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Simvastatin, a commonly used, cholesterol-lowering drug, may prevent Parkinson's disease from progressing further. Neurological researchers at Rush University Medical Center conducted a study examining the use of the FDA-approved medication in mice with Parkinson's disease and found that the drug successfully reverses the biochemical, cellular and anatomical changes caused by the disease.

"Statins are one of the most widely used cholesterol-lowering drugs throughout the world," said study author Kalipada Pahan, PhD, professor of neurological sciences at Rush University Medical Center. "This may be a safer approach to halt the disease progression in Parkinson's patients."

Pahan and colleagues from Rush, along with researchers at the University of Nebraska Medical Center in Omaha published these findings in the October 28 issue of the Journal of Neurosciences.

The authors have shown that the activity of one protein called p21Ras is increased very early in the midbrain of mice with Parkinson's pathology. Simvastatin enters into the brain and blocks the activity of the p21Ras protein and other associated toxic molecules, and goes on to protect the neurons, normalize neurotransmitter levels, and improves the motor functions in the mice with Parkinson's.

"Understanding how the disease works is important to developing effective drugs that protect the brain and stop the progression of Parkinson's," said Pahan. "If we are able to replicate these results in Parkinson's patients in the clinical setting, it would be a remarkable advance in the treatment of this devastating neurodegenerative disease."

The study was supported by grants from National Institutes of Health and Michael J. Fox Foundation for Parkinson's Research.

Parkinson's is a slowly progressive disease that affects a small area of cells within the mid-brain known as the substantia nigra. Gradual degeneration of these cells causes a reduction in dopamine, which is a vital chemical neurotransmitter. The decrease in dopamine results in one or more of the classic signs of Parkinson's disease that includes, resting tremor on one side of the body, generalized slowness of movement, stiffness of limbs, and gait or balance problems. The cause of Parkinson's disease is unknown. Both environmental and genetic causes of the disease have been postulated.

Parkinson's disease affects about 1.2 million patients in the United States and Canada. Although 15 percent of patients are diagnosed before age 50, it is generally considered a disease that targets older adults, affecting one of every 100 persons over the age of 60. This disease appears to be slightly more common in men than women.

Scientists discover influenza's Achilles heel: Antioxidants

New research in the FASEB Journal opens the door for new drugs that could prevent severe flu-related lung damage

As the nation copes with a shortage of vaccines for H1N1 influenza, a team of Alabama researchers have raised hopes that they have found an Achilles' heel for all strains of the flu—antioxidants. In an article appearing in the November 2009 print issue of the FASEB Journal (http://www.fasebj.org) they show that antioxidants—the same substances found in plant-based foods—might hold the key in preventing the flu virus from wreaking havoc on our lungs.

"The recent outbreak of H1N1 influenza and the rapid spread of this strain across the world highlights the need to better understand how this virus damages the lungs and to find new treatments," said Sadis Matalon, co-author of the study. "Additionally, our research shows that antioxidants may prove beneficial in the treatment of flu."

"Although vaccines will remain the first line of intervention against the flu for a long time to come, this study opens the door for entirely new treatments geared toward stopping the virus after you're sick," said Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal, "and as Thanksgiving approaches, this discovery is another reason to drink red wine to your health."

New research from Queen Mary, University of London and Harvard Medical School has revealed precisely why taking fish oils can help with conditions like rheumatoid arthritis.

In a paper published in Nature today*, researchers describe how the body converts an ingredient found in fish oils into another chemical called Resolvin D2 and how this chemical reduces the inflammation that leads to a variety of diseases.

The research also suggests that Resolvin D2 could be the basis for a new treatment for diseases including sepsis, stroke and arthritis. Unlike other anti-inflammatory drugs, this chemical does not seem to suppress the immune system.

The researchers, who were funded by the Arthritis Research Campaign, the Wellcome Trust and the National Institutes of Health, looked at a particular ingredient of fish oils called DHA. They were able to show how the body converts DHA into Resolvin D2 and discover its exact chemical structure.

Mauro Perretti, Professor of Immunopharmacology at Queen Mary, University of London, led the UK team. He said: "We have known for some time that fish oils can help with conditions like arthritis which are linked to inflammation. What we've shown here is how the body processes a particular ingredient of fish oils into Resolvin D2. We've also looked in detail at this chemical, determining at least some of the ways it relieves inflammation. It seems to be a very powerful chemical and a small amount can have a large effect."

"This research is important because it explains at least one way in which fish oils can help in different types of arthritis. We can also work on this chemical and see if it can be used not only to treat or even prevent arthritis, but also as a possible treatment for a variety of other diseases associated with inflammation."

Arthritis, and many other diseases, are caused by inflammation. This means that the body's natural defences against infections are mistakenly directed at healthy tissue.

Previous research has shown that a crucial step in this process occurs when white blood cells, called leukocytes, stick to the inner lining of the blood vessels, called the endothelium.

Researchers studied these blood cells and how they interact with the endothelium in the lab. When they added Resolvin D2 they found that the endothelial cells produced small amounts of nitric oxide, which acts as a chemical signal discouraging the white blood cells from sticking to the endothelial cells and preventing inflammation.

Insoluble dietary fibre, or roughage, not only keeps you regular, say Australian scientists, it also plays a vital role in the immune system, keeping certain diseases at bay.

The indigestible part of all plant-based foods pushes its way through most of the digestive tract unchanged, acting as a kind of internal broom. When it arrives in the colon, bacteria convert it to energy and compounds known as ‘short chain fatty acids’. These are already known to alleviate the symptoms of colitis, an inflammatory gut condition.

Similarly, probiotics and prebiotics, food supplements that affect the balance of gut bacteria, reduce the symptoms of asthma and rheumatoid arthritis, also inflammatory diseases. Until now no-one has understood why.

Published tomorrow in Nature, breakthrough research by a Sydney-based team makes new sense of such known facts by describing a mechanism that links diet, gut bacteria and the immune system.

PhD student Kendle Maslowski and Professor Charles Mackay from the Garvan Institute of Medical Research, in collaboration with the Co-operative Research Centre for Asthma and Airways, have demonstrated that GPR43, a molecule expressed by immune cells and previously shown to bind short chain fatty acids, functions as an anti-inflammatory receptor,

“The notion that diet might have profound effects on immune responses or inflammatory diseases has never been taken that seriously” said Professor Mackay. “We believe that changes in diet, associated with western lifestyles, contribute to the increasing incidences of asthma, Type 1 diabetes and other autoimmune diseases. Now we have a new molecular mechanism that might explain how diet is affecting our immune systems.”

“We’re also now beginning to understand that from the moment you’re born, it’s incredibly important to be colonised by the right kinds of gut bacteria,” added Kendle. “The kinds of foods you eat directly determine the levels of certain bacteria in your gut.”

“Changing diets are changing the kinds of gut bacteria we have, as well as their by-products, particularly short chain fatty acids. If we have low amounts of dietary fibre, then we’re going to have low levels of short chain fatty acids, which we have demonstrated are very important in the immune systems of mice.”

Mice that lack the GPR43 gene have increased inflammation, and poor ability to resolve inflammation, because their immune cells can’t bind to short chain fatty acids.

There is plenty of evidence to suggest that bacteria and their by-products play an important role in people. An American study published in Nature in 2006 2 compared the bacteria in the guts of obese and lean people. The obese people were put on a diet, and as they lost weight their bacteria profile gradually came to match that of the lean people.

Another study 3 looked at what diets might do to short chain fatty acid levels. Obese people were put on three different diets over time – high, medium and low fibre – and there was a direct correlation between the level of carbohydrate, or fibre, in the diet and the level of short chain fatty acids.

The conclusions drawn from the current research provide some of the most compelling reasons yet for eating considerably more unprocessed whole foods - fruits, vegetables, grains, nuts and seeds.

Dietary fibre, of course, has many known health benefits in addition to those discussed above, including reduced risk of cardiovascular disease and certain cancers 5, and various health organizations around the world recommend daily minimum levels. 6 It is certain that the majority of people in countries like Australia, the United States and Britain eat much less fibre than they need to stay healthy.

“The role of nutrition and gut intestinal bacteria in immune responses is an exciting new topic in immunology, and recent findings including our own open up new possibilities to explore causes as well as new treatments for inflammatory diseases such as asthma”, said Professor Mackay.

National data suggest non-whites are especially at risk

Millions of children in the United States between the ages of 1 and 11 may suffer from suboptimal levels of vitamin D, according to a large nationally representative study published in the November issue of Pediatrics, accompanied by an editorial.

The study, led by Jonathan Mansbach, MD, at Children's Hospital Boston, is the most up-to-date analysis of vitamin D levels in U.S. children. It builds on the growing evidence that levels have fallen below what's considered healthy, and that black and Hispanic children are at particularly high risk.

Both the optimal amount of vitamin D supplementation and the healthy blood level of vitamin D are under heated debate in the medical community. Currently, the American Academy of Pediatrics recommends children should have vitamin D levels of at least 50 nmol/L (20 ng/ml). However, other studies in adults suggest that vitamin D levels should be at least 75 nmol/L (30 ng/ml), and possibly 100 nmol/L (40 ng/ml), to lower the risk of heart disease and specific cancers.

Mansbach and collaborators from the University of Colorado Denver and Massachusetts General Hospital used data from the National Health and Nutrition Examination Survey (NHANES) to look at vitamin D levels in a nationally representative sample of roughly 5,000 children from 2001-2006. Extrapolating to the entire U.S. population, their analysis suggests that roughly 20 percent of all children fell below the recommended 50 nmol/L. Moreover, more than two-thirds of all children had levels below 75 nmol/L, including 80 percent of Hispanic children and 92 percent of non-Hispanic black children.

"If 75 nmol/L or higher is eventually demonstrated to be the healthy normal level of vitamin D, then there is much more vitamin D deficiency in the U.S. than people realize," Mansbach says.

Mansbach and his co-authors suggest that all children take vitamin D supplements, because of the generally low levels that they found and the potential health benefits of boosting vitamin D to normal levels. Vitamin D improves bone health and prevents rickets in children, and recent studies suggest that it also may prevent a host of common childhood illnesses, including respiratory infections, childhood wheezing, and winter-related eczema.

Although sun exposure generates healthy doses of vitamin D, it can also cause skin cancer. Dermatologists and the AAP recommend wearing sunblock, but this actually blocks our skin's ability to make vitamin D. Furthermore, children with more highly pigmented skin require much more sun exposure than fair-skinned children to obtain healthy levels of vitamin D. Vitamin D can also be obtained from certain foods, like liver and fatty fish, but almost all children in the U.S. don't consume these foods in high enough quantities to match the vitamin D that could be provided by summer sunshine or vitamin D supplements.

In the study, children taking multi-vitamins that included vitamin D had higher levels overall, but this accounted for less than half of all children. Mansbach recommends that all children take vitamin D supplements, especially those living in high latitudes, where the sun is scarce in the wintertime.

"We need to perform randomized controlled trials to understand if vitamin D actually improves these wide-ranging health outcomes," Mansbach says. "At present, however, there are a lot of studies demonstrating associations between low levels of vitamin D and poor health. Therefore, we believe many U.S. children would likely benefit from more vitamin D."

Millions of people around the world use medicines based on statins to lower their blood cholesterol, but new research from the University of Gothenburg, published in the prestigious journal PNAS, shows that statins may also be effective in the treatment of cancer.

Statins lower cholesterol by blocking certain enzymes involved in our metabolism. However, they have also been shown to affect other important lipids in the body, such as the lipids that help proteins to attach to the cell membrane (known as lipid modification). Because many of the proteins that are lipid-modified cause cancer, there are now hopes that it will be possible to use statins in the treatment of cancer.


"Our results support the idea that statins can be used in more ways than just to lower cholesterol," says Pilon. "Not least that they can prevent the growth of cancer cells caused by lipid-modified proteins, but also that they can be effective in the treatment of diabetes and neurological disorders such as Parkinson's."

New evidence is emerging for how important it is for pregnant women to eat good, nutritious food. Expecting mothers who eat vegetables every day seem to have children who are less likely to develop type 1 diabetes, a new study from the Sahlgrenska Academy has revealed.

The study was performed in collaboration with Linköping University, which is conducting a population study called ABIS (All Babies in Southeast Sweden). The results have been published in the journal Pediatric Diabetes.

"This is the first study to show a link between vegetable intake during pregnancy and the risk of the child subsequently developing type 1 diabetes, but more studies of various kinds will be needed before we can say anything definitive," says researcher and clinical nutritionist Hilde Brekke from the Sahlgrenska Academy.

Blood samples from almost 6,000 five year-olds were analysed in the study. In type 1 diabetes, certain cells in the pancreas gradually get worse at producing insulin, leading to insulin deficiency. Children at risk of developing type 1 diabetes have antibodies in their blood which attack these insulin-producing cells.

Of the 6,000 children tested, three per cent had either elevated levels of these antibodies or fully developed type 1 diabetes at the age of five. These risk markers were up to twice as common in children whose mothers rarely ate vegetables during pregnancy. The risk was lowest among children whose mothers stated that they ate vegetables every day.

"We cannot say with certainty on the basis of this study that it's the vegetables themselves that have this protective effect, but other factors related to vegetable intake, such as the mother's standard of education, do not seem to explain the link," says Brekke. "Nor can this protection be explained by other measured dietary factors or other known risk factors."

The term "Vegetables "in this study included all vegetables except for root vegetables.

TYPE 1 DIABETES

Around 50,000 Swedes have type 1 diabetes, a chronic disease which normally emerges before the age of 35. It is not yet known what causes type 1 diabetes, but some of the factors believed to play a role are various immunological mechanisms, environmental toxins and genetic variations. Type 1 diabetes is found throughout the world but is most common in Finland and Sweden.

Fight Off Back Aches & Pains This Winter With Extra Vitamin D

It’s no wonder that many people feel extra soreness and aches in their backs during winter months -- they’re often not getting enough vitamin D. The body makes vitamin D from the sun’s ultraviolet rays, so it’s known as the sunshine vitamin. However, even in the sunniest parts of America, this essential vitamin for keeping bones healthy is in short supply during late fall and winter.

Up to 8 out of 10 persons will have back pain in their lifetimes. In many cases, there is no evidence of any injury, disease, or bone problem like a slipped disk. An extensive review of clinical research in a report from Pain Treatment Topics found that help may be available from a surprising champion of pain relief – Vitamin D.

According to Stewart B. Leavitt, MA, PhD, Executive Director of Pain Treatment Topics and author of the report, “our examination of the research, which included numerous clinical studies, found that patients with chronic back pain usually had inadequate levels of vitamin D. When sufficient vitamin D supplementation was provided, their pain either vanished or was at least helped to a significant extent.”

The report, “Vitamin D – A Neglected ‘Analgesic’ for Chronic Musculoskeletal Pain,” which was peer-reviewed by a panel of experts, includes the following important points:

> Vitamin D is essential for calcium absorption and bone health. Among other things,inadequate vitamin D intake can result in a softening of bone surfaces, called osteomalacia, which causes pain. The lower back seems to be particularly vulnerable.
> In one study of 360 patients with chronic back pain, all of them were found to have inadequate levels of vitamin D. After taking vitamin D supplements for 3 months, symptoms were improved in 95% of the patients.
> The currently recommended adequate intake of vitamin D – up to 600 IU per day – is outdated and too low. According to newer research, most children and adults need at least 1000 IU per day, and persons with chronic back pain would benefit from 2000 IU or more per day of supplemental vitamin D3 (also called cholecalciferol).
> Vitamin D supplements interact with very few medicines or other agents, and are generally safe unless very high doses – such as 10,000 IU or more – are taken daily for a long period of time. However, it is always wise to check with a healthcare professional before starting a new dietary supplement.
> Vitamin D supplements are easy to take, usually have no side effects, and typically cost as little as 7 to 10 cents per day.


In conclusion, Leavitt stresses that vitamin D should not be viewed as a cure for all back pain conditions, and it is not necessarily a replacement for other pain-relief treatments. “While further research would be helpful,” he says, “extra vitamin D should be considered for all persons during winter months, and especially for those who have back aches and pains.”

Scientists in Japan are reporting the first scientific explanation for one of the most widely known rules of thumb for pairing wine with food: "Red wine with red meat, white wine with fish." The scientists are reporting that the unpleasant, fishy aftertaste noticeable when consuming red wine with fish results from naturally occurring iron in red wine. The study is in ACS' Journal of Agricultural and Food Chemistry, a bi-weekly publication.

Takayuki Tamura and colleagues note that wine connoisseurs established the rule of thumb because of the flavor clash between red wine and fish. They point out, however, that there are exceptions to the rule, with some red wines actually going well with seafood. Until now, nobody could consistently predict which wines might trigger a fishy aftertaste because of the lack of knowledge about its cause.

The scientists asked wine tasters to sample 38 red wines and 26 white wines while dining on scallops. Some of the wines contained small amounts of iron, which varied by country of origin, variety, and vintage. They found that wines with high amounts of iron had a more intensely fishy aftertaste. This fishy taste diminished, on the other hand, when the researchers added a substance that binds up iron. The findings indicate that iron is the key factor in the fishy aftertaste of wine-seafood pairings, the researchers say, suggesting that low-iron red wines might be a good match with seafood.

Healthy eating, not supplements, is the best way to keep the good bacteria in your gut healthy, says a dietitian and researcher.

As with vitamins, it's best to get the bacteria you need from healthy food rather than taking often expensive and potentially ineffective supplements, says Gail Cresci, Medical College of Georgia dietitian and researcher.

"Consumers are buying stuff like crazy that is probably not even helping them and could potentially hurt them," says Ms. Cresci, assistant professor of surgery at the MCG School of Medicine and winner of the 2009 Excellence in Practice Award for Clinical Nutrition by the American Dietetic Association.

Increasing awareness of the benefit some of these organisms play in sickness and in health has resulted in an explosion of prebiotic and probiotic additives and products marketed directly to consumers. It's also created confusion – even among nutrition and other health care experts – about how best to use them, says Ms. Cresci, who prescribes them to help surgery patients recover and works in the lab to learn more about their potential.

She equates the good bacterium in your gastrointestinal tract to another living being inside that helps keep you healthy. "If you do good by your bacteria, they will do good by you," Ms. Cresci says.

There are about 800 bacterial species with more than 7,000 strains inhabiting the average gut and even though many sound similar they likely aren't: a little Lactobacillus acidophilus combined with some Lactobacillus bifidus, for example, has been shown extremely beneficial in preventing antibiotic-induced diarrhea while Lactobacillus bulgaricus with some Streptococcus thermophilus is useless.

"You need to be careful," Ms. Cresci says. "You don't just give the same probiotic to try and treat everybody." That's why she lectures to dietitians, physicians and anyone interested in how to make good use of these front-line protectors that attack invaders that enter the body via the mouth and help the immune system keep a more global watch over the body, as well.

There is even mounting evidence that a healthy gut microbiota helps maintain a healthy weight. Studies have shown, for example, that when bacteria from a genetically fat mouse are placed in a lean germ-free mouse, it gains weight without changing its food intake.

Unfortunately poor diets are hurting the bacteria in many of us and the overuse of antibiotics is taking its toll as well, she says, particularly the common, broad spectrum antibiotics that wipe out anything in their path, good and bad bacteria included.

Diarrhea is an extremely common consequence of disturbing the natural balance of your gut's microbiota. In generally healthy individuals, a good diet, rich in fiber, protein and low in fat, will quickly help restore good bacteria. But in older individuals or those with an underlying condition, probiotics may be needed to avoid potentially deadly problems such as overgrowth of bad bacterium like Clostridium difficile. When that bacteria starts to thrive, it can result in an extremely enlarged colon that must be removed and, even then, about 80 percent of patients die.

To avoid such havoc, it's important that you pull the right live bugs off the shelf and that they survive to reach the lower gut, Ms. Cresci says of fragile bacteria that can be lambasted by gastric juices or killed off by even a short-term exposure to ambient heat.

The right combination is essential as well. "A lot of these probiotics have only one bacterium but we have trillions of colony forming units in our gut," she says. There is mounting evidence that one of the best ways to quickly restore the complex gut complement is by using feces from healthy individuals. It's called fecal bacteriotherapy, when feces mixed with a little saline, is given typically via a rectal enema or a nasogastric tube.

The good news is, if you eat right, you likely won't need such extremes.

Ms. Cresci says a good daily diet has:

30 percent or less of calories coming from fat and saturated fats comprising no more than 10 percent of that. The majority should come from monounsaturated fats such as olive and canola oils.

25-30 grams of fiber, not from supplements, but from fiber-rich foods like whole grains and fresh fruits and vegetables, which also provide needed vitamins and minerals.

If tolerable, dairy products to help ensure adequate protein, calcium, and other nutrients.

Protein, through meat or dairy products, or nuts and beans, which also provide fiber and healthy fats.

The cheeseburger and French fries might look tempting, but eating a serving of broccoli or leafy greens first could help people battle metabolic processes that lead to obesity and heart disease, a new University of Florida study shows.

Eating more plant-based foods, which are rich in substances called phytochemicals, seems to prevent oxidative stress in the body, a process associated with obesity and the onset of disease, according to findings published online in advance of the print edition of the Journal of Human Nutrition and Dietetics.

To get enough of these protective phytochemicals, researchers suggest eating plant-based foods such as leafy greens, fruits, vegetables, nuts and legumes at the start of a meal. Using what is known as a phytochemical index, which compares the number of calories consumed from plant-based foods compared with the overall number of daily calories, could also help people make sure they remember to get enough phytochemicals during their regular meals and snacks, said Heather K. Vincent, Ph.D., the lead author of the paper.

"We need to find a way to encourage people to pull back on fat and eat more foods rich in micronutrients and trace minerals from fruits, vegetables, whole grains and soy," said Vincent, an assistant professor in the UF Orthopaedics and Sports Medicine Institute. "Fill your plate with colorful, low-calorie, varied-texture foods derived from plants first. By slowly eating phytochemical-rich foods such as salads with olive oil or fresh-cut fruits before the actual meal, you will likely reduce the overall portion size, fat content and energy intake. In this way, you're ensuring that you get the variety of protective, disease-fighting phytochemicals you need and controlling caloric intake."

The researchers studied a group of 54 young adults, analyzing their dietary patterns over a three-day period, repeating the same measurement eight weeks later. The participants were broken into two groups: normal weight and overweight-obese.

Although the adults in the two groups consumed about the same amount of calories, overweight-obese adults consumed fewer plant-based foods and subsequently fewer protective trace minerals and phytochemicals and more saturated fats. They also had higher levels of oxidative stress and inflammation than their normal-weight peers, Vincent said. These processes are related to the onset of obesity, heart disease, diabetes and joint disease, she added.

"Diets low in plant-based foods affect health over the course of a long period of time," Vincent said. "This is related to annual weight gain, low levels of inflammation and oxidative stress. Those are the onset processes of disease that debilitate people later in life."

Oxidative stress occurs when the body produces too many damaging free radicals and lacks enough antioxidants or phytochemicals to counteract them. Because of excess fat tissue and certain enzymes that are more active in overweight people, being obese can actually trigger the production of more free radicals, too.

Because many phytochemicals have antioxidant properties, they can help combat free radicals, Vincent said. Phytochemicals include substances such as allin from garlic, lycopene from tomatoes, isoflavones from soy, beta carotene from orange squashes and anythocyanins from red wine, among others.

"People who are obese need more fruits, vegetables, legumes and wholesome unrefined grains," she said. "In comparison to a normal-weight person, an obese person is always going to be behind the eight ball because there are so many adverse metabolic processes going on."

Instead of making drastic changes, people could substitute one or two choices a day with phytochemical-rich foods to make a difference in their diets, Vincent said. For example, substituting a cup of steeped plain tea instead of coffee or reaching for an orange instead of a granola bar could increase a person's phytochemical intake for the day without even changing the feeling of fullness. Over time, replacing more pre-packaged snacks with fresh produce or low-sugar grains could become a habit that fights obesity and disease, Vincent said.

"We always want to encourage people to go back to the whole sources of food, the nonprocessed foods if we can help it," Vincent said. "That would be the bottom line for anyone, regardless of age and body size, keep going back to the purer plant-based foods. Remember to eat the good quality food first."

Currently, there are no recommendations for how much of these plant compounds people should be getting each day, says Susanne Talcott, Ph.D., an assistant professor of food science and nutrition at Texas A&M University. Using the phytochemical index could be a good way to come up with these recommendations, she said.

Like Vincent, Talcott also cautions people to try and stick to the whole sources of foods and be wary of processed foods that promise benefits from added plant compounds.

"Consumers should stick with what we have known for decades and eat fresh or frozen fruits and vegetables," she said. "Stick with those kinds of foods rather than reaching out for a tropical wonder pill or juice."

in chronic hepatitis C sufferers

Patients with chronic hepatitis C and advanced liver disease who drink three or more cups of coffee per day have a 53% lower risk of liver disease progression than non-coffee drinkers according to a new study led by Neal Freedman, Ph.D., MPH, from the National Cancer Institute (NCI). The study found that patients with hepatitis C-related bridging fibrosis or cirrhosis who did not respond to standard disease treatment benefited from increased coffee intake. An effect on liver disease was not observed in patients who drank black or green tea. Findings of the study appear in the November issue of Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases.

Hepatitis C virus (HCV) infects approximately 2.2% of the world's population with more than 3 million Americans infected. The Centers for Disease Control and Prevention (CDC) cites HCV as the leading cause of liver transplantation in the U.S. and accounts for 8,000 to 10,000 deaths in the country annually. Globally, the World Health Organization (WHO) estimates 3 to 4 million persons contract HCV each year with 70% becoming chronic cases that can lead to cirrhosis of the liver and liver cancer.

This study included 766 participants enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial who had hepatitis C-related bridging fibrosis or cirrhosis and failed to respond to standard treatment of the anti-viral drugs peginterferon and ribavirin. At the onset of the study, HALT-C patients were asked to report their typical frequency of coffee intake and portion size over the past year, using 9 frequency categories ranging from 'never' to 'every day' and 4 categories of portion size (1 cup, 2 cups, 3-4 cups, and 5+ cups). A similar question was asked for black and green tea intake. "This study is the first to address the association between liver disease progression related to hepatitis C and coffee intake," stated Dr. Freedman.

Participants were seen every 3 months during the 3.8-year study period to assess clinical outcomes which included: ascites (abnormal accumulation of fluid in the abdomen), prognosis of chronic liver disease, death related to liver disease, hepatic encephalopathy (brain and nervous system damage), hepatocellular carcinoma (liver cancer), spontaneous bacterial peritonitis, variceal hemorrhage, or increase in fibrosis. Liver biopsies were also taken at 1.5 and 3.5 five years to determine the progression of liver disease.

Results showed that participants who drank 3 or more cups of coffee per day had a relative risk of .47 for reaching one of the clinical outcomes. Researchers did not observe any association between tea intake and liver disease progression, though tea consumption was low in the study. "Given the large number of people affected by HCV it is important to identify modifiable risk factors associated with the progression of liver disease," said Dr. Freedman. "Although we cannot rule out a possible role for other factors that go along with drinking coffee, results from our study suggest that patients with high coffee intake had a lower risk of disease progression." Results from this study should not be generalized to healthier populations cautioned the authors.

According a new study of over 3,000 adults aged 70-79, the apparent association between light-to-moderate alcohol consumption and reduced risk of functional decline over time did not hold up after adjustments were made for characteristics related to lifestyle, in particular physical activity, body weight, education, and income.

The authors of the study, publishing today in the Journal of the American Geriatrics Society, say this suggests that life-style related characteristics may be the real determinant of the reported beneficial effects of alcohol and functional decline.

“In recent years the relationship between alcohol intake and health outcomes has gained growing attention, but while there is now considerable consensus that consuming alcohol at moderate levels has a specific beneficial effect on the risk of cardiovascular disease, the benefit of alcohol intake on other health-related outcomes is less convincing,” said study author Cinzia Maraldi, M.D., of the University of Ferrara, Italy. “We wanted to evaluate this question over a long-term follow-up and with a prospective design, which most previous studies have not used.”

During a follow-up time of six and a half years, the researchers found that participants consuming moderate levels of alcohol had the lowest incidence of mobility limitation and disability. After adjusting for demographic characteristics, moderate alcohol intake was still associated with reduced risk compared to never or occasional consumption, but adjusting for life-style related variables substantially reduced the strength of the associations. Adjustment for diseases and health status indicators did not affect the strength of the associations, which led the authors to conclude that life-style is the most important factor in confounding this relationship.

“Globally taken, these results suggest that the reported protective effect of moderate alcohol intake on physical performance may be only apparent, because life-style related characteristics seem to be the real determinant of the reported association, suggesting caution in attributing a direct benefit of moderate alcohol intake on functional ability,” added Maraldi. “This assumes particular relevance given the risk of alcohol-dependence and the health hazards associated with excessive alcohol consumption. From this point of view, in our opinion life-style recommendations for the prevention of disability should be based on interventions proven to be safe and effective, such as weight control and physical exercise.”

New research in the FASEB Journal suggests that vitamin A has essential functions in the regulation of energy production in all cells of the body

If a little vitamin A is good, more must be better, right? Wrong! New research published online in the FASEB Journal (http://www.fasebj.org) shows that vitamin A plays a crucial role in energy production within cells, explaining why too much or too little has a complex negative effect on our bodies. This is particularly important as combinations of foods, drinks, creams, and nutritional supplements containing added vitamin A make an overdose more possible than ever before.

"Our work illuminates the value and potential harm of vitamin A use in cosmetic creams and nutritional supplements," said Ulrich Hammerling, co-author of the study, from the Sloan-Kettering Institute for Cancer Research in New York. "Although vitamin A deficiency is not very common in our society, over-use of this vitamin could cause significant disregulation of energy production impacting cell growth and cell death."

Although the importance of vitamin A to human nutrition and fetal development is well-known, it has been unclear why vitamin A deficiencies and overdoses cause such widespread and profound harm to our organs, until now. The discovery by Hammerling and colleagues explains why these effects occur, while also providing insight into vitamin A's anti-cancer effects. The scientists used cultures from both human and mice cells containing specific genetic modifications of the chemical pathways involved in mitochondrial energy production. The cells were then grown with and without vitamin A, and scientists examined the impact on the various steps of energy production. Results showed that retinol, the key component of vitamin A, is essential for the metabolic fitness of mitochondria and acts as a nutritional sensor for the creation of energy in cells. When there is too much or too little vitamin A, mitochondria do not function properly, wreaking havoc on our organs.

"Beauty might be only skin deep, but vitamin A isn't. It goes to the nucleus of our cells and can affect our health for better or worse," said Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal. "Using too many products enriched with vitamin A could lead to negative, even fatal, consequences."

Nutrition scientists led by Young-Cheul Kim at the University of Massachusetts Amherst have identified the molecular pathway that allows foods rich in soy bioactive compounds called isoflavones to lower diabetes and heart disease risk. Eating soy foods has been shown to lower cholesterol, decrease blood glucose levels and improve glucose tolerance in people with diabetes.

According to Kim, the study shows that “what we eat can have tremendous impact on health outcomes by interacting with certain genes. Recent research also suggests that diet can even change the copy number of a certain gene, leading to biological changes.”

Soy is the most common source of isoflavones in food. In experiments with mouse cells, Kim, a molecular nutrition researcher who studies how fat cells develop in the body, and colleagues, focused on daidzein, one of the two main isoflavones found in soy. Many epidemiological observations and human clinical studies have shown that adding soy to one’s diet is associated with lower diabetes risk and improved insulin sensitivity, as well as lower cardiovascular disease risk, Kim notes. However, until now the direct target tissue and molecular pathways by which soy exerts its anti-diabetic effects was not clearly understood.

Kim and colleagues at Southern Illinois University, with others at the universities of Tennessee and Florida, had earlier found that dietary isoflavones reduced the severity of diabetes in an animal model of the disease by increasing the activity of certain transcription regulators in the fat tissue. For the current study, they hypothesized that daidzein and its metabolite, equol, are part of this activation process.

They found that daidzein and equol enhanced adipocyte differentiation, or the formation of fat cells, through activation of a key transcription regulator, the same receptor that mediates the insulin-sensitizing effects of anti-diabetes drugs. Thus, daidzein and equol daidzein and equol seem to work in a similar manner as anti-diabetic drugs currently in the market. Their findings are reported in a September online version of the Journal of Nutritional Biochemistry.

“Our results suggest that soy isoflavones exert anti-diabetic effects by targeting fat cell-specific transcription factors and the downstream signaling molecules that are important for glucose uptake and thus insulin sensitivity,” Kim notes. “The new findings help us to understand the cellular mechanisms.” That is, how these biologically active compounds in soy interact to regulate and initiate metabolic and biological functions.

Results demonstrate that daidzein and equol enhance adipocyte differentiation by activating a specific receptor. The downstream responses include increased expression of three proteins, resulting in enhanced glucose uptake and insulin sensitivity.

“Although some details remain to be worked out, our data provide an additional molecular basis for the mechanism of insulin-sensitizing action by soy isoflavones,” says Kim. “These new findings help fill a critical gap between epidemiological observations and clinical studies on the anti-diabetic benefits of dietary soy.”

Future studies will extend the work to primary cultures of human cells through collaboration with researchers at Pioneer Valley Life Science Institute and Baystate Medical Center in Springfield. If replicated, studies can move on to further work in whole body systems.

We've all heard about the damage that reactive oxygen species (ROS) – aka free radicals – can do to our bodies and the sales pitches for antioxidant vitamins, skin creams or "superfoods" that can stop them. In fact, there is considerable scientific evidence that chronic ROS production within cells can contribute to human diseases, including insulin resistance and type 2 diabetes.

But a new report in the October 7th Cell Metabolism, a Cell Press publication, adds to evidence that it might not be as simple as all that. The researchers show that low levels of ROS – and hydrogen peroxide in particular -- might actually protect us from diabetes, by improving our ability to respond to insulin signals.

"Our studies indicate that 'physiological' low levels of ROS may promote the insulin response and attenuate insulin resistance early in the progression of type 2 diabetes, prior to overt obesity and hyperglycemia," said Tony Tiganis of Monash University in Australia. "In a way, we think there is a delicate balance and that too much of a good thing - surprise, surprise - might be bad."

Tiganis' team found that mice with a deficiency that prevented them from eliminating physiological ROS didn't become insulin resistant on a high-fat diet as they otherwise would have. They showed that those health benefits could be attributed to insulin-induced signals and the uptake of glucose into their muscles. When those animals were given an antioxidant, those benefits were lost, leaving the mice with more signs of diabetes.

Tiganis said whether antioxidants are ultimately good for people will probably depend on their state of health or disease. "In the case of early type 2 diabetes and the development of insulin resistance, our studies suggest that antioxidants would be bad for you." Under some conditions, treatments designed to selectively increase ROS in muscle – if they can be devised – might even help, he says.

It's not the first time studies have suggested that antioxidants can be a negative, Tiganis adds. Studies in worms have suggested that antioxidants can shorten lifespan, as have some epidemiological studies in humans. Other recent reports indicate that antioxidants may negate the longer-term benefits of exercise training by lowering the activity of certain genes involved in ROS defense.

Tiganis said it will ultimately be important to work out at what stage ROS go from being good to bad. He suspects it probably depends on the levels and/or the source of their generation. (ROS are generated both on the surfaces of cells and within cells by mitochondria, which convert nutrients such as glucose into energy, he explained.)

Although any health implications of the new findings would require further study, the findings lead Tiganis to suspect it is best not to take daily antioxidant vitamins, especially if you are otherwise healthy. "Do exercise," he says, as this is a natural source of ROS that may promote insulin action.

Individuals who follow the Mediterranean dietary pattern—rich in vegetables, fruits, nuts, whole grains and fish—appear less likely to develop depression, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

The lifetime prevalence of mental disorders has been found to be lower in Mediterranean than Northern European countries, according to background information in the article. One plausible explanation is that the diet commonly followed in the region may be protective against depression. Previous research has suggested that the monounsaturated fatty acids in olive oil—used abundantly in the Mediterranean diet—may be associated with a lower risk of severe depressive symptoms.

Almudena Sánchez-Villegas, B.Pharm., Ph.D., of University of Las Palmas de Gran Canaria and Clinic of the University of Navarra, Pamplona, Spain, and colleagues studied 10,094 healthy Spanish participants who completed an initial questionnaire between 1999 and 2005. Participants reported their dietary intake on a food frequency questionnaire, and the researchers calculated their adherence to the Mediterranean diet based on nine components (high ratio of monounsaturated fatty acids to saturated fatty acids; moderate intake of alcohol and dairy products; low intake of meat; and high intake of legumes, fruit and nuts, cereals, vegetables and fish).

After a median (midpoint) of 4.4 years of follow-up, 480 new cases of depression were identified, including 156 in men and 324 in women. Individuals who followed the Mediterranean diet most closely had a greater than 30 percent reduction in the risk of depression than whose who had the lowest Mediterranean diet scores. The association did not change when the results were adjusted for other markers of a healthy lifestyle, including marital status and use of seatbelts.

"The specific mechanisms by which a better adherence to the Mediterranean dietary pattern could help to prevent the occurrence of depression are not well known," the authors write. Components of the diet may improve blood vessel function, fight inflammation, reduce risk for heart disease and repair oxygen-related cell damage, all of which may decrease the chances of developing depression.

"However, the role of the overall dietary pattern may be more important than the effect of single components. It is plausible that the synergistic combination of a sufficient provision of omega-three fatty acids together with other natural unsaturated fatty acids and antioxidants from olive oil and nuts, flavonoids and other phytochemicals from fruit and other plant foods and large amounts of natural folates and other B vitamins in the overall Mediterranean dietary pattern may exert a fair degree of protection against depression," the authors write.

than their labels indicate




A team of pharmacists from the University of Santiago de Compostela (USC) has established that the levels of vitamin C in many fruit juices and soft drinks are far higher than those indicated on their labels by the manufacturers. This finding has been possible owing to a new technique developed by the researchers to determine the content of vitamin C in these kinds of drinks.

Ascorbic acid or vitamin C is a natural antioxidant in fruits and vegetables, but the European Commission permits its use as an additive in juices, jams, dairy products and other foods. The involvement of this substance in the immune response and other biochemical processes such as the formation of collagen and the absorption of iron is well-known. However, high levels of ascorbic acid can cause diarrhoea and gastrointestinal problems, as a result of which scientists are attempting to determine the content of vitamin C in foods with greater and greater accuracy.

Now, a group of researchers from the Faculty of Pharmacy of the USC has developed a new chromatographic technique (these are used to separate and identify chemical elements) aimed at accurately measuring the ascorbic acid in fruit juices and soft drinks. By applying this method, they have found that the amounts of vitamin C stipulated on the labels of many drinks are not real. In a sample of 17 fruit juices, soft drinks and isotonic drinks, only two correspond to what is indicated on the bottle.

Ana Rodríguez Bernaldo de Quirós is a member of the team which has developed the new technique, whose details have recently been published in the Food Chemistry magazine. "The other drinks contain much higher levels than those specified by the manufacturer because, as has already been indicated in a previous study, the label probably only shows the amount of added ascorbic acid, without taking into account the fruit's natural vitamin C content", she explained to SINC.

Bernaldo de Quirós highlights the greater resolution and sensitivity of the method, by means of which it is possible to detect up to 0.01 milligrams of vitamin C per litre, "thanks to the use of new column chromatography, based on spherical particles of ultra pure silica 3 microns in size".

"Another advantage of the method is its simplicity and speed, as the total time taken to carry out the analyses is no more than six minutes", the researcher remarked.

With the new technique, the valuation of the ascorbic acid in the drinks has revealed some curious data. Of the 17 samples analyzed, the one with the highest vitamin C content was an apple juice (840 mg/l), more than the orange juices (352-739 mg/l). The results for the pineapple and grape juices were 702 mg/l and between 30.2 and 261 mg/l for the soft drinks (orange, lemon and apple).

The researchers also evaluated how the vitamin C content of the orange juices and tea drinks varies while they are on the shelves in the temperature conditions specified by the manufacturer. After six days, the former barely lose 8% of their ascorbic acid while, in the tea drinks, this substance falls by 54% at 4ºC and practically disappears at room temperature.

A daily supplement of vitamin D at a dose of 700-1000 IU reduces the risk of falling among older people by 19% according to a study published on bmj.com today. But a dose of less than 700 IU per day has no effect.

IU is an international unit of measurement for vitamins and other biologically active substances.

Each year, one in three people aged 65 and older experience at least one fall, with around 6% resulting in a fracture. Fall prevention has therefore become a public health goal especially as the older segment of the population grows.

Several trials have shown that vitamin D improves strength and balance among older people, while others have found no significant effect on the risk of falling.

So an international team of researchers analysed the results of eight fall prevention trials to assess the effectiveness of vitamin D in preventing falls among older individuals (aged 65 or more). Differences in study design and quality were taken into account to minimise bias.

The pooled results showed that benefit from supplemental vitamin D on fall prevention depended on treatment dose.

Supplemental vitamin D2 and Vitamin D3 were investigated. 700-1000 IU supplemental vitamin D per day (vitamin D2 or vitamin D3) reduced falls by 19% and up to 26% with vitamin D3.

This effect was independent of age, type of dwelling or additional calcium supplementation. The effect was significant within two to five months of starting treatment and extended beyond 12 months.

Supplemental vitamin D did not reduce falls at a dose of less than 700 IU per day.

The use of active forms of vitamin D did not appear to be more effective than 700-1000 IU supplemental vitamin D. Active forms of vitamin D also cost more and are associated with a higher risk for hypercalcaemia (elevated calcium levels in the blood) than standard supplemental vitamin D.

To reduce the risk of falling, a daily intake of at least 700-1000 IU supplemental vitamin D is warranted in all individuals aged 65 and older, say the authors.

Higher doses may be even more effective and should be explored in future research to optimise the fall prevention benefit with vitamin D, they conclude.

From Ruptured Carotid Artery Plaques

Research led by Hernan A. Bazan, MD, Assistant Professor of Surgery, Section of Vascular Surgery, at LSU Health Sciences Center New Orleans School of Medicine, has found that unstable carotid artery plaques - those in danger of rupturing and leading to a stroke - contain more inflammation and significantly less omega-3 fatty acids than asymptomatic plaques. This suggests that increasing the levels of omega-3 fatty acids in carotid artery plaques could either prevent strokes or improve the safety of treatment. This may be accomplished by increasing dietary intake of foods rich in omega-3 fatty acids. The study is an Article in Press in the journal, Vascular Pharmacology, currently online.

Our bodies produce only a small amount of omega-3 fatty acids, so most of what we need has to come from eating omega-3 fatty acid-rich foods like fish (salmon, tuna, trout, herring, etc.) or from supplements. Omega-3 fatty acids have been shown to protect against cardiovascular disease, particularly heart attack and sudden cardiac death. Dr. Bazan's team wanted to determine what the association might be with plaques in the carotid arteries, a common cause of strokes. Vulnerable plaques which can rupture in the carotid arteries may lead to transient ischemic attacks (TIAs), strokes, or vision loss by affecting the artery to the retina. The mechanisms leading to plaque rupture are still not fully understood but inflammation within the plaque is beginning to be recognized as an important cause of plaque rupture.

Dr. Bazan, an LSUHSC vascular/endovascular surgeon, in collaboration with researchers at Yale University and others at LSUHSC, analyzed plaques from 41 patients who underwent carotid endarterectomy (CEA) to remove plaque buildup in their arteries. Twenty-four patients were asymptomatic and 17 were symptomatic, having had neurological symptoms. All of the fats in the plaques were assessed with mass spectrometry, in collaboration with Dr. Song Hong at LSUHSC. The team was measuring the amounts of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) - the components of long-chain omega-3 polyunsaturated fatty acids. The plaques of asymptomatic patients contained more than twice as much DHA as the symptomatic patients, and about one and a half times as much EPA. Significantly less inflammation was also seen in the carotid atherosclerotic plaques from asymptomatic patients.

"In the future, a study to address whether supplementation with dietary omega-3 polyunsaturated fatty acids prevents carotid-related events in patients with moderate or high-grade carotid stenosis will help answer whether this is a formidable therapeutic target for the prevention of stroke," says Dr. Bazan.

According to the Centers for Disease Control and Prevention, stroke is the third leading cause of death in the United States, as well as a leading cause of serious long-term disability. About 795,000 strokes occur in the US each year and about 610,000 of these are first, or new, strokes. About 185,000 occur in people who have already had a stroke. Nearly 25 percent of strokes occur in people under the age of 65. Of all ischemic strokes occurring, carotid artery atherosclerotic plaques account for over a third of them. It has been noted for several decades that the southeastern United States has the highest stroke mortality in the country. It is not completely clear what factors might contribute to the higher incidence and mortality from stroke in this region.

Eating Sweets Every Day In Childhood 'Increases Adult Aggression'

Children who eat sweets and chocolate every day are more likely to be violent as adults, according to new research.

A study of almost 17,500 participants in the 1970 British Cohort Study found that 10-year-olds who ate confectionary daily were significantly more likely to have been convicted for violence at age 34 years.

The study, published in the October issue of the British Journal of Psychiatry, is the first to examine the long-term effects of childhood diet on adult violence.

Researchers from Cardiff University found that 69 per cent of the participants who were violent at the age of 34 had eaten sweets and chocolate nearly every day during childhood, compared to 42% who were non-violent.

This link between confectionary consumption and violence remained after controlling for other factors.

The researchers put forward several explanations for the link. Lead researcher Dr Simon Moore said: "Our favoured explanation is that giving children sweets and chocolate regularly may stop them learning how to wait to obtain something they want. Not being able to defer gratification may push them towards more impulsive behaviour, which is strongly associated with delinquency."

The researchers concluded: "This association between confectionary consumption and violence needs further attention. Targeting resources at improving children's diet may improve health and reduce aggression."

Recent, Vigorous Exercise Is Associated With Reduced Breast Cancer Risk

Post-menopausal women who engage in moderate to vigorous exercise have a reduced risk of breast cancer. This comes from researchers writing the open access journal BMC Cancer who investigated the link between breast cancer and exercise.

"With an estimated 182,460 new cases diagnosed in the United States in 2008, breast cancer is recognized as the most common cancer affecting U.S. women," says Dr. Tricia M Peters from the U.S. National Cancer Institute, Bethesda, Maryland, who headed up an international team of researchers. Vigorous exercise has been hypothesized to reduce cancer risk for some time. However, this new study is one of the first prospective investigations to look at the importance of various intensities of exercise at different stages in an individual's life.

Over 110,000 post menopausal women were asked to rate their level of physical activity at ages 15-18, 19-29, 35-39, and in the past 10 years. It was found, over 6.6 years of follow up, that women who engaged in more than 7 hours per week of moderate-to-vigorous exercise for the last ten years were 16% less likely to develop breast cancer than those who were inactive. However, no link was observed between breast cancer risk and physical activity in women who were active at a younger age.

Dr. Peters concludes: "Our findings could help inform the mechanisms of the physical activity-breast cancer relationship. With breast cancer still claiming so many lives, all the information of potential preventive measures we can get is vital."

Platelet -rich plasma (PRP) is currently used as an alternative treatment method for several common orthopaedic-related sports medicine conditions. According to a new study in the October issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), early outcomes of PRP appear promising; however, larger clinical studies are still needed to determine the benefits of its use.

“Some believe that PRP may catalyze the body’s repair mechanisms at areas of injury, improve healing and shorten recovery time,” said study co-author Michael Hall, MD, a senior orthopaedic surgery resident at the NYU Hospital for Joint Diseases in New York. “However, there currently is minimal evidence of this clinically and more research must be performed.”

A Simple Process and Procedure

• Obtaining and utilizing PRP is a relatively simple process: a patient’s own blood is placed into a centrifuge that rotates at high speed.
• This procedure separates the red blood cells from the platelets, which are blood cells that release growth factors that help the body heal itself.
• Next, the physician takes the platelet-rich portion of this blood (PRP) and injects it directly into the patient’s injured area and the treatment is complete.

PRP Used Primarily for Chronic Conditions

PRP treatments have been used for the past two decades to improve wound healing and bone grafting procedures by plastic and maxillofacial (mouth, jaw and neck) surgeons. It is only in recent years that orthopaedic surgeons and sports medicine specialists have utilized this technology.

PRP use in sports medicine primarily has been for the treatment of chronic tendon conditions, but also for acute muscle injuries and for the augmentation of tendon repair in the operating room.

The most common applications include:
• tennis elbow (lateral epicondylitis);
• Achilles tendonitis (inflammation and swelling of the Achilles tendon);
• patellar tendonitis (inflammation of the patellar tendon, also called “Jumper's Knee”); and
• rotator cuff tendonopathy.

Should I Have PRP Treatment?

According to Dr. Hall, PRP use has increased in recent years, and it has become a popular topic of discussion because the process is “simple, quick and relatively safe for patients.”

“Use of PRP has increased, in large part due to new devices that enable fast preparation in the outpatient setting. A patient gives a blood sample and 30 minutes later can receive their injection,” he explained. “There is always a risk of infection with any injection, and some have reported increased pain or inflammation at the injection site, but otherwise the risks with PRP appear minimal.”

Questions to Ask Your Doctor

Each patient and injury is unique; therefore it is important to discuss any treatment with an orthopaedic surgeon. If PRP treatment is recommended, Dr. Hall suggests asking your doctor the following to help determine if it is right for you:
1. What is your experience in administering PRP? (Precise placement of PRP injection into the area of injury is important for it to be effective, therefore physicians with more experience may be best.)
2. What are possible side effects? (Examples include increased pain or inflammation at the injection site.)
3. How many injections will I receive? (Several studies have reported using multiple injections, but the benefit of this is unknown.)
4. Will there be any restrictions? (Generally, patients are asked to avoid strenuous activity or sports for a short period of time after the injection to aid in the healing process.)
5. Will my insurance cover treatment? (Currently, most insurance companies do not cover treatment.)

Also, before embarking on PRP, Dr. Hall suggests trying conventional treatments, such as anti-inflammatory medications, physical therapy, massage, activity modification, bracing and even cortisone injections.

“The bottom line is that there are some studies indicating that PRP may be beneficial in the healing process. Does it really have a positive effect clinically? We don’t know,” said Dr. Hall. “The good news is that there are a tremendous amount of studies underway. Hopefully, in the next few years, we will be able to help determine the true benefit of PRP.”

To address a consumer trend that is gaining momentum, the Ethics, Law and Humanities Committee of the American Academy of Neurology (AAN) has released a special report, “Responding to requests from adult patients for neuroenhancements,” which was published in the September 23, 2009, online issue of Neurology, the medical journal of the AAN.

According to lead author, Dan Larriviere, MD, JD, an assistant professor of neurology at the University of Virginia School of Medicine, “A growing number of patients without illness believe they can improve their memory, cognitive focus and attention span by taking neuroenhancement drugs and are asking for prescriptions.”
Originally developed to improve executive function in people with attention deficit hyperactivity disorder and Alzheimer’s disease, neuroenhancement drugs – or memory-boosters – have become popular among healthy adults seeking a mental edge at work, school or in sports. The medications require a prescription and include stimulants (e.g., methylphenidates) and cholinesterase inhibitors (e.g., donepezil).

Prescription requests, says Larriviere, have created a dilemma for neurologists for two reasons: little or no practical clinical guidance has been available and there is no professional or societal consensus regarding how physicians should approach the issue. “Prescribing neuroenhancements to healthy patients has been widely debated among clinicians,” he notes. “Arguments are often based on fervently held convictions about the appropriate practice of medicine. “

Larriviere say the report’s goal is to provide neurologists with “an essential framework in which to exercise their clinical and ethical judgment when faced with a request to prescribe neuroenhancement medications.”

A key conclusion of the report is that there are no legal or ethical barriers to prescribing, refusing to prescribe, or ending a prescription for neuroenhancement drugs. However, it notes that neurologists who prescribe memory-boosting drugs have ethical and legal responsibilities to their patients.

The report’s guidance is that neurologists:
-- work within the context of the physician-patient relationship to make their prescribing decision;
-- respond to a patient’s request for brain-boosting drugs in the same way they would address a chief medical complaint that requires further investigation;
-- follow the same medical principles they would use in developing and initiating treatment plans for medical conditions;
-- consider the potential influence of neuroenhancement medications on a patient’s decision-making capacity;
-- follow principles of informed consent.

As the report cautions, neurologists should be aware of the potential downside to prescribing neuroenhancements. First, there is limited evidence regarding the safety and efficacy of neuroenhancements prescribed to healthy adults. Second, there is uncertainty about the liability risks associated with prescribing such medications.