
  • Reduce the risk of blood clots forming – especially over areas of endothelial damage
  • Reduce the size and tenacity (difficulty of being broken down) of the blood clots that develop
  • If you can do all three, you will reduce your risk of dying of a heart attack, or stroke, to virtually zero.

What protects the endothelium?

There are many things that that can do this, but the number one agent that protects the endothelium is nitric oxide (NO). Thus, anything that stimulates NO synthesis will be protective against CVD. Which brings us to sunshine and vitamin D.

  • Sunlight on the skin directly stimulates NO synthesis, which has been shown to reduce blood pressure, improve arterial elasticity, and a whole host of other beneficial things for your cardiovascular system, not least a reduction in blood clot formation.
  • Sunlight on the skin also creates vitamin D, which has significant impact on NO synthesis in endothelial cells, alongside many other actions. It also prevents cancer, so you get a double benefit.

Therefore, my first direct piece of direct advice for those who want to prevent heart disease, is to sunbathe. In the winter when the sun is not shining take vitamin D supplementation. Alternatively, go on holiday to somewhere sunny. Or get a UVB sunbed, and use it.

My only note of warning here is to say, don’t burn, it is painful and you don’t need to.


Intensive LDL-cholesterol lowering therapy and neurocognitive function

Schematic presentation of the potential mechanisms (1 − 2 − 3) of statins on neurocognition: (1) the potential role of total cholesterol reduction and/or alterations in isoprenoid levels; (2) the influence of age, education level, increased body mass index, waist hip ratio, insulin resistance, and other possible risk factors; (3) the meaning of the modulation of NMDA receptor and/or activation of Aβ cascade and/or β-amyloid and tau phosphorylation. Detailed information on the suggested mechanisms can be found in the section: Potential pathomechanisms involved in neurocognition.


Statins may increase endothelial nitric oxide syntheses and decrease endothelin-1, thereby increasing cerebral blood flow (Cucchiara and Kasner, 2001 and Sahebkar et al., 2015). The antioxidant, anti-inflammatory, and platelet effects of statins may also play a role in neuroprotection (Serban et al., 2015). On the other hand, controversial recent research has suggested that the cholesterol-independent activities of statins possibly involve alterations in isoprenoid levels (Ling & Tejada-Simon, 2016). A reduction of isoprenoids in the central nervous system might result in effective biochemical and behavioural improvements in certain neurological disorders (Ling & Tejada-Simon, 2016) (Fig. 1). Actually, besides regulating the synthesis of cholesterol, statins also inhibit the production of mevalonate and downstream isoprenoids (farnesyl pyrophosphate and geranylgeranyl pyrophosphate), which appears to contribute to the effects of statins on, among others, neurological disorders (Ghosh et al., 2009, Ling and Tejada-Simon, 2016 and Osterweil et al., 2013). There is also evidence that statin therapy induces a significant reduction of isoprenoids (such as farnesyl pyrophosphate and geranylgeranyl pyrophosphate) in the brain with only a slight effect on cholesterol level (Wood, Mupsilonller, & Eckert, 2014). While still controversial, recent research has suggested that statins have cholesterol-independent activities in the central nervous system, and therefore might be involved in brain function. One prominent effect is the inhibition on the prenylation of small G proteins (Ling & Tejada-Simon, 2016). However, in the brain, whether inhibition of isoprenylation will occur without compromising safe cholesterol levels is still uncertain and poorly studied. Several available studies, however, support the idea that, while changes in plasma cholesterol can be significant, only minimal changes in brain cholesterol occur after treatment with statins, pointing to their effects in the brain as independent of local cholesterol metabolism (Butterfield et al., 2011 and Eckert et al., 2009). It remains controversial and poorly determined which effect, cholesterol-dependent or cholesterol-independent is more closely related to the reported effects of statins on neurological diseases. Biochemically, a key question is at which level is the mevalonate/cholesterol synthesis pathway affected, and whether this plays a role in any symptoms observed (Ling & Tejada-Simon, 2016).


Friday, January 27, 2017

Pall Protocol for Treating Chronic Fatigue Syndrome

Some researchers speculate that chronic fatigue syndrome (CFS or ME/CFS) and fibromyalgia (FMS) could have a common cause. One researcher says that cause is nitric oxide and that it is also responsible for multiple chemical sensitivity (MCS) and post-traumatic stress disorder (PTSD).

Martin Pall, ​PHD, is a professor of microbiology at Washington State University and started looking into ME/CFS after he was diagnosed with it.

The essence of his theory is that short-term stressors cause a build up of naturally occurring nitric oxide, which starts a vicious cycle and leads to long-term illness.

It's important to remember that this protocol is experimental and has not been scientifically proven. A growing number of studies, however, support the theory of dysfunctional oxidative pathways, and some people who've tried the protocol say it has worked for them.

The information here is not intended to either support or refute Pall's theory but is here to inform you about available theories and treatment protocols so you can make informed decisions. It's important to include your doctor in your treatment decisions and to be monitored for any changes to your health.


Gut bacteria mediate link between diet and colorectal cancer

In 2017, it is estimated that there will be 95,520 new cases of colon cancer and 39,910 new cases of rectal cancer diagnosed in the U.S.

Studies have shown that a diet high in red and processed meats may increase the risk of colorectal cancer, while a high-fiber diet - rich in fruits, vegetables, and whole grains - has been associated with a lower risk of the disease.

Previous research has suggested that one way by which diet influences the risk of colorectal cancer is through the changes it makes to the gut microbiome (the population of microorganisms that live in the intestine).

The new study from Dr. Ogino and team supports this association, after finding that individuals who followed a high-fiber diet were at a lower risk of developing colorectal cancer tumors containing the bacterium F. nucleatum. 


Thursday, January 26, 2017

Wal-Mart identifies eight chemicals to be removed from products | Fox News

Wal-Mart Stores Inc said on Wednesday it was pushing suppliers to remove eight hazardous chemicals from products including household cleaning, personal care and beauty items.

The chemicals include formaldehyde, a carcinogen found in wood products and building materials; butylparaben used as a preservative in cosmetics; and triclosan, which is used in toothpaste for treating plaque.

Wal-Mart committed in 2013 to increase transparency about ingredients in products it sells, advance safer formulations and attain the U.S. Environmental Protection Agency's Safer Choice certification for Walmart private brand products. 


Target revamps chemical use policy, asks suppliers to list ingredients | Fox News

The company said it is seeking to remove perfluorinated chemicals and potentially carcinogenic flame retardants from its textile products by 2022, having already moved to abolish more than a 1,000 chemicals from some of its products in 2015.

The chemical strategy will include all Target-owned and national brand products and operations, Chief Sustainability Officer Jennifer Silberman said.

Target's announcement comes six months after Wal-Mart Stores Inc said it was pushing suppliers to remove or restrict the use of eight hazardous chemicals from some of the products it sells.


Tuesday, January 24, 2017

Are Vegetable and Seed Oils Bad For Your Health? A Critical Look

The consumption of processed seed and vegetable oils has increased dramatically in the past century.

Commonly mistaken as health foods, quite a few studies show that these oils can cause harm.

What Are They and How Are They Made?

These are oils that are extracted from seeds like Soybean, Cottonseed, Sunflower and a few others.

They were never available to humans until the 20th century, because we simply didn’t have the technology to extract them.

The way these oils are manufactured is very disgusting (see video) and it is mind-baffling that someone ever thought they would be suitable for human consumption.

It involves a harsh extraction process that includes bleaching, deodorizing and the highly toxic solvent hexane.

These oils have made their way to all sorts of processed foods, including “healthy” salad dressings, butter replicates, mayonnaise, cookies and more.

Bottom Line: The processing method for industrial seed- and vegetable oils involves factories, many machines and chemicals like hexane.


How to Optimize Your Omega-6 to Omega-3 Ratio

Today, most people are eating way too many Omega-6 fatty acids.

At the same time, consumption of animal foods high in Omega-3 is the lowest it has ever been.

A distorted ratio of these polyunsaturated fatty acids may be one of the most damaging aspects of the Western diet.

Why Care About Omega-6 and Omega-3 Fatty Acids?

Omega-6 and Omega-3 fatty acids are called polyunsaturated because they have many double bonds (poly = many).

Our bodies don’t have the enzymes to produce them and therefore we must get them from the diet.

If we don’t get any from the diet, then we develop a deficiency and become sick. That is why they are termed the “essential” fatty acids.

However, these fatty acids are different than most other fats. They are not simply used for energy or stored, they are biologically active and have important roles in processes like blood clotting and inflammation.

The thing is… Omega-6s and Omega-3s don’t have the same effects. Omega-6s are pro-inflammatory, while Omega-3s have an anti-inflammatory effect (1).

Of course, inflammation is essential for our survival. It helps protect our bodies from infection and injury, but it can also cause severe damage and contribute to disease when the inflammatory response is inappropriate or excessive.

In fact, excess inflammation may be one of the leading drivers of the most serious diseases we are dealing with today, including heart disease, metabolic syndrome, diabetes, arthritis, Alzheimer’s, many types of cancer, etc.

Put simply, a diet that is high in Omega-6 but low in Omega-3 increases inflammation, while a diet that includes balanced amounts of each reduces inflammation (2).

The problem today, is that people who eat a typical Western diet are eating way too many Omega-6s relative to Omega-3s.

Bottom Line: An Omega-6:Omega-3 ratio that is too high can contribute to excess inflammation in the body, potentially raising the risk of all sorts of diseases.


10 Types of Saturated Fat Reviewed

The health effects of saturated fats are a controversial topic.

In the past, saturated fat was widely believed to be a major cause of heart disease. Today, scientists are not so sure.

However, one thing is clear: saturated fat is not a single nutrient. It is a group of different fatty acids with varying effects on health and metabolism.

This article takes a detailed look at the most common saturated fatty acids, their health effects and dietary sources.

Heart-Shaped Piece of Butter

What Is Saturated Fat?

Saturated fat is one of the two main classes of fat, the other being unsaturated fat.

These groups differ slightly in their chemical structure and properties. For instance, saturated fat is generally solid at room temperature, while unsaturated fat is liquid.

The main dietary sources of saturated fat are fatty meat, lard, tallow, cheese, butter, cream, coconut oil, palm oil and cocoa butter.

All fats are composed of molecules called fatty acids, which are chains of carbon atoms. The different types of saturated fatty acids can be distinguished by the length of their carbon chains.

Here are the most common saturated fatty acids in the human diet:

  • Stearic acid: 18 carbon atoms long
  • Palmitic acid: 16 carbon atoms long
  • Myristic acid: 14 carbon atoms long
  • Lauric acid: 12 carbon atoms long
  • Capric acid: 10 carbon atoms long
  • Caprylic acid: 8 carbon atoms long
  • Caproic acid: 6 carbon atoms long

It’s rare to find saturated fatty acids other than these in the diet.

Saturated fatty acids that are less than six carbon atoms long are collectively known as short-chain fatty acids.

These are produced when gut bacteria ferment fiber. They are created in your gut from the fiber you eat and can also be found in trace amounts in some fermented food products.

Bottom Line: Saturated fatty acids are one of the two major categories of fat. Common dietary saturated fatty acids include stearic acid, palmitic acid, myristic acid and lauric acid.


Monday, January 23, 2017

14 Home Remedies for Heartburn and Acid Reflux

Millions of people suffer from acid reflux and heartburn.

The most frequently used treatment involves commercial medications, such as omeprazole. However, lifestyle modifications may be effective as well.

Simply changing your dietary habits or the way you sleep may significantly reduce your symptoms of heartburn and acid reflux, improving your quality of life.

  • 1. Don’t Overeat
  • 2. Lose Weight
  • 3. Follow a Low-Carb Diet
  • 4. Limit Your Alcohol Intake
  • 5. Don’t Drink Too Much Coffee
  • 6. Chew Gum
  • 7. Avoid Raw Onion
  • 8. Limit Your Intake of Carbonated Beverages
  • 9. Don’t Drink Too Much Citrus Juice
  • 10. Consider Eating Less Chocolate
  • 11. Avoid Mint, If Needed
  • 12. Elevate the Head of Your Bed
  • 13. Don’t Eat Within Three Hours of Going to Bed
  • 14. Don’t Sleep on Your Right Side

16 Foods to Eat on a Ketogenic Diet

The ketogenic diet has become quite popular recently.

Studies have found that this very low-carb, high-fat diet is effective for weight loss, diabetes and epilepsy (1, 2, 3).

There's also early evidence to show that it may be beneficial for certain cancers, Alzheimer's disease and other diseases, too.

A ketogenic diet typically limits carbs to 20–50 grams per day. While this may seem challenging, many nutritious foods can easily fit into this way of eating.

Here are 16 healthy foods to eat on a ketogenic diet.

  • 1. Seafood
  • 2. Low-Carb Vegetables
  • 3. Cheese
  • 4. Avocados
  • 5. Meat and Poultry
  • 6. Eggs
  • 7. Coconut Oil
  • 8. Plain Greek Yogurt and Cottage Cheese
  • 9. Olive Oil
  • 10. Nuts and Seeds
  • 11. Berries
  • 12. Butter and Cream
  • 13. Shirataki Noodles
  • 14. Olives
  • 15. Unsweetened Coffee and Tea
  • 16. Dark Chocolate and Cocoa Powder

Framingham: Low HDL, in Isolation, Not a CV Risk Predictor

FRAMINGHAM, MA — Long-term findings from a famous cohort study challenge the idea that low HDL-cholesterol levels predict raised cardiovascular risk independently of other blood lipid markers and add to doubts about HDL-C per se as a target for therapy[1].

It suggests that the association between future CV risk and levels of HDL-C, as currently measured in practice, is modified by LDL cholesterol and triglycerides. The predictive power of HDL-C is diminished when measures of either or both of the other markers are high.

"We're not taking away the importance of HDL. We're just putting it into perspective. If you have low HDL but everything else is normal, your risk of CV disease is not elevated," according to lead author Dr Michael Miller (University of Maryland School of Medicine, Baltimore).


Chinese API company found faking CoAs, selling potentially tainted products

The FDA discovered that a Chinese company peddling active pharmaceutical ingredients (API) in the U.S. was selling APIs from another supplier and claiming it had manufactured them itself. The big problem was the original supplier of some of those was on an FDA import alert list at the time.

The FDA outlined the problem, among a host of others, in a warning letter to the Suzhou Pharmaceutical Technology facility in Suzhou, Jiangsu Province. The warning letter was one of two posted Tuesday that were sent to Asian producers.  The other was to Sato Yakuhin Kogyo, a solid-dose finished drugmaker in Kashihara City in Japan that the FDA cited for serious data integrity issues.

As for Suzhou Pharmaceutical, the FDA said its June 2016 inspection found that the company was creating fake certificates of analysis (CoA) for the products it was selling by copying and pasting analytical results from the original API manufacturer, replacing the manufacturer's information with its own letterhead, then issuing the CoAs to its customers.

In fact, Suzhou didn't have a quality assurance unit to test the APIs it sells. Instead, it had salespeople sign off on the certificates, using the title "QC Director." On top of that, the APIs were being stored in a facility with no temperature controls and no assurance they were not compromised.


First GMO apple slices to go on sale in Midwest - - Capital Press

A small amount of Arctic brand sliced and packaged Golden Delicious, produced by Okanagan Specialty Fruits of Summerland, B.C., will be in 10 stores this February and March, said Neal Carter, the company's founder and president. He would not identify the retailers, saying that's up to them.

"We're very optimistic with respect to this product because people love it at trade shows," Carter said. "It's a great product and the eating quality is excellent."

Carter reduced the enzyme polyphenol oxidase to prevent browning when apples are sliced, bitten or bruised. The apples match the industry norm of not browning for three weeks after slicing but without using flavor-altering, chemical additives that the rest of the fresh-sliced apple industry uses.


Thursday, January 19, 2017

1 in 4 US men have cancer-linked HPV genital infections

The new estimate comes from an analysis of a 2013-14 national health survey; nearly 2,000 men aged 18 to 59 were tested for HPV. Results were published Thursday in the journal JAMA Oncology . The researchers say it's the first published estimate for genital HPV infections in men. The 45 percent rate is higher than previously reported rates for women, said Dr. Jasmine Han, the lead author and a cancer specialist at Womack Army Medical Center at Fort Bragg, North Carolina.

HPV virus can also be found in the mouth at much lower rates in men and women. The new study involved only genital HPV.


Ticks that transmit Lyme disease reported in nearly half of all US counties

The team used surveillance methods similar to those used in 1998 so that they would be able to accurately judge the degree to which the distribution of these ticks had changed. Using the gathered data, they figured out which counties had established populations, which ones had one or more reports of a blacklegged ticks, and which ones had none.

They found that the blacklegged tick has been reported in more than 45% of U.S. counties, compared to 30% of counties in 1998. Even more alarming, the blacklegged tick is now considered established in twice the number of counties as in 1998.

Most of the geographic expansion of the blacklegged tick appears to be in the northern U.S., while populations in southern states have remained relatively stable. The range of the western blacklegged tick only increased from 3.4% to 3.6% of counties.

"This study shows that the distribution of Lyme disease vectors has changed substantially over the last nearly two decades and highlights areas where risk for human exposure to ticks has changed during that time," Dr. Eisen said. "The observed range expansion of the ticks highlights a need for continuing and enhancing vector surveillance efforts, particularly along the leading edges of range expansion."


The Value of Physical Examination

As the medical community seeks remedies to the problems of medical misdiagnosis, escalating healthcare costs, the sputtering doctor–patient relationship, and physician burnout, it is tempting to suggest that one part of all of these problems—and perhaps a component of the solutions—lies in bedside skills. These skills once characterized the best clinicians, both as a symbol of respect and a factor in referrals, but they have apparently waned in modern medicine. PE is not a panacea, however; many other aspects of our approach to patients and their care also must be addressed if we are to improve their, and our own, lots.

But we must start somewhere and we suggest that that is with the next generation of doctors, in our medical schools and residency programs.[27] We hope that the value of the PE, the value of history taking, and the ability to gather information and derive conclusions through talk and touch can be re-emphasized. We have highlighted ways in which the benefit of PE is expressed beyond its contribution to diagnosis alone and believe these mixed qualitative and quantitative indices will provide a truer notion of its value.

The value of the PE extends far beyond diagnostic accuracy alone, far beyond a single figure such an odds or a likelihood ratio. We hope that our attempt to create a broader metric stimulates others to think further about its place in their practice.


Clinicians Often Underestimate Harms of Tests and Treatments

Clinicians are likely to underestimate harms and overestimate benefits of tests and treatments, according to the results of a review of 48 studies published online January 9 in JAMA Internal Medicine.

"[P]atients cannot be assisted to make informed decisions if clinicians themselves do not have accurate expectations of intervention benefits and harms," write study authors Tammy Hoffman, PhD, and Chris Del Mar, MD, from the Centre for Research in Evidence-Based Practice at Bond University in Queensland, Australia.

The review showed that the majority of clinicians correctly estimated harms only 13% of the time, and benefits only 11% of the time. Previous studies on patient expectations show that they, too, overestimate benefits and underestimate harms of many aspects of their care.

The clinicians' estimates varied widely across specialties and treatments. For example, more than 90% overestimated hormone replacement therapy's ability to reduce the risk for hip fracture, whereas more than 90% underestimated the risk for fatal cancer from bone scans.

"This was a very nicely done systematic review," Daniel Matlock, MD, MPH, from the Department of Medicine at the University of Colorado School of Medicine, Denver, told Medscape Medical News. "Bottom line, this kind of highlights that doctors are human and subject to a lot of these same data biases that patients are as well."


Wednesday, January 18, 2017

Shikimate pathway & Glyphosate

The shikimate pathway (shikimic acid pathway) is a seven step metabolic route used by bacteria, fungi, algae, some protozoan parasites and plants for the biosynthesis of folates and aromatic amino acids (phenylalanine, tyrosine, and tryptophan). This pathway is not found in animals, which require these amino acids, hence the products of this pathway represent essential amino acids that must be obtained from bacteria or plants (or animals which eat bacteria or plants) in the animal's diet.


Glyphosate formulations and their use as antibiotics

The shikimate pathway is an ancient pathway that is involved in primary and secondary metabolism and is found in all prokaryotes, many lower eukaryotes, and plants, but not in mammals. In primary metabolism, the function of the pathway is to provide the precursors for the production of the aromatic amino acids and para-aminobenzoic acid. The shikimate pathway includes the enzymes and metabolites formed by converting 3-Deoxy-D-arabino-heptulosonic 3-phosphate (DAHP) to chorismic acid, the trifurication point for the three pathways leading to the production of tryptophane, tyrosine, and phenylalanine.

The importance of the shikimate pathway to cell viability is illustrated by experiments that result in the disruption of enzyme function. In plants, the shikimate pathway enzyme, EPSP synthase, has been targeted by a chemical inhibitor strategy that has resulted in the commercially successful, broad range, post-emergent herbicide called glyphosate. Glyphosate inhibits the shikimic acid pathway, which leads to the biosynthesis of aromatic compounds including amino acids, plant hormones, and vitamins. Specifically, glyphosate inhibits the conversion of phosphoenolpyruvic acid (PEP) and 3-phosphoshikimic acid to 5-enolpyruvyl-3-phosphoshikimic acid by binding to the enzyme 5-enolpyruvyishikimate-3-phosphate synthase (hereinafter referred to as EPSP synthase or EPSPS).


10 Natural Ways to Build Healthy Bones

Building healthy bones is extremely important.

Minerals are incorporated into your bones during childhood, adolescence and early adulthood. Once you reach 30 years of age, you have achieved peak bone mass.

If not enough bone mass is created during this time or bone loss occurs later in life, you have an increased risk of developing fragile bones that break easily (1).

Fortunately, many nutrition and lifestyle habits can help you build strong bones and maintain them as you age.

Here are 10 natural ways to build healthy bones.

  • 1. Eat Lots of Vegetables
  • 2. Perform Strength Training and Weight-Bearing Exercises
  • 3. Consume Enough Protein
  • 4. Eat High-Calcium Foods Throughout the Day
  • 5. Get Plenty of Vitamin D and Vitamin K
  • 6. Avoid Very Low-Calorie Diets
  • 7. Consider Taking a Collagen Supplement
  • 8. Maintain a Stable, Healthy Weight
  • 9. Include Foods High in Magnesium and Zinc
  • 10. Consume Foods High in Omega-3 Fats

Can bacteria defeat diabetes?

The tiny microbes in our gut that feast on the food we eat as it moves through the digestion process have a powerful influence on our bodies. "Microbes have the capacity to communicate to the brain and influence behavior," Khoruts explains. For example, they send the signal for hunger and thus nudge us to eat more.

However, in people with prediabetes and type 2 diabetes, these microbes may have lost some of their ability to process certain foods. This could be due to larger societal shifts, in particular our use of antibiotics, which can kill some of the "good" bacteria and leave the remaining bacteria less able to do their work. Or, it may be that the food reaching our intestines doesn't need the final digestive action of these microbes because it is highly processed. In either scenario, the microbes continue to send hunger signals to the brain. This, in turn, may lead to overeating, obesity, and, eventually, type 2 diabetes.

By restoring a normal balance of bacteria in a patient's gastrointestinal tract, a fecal transplant  may help prevent these false hunger signals. For the clinical trial Khoruts is leading, physicians will use fecal matter collected from a "champion" donor who has normal blood sugar levels and an ideal mix of gut microbes. This stool is then mixed with a saline solution and placed in the patient's intestine during a colonoscopy. After the procedure, participants receive 10 weeks of healthy meals developed by a dietician. Khoruts and his team believe the transplant and closely monitored diet will jump-start healthy processes in the guts of study participants and lead to better glucose regulation.


Tuesday, January 17, 2017

Updated Hypertension Guidelines Released by ACP, AAFP

The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) have released a joint practice guideline on systolic blood pressure targets for people aged 60 years and older with hypertension.

The guidance calls for physicians to start treatment for patients who have persistent systolic blood pressure at or above 150 mm Hg to achieve a target of less than 150 mm Hg to reduce risk for stroke, cardiac events, and death. The recommendation was rated strong, with high-quality evidence.

"The evidence showed that any additional benefit from aggressive blood pressure control is small, with a lower magnitude of benefit and inconsistent results across outcomes," ACP's President Nitin S. Damle, MD, said in a news release.

However, in some cases, a lower systolic target should be considered, according to the guidelines.

If patients have a history of stroke or transient ischemic attack or have high cardiovascular risk, physicians should consider starting or increasing drug therapy to achieve systolic blood pressure of less than 140 mm Hg to reduce risk for stroke and cardiac events. The authors note, however, that this recommendation was rated weak, with moderate-quality evidence.

High cardiovascular risk generally includes patients with diabetes, vascular disease, metabolic syndrome, or chronic kidney disease, as well as older adults.


Monday, January 16, 2017

Is Fibromyalgia A Mitochondrial Disorder? - Health Rising

In 2013 a Spanish group proposed that mitochondrial dysfunction in FM patient was driving an inflammatory process. Now, in 2015 they have returned with a study looking at mitochondrial dysfunction, oxidative stress and inflammation using skin biopsies from people with FM.

Oxidative stress, mitochondrial dysfunction and, inflammation common events in skin of patients with Fibromyalgia. Benito Sánchez-Domínguez a,1, Pedro Bullón a,1, Lourdes Román-Malo a, Fabiola Marín-Aguilar a, Elísabet Alcocer-Gómez b, Angel M. Carrión c, José Antonio Sánchez-Alcazar b,d, Mario D. Cordero a. Mitochondrion 21 (2015) 69–75

Given the allodynia present, and the increasing evidence of small fiber neuropathy in FM, the skin is becoming an ever more intriguing place to look in fibromyalgia.  Something, after all, is "burning  away" those small unmyelinated nerve fibers in their skin. Is it inflammation? Are the mitochondria going bananas? (Could it be both?). This study won't tell us what's causing the SFN or allodynia in FM – it's not going to assess either of them– but it may provide some suspects future studies can follow up on.

This small Spanish study looked at the levels of mitochondrial enzymes, mitochondrial proteins, ATP, CoQ 10 and TNF-a from a small patch of skin in the left shoulder region, as well as in the blood and saliva of 23 people with FM and 20 healthy controls.


Coumadin and Vitamin K2

Recent studies found a clear association between long-term anticoagulant treatment (OAC) and reduced bone quality due to reduction of active osteocalcin. OAC might lead to an increased incidence of fractures, reduced bone mineral density/bone mineral content, osteopenia, and increased serum levels of undercarboxylated osteocalcin.[21] Bone mineral density was significantly lower in stroke patients with long-term warfarin treatment compared to untreated patients and osteopenia was probably an effect of warfarin-interference with vitamin K recycling.[22]

Furthermore, OAC is often linked to an undesired soft-tissue calcification in both children and adults.
[23][24] This process has been shown to be dependent upon the action of K vitamins. Vitamin K deficiency results in undercarboxylation of MGP. Vascular calcification was shown to appear in warfarin-treated experimental animals within two weeks.[25] Also in humans on OAC treatment, two-fold more arterial calcification was found as compared to patients not receiving vitamin K antagonists.[26][27] Among consequences of anticoagulant treatment: increased aortic wall stiffness, coronary insufficiency, ischemia, and even heart failure. Arterial calcification might also contribute to systolic hypertension and ventricular hypertrophy.[28][29] Coumarins, by interfering with vitamin K metabolism, might also lead to an excessive calcification of cartilage and tracheobronchial arteries.

Anticoagulant therapy is usually instituted to avoid life-threatening diseases and a high vitamin K intake interferes with the anticoagulant effect. Patients on warfarin (Coumadin) treatment, or treatment with other vitamin K antagonist drugs, are therefore advised not to consume diets rich in K vitamins. However, the latest research proposed to combine vitamins K with OAC to stabilize the INR (International normalized ratio, a laboratory test measure of blood coagulation).

Individuals taking anticoagulant medications, such as warfarin (coumarins), should consult their doctor before taking Vitamin K2.


For women, heavy drinking has been normalized. That’s dangerous. - The Washington Post

As it happens, drinking can be especially hazardous for women.

Women tend to have smaller bodies than men, and differences in physiology that make blood-alcohol­ levels climb faster and stay elevated longer. Some studies have found that women have lower levels of the stomach enzymes needed to process the toxins in alcoholic beverages.

As a result, according to the Centers for Disease Control and Prevention, women are more prone to suffer brain atrophy, heart disease and liver damage. Even if a woman stops drinking, liver disease continues to progress in ways it does not in men, said Gyongyi Szabo, a professor at the University of Massachusetts Medical School. And research definitively shows that women who drink have an increased risk of breast cancer.

"There is no gender equity when it comes to the effects of alcohol on men versus women," Szabo said. "Females are more susceptible to the unwanted biological effects of alcohol when they consume the same amount of alcohol and at the same frequency — even when you adjust for weight."

Many women don't know this — nor do they understand what constitutes excessive drinking, said Robert D. Brewer, leader of the CDC's alcohol program. For women in the United States, anything more than one drink a day is considered excessive. That's one ounce of distilled spirits, 12 ounces of beer or five ounces of wine.

Four drinks consumed within two hours is considered binge drinking. That's about two-thirds of a bottle of wine.

"Most people do not understand what binge drinking looks like, and they don't yet recognize how dangerous it is," Brewer said. "Smoking, eating unhealthy foods, not exercising — people get what that can do to your health. But we are in a way different stage with binge drinking."


Sunday, January 15, 2017

Bugging inflammation: role of the gut microbiota

The advent of vaccination and improved hygiene have eliminated many of the deadly infectious pathogens in developed nations. However, the incidences of inflammatory diseases, such as inflammatory bowel disease, asthma, obesity and diabetes are increasing dramatically. Research in the recent decades revealed that it is indeed the lack of early childhood microbial exposure, increase use of antibiotics, as well as increase consumption of processed foods high in carbohydrates and fats, and lacking fibre, which wreak havoc on the proper development of immunity and predispose the host to elevated inflammatory conditions. Although largely unexplored and under-appreciated until recent years, these factors impact significantly on the composition of the gut microbiota (a collection of microorganisms that live within the host mucosal tissue) and inadvertently play intricate and pivotal roles in modulating an appropriate host immune response. The suggestion that shifts in the composition of host microbiota is a risk factor for inflammatory disease raises an exciting opportunity whereby the microbiota may also present as a potential modifiable component or therapeutic target for inflammatory diseases. This review provides insights into the interactions between the microbiota and the immune system, how these affect disease phenotypes, and explore current and emerging therapies that target the gut microbiota as potential treatment for inflammatory diseases.


Saturday, January 14, 2017

Scientists solve a whale of a mystery: Why orcas have menopause - LA Times

Out of all the mammal species in the world, only three are known to experience menopause: humans, short-finned pilot whales and killer whales. But the exact reasons for it in killer whales (known formally as Orcinus orca) have remained up for debate.

"Why females of some species cease ovulation prior to the end of their natural lifespan is a long-standing evolutionary puzzle," the study authors wrote. "The fitness benefits of post-reproductive helping could in principle select for menopause, but the magnitude of these benefits appears insufficient to explain the timing of menopause."

Certainly, long beyond their most fertile years, older females play crucial roles in the lives of many social mammals. Researchers have argued that the presence of grandmothers in human populations helped improve the survival rates of their daughters' offspring. In a herd of elephants, typically run by a long-lived matriarch, older females help out with grandchildren and other relatives. Grandmothers help improve survival in these groups because they often find and share food resources communally. That's also true of killer whales, the researchers pointed out.


Imagine Our World if We Taught It How to Eat

Melissa Walton-Shirley, MD, Cardiologist: In my office, I have a copy of the Mediterranean diet pyramid at checkout for every new patient. Many established patients who suffer from metabolic syndrome, coronary artery disease, or obesity receive a second or even a third copy. I spend hours teaching the simple mechanics of nutrition. I stress that it's more impactful on longevity than any metal scaffold electively deployed into a coronary artery. I found a kindred spirit in Dr Simon Poole. His salient points came rapid fire, finding their mark and leaving quite an impression.

Dr Simon Poole: "If patients with coronary artery disease came out of the office of a practicing physician or cardiologist not on a statin, you could argue that's a negligent practice, but I'd argue that most have no advice on diet. I lay down the gauntlet. We as physicians need to emphasize diet," he began. He then lauded Dr Stender by saying, "Steen has done remarkably well with his government. Our secretary of state wanted to make an impact. We were shuffled into a room to discuss how to decrease mortality in 2.5 years. We emphasized "brave legislation" (hinting at labeling, reduction in trans-fat content, and education). The reply was a terse, "Well, we don't do social engineering." Someone in the group argued, "If you look at eye-level in a market at the packaging of chocolates for children . . . if that isn't social engineering, I don't know what is."


Dean Ornish in Defense of the Dietary Fat - Heart Disease Link

Dr Ornish: We still have the only randomized controlled trial[1] showing that lifestyle changes can actually reverse the progression of coronary heart disease. We showed this using radionuclide ventriculography to measure the ejection fraction response from rest and peak exercise in our study published in JAMA in 1983. The Lifestyle Heart trial 1-year data published in the Lancet,[2] and the 5-year data published in JAMA,[3] showed that the percent diameter stenosis improved in the people who went through our program, and it got worse in the control group.

We also found that cardiac PET scans[4]—and these were all performed and blindly analyzed by independent observers—showed a 300% improvement in blood flow to the heart in the intervention group compared with the randomized control group, and they had 2.5 times fewer cardiac events.[3] We found a dose-response correlation at both 1 year[2] and 5 years[3] between the degree of adherence to both the lifestyle program as a whole and the diet, in terms of cholesterol milligrams and fat grams consumed, and changes in the arteries. These things make a difference. The burden of proof is on others to show that a higher-fat diet can reverse the progression of heart disease.

That said, this is a work in progress. I have been doing work in this field for 39 years, and as new science comes, we modify accordingly. For example, when I did my internship and residency at Harvard Medical School and the Mass General Hospital, the chief of medicine at the time, Dr Alexander Leaf, was my mentor. He had done a lot of the pioneering work with fish oil[5] and convinced me back then that we should add fish oil to our diet, which we have been doing ever since. Given the preponderance of evidence on the benefits of seeds and nuts, we have added those in small quantities this year.


  1. Ornish D, Scherwitz LW, Doody RS, et al. Effects of stress management training and dietary changes in treating ischemic heart disease. JAMA. 1983;249:54-59. Abstract
  2. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336:129-133. Abstract
  3. Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280:2001-2007. Abstract
  4. Gould KL, Ornish D, Scherwitz L, et al. Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA. 1995;274:894-901. Abstract
  5. Leaf A. Cardiovascular effects of fish oils. Beyond the platelet. Circulation. 1990;82:624-628. Abstract

Nutrition Counseling: From Clueless to Competent

Seth Bilazarian, MD

I feel ill-equipped to talk about these things, but perhaps there's value in the poor preparation I have for talking with patients about diet and nutrition. I received 1 hour of nutrition counseling in my medical training—that's not an excuse, it's just a fact—and very little training in my residency or fellowship. So I'm largely self-taught in this area, and there may be obvious deficiencies in my knowledge base, but I make the best effort I can.

I want to talk a bit about some of the difficulties I have had counseling patients about diet and nutrition, and I want to share the things that have worked for me. They are anecdotal, and I hope others will also share ideas by clicking on the comments section below. I'm sure other community-based physicians have valuable strategies that streamline effective communication with patients about diet and nutrition.

Maimonides reportedly said, "No disease that can be treated by diet should be treated with any other means." Certainly treating by other means is largely what we're doing in the United States to reduce cardiovascular risks. We could potentially reduce those risks with better nutritional strategies. I think we all acknowledge that.



New 'Brain Food' Scale Flags Best Nutrients for Depression

In addition to leafy green vegetables, researchers highlighted the importance of organ meats, game meats, nuts (pecans, walnuts, and peanuts), bivalves (mussels, clams, oysters), mollusks (octopus, squid, snail), and fish (salmon and sardines). Although it is recommended that patients eat 8 to 12 ounces of fish a week, it is important to choose fish that are lower in mercury. Individuals should therefore limit consumption of shark and swordfish.

Dr Reynolds also stressed that he wants to help patients make better choices when it comes to meat. Those choices, he said, should include grass-fed and pastured animals.

Although the research focuses more in the areas of depression and dementia, new trials are looking at attention-deficit/hyperactivity disorder, anxiety, and addictions, said Dr Reynolds.

Although most of the emerging data are from case reports and epidemiologic studies, the first randomized controlled study, known as the SMILES Trial, is testing the impact of a diet rich in many of these nutrients on major depression.

The study includes 176 patients with major depressive episodes at two centers in Victoria, Australia. Participants were randomly assigned to either a dietary intervention group, which focuses on advocating a healthy diet, or a social support group.

Although results of this trial likely will not be published until later this year, Dr Ramsey's group has had a chance to discuss the results with its investigators, and the results are "positive" and "better than expected."

"What's exciting about that is that it helps give the psychiatric community and our patients another set of tools in terms of treating and preventing mental illness," said Dr Ramsey.


Antibiotics and Mental Status Changes

Adrienne M. Rouiller, PharmD 

Any change in mental status should always prompt a review of medications as a potential contributing factor. Antimicrobials, a drug class that is an often-overlooked etiology, have been associated with a wide range of neurologic symptoms, including sedation, sleep disturbance, confusion, delirium, seizures, mood changes, psychosis, and hallucinations.[1]

The type and frequency of mental status changes vary by drug and drug class and are increased with higher doses, concurrent central nervous system (CNS) disorders, older age, and renal dysfunction. Fluoroquinolones, cephalosporins, and macrolides appear to be the most common causative agents, with the incidence varying from a few isolated case reports to 15% of patients in the intensive care unit receiving cefepime and over 50% of elderly patients receiving high-dose clarithromycin.[2,3]

With the high frequency of antimicrobial use, clinicians should be aware of the potential for antimicrobials to induce changes in mental status. In addition, patients and families should be appropriately counseled regarding these adverse effects, because recognition and management may reduce morbidity.

Mechanisms and Pathophysiology
The exact mechanisms by which antimicrobials produce altered mental status are largely unknown. Antimicrobials may have direct and secondary effects on the CNS. Antimicrobials may directly alter CNS function through alteration of neurotransmission such as gamma-aminobutyric acid (GABA) antagonism by fluoroquinolones, cephalosporins, and penicillins.[2]

Altered mental status may be secondary to another adverse effect of an antimicrobial. For example, it may be indirectly due to inflammation arising from aseptic meningitis, which has been reported with trimethoprim/sulfamethoxazole in elderly or immunocompromised patients.[2,4]

In addition, antimicrobials may interact with concurrent medications and produce CNS effects. Examples include serotonergic syndrome with linezolid and other serotonergic drugs or antimicrobial inhibition of cytochrome P450 enzymes, resulting in accumulation of other CNS-acting medications.[2]


  • Acute psychosis
  • Confusion
  • Delirium
  • Hallucinations
  • Mania

Cephalosporins[2,3,6-8] Most common: cefepime, ceftazidime, cefazolin

  • Confusion
  • Delirium
  • NCSE
  • Seizures

Penicillins[2,6]  Most common: piperacillin/tazobactam

  • Bizarre behavior
  • Confusion
  • Delirium
  • Disorientation
  • Hallucinations
  • NCSE
  • Seizures

Carbapenems[2,6,7,18,19] Most common: imipenem,ertapenem

  • Cognitive impairment
  • Delirium
  • Hallucinations
  • Psychosis syndrome
  • Seizures

Macrolides[2,20]  Most common: clarithromycin, erythromycin

  • Acute psychosis
  • Delirium
  • Mania

Sulfonamides[2,4,21]  Most common: TMP/SMX

  • Acute psychosis
  • Aseptic meningitis
  • Hallucinations


  • Agitation
  • Altered mental status
  • Cerebellar dysfunction
  • Encephalopathy
  • Ototoxicity
  • Peripheral neuropathy
  • Psychosis
  • Seizures

Oxazolidinones[2,10,11]  Most common: linezolid

  • Delirium
  • Encephalopathy
  • Peripheral neuropathy
  • Serotonin syndrome

Azole antifungals[1,12]  Most common: voriconazole

  • Delirium
  • Hallucinations
  • Acyclovir[25-27]
  • Confusion
  • Impaired consciousness


  • Anxiety
  • Behavioral change
  • Delirium
  • Delusions
  • Convulsions
  • Encephalitis
  • Sleep disturbance
  • Suicidal ideation

Amantadine and rimantadine[30]

  • Anxiety
  • Behavioral change
  • Delirium
  • Hallucinations
  • Nervousness

Thursday, January 12, 2017

The Downside of Breast Cancer Screening - NYTimes.com

A 17-year study has concluded that screening mammography — in which all women in certain age groups are routinely screened for breast cancer — does not reduce the incidence of advanced tumors, but does increase the diagnosis of lesions that would never have led to health problems.

In Denmark, screening was implemented in different regions at different times, so researchers there were able to compare groups of women who were screened with those who were not.

If screening were effective, a reduction in the incidence of advanced tumors would be expected — tumors would be caught and treated when small. Instead, the researchers found no difference in incidence between screened and unscreened groups. But in screened groups, they found substantial overdiagnosis — that is, detection of tumors that would not become cancers needing treatment.

The study, in Annals of Internal Medicine, found that, depending on age and other factors, between a fifth and a third of tumors detected by screening were overdiagnosed. The researchers concluded that screening does not prevent advanced cancers or lower breast cancer mortality.

"Some types of screening are a good idea — colorectal, for example," said the lead author, Dr. Karsten Juhl Jorgensen, deputy director of the Nordic Cochrane Center. "But breast cancer has a biology that doesn't lend itself to screening. Healthy women get a breast cancer diagnosis, and this has serious psychological consequences and well-known physical harms from unnecessary treatment. We're really doing more harm than good."


Metabolic Disorders Linked to Severe, Refractory Depression

A large proportion of patients with severe, refractory depression have metabolic disorders that, once treated, appear to alleviate depressive symptoms over the long term.

"Our findings, if replicated, suggest that neurometabolic disorders may contribute to treatment-refractory psychiatric disorders even without other systemic illness," the authors, led by Lisa A. Pan, MD, University of Pittsburgh School of Medicine in Pennsylvania, write.

"An important question is whether early identification and treatment of an underlying metabolic abnormality early in the course of psychiatric illness could prevent long-term emotional and cognitive complications," they add.

The study was published in the January issue of the American Journal of Psychiatry.

Dramatic, Durable Remission

The impetus for the current study was a previous case reported by the same investigators and published in the BMJ. It involved a 19-year-old man with treatment-refractory depression who had attempted suicide multiple times. The researchers found that the man had a severe deficiency of cerebrospinal fluid (CSF) tetrahydrobiopterin, a critical cofactor for monoamine neurotransmitter synthesis.

Upon undergoing replacement therapy with the tetrahydrobiopterin analogue sapropterin, the patient experienced dramatic and long-lasting remission of his depression.

To investigate further, the researchers conducted a case-control study that included 33 adolescent and young adult patients with refractory depression and 16 healthy control persons. Refractory depression was defined as depression for which at least three courses of medication administered at a maximum dose for an adequate duration failed.

The patients with treatment-refractory depression were aged 14 to 40 years. For these patients, the depression was of relatively early onset (mean age of onset, 12.4 years). Half the patients reported at least one suicide attempt. Severity of depression at the time of study screening was moderate to severe.

A metabolomic analysis that included testing of central nervous system–specific metabolites showed CSF metabolite abnormalities among 21 of 33 of the patients with treatment-refractory depression, compared to none of the healthy control patients.

The most common abnormality, present in 12 (36%) participants, was cerebral folate deficiency (CFD), in which serum folate levels were normal but levels of CSF 5-MTHF were low (<40 nmol/L). CFD can be caused by mutations in the cerebral folate receptor gene (FOLR1), although genetic testing of eight patients with CFD indicated that none had the mutation.

Importantly, none of the patients had primary neurologic symptoms or other overt clinical disease, suggesting previously reported causes of the abnormalities were unlikely, the authors note.


Marijuana DOES cause schizophrenia and triggers heart attacks, experts say | Daily Mail Online

Marijuana does raise the risk of getting schizophrenia and triggers heart attacks, according to the most significant study on the drug's effects to date.

A federal advisory panel admitted cannabis can almost certainly ease chronic pain, and might help some people sleep.

But it dismisses most of the drug's other supposedly 'medical benefits' as unproven.

Crucially, the researchers concluded there is not enough research to say whether marijuana effectively treats epilepsy - one of the most widely-recognized reasons for cannabis prescriptions. 

The report also casts doubt on using cannabis to treat cancers, irritable bowel syndrome, or certain symptoms of Parkinson's disease, or helping people beat addictions.


Turning to potential harms, the committee concluded:

  • Strong evidence links marijuana use to the risk of developing schizophrenia and other causes of psychosis, with the highest risk among the most frequent users.
  • Some evidence suggests a small increased risk for developing depressive disorders, but there's no evidence either way on whether it affects the course or symptoms of such disorders, or the risk of developing post-traumatic stress disorder.
  • There's strong evidence that using marijuana increases the risk of a traffic accident, but no clear indication that it promotes workplace accidents or injuries, or death from a marijuana overdose.
  • There's only weak evidence for the idea that it hurts school achievement, raises unemployment rates or harms social functioning.
  • For pregnant women who smoke pot, there's strong evidence of reduced birthweight but only weak evidence of any effect on pregnancy complications for the mother, or an infant's need for admission to intensive care. There's not enough evidence to show whether it affects the child later, like sudden infant death syndrome or substance use.
  • Some evidence suggests there's no link to lung cancer in marijuana smokers. But there's no evidence, or insufficient evidence, to support or rebut any link to developing cancers of the prostate, cervix, bladder, or esophagus.
  • Substantial evidence links pot smoking to worse respiratory symptoms and more frequent episodes of chronic bronchitis.
  • There's weak evidence that suggests smoking marijuana can trigger a heart attack, especially for people at high risk of heart disease. But there's no evidence either way on whether chronic use affects a person's risk of a heart attack.
  • Some evidence suggests a link between using marijuana and developing a dependence on or abuse of other substances, including alcohol, tobacco and illicit drugs.


Study Says Walnuts Reduce Risk of Stroke

New England Journal of Medicine, findings from the landmark Spanish PREDIMED (PREvención con DIeta MEDiterranea) trial, report that a Mediterranean diet including nuts, primarily walnuts, reduced the risk of cardiovascular diseases (myocardial infarction, stroke or cardiovascular death) by 30%.

And it specifically reduced the risk of stroke by 49% when compared to a reference diet consisting of advice on a low-fat diet (American Heart Association guidelines).

As one of the world's largest and longest dietary intervention studies, according to California Walnut Commission, PREDIMED is a multicenter, randomized, primary prevention trial of cardiovascular disease funded by the Spanish Ministry of Health.

These findings are significant considering that heart disease is the leading cause of death for both men and women in the United States.  In addition to being the first and third leading causes of death in America, heart disease and stroke result in serious illness and disability, decreased quality of life, and hundreds of billions of dollars in economic loss every year. 

According to lead researcher Dr. Ramon Estruch, "the results of the PREDIMED trial are of utmost importance because they convincingly demonstrate that a high vegetable fat dietary pattern is superior to a low-fat diet for cardiovascular prevention."

The trial included 7,447 individuals (55-80 years old) at high cardiovascular risk who were followed for an average of 4.8 years. Participants were randomized into one of three intervention diets: Low-fat diet (control group), Mediterranean diet supplemented with extra-virgin olive oil (50 ml per day), or a Mediterranean diet supplemented with 30 g mixed nuts, primarily walnuts, per day (15 g walnuts, 7.5 g almonds and 7.5 g hazelnuts.)

In addition to the benefits of the Mediterranean diet supplemented with nuts, the research found that the Mediterranean diet enriched with extra-virgin olive oil also reduced the risk of cardiovascular diseases by 30%.


Wednesday, January 11, 2017

Natural Antiinflammatory Agents for Pain Relief in Athletes

Since ancient times our ancestors have used phytochemicals found in plants to curtail the inflammatory process. For example, the bark of the willow tree was used as an analgesic and antipyretic medication more than 2400 years ago by the Greeks and Romans.[20] The discovery of aspirin in 1899 was based on this observation.

The emergence of today's pharmaceutical industry, in large part, has been based on natural products. Drugs such as digoxin, Taxol, artemisinin, and scores more have been developed from phytochemicals.[80,138] Not only have many medical breakthroughs been based on compounds of natural origin, but these also represent a large share of the drug market. In 1999, close to 50% of the 20 best-selling drugs were derived from natural products, and their sales amounted to approximately $16 billion.[80,92] According to a survey by the National Cancer Institute, 61% of the 877 small molecules, which are new chemical entities introduced as drugs worldwide from 1981 to 2002, were inspired by natural products. The following is a discussion of the most commonly used natural antiinflammatory agents and their mechanism of action.