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Survey: Men may not be adequately involved in decisions about prostate cancer screening

Second study attempts to quantify benefits, risks

Men largely make decisions about prostate cancer screening based on conversations with their clinicians, but these discussions often do not include information about the risks of testing in addition to the benefits, according to a report in the September 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. A second report in the same issue uses statistical modeling to estimate the benefits and risks of prostate-specific antigen (PSA) screening in men of various ages and risk levels.

The majority of American men older than 50 have been screened with the PSA blood test, according to background information in one of the articles. However, the practice is controversial because there is no convincing evidence that screening prevents deaths from the disease, and treating early-stage cancers detected by screenings may lead to important complications. "Given the uncertain benefit for screening and known treatment risks, prostate cancer screening decisions should be guided by patient preferences," the authors write. "Indeed, most professional organizations recommend that the first step in screening should be a discussion between health care providers and patients about the risks and benefits of early detection and treatment so that patients can make informed decisions about whether to be screened."

Richard M. Hoffman, M.D., M.P.H., of New Mexico VA Health Care System and University of New Mexico School of Medicine, Albuquerque, and colleagues conducted a telephone survey of 3,010 randomly selected English-speaking adults age 40 and older in 2006 and 2007. The sample included 375 men who had either undergone or discussed PSA testing with their clinicians in the previous two years. These men were asked what they knew about prostate cancer, what their discussions with clinicians were like and what factors and sources of information influenced their screening decisions.

Overall, 69.9 percent of the men had discussed screening with their clinician before making a decision, including 14.4 percent who chose not to undergo testing. Most often, clinicians raised the idea of screening (64.6 percent), and 73.4 percent recommended it. Recommendation from a clinician was the only characteristic of the discussion associated with testing.

"Although respondents generally endorsed shared decision-making process and felt informed, only 69.9 percent actually discussed screening before making a testing decision, few subjects [32 percent] reported having discussed the cons of screening, 45.2 percent said they were not asked for their preference about PSA testing and performance on knowledge testing was poor," with only 47.8 percent of men correctly answering any of three questions about prostate cancer risk and screening accuracy, the authors write. "Therefore, these discussions—when held—did not meet criteria for shared decision making. Our findings suggest that patients need a greater level of involvement in screening discussions and to be better informed about prostate cancer screening issues."

In a second study, Kirsten Howard, B.Sc., M.App.Sc., M.P.H., M.Health.Econ., Ph.D., of the University of Sydney, Australia, and colleagues constructed a statistical model to provide information for men age 40, 50, 60 and 70 years at low, moderate and high risk for prostate cancer based on family history. Using Australian prostate cancer incidence rates before PSA screening began in 1989 and cancer death rates in 2005, along with data from the European Randomized Study of Screening for Prostate Cancer and the Australian Bureau of Statistics, the authors examined two hypothetical cohorts of men who either participated in or declined annual PSA screening.

The model predicts that benefits and harms of annual PSA screening vary with age and risk level. For example, for every 1,000 60-year-old men at low risk, 53 of those who were screened yearly would be diagnosed with prostate cancer and 3.5 would die of the disease during a 10-year period, compared with 23 diagnoses and 4.4 deaths in unscreened men. "For 1,000 men screened from 40 to 69 years of age, there will be 27.9 prostate cancer deaths and 639.5 deaths overall by age 85 years compared with 29.9 prostate cancer deaths and 640.4 deaths overall in unscreened men," the authors write. "Higher-risk men have more prostate cancer deaths averted but also more prostate cancers diagnosed and related harms."

In the model, screened men are two to four times more likely to be diagnosed with prostate cancer than unscreened men, but death rates from prostate cancer and from all causes are not significantly different. This implies that many men whose cancer is detected by PSA screening may be undergoing treatment for clinically insignificant cancers, the authors note.

"In conclusion, before undergoing PSA screening, men should be aware of the possible benefits and harms and of their chances of these benefits and harms occurring," they write. "Even under optimistic assumptions, the net mortality benefit is small, even when prostate cancer deaths are cumulated to 85 years of age. These quantitative estimates can be used to support the goal of individual informed choices about PSA screening."

(Arch Intern Med. 2009;169[17]:1611-1618, 1603-1610. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Study Helps Highlight Difficulties of Shared Decision Making

Virtually every professional organizations' PSA screening guidelines urge clinicians to engage patients in shared decision making before performing PSA testing, write Steven H. Woolf, M.D., M.P.H., of Virginia Commonwealth University, Richmond, and Alex Krist, M.D., M.P.H., in an accompanying editorial.

"Definitions of shared decision making vary, but the term generally refers to the effort to help patients understand the benefits, harms and uncertainties of available options and to apply personal preferences to determine the best choice. Both parties share information, jointly participate in decision making and agree on a course of action that incorporates personal preferences."

"Today's practice environment presents few incentives or support tools for those clinicians and patients who prefer a discussion rather than simply marking a checkbox for PSA on a laboratory requisition form," they continue. "In the United States, where medical technologies are often adopted long before their effectiveness and safety are confirmed, the difficulties of implementing shared decision making for prostate cancer screening will likely recur with other modalities of care. What is ultimately required is a deeper change in culture among providers and consumers of health care to delay dissemination, resist the assumption that newer is better, wait for evidence, tolerate observation over intervention and accept uncertainty."

(Arch Intern Med. 2009;169[17]:1557-1559. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Information Can Aid Discussion of PSA Screening

"Data from the National Survey of Medical Decisions reported in this issue of the Archives suggest that many patients have not had an opportunity to discuss the full range of issues related to the PSA screening decision," writes Michael Pignone, M.D., M.P.H., of University of North Carolina–Chapel Hill, in an accompanying editorial.

"Because of the complexity of factors that need to be considered in such discussions, tools have been developed to help guide providers and patients in considering the benefits and downsides of screening and in reaching a value-concordant decision," he continues. "One type of tool, patient decision aids, has been shown to increase patient knowledge, participation and confidence."

"To inform the development of future decision aids, Howard and colleagues present a balance sheet of the consequences of PSA screening in Australian men from different age groups and with different levels of underlying risk," Dr. Pignone continues. "The work by Howard and colleagues is an important step in providing information to patients and providers to facilitate discussion about this trade-off."

The consumption of fish has no major role in the prevention of heart failure, according to results from a large prospective population study.(1) The study, which was started in 1990 and involved all men and women over the age of 55 living in a suburb of Rotterdam, found no difference in the risk of developing heart failure between those who did eat fish and those who didn't.

The study is published on 30 September in the October issue of the European Journal of Heart Failure.

"Scientists and health authorities are increasingly persuaded that the intake of fish - even in small amounts - will protect against the risk of fatal myocardial infarction," said study investigator Dr Marianne Geleinjse from Wageningen University in the Netherlands. "However, there is no strong evidence that eating fish will protect against heart failure. One study has suggested that this might be so, but we could not confirm it in our cohort study of older Dutch people."

Heart failure is by far today's single biggest reason for acute hospital admission. Around 30 million people in Europe have heart failure and its incidence is still increasing: more cases are being identified, more people are living to an old age, and more are surviving a heart attack but with damage to the heart muscle. According to one study, the reported prevalence among those aged 65-74 years is one in 35, and among the over-85s one in seven.

According to background information to the study, the lifetime risk of developing heart failure is even higher - estimated in men and women as one in four at age 40. The risks increase with age, and prognosis is poor; a previous report from the same Rotterdam Study has shown survival rates at one, two and five years of 89%, 79%, and 59%, representing an age-adjusted mortality rate twice that of those without heart failure.(2) The hazard ratio for sudden death was found to be almost five times higher.

With heart failure treatments often limited to palliative care, much rests on prevention; this latest report from the Rotterdam Study was to investigate whether intake of the long-chain n-3 polyunsaturated fatty acids (PUFAs) found in fish conferred protection against heart failure as they seem to do against coronary heart disease.(3)

The analysis comprised 5299 subjects (41% men, mean age 67.5 years) who were free from heart failure and for whom dietary data were available. During 11.4 years of follow-up, 669 subjects developed heart failure. Their habitual diet had been assessed at baseline (in a self-reported checklist and by expert interview), with subjects specifically asked to indicate the frequency, amount, and kind of fish they had eaten, either as a hot meal, on a sandwich, or between meals.

Results showed that the dietary intake of fish was not significantly related to heart failure incidence. This relative risk was measured according to five levels of fish consumption as reflected in intake of two long chain n-3 PUFAs (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]), both of which have been shown to exert some cardiovascular benefit via anti-inflammatory mechanisms, anti-arrhythmic effects and/or a reduction in serum triglycerides, blood pressure, and heart rate.

The relative risk (RR) of heart failure in the top (highest) and bottom (lowest) quintile of EPA plus DHA intake was 0.89 (95% CI, 0.69𔂿.14) after adjustment for lifestyle and dietary factors, a non-significant finding.

Results were also estimated according to the weight of fish consumed; but even for a high daily fish consumption of more than 20 grams a day there appeared no added protection against heart failure. Incidence rates were the same in those who consumed no fish (incidence rate of 11 per 1000), moderate fish (median 9g per day, 12.3 per 1000) or high fish (9.9 per 1000). The relative risk of heart failure in the high intake groups was 0.96 (0.78𔂿.18) when compared with no intake.

Variations in risk were seen in various sub-groups according to age, sex and body mass index (BMI), but once again the differences were not statistically significant. In diabetic subjects, however, an inverse association of EPA plus DHA intake with heart failure was observed (RR 0.58 (0.32𔂿.06) for top vs. bottom quartile), which was just of borderline statistical significance. Similarly, a high EPA plus DHA intake tended to be protective (but not statistically significant) in women (RR 0.75, 0.54𔂿.04), although not in men.

Commenting on the public health implications of the study Dr Geleijnse said: "Many health authorities recommend two weekly servings of fish - particularly fatty fish like salmon, mackerel and herring - for the prevention of cardiovascular disease. Based on our data we would not change this advice, even though fish intake was not associated with the development of heart failure in our cohort. Fish intake in the Netherlands is extremely low - on average less than one portion per week - so maybe higher intakes are needed for any protection against heart failure.

"Apart from n-3 fatty acids, fish also contains other healthy components such as vitamin D and selenium. Fish is a good source of protein and is more healthy than, for example, red meat."

According to the authors this is only the second ever study to examine the relationship between PUFAs and the risk of heart failure; the other, over 12 years of follow-up among older adults, did find that consumption of tuna or other broiled or baked fish (but not fried fish) was associated with a lower incidence of heart failure.(4)

Oleocanthal, a naturally-occurring compound found in extra-virgin olive oil, alters the structure of neurotoxic proteins believed to contribute to the debilitating effects of Alzheimer's disease. This structural change impedes the proteins' ability to damage brain nerve cells.

"The findings may help identify effective preventative measures and lead to improved therapeutics in the fight against Alzheimer's disease," said study co-leader Paul A.S. Breslin, PhD, a sensory psychobiologist at the Monell Center.

Known as ADDLs, these highly toxic proteins bind within the neural synapses of the brains of Alzheimer's patients and are believed to directly disrupt nerve cell function, eventually leading to memory loss, cell death, and global disruption of brain function. Synapses are specialized junctions that allow one nerve cell to send information another.

"Binding of ADDLs to nerve cell synapses is thought to be a crucial first step in the initiation of Alzheimer's disease. Oleocanthal alters ADDL structure in a way that deters their binding to synapses," said William L. Klein, PhD, who co-led the research with Breslin. "Translational studies are needed to link these laboratory findings to clinical interventions." Klein is Professor of Neurobiology & Physiology, and a member of the Cognitive Neurology and Alzheimer's Disease Center, at Northwestern University.

Klein and his colleagues identified ADDLs in 1998, leading to a major shift in thinking about the causes, progression and treatment of Alzheimer's disease. Also known as beta-amyloid oligomers, ADDLs are structurally different from the amyloid plaques that accumulate in brains of Alzheimer's patients.

Reporting on a series of in vitro studies, the team of Monell and Northwestern researchers found that incubation with oleocanthal changed the structure of ADDLs by increasing the protein's size.

Knowing that oleocanthal changed ADDL size, the researchers next examined whether oleocanthal affected the ability of ADDLs to bind to synapses of cultured hippocampal neurons. The hippocampus, a part of the brain intimately involved in learning and memory, is one of the first areas affected by Alzheimer's disease.

Measuring ADDL binding with and without oleocanthal, they discovered that small amounts of oleocanthal effectively reduced binding of ADDLs to hippocampal synapses. Additional studies revealed that oleocanthal can protect synapses from structural damage caused by ADDLs.

An unexpected finding was that oleocanthal makes ADDLs into stronger targets for antibodies. This action establishes an opportunity for creating more effective immunotherapy treatments, which use antibodies to bind to and attack ADDLs.

Breslin commented on the implications of the findings. "If antibody treatment of Alzheimer's is enhanced by oleocanthal, the collective anti-toxic and immunological effects of this compound may lead to a successful treatment for an incurable disease. Only clinical trials will tell for sure."

In earlier work at Monell, Breslin and co-workers used the sensory properties of extra virgin olive oil to identify oleocanthal based on a similar oral irritation quality to ibuprofen. Oleocanthal and ibuprofen also have similar anti-inflammatory properties, and ibuprofen – like extra virgin olive oils presumably rich in oleocanthal – is associated with a decreased risk of Alzheimer's when used regularly.

Future studies to identify more precisely how oleocanthal changes ADDL structure may increase understanding of the pharmacological actions of oleocanthal, ibuprofen, and structurally related plant compounds. Such pharmacological insights could provide discovery pathways related to disease prevention and treatment.

The findings are reported in the October 15 issue of Toxicology and Applied Pharmacology.

Women who put on weight as they approach middle-age could reduce their chances of enjoying a healthy old age by up to 80%, according to research from the University of Warwick.

The study, published today (Wednesday) in the British Medical Journal, suggests that women who have a high body mass index in middle age are significantly more likely to suffer from major chronic diseases such as cancer and coronary heart disease and poor quality of life.

Dr Oscar Franco, Assistant Clinical Professor of Public Health at Warwick Medical School collaborated on the paper with researchers from Harvard School of Public Health in Boston, Massachusetts.

The research team found that for every 1kg gained in weight since the age of 18, the odds of healthy survival into old age decreased by 5%.

They also found that women who were overweight at the age of 18 and continued to gain weight as they grew older were most at risk of developing a major chronic disease. Obese women with a body mass index of more than 25kg/m2 had 79% lower odds of aging without developing a chronic disease, compared to women with a body mass index of 18.5-22.9kg/m2.

The research team used the Nurses' Health Study, which has gathered data from more than 120,000 female registered nurses living in 11 US states since 1976. Follow-up questionnaires have been sent out every two years to update information on disease incidence and lifestyle factors.

Dr Franco said those study participants who had reached the age of 70 and were free of major chronic disease, had no major impairment of cognitive function and no major limitation of physical function were considered as examples of 'successful aging'.

He said: "In summary, this study provides new evidence that adiposity at mid-life is a strong risk factor predicting a worse probability of successful survival among older women. In addition, our data suggest that maintenance of healthy weight throughout adulthood may be vital to optimal overall health at older ages. Given that more and more people are surviving to older ages and, at the same time, gaining weight, our results may be particularly important with respect to clinical or public health interventions."

A comparison of outcomes of different eras of conservative treatment for localized prostate cancer indicates that overall and prostate cancer-specific survival rates are higher for men diagnosed from 1992 through 2002 compared to men diagnosed in the 1970s and 1980s, according to a study in the September 16 issue of JAMA.

"Among men, prostate cancer is the most common nonskin cancer and the second most common cause of cancer death in the United States. When diagnosed, prostate cancer is contained within the prostate in approximately 85 percent of cases, and standard treatment options usually include surgery, radiation, or conservative management (active surveillance or deferral of treatment until necessitated by disease signs or symptoms)," according to background information in the article. "Despite its potential as a reasonable treatment choice, however, conservative management has been used in only about 10 percent of patients, perhaps because of a limited understanding of and contemporary data on the anticipated course and outcomes of this approach." The authors add that this lack of reliable contemporary information makes it difficult for patients and their physicians to anticipate outcomes and make informed treatment decisions.

Grace L. Lu-Yao, M.P.H., Ph.D., of the Cancer Institute of New Jersey and UMDNJ-Robert Wood Johnson Medical School, Piscataway, N.J., and colleagues analyzed data for men with localized T1 or T2 prostate cancer to evaluate the outcomes of conservatively managed localized prostate cancer diagnosed in the contemporary prostate-specific antigen (PSA) era. The population-based cohort study included 14,516 men age 65 years or older when they were diagnosed (1992-2002) with stage T1 or T2 prostate cancer and whose cases were managed without surgery or radiation for 6 months after diagnosis. Living in areas covered by the Surveillance, Epidemiology, and End Results (SEER) program, the men were followed up for a median (midpoint) of 8.3 years (through December 2007). The median age at diagnosis was 78 years.

The researchers found that ten-year prostate cancer–specific mortality was 8.3 percent for men with well-differentiated tumors, 9.1 percent for moderately differentiated, and 25.6 percent for those with poorly differentiated tumors. The corresponding 10-year risks of dying of causes other than prostate cancer were 59.8 percent, 57.2 percent, and 56.5 percent for each respective group.

Ten-year disease-specific mortality for men age 66 to 74 years diagnosed with moderately differentiated disease was 60 percent to 74 percent lower than earlier studies. "Survival results in our contemporary PSA era study cohort were more favorable than results previously reported. For example, in the current study, 10-year prostate cancer–specific mortality was 6 percent in the contemporary PSA era (1992-2002) compared with results of previous studies (15 percent-23 percent) in earlier eras (1949-1992) for men aged 65 to 74 years diagnosed with moderately differentiated disease. Improvement in survival among men with older age or poorly differentiated disease was also observed," the authors write.

"The substantial improvement in survival that we observed in our study compared with previous reports might be explained, in part, by additional lead time, overdiagnosis related to PSA testing, or grade migration, among other factors. Prostate-specific antigen testing identifies disease 6 to 13 years before it presents clinically. Contemporary patients identified through such testing would be expected to live at least 6 to 13 years longer because of this lead time. In addition, previously documented systematic upgrading of modern tumors compared with earlier eras makes more recently graded tumors appear to have a more benign course, resulting in longer survivals. Finally, it is also possible that advancements in medical care might have led to improved outcomes."

"The net overall effect is that outcomes following conservative management are now significantly better than those reported in previous eras; therefore, physicians and their patients may need to reconsider this management option, particularly in light of randomized trial data from the pre-PSA era suggesting little if any benefit to more aggressive intervention."

Just two weeks on a high-fructose diet raises blood pressure in men

A high-fructose diet raises blood pressure in men according to research reported at the American Heart Association’s 63rd High Blood Pressure Research Conference.

“This is the first evidence of a role of fructose in raising blood pressure and a role for lowering uric acid to protect against that blood pressure increase in people,” said Richard Johnson, M.D., co-author of the study and professor and head of the division of Renal Diseases and Hypertension at the University of Colorado–Denver medical campus in Aurora, Colo.

In the study, excessive fructose consumption seemed to increase new onset of metabolic syndrome, a cluster of risk factors associated with the development of cardiovascular disease and type 2 diabetes. On the other hand, the gout drug seemed to halt it — most likely by lowering uric acid, which affects blood pressure.

Fructose, one of several dietary sugars, makes up about half of all the sugar molecules in table sugar and in high-fructose corn syrup, a sweetener often used in packaged products because it’s relatively cheap and has a long shelf life. Glucose makes up the other half. Fructose is the only common sugar known to increase uric acid levels.

Patients with high blood pressure, diabetes and kidney disease often have high uric acid levels and gout. But all the ways in which those conditions might contribute to the development or worsening of the others isn’t completely understood, Johnson said.

Johnson and co-author Santos Perez-Pozo, M.D., a nephrologist at Mateo Orfila Hospital in Minorca, Spain who led the study, evaluated 74 adult men, average age 51, who consumed a diet that included 200 grams (g) of fructose per day in addition to their regular diet. The amount is much higher than the estimated U.S. daily intake of 50 g to 70 g of fructose consumed by most U.S. adults. Half of the men were randomly assigned to get the gout drug allopurinol and the other half acted as controls.

After only two weeks on the diet, the high-fructose plus placebo group experienced significant average blood pressure increases of about 6 millimeters of mercury (mm Hg) in systolic blood pressure (the pressure when the heart beats) and about a 3 mm Hg rise in diastolic blood pressure (the pressure between heartbeats). They were measured with strap-on monitors that record blood pressure periodically around the clock.

In contrast, men on the high-fructose diet plus allopurinol had significantly lower uric acid levels and virtually no increase in systolic blood pressure (only 1 mm Hg). The blood pressure levels of most of the men returned to normal within two months of the study’s conclusion when the participants returned to their normal dietary intake, Johnson said.

The study also found changes in the incidence of metabolic syndrome. The United States and the international community define the syndrome slightly differently, so researchers used both criteria in the study. In general, metabolic syndrome is defined as having three or more of these five risk factors:
• Increased waist circumference;
• High triglyceride levels;
• Low levels of high-density lipoprotein (HDL), a component of total cholesterol thought to have a protective effect;
• High blood pressure; and
• High fasting blood sugar.

After just two weeks, the incidence of metabolic syndrome more than doubled in the men who consumed a heavy fructose diet and took the placebo pill. The incidence went from 19 percent at baseline to 44 percent at the study’s end, according to the U.S. National Cholesterol Education Program-ATP III (NCEP–ATP III) definition, and from 25 percent to 58 percent under the International Diabetes Federation (IDF) definition.

Among men consuming fructose plus allopurinol, virtually no change in the rate of metabolic syndrome occurred — perhaps because the gout drug prevented the blood pressure rise associated with increased fructose consumption.

The study should be viewed as a pilot and more investigations are needed before doctors consider lowering uric acid in the clinical setting, said Johnson, noting that allopurinol can have rare but serious side effects.

Men in both groups had an increase in fasting triglycerides and an indication of insulin resistance by a method called homeostatic model assessment (HOMA), while on the increased fructose diet. The HOMA method is used to quantify insulin resistance and beta-cell function. Allopurinol treatment appeared to lower low-density lipoprotein cholesterol (LDL), a component of total blood cholesterol linked to the development of cardiovascular disease, compared to placebo, the researchers reported.

“These results suggest that fructose may be a cause of metabolic syndrome,” Johnson said. “They also suggest that excessive fructose intake may have a role in the worldwide epidemic of obesity and diabetes.”

Fruit, which has just 4 g to 10 g of fructose per serving, also contains many beneficial substances including antioxidants, vitamin C, potassium and fiber that are believed to counter the effects of fructose alone. The main risk for excessive fructose consumption in the Western diet comes from sweetened drinks and foods rich in sugar or high fructose corn syrup, he said.

“When you give fructose to animals, they absolutely develop every feature of metabolic syndrome: they get abdominal fat, high triglycerides, low HDL, their blood pressure goes up and they get insulin resistance,” Johnson said. “However, you must give massive amounts of fructose to rats to raise uric acid levels, because rats and most other animals have an enzyme that breaks down uric acid. Humans lack that enzyme. It turns out humans get gout but other animals don’t.”

If you inhibit the enzyme in rats that breaks down uric acid, it takes only a small amount of fructose to cause uric acid to rise and the symptoms of metabolic syndrome to appear in the animals, he said.

In the largest study of its kind, the international team of pathologists studied an initial 4,000 prostate cancer patients over a period of 15 years to further understanding into the natural progression of the disease and how it should be managed. The research, published in the British Journal of Cancer, could be used to develop a blood test to distinguish between aggressive and non-aggressive forms of prostate cancer.

Globally, prostate cancer is the fifth most common malignancy and accounts for 13% of male deaths in the UK. Studies have shown that men with non-aggressive prostate cancer can live with the disease untreated for many years, but aggressive cancer requires immediate treatment.

Pathologists found that the presence of a protein, called Hsp-27, in cancer cells was an indicator that the disease will progress and require treatment. The study showed, however, that in more than 60% of cases the protein was not expressed and the cancer could be managed by careful monitoring, rather than with active invention methods, such as drug treatment or surgery.

The protein normally has a positive function in the body, helping healthy cells survive when they are placed under 'stressful' conditions, such as disease or injury. If the protein is expressed in cancer, however, it can prevent the diseased cells from dying, allowing the cancer to progress. The team, supported by Cancer Research UK (CRUK) and in collaboration with scientists in London and New York, found that the protein can be used to predict how the disease will behave and could help doctors advise patients on how the disease could affect their daily lives.

Professor Chris Foster, Head of the University's Division of Pathology, explains: "Cancer of any kind is a very distressing disease and has the ability to impact on every aspect of a person's life. Chemotherapy and surgery can also have a significant effect on health and wellbeing and that is why it is important that we first understand the biological nature of the disease and how it will behave in each individual patient, before determining if and when a person needs a particular type of treatment.

"By studying the disease in a large number of men throughout the UK and over a long period of time, we have been able to get a more complete picture of how to manage the disease successfully, whilst limiting the negative impact it can have on a patient's life. The study also demonstrates the role of modern of Pathology, not only in establishing diagnoses but in determining if the subsequent management of individual patients is biologically appropriate for their particular condition.

"The protein – or biomarker – we have identified provides us with a signal that the disease will continue to progress. We know that at the point this marker is expressed, medics need to administer treatment to kill the cancer cells. We have shown that in the majority of cases, however, this marker is not expressed and therefore patients do not necessarily need to go through treatment to lead a normal life."

Currently, the test can be performed after the patient has undergone a biopsy. Scientists are now working to allow the test to be conducted by blood test.

Vitamin D deficiency in younger women is associated with three times the risk risk of high blood pressure in mid-life, according to research reported at the American Heart Association’s 63rd High Blood Pressure Research Conference.

Since the introduction of statins to treat high cholesterol, the decline in lipid levels experienced by the wealthy has been double that experienced by the poor. While statins are highly effective in reducing cholesterol and improving heart health, their use may have contributed to expanding social disparities in the treatment of cardiovascular disease, according to research by Virginia W. Chang, MD, PhD, of the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania, and Diane S. Lauderdale, PhD, of the University of Chicago, published in the September issue of Journal of Health and Social Behavior.

"Income disparities in lipid levels have reversed over the past three decades," according to Dr. Chang, lead author and Assistant Professor of Medicine and Sociology at the University of Pennsylvania. "High cholesterol was once known as a rich man's disease, because the wealthy had easier access to high fat foods (e.g., red meat). Now wealthy Americans are least likely to have high cholesterol, because they are more likely to be treated with statins, an expensive but highly effective pharmaceutical treatment to lower lipid levels."

While cardiovascular disease remains a leading cause of death in the U.S., mortality due to heart disease has declined dramatically since the 1980s. Researchers estimate that about one-third of that reduction is a result of pharmaceutical innovation, including the use of statins. Dr. Chang notes, "Though statins have a longer-run potential to reduce disparities by making it easier for everyone to lower cholesterol relative to lifestyle changes, they have yet to diffuse widely across all income levels."

Seasonality of mortality: Summer vacation link?

Mortality rates in several Mediterranean countries decline in September, due in part to environmental factors but possibly linked to summer vacations, suggests a new study in CMAJ (Canadian Medical Association Journal) www.cmaj.ca.

The study looked at official statistics for Greece, Cyprus, Italy, France and Spain.

Extreme heat and cold are associated with an increased risk of death.

"We speculate that another factor accounting for the lower mortality observed in September in the Mediterranean countries is the preceding summer vacations," write Dr. Matthew Falagas of the Alfa Institute of Biomedical Sciences in Greece and coauthors. The authors suggest the physiological effect of increased vitamin D synthesis combined with the stress-relieving benefits of time off may contribute to these lower mortality figures.

In North America and Sweden, August is the lowest month for mortality, in Japan it is July, and in Australia, it is March (the counterpart to September in the southern hemisphere).

A new study by researchers at the University of Colorado Denver and Massachusetts General Hospital (MGH) shows vitamin D plays a vital role in reducing the risk of death associated with older age. The research, just published in the Journal of the American Geriatrics Society, evaluated the association between vitamin D levels in the blood and the death rates of those 65 and older. The study found that older adults with insufficient levels of vitamin D die from heart disease at greater rates that those with adequate levels of the vitamin.

"It's likely that more than one-third of older adults now have vitamin D levels associated with higher risks of death and few have levels associated with optimum survival," said Adit Ginde, MD, MPH, an assistant professor at the University of Colorado Denver School of Medicine's Division of Emergency Medicine and lead author on the study. "Given the aging population and the simplicity of increasing a person's level of vitamin D, a small improvement in death rates could have a substantial impact on public health."

Older adults are at high risk for vitamin D deficiency because their skin has less exposure to the sun due to more limited outdoor activities as well as reduced ability to make vitamin D.

The study analyzed data from the Third National Health and Nutrition Examination Survey conducted by the National Center for Health Statistics. The research team analyzed vitamin D in blood samples of more than 3,400 participants that were selected to be representative of the 24 million older adults in the United States. Compared to those with optimal vitamin D status, those with low vitamin D levels were 3 times more likely to die from heart disease and 2.5 times more likely to die from any cause.

Dr. Ginde says the findings suggest that current daily recommendations of vitamin D may not be enough for older adults to maintain optimal health. The research team has applied for research funding from the National Institutes of Health to perform a large, population-based clinical trial of vitamin D supplementation in older adults to see if it can improve survival and reduce the incidence of heart disease.

"Confirmation of these results in large randomized trials is critically important for advancing public health," says Carlos Camargo, MD, DrPH, of the MGH Department of Emergency Medicine, the senior author of the study and an associate professor of medicine at Harvard Medical School.

The study looking at elderly death rates is the second of two studies by the same team of researchers on vitamin D and general health. The first study, published in Archives of Internal Medicine earlier this year, identified vitamin D as playing a significant role in boosting the immune system and warding off colds and flu.

"Vitamin D has health effects that go beyond strong bones," says Ginde. "It's likely that it makes a vital contribution to good health."

Rush University Medical Center is participating in a large-scale, multi-center clinical trial in the U.S. and Canada to determine whether a vitamin-like substance, in high doses, can slow the progression of Parkinson's disease, a neurodegenerative disorder that affects about one million people in the United States.

"At present, the very best therapies we have for Parkinson's can only mask the symptoms – they do not alter the underlying disease," said neurologist Dr. Katie Kompoliti, a specialist in movement disorders. "Finding a treatment that can slow the degenerative course of Parkinsons's is the holy grail of Parkinson's research."

The substance being tested, called coenzyme Q10, is produced naturally in the body and is an important link in the chain of chemical reactions that produce energy in mitochondria, the "powerhouses" of cells. The enzyme is also a potent antioxidant – a chemical that "mops up" potentially harmful chemicals generated during normal metabolism.

Several studies have shown that Parkinson's patients have impaired mitochondrial function and low levels of coenzyme Q10. Moreover, laboratory research has demonstrated that coenzyme Q10 can protect the area of the brain damaged in Parkinson's.

The Phase III clinical trial, a large, randomized study with a control group, follows an earlier investigation that tested several doses of coenzyme Q10 in a small group of patients with early-stage Parkinson's disease. The highest dose, 1,200 mg, appeared promising. Over the course of 16 months, patients taking this dose experienced significantly less decline than other patients in motor (movement) function and ability to carry out activities of daily living, such as feeding or dressing themselves.

But researchers involved in the study, including Kompoliti, were cautious about their findings, citing the need for a more extensive review to confirm the results.

In the present trial, funded by the National Institutes of Health and the National Institute of Neurological and Disorders and Stroke, 600 patients will be enrolled at 60 centers in the U.S. and Canada. Two dosages of coenzyme Q10 are being tested,1,200 mg and 2,400 mg, delivered in maple nut-flavored chewable wafers that also contain vitamin E.

Participants in the study will be evaluated periodically over 16 months for symptoms of Parkinson's disease, including tremor, stiffness of the limbs and trunk, impaired balance and coordination, and slowing of movements. They will also be assessed for ability to perform daily activities, overall quality of life, and need to take medications to alleviate symptoms.

Older adults who continue or begin to do any amount of exercise appear to live longer and have a lower risk of disability, according to a report in the September 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

“Physical activity is a modifiable behavior associated with health, functional status and longevity, and encouraging a physically active lifestyle has become an accepted public health goal,” the authors write as background information in the article. However, most research on the benefits of physical activity has focused on middle-aged populations.

Jochanan Stessman, M.D., and colleagues at Hebrew University Medical Center and Hebrew University Hadassah Medical School, Jerusalem, studied 1,861 individuals born in 1920 and 1921. Participants underwent assessments in their homes at ages 70, 78 and 85 years, during which they were asked about their physical activity levels. Those who performed less than four hours per week of physical activity were considered sedentary, while those who exercised about four hours weekly, performed vigorous activities such as jogging or swimming at least twice weekly or who engaged in regular physical activity (for example, walking at least an hour daily) were considered physically active.

The proportion of participants who were physically active was 53.4 percent at age 70, 76.9 percent at age 77 and 64 percent at age 85. When compared with those who were sedentary, individuals who were physically active were 12 percent less likely to die between ages 70 and 78, 15 percent less likely to die between ages 78 and 85 and 17 percent less likely to die between ages 85 and 88; were more likely to remain independent and experienced fewer declines in their ability to perform daily tasks; and reported fewer new instances of loneliness (12.2 percent vs. 22.6 percent from ages 70 to 78 and 26.5 percent vs. 44.1 percent from ages 78 to 85) and poor self-rated health (77.3 percent vs. 63.3 percent from ages 70 to 78 and 63.8 percent vs. 82.6 percent from ages 78 to 85).

The benefits associated with physical activity were observed not only in those who maintained an existing level of physical activity, but also in those who began exercising between ages 70 and 85.

“Although the mechanism of the survival benefit is most likely multifactorial, one important finding was the sustained protective effect of physical activity against functional decline,” the authors write. Physical activity may delay the spiral of decline that begins with inability to perform daily activities and continues through illness and death by improving cardiovascular fitness, slowing loss of muscle mass, reducing fat, improving immunity and suppressing inflammation.

“Despite the increasing likelihood of comorbidity, frailty, dependence and ever-shortening life expectancy, remaining and even starting to be physically active increases the likelihood of living longer and staying functionally independent,” the authors write. “The clinical ramifications are far reaching. As this rapidly growing sector of the population assumes a prominent position in preventive and public health measures, our findings clearly support the continued encouragement of physical activity, even among the oldest old. Indeed, it seems that it is never too late to start.”

I supplement my diet with Omega-3 pills derived from fish or flaxeed. Here is more info on the positive effects of flaxseed:

Research shows that cancer risks, including the risk for prostate cancer, may be reduced by 30 to 40 percent if people ate a more plant-based diet. This healthy diet includes fruits, vegetables, whole grains, beans, nuts and seeds – including flaxseed.

“Cancer cells migrate by attaching onto other cells. The omega 3 fatty acids found in flaxseed keep cells from binding together and attaching to blood vessels,” Demark-Wahnefried says. “Lignan may reduce testosterone and other hormone levels. Lowering testosterone levels may reduce a man’s chances of getting prostate cancer.”

Demark-Wahnefried and her team learned about the potential cancer-reducing benefits of flaxseed during a study with 161 men. The men had been diagnosed with prostate cancer, but had not started treatment. Each participant ate three tablespoons of flaxseed a day. This study and its results were published in the December 2008 issue of "Cancer Epidemiology Biomarkers and Prevention."

“While our study used three tablespoons a day, men who don’t have cancer but want to try flaxseed, probably don’t need that much,” Demark-Wahnefried says. “One tablespoon a day should be fine.”

but Increase Risk of Adverse Effects


Three drugs, including tamoxifen, reduce a woman’s chance of getting breast cancer, but each drug carries distinct potential harms of its own, according to a new report from HHS’ Agency for Healthcare Research and Quality.

Drugs to reduce the risk of breast cancer can be prescribed to women with a family history of breast cancer or other risk factors, but prescribing practices vary widely. The comparative effectiveness review found that all three drugs — tamoxifen, raloxifene, and tibolone — significantly reduce invasive breast cancer in midlife and older women but that benefits and adverse effects can vary depending on the drug and the patient.

“Taking medicine to avoid breast cancer in the first place is an attractive notion, but the decision to do so must be made by patients in consultation with their clinicians with benefit of the best evidence available,” said AHRQ Director Carolyn M. Clancy, M.D. “These drugs are not necessarily for everyone. This report sheds important light on their advantages and potential harms.”

The report is the first to make a direct, comprehensive comparison of the drugs so that women and their health care providers can assess the medications’ potential effectiveness and adverse effects. The report compares the use of the three drugs to reduce the risks of getting breast cancer in women who have not previously had breast cancer.

Breast cancer is the second most commonly diagnosed cancer of women (after skin cancer), with more than 190,000 new cases diagnosed each year in the United States. It is estimated to cause more than 40,000 deaths per year. The National Cancer Institute estimates that nearly 15 percent of women born today will develop breast cancer in their lifetimes. Most cases of breast cancer occur in women with no specific risk factors other than age and gender, although family history of breast and ovarian cancer is associated with higher risk.

Tamoxifen, a selective estrogen receptor modulator (SERM), was approved by the U.S. Food and Drug Administration in 1998 to prevent breast cancer in women at high risk of developing the disease. Tamoxifen’s use to reduce the risk of breast cancer is accepted clinical practice, although the drug is primarily used for treatment rather than risk reduction.

The AHRQ report compared tamoxifen with another SERM, raloxifene, which is primarily used to prevent and treat osteoporosis and was approved by the FDA for breast cancer risk reduction in 2007. A third drug, tibolone, which has not been approved by the FDA for use in the United States but is commonly used in other countries to treat menopausal symptoms and osteoporosis, also was included in the study.
The report found that all three drugs reduce the occurrence of breast cancer but have various side effects. The most common side effects for tamoxifen are flushing and other vasomotor symptoms (e.g., night sweats, hot flashes), vaginal discharge and other vaginal symptoms such as itching or dryness; for raloxifene, side effects include vasomotor symptoms and leg cramps; and for tibolone, side effects include vaginal bleeding.

The report also found that each drug carried the risk of adverse effects. It found that tamoxifen increases risk for endometrial cancer, hysterectomies, and cataracts compared with the other drugs. Tamoxifen and raloxifene increase risk of blood clots, although tamoxifen’s risk is greater. Tibolone carries an increased risk of stroke.
The report also examined the drugs’ effectiveness and harms based on such factors as age, menopausal status, estrogen use, and family history of breast cancer and sought to identify the kinds of women who might be good candidates for prevention therapy, although the evidence is limited in this area. The report called for more research to more clearly identify characteristics of patients who would benefit from these drugs while suffering the least harm.

AHRQ’s new report, Comparative Effectiveness of Medications to Reduce Risk of Primary Breast Cancer in Women, is the latest analysis from the Agency’s Effective Health Care Program. That program, authorized by the Medicare Prescription Drug Improvement, and Modernization Act of 2003, represents an important federal effort to compare alternative treatments for health conditions and make the findings public. The program is intended to help patients, doctors, nurses, and others choose the most effective treatments. Information, including the new report, can be found at www.effectivehealthcare.ahrq.gov.

Vitamin D appears to boost health from head to toe, according to the September issue of Mayo Clinic Health Letter. But, so far, there’s no consensus on what level of vitamin D is optimal for good health.

Recent reports on vitamin D suggest that it offers many benefits, especially for older adults. Findings point to improved balance, reduction in the risk of bone fractures, and better thinking skills such as planning, organizing and abstract thinking. Low levels of vitamin D are associated with diabetes, cardiovascular disease, multiple sclerosis and other autoimmune disorders, infections such as tuberculosis, and periodontal disease. Low vitamin D levels also may affect certain cancers, including colon, breast and prostate cancers.

Vitamin D is the only vitamin that the body can manufacture itself. The only requirement is sunshine, specifically ultraviolet B rays. About 10 to 15 minutes of exposure two to three times a week during nonpeak sun hours is considered adequate. But the sunshine approach doesn’t work for everyone. With age, the body is less efficient at processing vitamin D. Other barriers are darker skin and living in northern climates. Using sunscreen -- still recommended to prevent skin cancer -- also reduces absorption of ultraviolet B rays.

Food sources are usually an excellent way to obtain vitamins, but choices are limited for vitamin D. Rich sources are fatty fish, fish-liver oils, liver and egg yolks. Milk fortified with vitamin D is another option.

With limited food choices, consumers may opt to rely on vitamin D supplements. The current daily recommended dose of vitamin D for adults 50 and older is 400 to 600 international units (IU). But many researchers believe that a higher amount is warranted because of the many health benefits. The National Osteoporosis Foundation recommends a daily intake of 800 to 1,000 IU per day for adults over age 50. The upper daily limit considered safe for use is 2,000 IU per day, but there’s debate about this level. Very large doses of vitamin D taken over time can cause ill effects, including nausea, vomiting, poor appetite, constipation, weakness and weight loss.

During CPR

Cardiac arrest victims have a better chance of surviving when their rescuers spend more time doing chest compressions during cardiopulmonary resuscitation (CPR).

The amount of time rescuers spend on chest compressions during CPR is highly variable.

The public is encouraged to learn CPR and deliver effective chest compressions.

The chance that a person in cardiac arrest will survive increases when rescuers doing cardiopulmonary resuscitation (CPR) spend more time giving chest compressions, according to a multi-center study reported in Circulation: Journal of the American Heart Association.

“Chest compressions move blood with oxygen to the heart and the brain to save the brain and prepare the heart to start up its own rhythm when a shock is delivered with a defibrillator,” said Jim Christenson, M.D., lead author of the study and clinical professor of emergency medicine at the University of British Columbia. “We found that even short pauses in chest compressions were quite detrimental.”

The proportion of time during CPR that rescuers spend giving chest compressions during each minute of CPR, called the chest compression fraction (CCF), is extremely variable.

Prior to 2005, interruptions to chest compressions resulted in less than 50 percent of total CPR time being spent on chest compressions. However, the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care emphasized the importance of minimizing interruptions in chest compressions. This resulted in some emergency medical services (EMS) agencies achieving a CCF between 60 percent and 85 percent, Christenson said.

Researchers analyzed data from 78 EMS agencies in seven locations that were part of the Resuscitation Outcomes Consortium (ROC), a group of 11 regional clinical centers in Canada and the United States that study promising out-of-hospital therapies for cardiac arrest and traumatic injury.

The study is the first to analyze CPR tracings in a large group of patients. Automated external defibrillators measured the presence and frequency of chest compressions for each patient.
Patients were studied if they had a ventricular fibrillation or pulseless ventricular tachycardia cardiac arrest prior to EMS arrival between December 2005 and March 2007.

Ventricular fibrillation or pulseless ventricular tachycardia are abnormal heart rhythms in which the heart’s lower chambers contract erratically or extremely rapidly and pump little or no blood.

In the 506 cases analyzed, researchers found that a return to spontaneous circulation was achieved 58 percent of the time when the CCF was 0 percent to 20 percent, and up to 79 percent when the CCF was 81 percent to 100 percent.

Return of spontaneous circulation means that the heart begins pumping blood effectively on its own.
Survival to hospital discharge occurred in 12 percent of patients when CCF was 0 percent to 20 percent. It increased to nearly 29 percent when CCF was 61 percent to 81 percent, but dropped slightly to 25 percent when CCF was 81 percent to 100 percent CCF.

Researchers said the slight drop in survival in the group with the highest CCF rate was likely due to the small sample size of the study and wide confidence limits, although they acknowledge the possibility of a plateau effect when CCF is above 80 percent.

“There was roughly a 10 percent increase in the chance of survival for every 10 percent increase in the chest compression fraction,” Christenson said.

More study is needed to identify the ideal CCF or to show when compressions are the most important, such as immediately before or after delivery of a shock, Christenson said.

“We should continue chest compressions as much as possible, only pausing to do things that are proven to be medically beneficial,” he said.

For bystanders, the results emphasize the lifesaving potential of learning CPR and delivering chest compressions.

“The chest compressions you do on a loved one are one of the most important things that can be done,” Christenson said. “If you feel rusty or are not confident giving mouth-to-mouth ventilation along with chest compressions then just do chest compressions. Even by themselves, chest compressions can make a difference.”

A dietary ingredient derived from a melon rich in antioxidant superoxide dismutase enzymes has been shown to relieve stress. In a double-blind, randomised, placebo-controlled trial, published in BioMed Central's open access Nutrition Journal, researchers found that the supplement decreased the signs and symptoms of perceived stress and fatigue in healthy volunteers.

Marie-Anne Milesi from Seppic, France, worked with a team of researchers to evaluate its anti-stress effects in 70 volunteers. She said, "Several studies have shown that there is a link between psychological stress and intracellular oxidative stress. We wanted to test whether augmenting the body's ability to deal with oxidative species might help a person's ability to resist burnout. The 35 people in our study who received capsules containing superoxide dismutase showed improvement in several signs and symptoms of perceived stress and fatigue".

The researchers found a strong placebo effect in the volunteers who received inactive starch capsules, as can be expected when studying subjective feelings like stress. However, the improvements seen in the supplement group were significantly greater, especially after 28 days. According to Milesi, "The placebo effect was only present during the first 7 days of supplementation and not beyond. It will be interesting to confirm these effects and better understand the action of antioxidants on stress in further studies with a larger number of volunteers and a longer duration".

Other vitamins and nutrients may get more headlines, but experts say as many as two billion people around the world have diets deficient in zinc – and studies at Oregon State University and elsewhere are raising concerns about the health implications this holds for infectious disease, immune function, DNA damage and cancer.

One new study has found DNA damage in humans caused by only minor zinc deficiency.

Zinc deficiency is quite common in the developing world. Even in the United States, about 12 percent of the population is probably at risk for zinc deficiency, and perhaps as many as 40 percent of the elderly, due to inadequate dietary intake and less absorption of this essential nutrient, experts say. Many or most people have never been tested for zinc status, but existing tests are so poor it might not make much difference if they had been.

"Zinc deficiencies have been somewhat under the radar because we just don't know that much about mechanisms that control its absorption, role, or even how to test for it in people with any accuracy," said Emily Ho, an associate professor with the Linus Pauling Institute at OSU, and international expert on the role of dietary zinc.

However, studies have shown that zinc is essential to protecting against oxidative stress and helping DNA repair – meaning that in the face of zinc deficiency, the body's ability to repair genetic damage may be decreasing even as the amount of damage is going up.

Two studies recently published, in the Journal of Nutrition and the American Journal of Clinical Nutrition, found significant levels of DNA damage both with laboratory animals and in apparently healthy men who have low zinc intake. Zinc depletion caused strands of their DNA to break, and increasing the intake of zinc reversed the damage back to normal levels.

"In one clinical study with men, we were able to see increases in DNA damage from zinc deficiency even before existing tests, like decreased plasma zinc levels, could spot the zinc deficiency," Ho said. "An inadequate level of zinc intake clearly has consequences for cellular health."

Many zinc studies, Ho said, have focused on prostate cancer – the second leading cause of cancer deaths in American men – because the prostate gland has one of the highest concentrations of zinc in the body, for reasons that are not clearly known.

When prostate glands become cancerous, their level of zinc drops precipitously, and some studies have suggested that increasing zinc in the prostate may at least help prevent prostate cancer and could potentially be a therapeutic strategy. There are concerns about the relationship of zinc intake to esophageal, breast, and head and neck cancers. And the reduced zinc status that occurs with aging may also contribute to a higher incidence of infection and autoimmune diseases, researchers said in one study in the Journal of Nutrition.

Zinc is naturally found associated with proteins in such meats as beef and poultry, and in even higher levels in shellfish such as oysters. It's available in plants but poorly absorbed from them, raising additional concerns for vegetarians. And inadequate intake is so prevalent in the elderly, Ho said, that they should usually consider taking a multivitamin to ensure adequate levels.

Zinc is an essential micronutrient for numerous cellular processes. But taking too much zinc can also be a concern, because in excess it can interfere with the absorption of other important nutrients such as iron and copper. The recommended daily allowance is eight milligrams a day for women, 11 for men, and anything over 50 milligrams a day could be considered excessive, Ho said.

"The consequences of zinc deficiency in adults have been understudied despite the recognition of symptoms of zinc deficiency for decades," researchers wrote in one recent report. "A considerable body of evidence suggests that zinc deficiency may increase the risk of some chronic diseases, including cancer. This link may be attributed to the role of zinc in antioxidant defense and DNA damage repair."

Researchers in Hong Kong are reporting new evidence that green tea — one of the most popular beverages consumed worldwide and now available as a dietary supplement — may help improve bone health. They found that the tea contains a group of chemicals that can stimulate bone formation and help slow its breakdown. Their findings are in ACS' Journal of Agricultural and Food Chemistry, a bi-weekly publication. The beverage has the potential to help in the prevention and treatment of osteoporosis and other bone diseases that affect million worldwide, the researchers suggest.

In the new study, Ping Chung Leung and colleagues note that many scientific studies have linked tea to beneficial effects in preventing cancer, heart disease, and other conditions. Recent studies in humans and cell cultures suggest that tea may also benefit bone health. But few scientific studies have explored the exact chemicals in tea that might be responsible for this effect.

The scientists exposed a group of cultured bone-forming cells (osteoblasts) to three major green tea components — epigallocatechin (EGC), gallocatechin (GC), and gallocatechin gallate (GCG) — for several days. They found that one in particular, EGC, boosted the activity of a key enzyme that promotes bone growth by up to 79 percent. EGC also significantly boosted levels of bone mineralization in the cells, which strengthens bones. The scientists also showed that high concentrations of ECG blocked the activity of a type of cell (osteoclast) that breaks down or weakens bones. The green tea components did not cause any toxic effects to the bone cells, they note.

An important analysis conducted by Children's Hospital Oakland Research Institute scientists suggests the importance of ensuring optimal dietary intakes of vitamin K to prevent age-related conditions such as bone fragility, arterial and kidney calcification, cardiovascular disease, and possibly cancer (1). Vitamin K is concentrated in dark green plants such as spinach or Swiss chard, and is either not present or present in only small amounts in most multivitamin pills.

This finding comes from Associate Staff Scientist, Joyce McCann, PhD, and Senior Scientist, Bruce Ames, PhD, who analyzed data from hundreds of published articles dating back to the 1970's. Their review was designed to test Dr. Ames' "triage" theory that provides a new basis for determining the optimum intake of individual vitamins and minerals (also called micronutrients), and has major implications for preventive medicine. The analysis, which strongly supports his theory, will be published in the October 2009 issue of the American Journal of Clinical Nutrition.

Dr. Ames proposed the triage theory in 2006 (2,3) to explain numerous observations from his own lab and the scientific literature. The theory explains why diseases associated with aging like cancer, heart disease, and dementia (and the pace of aging itself) may be unintended consequences of mechanisms developed during evolution to protect against episodic vitamin/mineral shortages. If correct, the triage theory has widespread implications for public health because modest vitamin/mineral deficiencies are quite common. The theory also suggests a new scientifically based and consistent strategy for establishing optimal vitamin/mineral intake standards, and it provides a research strategy to uncover early biomarkers of chronic disease.

Vitamin K is known as the "Koagulation" vitamin because about half of the 16 known proteins that depend on vitK are necessary for blood coagulation. The other vitK-dependent proteins are involved in a variety of different functions involving the skeletal, arterial, and immune systems.

Average intakes of vitamin K in the United States and the United Kingdom are less even than currently recommended intakes, which are primarily based on levels to ensure adequate coagulation. McCann & Ames' analysis supports recommendations by some experts that non-clotting functions requiring vitamin K may need higher intakes than are currently recommended.

McCann says, "Encouraging support for the triage theory from our vitamin K analysis suggests that experts aiming to set micronutrient intake recommendations for optimal function and scientists seeking mechanistic triggers leading to diseases of aging may find it productive to focus on micronutrient-dependent functions that have escaped evolutionary protection from deficiency."

This vitamin K analysis is the first in a series of literature-based studies conducted by Drs. Joyce McCann and Ames to test the basic premises of the triage theory. As a reviewer of the manuscript notes, "…this review provides a unique perspective of consequences of vitamin K insufficiency and may serve as an important future reference, as new vitamin K dependent proteins are identified and new (non-clotting) functions of vitamin K are elucidated. More broadly, an assessment of micronutrient sufficiency from the perspective of triage theory may provide a valuable point of view, as current recommendations for nutrient intakes are reconsidered."

Red Yeast Rice

There's a newly posted website that says red yeast rice, which I have written about before, and am now taking regularly, is dangerous, because it really is a statin, and can cause severe muscle pains and muscle weakness, just like a statin.

Learn more about statins here.

The adverse reaction, according to the website, is because statins deprive us of co-enzyme Q-10 (which I discontinued taking recently.)

The website also says there is no reason to take statins to lower cholesterol, because cholesterol is good for you!

Well. I've been taking to lower my cholesterol ( which really isn't bad), but now that I think that it's really a statin, I'm going to continue to take it for the reasons cited below, but add co-enzyme Q-10 back to my regimen.

A. Statins suggest that these drugs may lower the risk of certain cancers, including colorectal and skin cancers.

B. And as I've written before:

1. statins may benefit men with prostate cancer, erectile dysfunction or lower urinary tract symptoms.

2. statin drugs may have a protective effect in the prevention of liver cancer and lead to a reduction in the need for gallbladder removals.

3. statins appear to slow decline in lung function in the elderly.

4. statins can protect nerve cells against damage which we know to occur in the brain of Alzheimer's disease patients.

Tea and Orange Juice

I try to drink some orange juice with my tea - I had read that citric acid magnifies the positive effects of drinking green tea. Research reported this week supports the previous research, and gives me additional reasons to drink orange juice:

I. adding ascorbic acid and sugar to green tea can help the body absorb helpful compounds.

II. Vitamin C helps to promote wound healing and also helped protect the DNA damage of skin cells.

III. subjects with a high daily intake of fruits and vegetables had higher antioxidant levels, lower indicators of free radical-induced damage against lipids as well as better cognitive performance.

Thin Thighs

One other positive note from recent research, at least for me: It's good not to have thin thighs.

While daily bathroom showers provide invigorating relief and a good cleansing for millions of Americans, they also can deliver a face full of potentially pathogenic bacteria, according to a surprising new University of Colorado at Boulder study.

The researchers used high-tech instruments and lab methods to analyze roughly 50 showerheads from nine cities in seven states that included New York City, Chicago and Denver. They concluded about 30 percent of the devices harbored significant levels of Mycobacterium avium, a pathogen linked to pulmonary disease that most often infects people with compromised immune systems but which can occasionally infect healthy people, said CU-Boulder Distinguished Professor Norman Pace, lead study author.

"It's not surprising to find pathogens in municipal waters," said Pace. But the CU-Boulder researchers found that some M. avium and related pathogens were clumped together in slimy "biofilms" that clung to the inside of showerheads at more than 100 times the "background" levels of municipal water. "If you are getting a face full of water when you first turn your shower on, that means you are probably getting a particularly high load of Mycobacterium avium, which may not be too healthy," he said.

The study appeared in the Sept. 14 online edition of the Proceedings of the National Academy of Sciences. Co-authors of the study included CU-Boulder researchers Leah Feazel, Laura Baumgartner, Kristen Peterson and Daniel Frank and University Colorado Denver pediatrics department Associate Professor Kirk Harris. The study is part of a larger effort by Pace and his colleagues to assess the microbiology of indoor environments and was supported by the Alfred P. Sloan Foundation.

Research at National Jewish Hospital in Denver indicates that increases in pulmonary infections in the United States in recent decades from so-called "non-tuberculosis" mycobacteria species like M. avium may be linked to people taking more showers and fewer baths, said Pace. Water spurting from showerheads can distribute pathogen-filled droplets that suspend themselves in the air and can easily be inhaled into the deepest parts of the lungs, he said.

Symptoms of pulmonary disease caused by M. avium can include tiredness, a persistent, dry cough, shortness of breath, weakness and "generally feeling bad," said Pace. Immune-compromised people like pregnant women, the elderly and those who are fighting off other diseases are more prone to experience such symptoms, said Pace, a professor in the molecular, cellular and developmental biology department.

The CU-Boulder researchers sampled showerheads in homes, apartment buildings and public places in New York, Illinois, Colorado, Tennessee and North Dakota.

Although scientists have tried cell culturing to test for showerhead pathogens, the technique is unable to detect 99.9 percent of bacteria species present in any given environment, said Pace. A molecular genetics technique developed by Pace in the 1990s allowed researchers to swab samples directly from the showerheads, isolate DNA, amplify it using the polymerase chain reaction, or PCR, and determine the sequences of genes present in order to pinpoint particular pathogen types.

"There have been some precedents for concern regarding pathogens and showerheads," said Pace. "But until this study we did not know just how much concern."

During the early stages of the study, the CU team tested showerheads from smaller towns and cities, many of which were using well water rather than municipal water. "We were starting to conclude that pathogen levels we detected in the showerheads were pretty boring," said Feazel, first author on the study. "Then we worked up the New York data and saw a lot of M. avium. It completely reinvigorated the study."

In addition to the showerhead swabbing technique, Feazel took several individual showerheads, broke them into tiny pieces, coated them with gold, used a fluorescent dye to stain the surfaces and used a scanning electron microscope to look at the surfaces in detail. "Once we started analyzing the big metropolitan data, it suddenly became a huge story to us," said Feazel, who began working in Pace's lab as an undergraduate.

In Denver, one showerhead in the study with high loads of the pathogen Mycobacterium gordonae was cleaned with a bleach solution in an attempt to eradicate it, said Pace. Tests on the showerhead several months later showed the bleach treatment ironically caused a three-fold increase in M. gordonae, indicating a general resistance of mycobacteria species to chlorine.

Previous studies by Pace and his group found massive enrichments of M. avium in "soap scum" commonly found on vinyl shower curtains and floating above the water surface of warm therapy pools. A 2006 therapy pool study led by Pace and CU-Boulder Professor Mark Hernandez showed high levels of M. avium in the indoor pool environment were linked to a pneumonia-like pulmonary condition in pool attendants known as "lifeguard lung," leading the CU team into the showerhead study, said Pace.

Additional studies under way by Pace's team include analyses of air in New York subways, hospital waiting rooms, office buildings and homeless shelters. Indoor air typically has about 1 million bacteria per cubic meter and municipal tap water has rough 10 million bacteria per cubic meter, said Pace.

So is it dangerous to take showers? "Probably not, if your immune system is not compromised in some way," said Pace. "But it's like anything else -- there is a risk associated with it." Pace said since plastic showerheads appear to "load up" with more pathogen-enriched biofilms, metal showerheads may be a good alternative.

"There are lessons to be learned here in terms of how we handle and monitor water," said Pace. "Water monitoring in this country is frankly archaic. The tools now exist to monitor it far more accurately and far less expensively that what is routinely being done today."

Lowering Sodium Consumption Could Save U.S. $18 Billion Annually in Health Costs, RAND Study Finds

Reducing Americans' average intake of sodium to the amount recommended by health officials could save the nation as much as $18 billion annually in avoided health care costs and improve the quality of life for millions of people, according to a new RAND Corporation study.

The study estimates that meeting national sodium guidelines could eliminate 11 million cases of high blood pressure nationally and extend the lives of thousands of people each year. The monetary value of the improved quality of life would be an estimated $32 billion annually, according to the findings published in the September/October edition of the American Journal of Health Promotion.

"This study provides an important first step toward quantifying the benefits of reducing the intake of sodium by the American public," said Kartika Palar, the study's lead author and a graduate fellow at the RAND Pardee Graduate School. "These findings make a strong case that there's value in pursuing a population-based approach to reducing sodium intake among Americans."

The study is one of the first to estimate the economic benefits of lowering sodium consumption among the American public.

Excessive consumption of sodium is a persistent health problem in the United States, causing increased rates of high blood pressure and related illnesses such as cardiovascular diseases. The Institute of Medicine recommends that adults consume no more than 2,300 milligrams of sodium each day, with lower amounts recommended for older adults, black patients and those with high blood pressure -- groups that are at higher risk.

Researchers from RAND Health analyzed information about Americans' blood pressure levels, use of antihypertensive medications and sodium intake from the National Health and Nutrition Examination Survey, a federal study that routinely assesses the health and nutritional status of adults and children in the United States. The study is unique in that it combines interviews and physical examinations.

Palar and study co-author Roland Sturm, a RAND senior economist, using a cross-sectional simulation model, calculated that lowering sodium intake would trim a sizable portion of the $55 billion spent nationally each year to treat high blood pressure. About half of the $18 billion in annual health care cost savings would accrue to public sector health spending. Researchers say their estimates are conservative because they were not able to calculate the savings for illnesses such as cardiovascular diseases where sodium consumption plays a less-defined role.

In addition, researchers estimated that meeting sodium consumption guidelines would save in one year 312,000 quality adjusted life years -- a research measurement that adjusts increased longevity for the relative healthiness experienced during additional years of life.

"Our results are driven by the fact that nearly 30 percent of the nation's population has hypertension," Palar said. "One of the reasons that hypertension is so pervasive is that sodium consumption is so high."

Researchers say that better strategies for lowering sodium intake broadly across the nation's population still need to be developed. Studies estimate that more than 75 percent of Americans dietary sodium intake comes from processed foods rather than from salt added during cooking at home or at the dining table. Restaurant food also is generally high in sodium.

Population-based strategies that have been discussed include redesigning food labeling information to better highlight sodium levels, having manufacturers voluntarily lower sodium levels and adopting regulations that would require food processors to lower sodium.

The research was funded by a subcontract from Harvard University.

High fruit and vegetable intake positively correlated with antioxidant status, cognitive performance

Researchers at the Institute of Biochemistry and Molecular Biology I of the Heinrich-Heine University, Düsseldorf, Germany, investigated the relationship between fruit and vegetable intake, plasma antioxidant micronutrient status and cognitive performance in healthy subjects aged 45 to 102 years. Their results, published in the August issue of the Journal of Alzheimer's Disease, indicated higher cognitive performance in individuals with high daily intake of fruits and vegetables.

Subjects with a high daily intake (about 400 g) of fruits and vegetables had higher antioxidant levels, lower indicators of free radical-induced damage against lipids as well as better cognitive performance compared to healthy subjects of any age consuming low amounts (< 100 g/day) of fruits and vegetables. Modification of nutritional habits aimed at increasing intake of fruits and vegetables, therefore, should be encouraged to lower the prevalence of cognitive impairment.

The work was performed in collaboration with the Department of Pharmacology at Temple University in Philadelphia, Pennsylvania, the Department of Geriatrics at Perugia University, Italy, and the Department of Neurology of the St. Elisabeth Hospital in Cologne, Germany.

Dr. M. Cristina Polidori, currently at the Department of Geriatrics, Marienhospital Herne, Ruhr-University of Bochum, Germany, explains: "It is known that there is a strong association between fruit and vegetable intake and the natural antioxidant defenses of the body against free radicals. It is also known that bad nutritional habits increase the risk of developing cognitive impairment with and without dementia. With this work we show a multiple link between fruit and vegetable intake, antioxidant defenses and cognitive performance, in the absence of disease and independent of age. Among other lifestyle habits, it is recommended to improve nutrition in general and fruit and vegetable intake in particular at any age, beginning as early as possible. This may increase our chances to remain free of dementia in advanced age."

These findings are independentof age, gender, body mass index, level of education, lipid profile and albumin levels, all factors able to influence cognitive and antioxidant status. The relevance of the findings is also strengthened by the large sample that included 193 healthy subjects.

Further studies are planned that will include larger subject cohorts, patients with Alzheimer's disease at different stages and patients with mild cognitive impairment without dementia.

Scientists have uncovered a new role played by Vitamin C in protecting the skin.

Researchers at the University of Leicester and Institute for Molecular and Cellular Biology in Portugal studied new protective properties of vitamin C in cells from the human skin, which could lead to better skin regeneration.

The work, by Tiago Duarte, Marcus S. Cooke and G. Don Jones, found that a form of Vitamin C helped to promote wound healing and also helped protect the DNA damage of skin cells. Their findings have been published in the journal Free Radical Biology and Medicine. This report is the latest in a long line of publications from these researchers, at the University of Leicester, concerning vitamin C. Previously, the group has published evidence that DNA repair is upregulated in people consuming vitamin C supplements. The researchers have now provided some mechanistic evidence for this, in cell culture, using techniques such as Affymetrix microarray, for looking at gene expression, and the 'Comet' assay to study DNA damage and repair.

Tiago Duarte, formerly of the University of Leicester, and now at the Institute for Molecular and Cellular Biology in Portugal, said: "The exposure to solar ultraviolet radiation increases in summer, often resulting in a higher incidence of skin lesions. Ultraviolet radiation is also a genotoxic agent responsible for skin cancer, through the formation of free radicals and DNA damage.

"Our study analysed the effect of sustained exposure to a vitamin C derivative, ascorbic acid 2-phosphate (AA2P), in human dermal fibroblasts. We investigated which genes are activated by vitamin C in these cells, which are responsible for skin regeneration.

"The results demonstrated that vitamin C may improve wound healing by stimulating quiescent fibroblasts to divide and by promoting their migration into the wounded area. Vitamin C could also protect the skin by increasing the capacity of fibroblasts to repair potentially mutagenic DNA lesions."

Even though vitamin C was discovered over 70 years ago as the agent that prevents scurvy, its properties are still under much debate in the scientific community. In fact, the annual meeting of the International Society for Free Radical Biology and Medicine, which will be held this year in San Francisco (USA), will feature a session dedicated to vitamin C, entitled "New discoveries for an old vitamin".

Dr Marcus S. Cooke from the Department of Cancer Studies and Molecular Medicine and Department of Genetics, at the University of Leicester, added: "The study indicates a mechanism by which vitamin C could contribute to the maintenance of a healthy skin by promoting wound healing and by protecting cellular DNA against damage caused by oxidation". "These findings are particular importance to our photobiology interests, and we will certainly be looking into this further".

These results will be of great relevance to the cosmetics industry. Free radicals are associated with premature skin aging, and antioxidants, such as vitamin C, are known to counter these highly damaging compounds. This new evidence suggest that, in addition to 'mopping up' free radicals, vitamin C can help remove the DNA damage they form, if they get past the cell's defences.

The study has the potential to lead to advances in the prevention and treatment of skin lesions specifically, as well as contributing to the fight against cancer.

Major clinical study rejects cancer safety fears of most common heartburn treatment


Fears about the cancer causing effects of the second most prescribed group of drugs in the Western world have been put to rest, following the largest ever study into their use.

'Proton pump inhibitors' (PPI) are the most commonly used treatment for chronic acid reflux, or 'heartburn', a painful burning sensation in the chest, neck and throat which is experienced by almost a third of people in developed countries.

Regular and prolonged heartburn is known to cause 'benign oesophagitis', a reversible inflammation of the gullet. However if left untreated a condition called Barrett's Oesophagus (BE) occurs in around 10 per cent of sufferers, which can in turn develop into a potentially fatal cancer called oesophageal adenocarcinoma.

Despite their excellent safety record, it was unclear if long-term use of PPIs to reduce the discomfort of heartburn could increase the risk of developing either BE or the spread of the associated cancer.

New research carried out at Queen Mary, University of London and Leicester Royal Infirmary, has given the most conclusive evidence yet that this is not the case. The work is published in the peer reviewed journal Gut.

Professor Janusz Jankowski, who co-authored the study, said: "This is one of the most detailed studies investigating both the laboratory and clinical side of proton pump inhibitor drugs. As a consequence we are now better able to inform patients of the good benefit/risk ratio of this commonly prescribed therapy."

Tests carried out during the two-year study looked at tissue sampled from the oesophagus lining of ninety volunteers, each of whom were given PPI drugs at either a high or low dosage. Researchers found there was no difference in the rate at which BE developed, neither was there a change in the number of precancerous cells in either group.

While there had also been fears about how the treatments might affect people already suffering from BE, the study also showed that there was no evidence that this led to any worsening of the condition or any extra incidences of cancer.

BE is marked by changes in the cells of the oesophagus lining (squamous epithelium) that makes them more like the cells of the intestines (columnar epithelium). As well as increasing the risk of oesophageal cancer, the condition narrows the oesophagus and patients can experience pain whilst swallowing. The chance of cancer developing is proportional to the length of BE.

PPIs work by blocking the action of gastrin, a hormone that controls acid levels in the stomach, and is known to increase the normal movement of cells in the gastro-intestinal tract. Since PPI therapy increases the levels of gastrin in the body, it had been thought this could cause expansion of BE affected tissue, but this was not found to be the case: the scientists observed neither expansion or contraction of the abnormal tissue. This is concordant with current UK practice, where PPI therapy is currently only licensed to treat heartburn and 'oesophagitis' but not BE.

An animal study at Purdue University has shown that adding ascorbic acid and sugar to green tea can help the body absorb helpful compounds.

Mario Ferruzzi, associate professor of food science and nutrition, adapted a digestion model with human intestinal cells to show that adding ascorbic acid to green tea would increase the absorbability of catechins found in the tea. Catechins, a class of polyphenols common in tea, cocoa and grape, are antioxidants thought to fight heart disease, stroke, cancer, diabetes and other health problems.

Ferruzzi, Elsa Janle, a Purdue associate research professor of foods and nutrition, and Catrina Peters, a Purdue graduate student in nutrition, were able to demonstrate that adding ascorbic acid, sucrose or both together increases by as much as three times the amount of catechins that can be absorbed into the bloodstream. The results of the in vivo study compared well with those predicted by the in vitro model.

"This model may be used as a pre-emptive screening tool at very little cost before you do expensive tests on animals or humans," said Ferruzzi, whose findings were published in the early online edition of the journal Food Research International. "If you want to get human screening off the ground, it takes months. If you want to use this model, it takes hours."

The model charts how the digestive stability, solubility and absorption of polyphenols changes based on modifications to a beverage's formula. It will not be exact in terms of measurements, but when compared to the in vivo test in rats, the model's predictions matched directionally to the in vivo study and were relatively close proportionately.

Ferruzzi said testing with the model could allow researchers to predict how a new product formula might change the product's properties, reducing the number of animals needed for testing to only products that showed desired characteristics in the model. The model also can be adapted to simulate the digestive characteristics of other animals or humans as originally intended.

"As long as we know the typical gastrointestinal conditions of an animal and the volumes, we can adapt the model to mimic those conditions," Ferruzzi said. "You don't have to do expensive precursor studies."

The in vivo study backed up the model study that showed adding sugar and vitamin C to green tea enhanced the body's ability to absorb polyphenols. Ferruzzi said that adding lemon juice or other citrus juice to tea would do the trick, or consumers could look for ready-to-drink products that contain 100 percent of the recommended amount of vitamin C or ascorbic acid on the ingredient list.

"Having that vitamin C seems to do it," Ferruzzi said. "And if you don't want to squeeze a lemon into your cup, just have a glass of juice with your green tea."

Connie Weaver, head of the National Institutes of Health Purdue University-University of Alabama at Birmingham Botanical Research Center for Age-Related Diseases, which funded the research, said the study's focus was an important part of understanding how to get the most out of compounds considered beneficial.

"There is a lot of interest in bioactive materials to protect people from disease and promote better health," Weaver said. "What's been totally ignored is the way these materials are found in foods in combination with other ingredients. How they're involved in the food matrix can affect how you absorb these health promoters."

Here's good news, I guess:

Large Thighs Protect Against Heart Disease And Early Death

Men and women whose thighs are less than 60cm in circumference have a higher risk of premature death and heart disease, according to research published on the British Medical Journal website. The study also concluded that individuals whose thighs are wider than 60cm have no added protective effect.

Lead author, Professor Berit Heitmann, based at Copenhagen University Hospital, says his research may help GPs identify patients who are at an increased risk of early death and developing heart disease.

While several studies have already demonstrated that being either very overweight or underweight are related to premature death and disease, this is the first to investigate the implications of thigh size on health.

Almost 3000 individuals took part in the study in Denmark - this included 1463 men and 1380 women. Participants were examined in 1987/88 for height, weight, thigh, hip and waist circumference and body composition. They were then followed up for 10 years for incidence of heart disease and 12.5 years for total number of deaths.

During the follow-up period 257 men and 155 women died, also 263 men and 140 women experienced cardiovascular disease and 103 men and 34 women suffered from heart disease. When assessing the results, the authors found that the survivors had higher fat-free thigh circumference levels.

The relationship between thigh size and early death and disease was found after taking body fat and other high risk factors (such as smoking and high cholesterol) into account. The authors therefore suggest that the risk from narrow thighs could be associated with too little muscle mass in the region. This is problematic because it may lead to low insulin sensitivity and type 2 diabetes and, in the long run, heart disease, they explain.

The authors conclude that the study "found that the risk of having small thighs was associated with development of cardiovascular morbidity and early mortality. This increased risk was found independent of abdominal and general obesity, lifestyle and cardiovascular risk factors such as blood pressure and lipids related to early cardio vascular morbidity and mortality".

The authors believe that doctors could use thigh size as an early marker for at risk patients and suggest that individuals increase lower body exercise in order to increase the size of the their thighs if necessary. Further research would be needed, however, to assess whether this approach was worthwhile.

From the latest research reports: (click on links for complete reports.)


1. I guess I'm not going to be taking Quercetin anymore: a new University of Georgia study finds that it is no better than a placebo. “The take home message here is that promising results in mice don’t necessarily translate to humans.”


2. Or cranberry pills:"Current clinical evidence for using cranberry juice to combat urinary tract infections is 'unsatisfactory and inconclusive'."



3. Eat more often to lose weight,



4. But not late at night, or you'll gain weight.



5. Dealing with high-blood pressure? Eat more melons,


6. But avoid hidden salt in prepared and processed foods.


7. A low carbohydrate, Mediterranean-style diet was much better than a low-fat diet for diabetics.Patients in the Mediterranean diet group also experienced greater weight loss and an improvement in some coronary risk factors.

8. But low-carb diets have been linked to atherosclerosis.



Here's some good news:
9. Whole grains are even better than I thought: “Research shows that whole grains are good for your heart, lower risk of diabetes and stroke, and may help prevent certain cancers. They also help in managing weight. Whole grains are chock full of good-for-you nutrients including fiber, folate and niacin, vital B vitamins, and magnesium. “The phytochemicals found in whole grains have been shown to have health promoting and disease prevention benefits."

10. And now I know exactly how much DHA Omega 3 oil I need: "A 200 mg dose of DHA per day is enough to affect biochemical markers that reliably predict cardiovascular problems, such as those related to aging, atherosclerosis, and diabetes. This study is the first to identify how much DHA is necessary to promote optimal heart health."