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High doses of antioxidant nutritional supplements, such as vitamins C and E, can increase genetic abnormalities in cells, which may predispose supplement-takers to developing cancer, according to a new study from the Cedars-Sinai Heart Institute.

The study, led by Eduardo Marbán, M.D., Ph.D., director of the Cedars-Sinai Heart Institute, was published online today in the medical journal Stem Cells. The study also will appear in the journal's July printed edition.

Marbán and his team accidentally discovered the danger of excessive antioxidant doses while seeking a way to reduce the genetic abnormalities that occurred naturally when the scientists sought to multiply human cardiac stem cells.

Marbán stressed that the study's finding applies only to excessive nutritional supplements and not to foods that are rich in antioxidants, such as milk, oranges, blueberries and peanuts. In recent years, multiple studies have touted the benefits of foods rich in antioxidants.

"Taking one multivitamin daily is fine, but a lot of people take way too much because they think if a little is good, a lot must be better," said Marbán, who is also the Mark Siegel Family Professor at Cedars-Sinai. "That is just not the case. If you are taking 10 or 100 times the amount in a daily multivitamin, you may be predisposing your cells to developing cancer, therefore doing yourself more harm than good."

In laboratories, stem cells are often grown in a Petri dish culture than is composed of 20 percent oxygen, whereas cells growing inside human tissue are exposed to just 3 to 5 percent oxygen. But Marbán's team of researchers became frustrated because the higher concentration of oxygen in lab-grown stem cells resulted in 9 percent of the cells being rejected because of genetic abnormalities.

"We sought to counter that oxidation problem by adding high doses of antioxidants directly to the cells," Marbán said. "That's when we made the serendipitous discovery that there is a danger zone for the cells exposed to antioxidants to develop genetic abnormalities that predispose to cancer."

Marbán is leading an ongoing, groundbreaking clinical trial in which heart attack patients undergo two minimally-invasive procedures in an effort to repair and re-grow healthy muscle in a heart injured by a heart attack. First, a biopsy of each patient's own heart tissue is used to grow specialized heart stem cells. About a month later, the multiplied stem cells are then injected back into the patient's heart via a coronary artery.

The two-step procedure was completed on the first patient in June 2009. The results of the trial are expected in early 2011.

Recently, Marbán received a $5.5 million grant from the California Institute for Regenerative Medicine to continue developing cardiac stem cell therapies.
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Taking vitamin D supplements during pregnancy is not only safe for mother and baby, but also can prevent preterm labor/births and infections, according to results of a randomized controlled study to be presented at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.

In the 1950s and '60s, people were concerned that vitamin D could cause birth defects, according to Carol L. Wagner, MD, lead author of the study and a pediatric researcher at Medical University of South Carolina. It now is known that vitamin D is important for maternal and infant health, including bone health and immune function.

Recent studies have shown that vitamin D deficiency during pregnancy is a serious public health issue.

"Diet doesn't provide enough vitamin D, and we don't go in the sun as much as we need," Dr. Wagner said.

Therefore, she and her colleagues, including Bruce W. Hollis, PhD, who has worked in the field of vitamin D research for the last 30 years, set out to determine the optimal dose of vitamin D supplements for pregnant women without doing harm.

Researchers randomized 494 pregnant women at 12-16 weeks' gestation into three treatment groups. Group one received 400 International Units (IU) of vitamin D a day until delivery; group two received 2,000 IU and group three received 4,000 IU. The women were evaluated monthly to ensure safety.

"No adverse events related to vitamin D dosing were found in any of the three arms of the study," Dr. Wagner said.

Investigators also looked at the effects of vitamin D supplementation on complications during pregnancy, including preeclampsia, gestational diabetes, infections, and preterm labor and birth.

"The spectacular part of the study was it showed women replete in vitamin D had lower rates of preterm labor and preterm birth, and lower rates of infection," Dr. Wagner said.

The greatest effects were seen among women taking 4,000 IU of vitamin D per day. Therefore, the researchers recommend this daily regimen for all pregnant women.

To view part 1 of the study on safety

To view part 2 of the study on outcomes,

How much "green exercise" produces the greatest improvement in mood and sense of personal well-being? A new study in the American Chemical Society's semi-monthly journal Environmental Science & Technology has a surprising answer.

The answer is likely to please people in a society with much to do but little time to do it: Just five minutes of exercise in a park, working in a backyard garden, on a nature trail, or other green space will benefit mental health.

Jules Pretty and Jo Barton explain in the study that green exercise is physical activity in the presence of nature. Abundant scientific evidence shows that activity in natural areas decreases the risk of mental illness and improves the sense of well-being. Until now, however, nobody knew how much time people had to spend in green spaces to get those and other benefits.

"For the first time in the scientific literature, we have been able to show dose-response relationships for the positive effects of nature on human mental health," Pretty said.

From an analysis of 1,252 people (of different ages, genders and mental health status) drawn from ten existing studies in the United Kingdom, the authors were able to show that activity in the presence of nature led to mental and physical health improvements.

They analyzed activities such as walking, gardening, cycling, fishing, boating, horse-riding and farming. The greatest health changes occurred in the young and the mentally-ill, although people of all ages and social groups benefited. All natural environments were beneficial including parks in urban settings. Green areas with water added something extra. A blue and green environment seems even better for health, Pretty noted.

From a health policy perspective, the largest positive effect on self-esteem came from a five-minute dose.

"We know from the literature that short-term mental health improvements are protective of long-term health benefits," Pretty said. "So we believe that there would be a large potential benefit to individuals, society and to the costs of the health service if all groups of people were to self-medicate more with green exercise," added Barton.

Alcohol consumption is a significant contributor to adverse outcomes in elective surgery, according to a new study from the University of Massachusetts Medical School.

Researchers studied more than 300,000 discharge records from the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database for elective adult admissions. The database includes data from approximately 125 hospitals across the country. Because of its size, this study was able to account for internal biases and determine the independent effect of alcohol consumption on morbidity and mortality following surgery.

Patient records examined in the study were divided into two groups: those with active alcohol exposure, which was defined as at least two drinks per day everyday for two weeks prior to surgery, and those who did not have active alcohol exposure. Those with active alcohol exposure represented 2.5 percent of the records examined. Researchers measured outcomes including length of stay, wound infection, sepsis and death, and found that alcohol use was an independent predictor of pneumonia, sepsis, superficial surgical site infection, wound disruption and longer median hospital stays, and that acute alcohol consumption had a significant effect on mortality.

"This is important information for both patients and surgeons," said Shimul A. Shah, PhD, assistant professor of surgery at the University of Massachusetts Medical School and senior author of the study. "Based on the significant adverse effects on outcomes following surgery, patients who regularly consume this amount of alcohol may want to consider postponing elective surgery until they have abstained from drinking for at least two weeks prior to surgery. Or surgeons may want to consider delaying surgery until patients have shown abstinence from alcohol for at least two weeks to avoid some of the potential complications."

Dr. Shah added that his study's findings serve as a basis for further research that can be done on the local level to examine alcohol consumption trends in more depth to determine the potential that undiagnosed cirrhosis is contributing to these poor surgical outcomes.

For the first time, in a large prospective study, researchers have identified an association between high protein intake and a significantly increased risk of inflammatory bowel disease (IBD). While doctors have long suspected that diet contributes to IBD, little has been assessed, and the studies conducted have been retrospective, which are less informative because they rely on the study participants' ability to recall what they have consumed in the past. This study examined the effects of different sources and amounts of protein.

Using participants in France's E3N cohort study, researchers led by Prevost Jantchou, MD, of the Center for Research in Epidemiology and Population and colleagues identified 77 women ages 40 to 65 with validated cases of IBD. In each case, the onset of IBD occurred after the first dietary questionnaire was administered, thereby assuring that they could be studied prospectively.

Dr. Jantchou examined participants' macronutrient (protein, fat and carbohydrate) intake, and determined that more than two-thirds of them had elevated levels of protein intake. Participants were divided into three groups based on their mean protein intake: the lowest intake group had a mean daily protein intake of 1.08 grams/kg of body weight; the middle group had 1.52 grams/kg; and the highest group had 2.07 grams/kg. The FDA recommends a daily intake of 0.8 grams of protein per kilogram of body weight.

When examining the effects of specific types of protein, Jantchou found that animal protein represented a threefold risk of developing IBD in the highest group compared to the lowest group. Specifically, animal protein from meat and fish, not dairy, created an increased risk, while vegetable protein created no increased risk of developing IBD.

Researchers found that the increased risk from animal protein intake were the same for Crohn's disease and ulcerative colitis. They also found that smoking and hormonal therapy, two factors known to be related to the risk of IBD, did not change their results.

"Our findings represent a tremendous step forward in our understanding of inflammatory bowel disease," said Dr. Jantchou. "For years we've known there was a connection between diet and IBD, and we now know specifically which aspect of diet is related to disease occurrence. The next step is to look at the effect of animal protein in patients already diagnosed with IBD to be able to give them better dietary advice."

A new study shows that patients with low vitamin D levels who develop Clostridia difficile (C. diff) have a higher recurrence rate and possibly higher hospital mortality. C. diff is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis, and often occurs after taking antibiotics.

Previous studies have shown that normal levels of vitamin D are associated with improved outcomes in hospitalized patients, and conversely, low levels of vitamin D have been associated with higher mortality rate in hospitalized patients. Investigators at New York Hospital Queens –Weill Cornell Medical College, led by Moshe Rubin, MD, director of gastroenterology, sought to determine whether vitamin D levels are associated with a persons' ability to resolve their infection.

Researchers tracked 83 patients who had been admitted to the hospital who were then diagnosed with C. diff. They measured vitamin D levels in all of the patients, then followed their hospital course. Researchers noted how many patients were still alive after 30 days, and compared the outcome of patients with normal vitamin D levels to those with low levels. They found that up to 40 percent of people, especially in an older age group with multiple illnesses, died from some cause if they developed C. diff during that hospitalization.

Furthermore, while they may not die from C. diff, Dr. Rubin said it definitely adds a major complication that contributes to high mortality.

Researchers found that those with normal levels of vitamin D had a higher resolution rate, and a lower recurrence rate than those with low vitamin D levels. These findings are consistent with what is currently understood about vitamin D — it plays a role in immune function, may be an important factor in fighting infection, low levels seem to be a marker for not resolving diseases in general and it is associated with higher mortality rates.

Sixty-two patients were tracked for 30 days; 45 percent had normal vitamin D levels while 55 percent had low vitamin D levels. In the normal vitamin D group, they found 53 percent remained disease-free for 30 days, but in the group with low vitamin D levels, only 26 percent resolved their C. diff infections. Dr. Rubin noted that since this study was observational, it does not prove a cause and effect relationship between vitamin D levels and recurrence of C. diff, but it does identify an association.

Dr. Rubin said that since the study sample was relatively small, it should be repeated with a larger patient population to corroborate the data.

"We're starting to understand the importance of vitamin D in relation to overall health and to particular infections, like C. diff," said Dr. Rubin. "It's important to pay attention to nutritional issues and possibly even supplement vitamin D in patients with low levels to help fight serious infections."

Oleic acid in one's diet may help reduce or prevent the development of ulcerative colitis (UC). Oleic acid, a monounsaturated fatty acid, is present in olive, peanut, and grapeseed oils and may prevent ulcerative colitis from developing by suppressing inflammation by blocking chemicals in the bowel that aggravate inflammation. UC affects men and women of all ages and is characterized by inflammation of the lining of the colon or large bowel, which can cause distressing symptoms such as abdominal pain, diarrhea and weight loss.

Researchers led by Andrew R. Hart, MD, senior lecturer in gastroenterology, University of East Anglia, Norwich, U.K., sought to determine whether people eating more oleic acid are protected against developing UC. They studied more than 25,000 men and women aged 40 to 65 years in Norfolk, England, who were recruited between 1993 and 1997 into a study called EPIC (European Prospective Investigation into Diet and Cancer). These participants, initially without UC, completed a diary of all the foods they ate for one week including foods eaten, the quantity and brands in detail.

The diaries were then coded by specially trained nutritionists using a specific computer program called DINER. The nutritionists, using DINER, calculated the dietary intake of different foods consumed by participants, including oleic acid. Patients were followed up to 2004 to identify those who were subsequently diagnosed with UC. Researchers compared any differences in diet, including oleic acid, between those who were diagnosed with UC and those who remained healthy.

The study found that individuals with the highest intake of oleic acid had a 90 percent lower risk of developing UC. Dr. Hart estimates that approximately half the cases of UC could be prevented if larger amounts of oleic acid were consumed — as much as two to three tablespoons of olive oil per day could have a protective effect.

Dr. Hart said similar work in other countries is now required to determine if the results are reproducible and consistent in other groups. These are required to confirm whether oleic acid is truly protective. If so, researchers believe that dietary modifications may prevent this distressing illness and that the use of oleic acid supplements should be clinically assessed as treatment for patients with UC. Additionally, while most conditions are treated with drugs rather than dietary treatments, Hart noted that a proven complementary approach using both may be a research topic for the future to benefit more patients.

"If we could show that dietary treatments complement drug treatments then that could have a better outcome than either approach by itself," he said. "This is critical since many patients with UC have to take medications life-long, may need surgery and have an increased risk of complications including cancer and perforation of the large bowel."