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New research points to a potential role for UV light exposure and vitamin D levels in chronic digestive conditions; Crohn's disease, a serious inflammatory condition in the small intestine; and ulcerative colitis (UC), which similarly affects the colon.

In two separate studies presented at the American College of Gastroenterology's 76th Annual Scientific Meeting, a group of investigators from Massachusetts General Hospital probed the connection between geography, UV exposure and incidence of inflammatory bowel disease while another group from Weill Cornell Medical Center looked at different levels of supplementation with Vitamin D to determine impact on severity of Crohn's disease.

"Geographic Variations and Risk of Crohn's Disease and Ulcerative Colitis"

Results from two large prospective studies among large cohorts of nurses enrolled in the U.S. Nurses Health Study I and II revealed a significant north-south gradient in the association between latitude and incidence of Crohn's disease and ulcerative colitis in the United States. Such geographic variation has been reported in Europe, however comparable data in the United States are lacking, so this study advances understanding of the epidemiology of chronic inflammatory bowel disease, which affects as many as 1.4 million patients in the United States.

"This differential risk may be explained by differences in UV light exposure, vitamin D status, or pollution," explained Dr. Hamed Khalili, who, along Dr. Andrew Chan and colleagues at Massachusetts General Hospital, analyzed data that included a 4,209,454 person-year follow up in which they confirmed 284 cases of Crohn's disease and 332 cases of ulcerative colitis.

While the mean age of diagnosis among the women was 51 for Crohn's and 48 for UC, the investigators found that the women's geographic location at age 30 was strongly associated with incidence of disease. Based on geographic location at age 30, compared to women in northern latitudes, women in southern latitudes had an adjusted hazard ratio of 0.51 for Crohn's and 0.65 for UC suggesting that the risk of disease is 50% and 35% lower in the southern latitudes compared to northern latitudes for CD and UC, respectively. Further studies are warranted on underlying lifestyle and environmental factors that mediate this association, as well as their interaction with known genetic risk factors for CD and UC.

"High-dose Vitamin D3 Improves Clinical Activity in Crohn's Disease"

Results of an interim analysis of the first 15 patients in a study conducted at Weill-Cornell Medical and presented at the ACG Annual Scientific Meeting by Dustin Boothe, MD, sought to determine if high doses of Vitamin D3 supplementation in Vitamin D deficient patients with Crohn's disease leads to improved clinical outcomes.

Two groups of patients with Crohn's disease, who had baseline levels of Vitamin D that were low, were randomized to either low-dose (1,000 IU/day) or high-dose (10,000 IU/day) Vitamin D treatment and assessed at day 1, and after 8 weeks and 26 weeks of treatment. The investigators measured the patients's symptom severity using the Harvey-Bradshaw Index (HBI) an index of disease activity in Crohn's.

Results from the first 15 patients suggest that after 26 weeks of therapy, there were persistently significant differences in Vitamin D levels between the high-dose and low-dose groups, but importantly the low-dose group had no significant change in disease activity as measured by HBI at 26 weeks compared to baseline, whereas the high dose group did.

"Our interim analysis suggests that supplementation with 10,000 IU of Vitamin D3 may be an effective adjunctive therapy for ameliorating symptoms in Crohn's disease patients," commented Dr. Boothe on the presentation of these preliminary data.

This dish is not only tasty, but is high in folic acid along with cancer fighting herbs.

The lemon zest also is rich in limonene. Belonging to a vital class of phytochemicals called terpenes, limonines may stimulate enzymes to block carcinogens and enhance the immune system.
The lemon juice helps to take away the toughness of greens and provides the lemon tang.

Greens with Lemon and Summer Herbs

Limonene, found in lemons, has been found to boost the immune system

Yields: 4 servings

• 1 Tbsp. extra-virgin olive oil
• 2 – 3 cloves garlic minced
• 1 bunch leafy greens (kale, collards) rinsed well,
• stem removed and sliced into ¼” ribbons
• 1 cup vegetable stock
• Grated zest of lemon
• Juice of 1/2 lemon
• 1 tsp. red wine vinegar
• 6 leaves fresh basil, minced
• 1 sprig of fresh rosemary, minced

Directions:
Heat oil and garlic in a skillet for about one minute over medium heat. Add greens and vegetable stock. Steam until the greens are tender (about 5 minutes). Toss in the remaining ingredients during the last 1 to 2 minutes of cooking. Remove from heat. Serve immediately.

Adapted from Greens: A Country Garden Cookbook by Sibella Krause. Collins Publishers, San Francisco ISBN 0-00-255166-7

Content provided by the Joan Karnell Cancer Center

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Eating a Mediterranean diet combined with physical activity can help to improve some of the symptoms of sleep apnoea, according to new research.

The study, which is published online in the European Respiratory Journal, looked at the impact a Mediterranean diet can have on obese people with sleep apnoea, compared to those on a prudent diet.

Obstructive sleep apnoea syndrome (OSAS) causes frequent pauses of breathing to occur during sleep, which disrupts a person’s normal sleeping pattern. It is one of the most prevalent sleep-related breathing disorders with approximately 2-4% of the adult population experiencing the condition. This percentage increases up to 20-40% with obesity, and weight loss is often an essential part of the recommended treatment plan.

The researchers, from the University of Crete in Greece, examined 40 obese patients suffering from OSAS. Twenty patients were given a prudent diet to follow, while the other 20 followed a Mediterranean diet*. Both groups were also encouraged to increase their physical activity, mainly involving walking for at least 30 minutes each day.

In both groups, the patients also received continuous positive airway pressure (CPAP) therapy which involves wearing a mask that generates an air stream, keeping the upper airway open during sleep.

The researchers monitored the patients during a sleep study, known as polysomnography. This involved monitoring several markers for OSAS, including electrical activity in the brain, eye movements and snoring. The patients were examined at the start of the study and again 6 months later.

The results showed that people following the Mediterranean diet had a reduced number of disturbances, known as apnoeas, during the rapid eye movement (REM) stage of sleep, which usually accounts for approximately 25% of total sleep during the night.

The findings also revealed that people following the Mediterranean diet also showed a greater adherence to the calorie restricted diet, an increase in physical activity and a greater decrease in abdominal fat.

The results of this small sample did show an improvement during one stage of sleep for people with sleep apnoea, however it did not show an overall improvement in severity of the condition. The authors suggest that further studies in a larger sample are required to fully understand the benefits of this diet.

Christopher Papandreou, lead author for the research, said: “This is the first study examining the impact of the Mediterranean diet in combination with physical activity on OSAS via changes in the human body. Our results showed that the number of disturbances during REM sleep was reduced more in the Mediterranean diet group than the other group. Recent reports have related an increase in disturbances during REM sleep with the risk of developing significant systemic consequences like diabetes type II. However, its clinical significance remains unclear. Finally, more studies are needed to examine the effect of the above diet on this sleep-related breathing disorder taking into account its anti-inflammatory and antioxidant properties.”

Recommended consumption of several food groups according to the prescribed diet:

Food groups Prudent Diet Mediterranean diet
Red meat (servings/wk) 9 3
Poultry (servings/wk) 3 3
Fish (servings/wk) 1 3 (1 fatty fish)
Dairy products, low fat 2 2
Fruit (servings/d) 1-2 4
Vegetables (servings/d) 1.5 5
Legumes (servings/wk) 1 ≥3
Potatoes (servings/wk) ≥5 ≥5
Non-refined cereals 2 6
Red wine (glasses/d) 0 1-2
Daily use of olive oil moderate moderate

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For the first time, scientists report a link between eating nuts and higher levels of serotonin in the bodies of patients with metabolic syndrome (MetS), who are at high risk for heart disease. Serotonin is a substance that helps transmit nerve signals and decreases feelings of hunger, makes people feel happier and improves heart health. It took only one ounce of mixed nuts (raw unpeeled walnuts, almonds and hazelnuts) a day to produce the good effects. The report appears in ACS' Journal of Proteome Research.

Cristina Andrés-Lacueva and colleagues from the Biomarkers & NutriMetabolomics Research Group of the University of Barcelona in collaboration with the Human Nutrition Unit of the Rovira i Virgili University explain that the rise in obesity around the world means more and more patients have MetS. Symptoms include excess abdominal fat, high blood sugar and high blood pressure, which increase the risk of developing type 2 diabetes and heart disease. Dietary changes may help patients shed the excess weight and become healthier, among the changes, the regular consumption of nuts — which are jam-packed with healthful nutrients, such as healthy fats (unsaturated fatty acids) and antioxidants (polyphenols) — have been recommended to fight the metabolic abnormalities associated with MetS. To check the biochemical effects of nut consumption, the researchers put 22 MetS patients on a nut-enriched diet for 12 weeks and compared them to another group of 20 patients who were told to avoid nuts.

The scientists analyzed the broad spectrum of compounds excreted in the patients' urine and found evidence of several healthful changes. One surprise was evidence that nut consumption had boosted patients' levels of serotonin metabolites in urine, since these findings suggest the role of serotonin in the beneficial effects of nuts. They point out that the study provides the first evidence in humans of the beneficial effects of nut consumption in reducing levels of substances in the body associated with inflammation and other cardiovascular risk factors in patients with metabolic syndrome.

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A study of postmenopausal women found no significant mortality benefit from vitamin D after controlling for health risk factors such as abdominal obesity. The only exception was that thin-waisted women with low vitamin D levels might face some risk. The results agree with advice issued last year by the Institute of Medicine that cautioned against vitamin D having a benefit beyond bone health.

Doctors agree that vitamin D promotes bone health, but a belief that it can also prevent cancer, cardiovascular disease and other causes of death has been a major health controversy. Consistent with advice issued last fall by the Institute of Medicine, a new study finds that vitamin D did not confer benefits against mortality in postmenopausal women after controlling for key health factors such as abdominal obesity.

"There's not enough evidence to do anything about vitamin D levels if it's not in regard to bone health.""What we have is clinical trial evidence that for the most part vitamin D doesn't seem to be helpful for conditions where people thought it might," said study lead author Charles Eaton, professor of family medicine and of epidemiology in the Warren Alpert Medical School of Brown University and a physician at Memorial Hospital in Pawtucket, R.I. "The best we can tell is that there isn't an association. Once we took into account these other factors, high levels didn't provide a benefit and low levels didn't put you at risk."

In the study, published online Oct. 26 in the American Journal of Clinical Nutrition, Eaton led an analysis of data from 2,429 postmenopausal women aged 50 to 79 who participated in the broad-based Women's Health Initiative study, in which Eaton and many co-authors were investigators. They tracked blood levels of vitamin D in the women and their mortality over a 10-year period. They not only looked at death from all causes but also focused on cancer and cardiovascular disease.

In all, 225 of the women died, including 79 from cardiovascular disease and 62 from cancer.

Eaton said he expected to find some protective effect against such mortality from vitamin D, and at first glance -- controlling only for age, ethnicity, and whether women took part in a calcium and vitamin D supplement trial -- that's what the data showed. But what was apparent in the data was that the women with the lowest levels of vitamin D also had a lot of other negative health indicators. The team therefore controlled for several more key health factors, such as smoking, history of cardiovascular disease, history of cancer, alcohol consumption, and waist circumference. The additional controls, especially waist circumference, which is a measure of abdominal obesity, eroded the statistical significance of vitamin D's seemingly protective effects down to nothing.

The one exception was that women with thinner waistlines (less than 35 inches) and with the lowest vitamin D levels seemed to have a greater risk of "all-cause" mortality within the 10-year analysis period. That result, however, was right on the borderline of statistical significance.

"If you are thin, this data suggest that maybe low vitamin D levels are potentially harmful and you should talk to your doctor about what to do about them," Eaton said.

Eaton said he and his co-authors can only speculate about why abdominal obesity was an especially important and powerful factor to control for in their analysis. In the study they note that abdominal obesity is associated with several negative health indicators that may overwhelm any modest benefit vitamin D might have. They also point out that fat tissue can store vitamin D, possibly meaning that women with larger waistlines are storing more of the vitamin than their blood serum levels alone would reveal.

More research into the connections between abdominal fat and the health effects of vitamin D could help resolve the question, Eaton said. He also said that a major new trial of vitamin D supplements and health called "VITAL" is getting underway and will likely inform the broader controversy about what vitamin D is good for.

For now, Eaton said, "there's not enough evidence to do anything about our vitamin D levels if it's not in regard to bone health."

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When obese men take a relatively small dose of resveratrol in purified form every day for a month, their metabolisms change for the better. In fact, the effects appear to be as good for us as severe calorie restriction. Resveratrol is a natural compound best known as an ingredient in red wine.

"We saw a lot of small effects, but consistently pointing in a good direction of improved metabolic health," said Patrick Schrauwen of Maastricht University in The Netherlands.

The findings in the November issue of the Cell Press journal Cell Metabolism are the first to report the clinical effects of resveratrol.

Earlier studies in animals had shown that resveratrol alleviates insulin resistance and protects against the ill effects of a high-fat diet, among other benefits, he explained. The effects are comparable to what happens when animals or humans significantly restrict the number of calories they consume, a diet plan shown to delay the onset of age-related diseases. Still, no studies had systematically examined the metabolic effects of resveratrol in humans.

To fill that gap, the researchers gave 11 obese but otherwise healthy men a dietary supplement containing 150 milligrams of a 99 percent pure trans-resveratrol (trade name resVida) for 30 days while they measured the amount of energy they expended, the amount of fat they were storing and burning, and more.

The data show that, like calorie restriction, resveratrol supplements lower energy expenditure and improve measures of metabolism and overall health. Those changes include a lower metabolic rate, less fat in the liver, lower blood sugar levels and a drop in blood pressure. Trial participants also experienced changes in the way their muscles burned fat.

"The immediate reduction in sleep metabolic rate was particularly striking," Schrauwen said. Of course, in the case of obesity, it's not entirely clear whether burning fewer calories is a good or a bad thing. It does suggest that participants' cells were operating more efficiently, as they do following calorie restriction.

Those metabolic effects of resveratrol also came with no apparent side effects.

Schrauwen said they chose to study obese individuals given their increased risk for type 2 diabetes. In future studies, he hopes to explore the effects of resveratrol in people who have already progressed to diabetes.

ResVida and other resveratrol supplements are already widely available, but more work is needed to establish whether they indeed have the potential to overcome the metabolic aberrations associated with obesity and aging, according to the researchers.

"I don't see a reason for particular caution, but we do need long-term studies," Schrauwen says.

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Consumption of 3 to 6 alcoholic drinks per week is associated with a small increase in the risk of breast cancer, and consumption in both earlier and later adult life is also associated with an increased risk, according to a study in the November 2 issue of JAMA.

"In many studies, higher consumption of alcohol has been associated with an increased risk of breast cancer. However, the effect of low levels of drinking as is common in the United States has not been well quantified," according to background information in the article. "In addition, the role of drinking patterns (i.e., frequency of drinking and 'binge' drinking) and consumption at different times of adult life are not well understood."

Wendy Y. Chen, M.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues examined the association of breast cancer with alcohol consumption during adult life, including quantity, frequency, and age at consumption. The study included 105,986 women enrolled in the Nurses' Health Study who were followed up from 1980 until 2008 with an early adult alcohol assessment and 8 updated alcohol assessments. The primary outcome the researchers measured was the risk of developing invasive breast cancer.

During the follow-up period, there were 7,690 cases of invasive breast cancer diagnosed among the study participants. Analyses of data indicated that a low level of alcohol consumption (5.0 to 9.9 grams per day, equivalent to 3-6 glasses of wine per week) was modestly but statistically significantly associated with a 15 percent increased risk of breast cancer. In addition, women who consumed at least 30 grams of alcohol daily on average (at least 2 drinks per day) had a 51 percent increased risk of breast cancer compared with women who never consumed alcohol.

The researchers also found that when examined separately, alcohol consumption levels at ages 18 to 40 years and after age 40 years were both strongly associated with breast cancer risk. The association with drinking in early adult life still persisted even after controlling for alcohol intake after age 40 years.

Binge drinking, but not frequency of drinking, was also associated with breast cancer risk after controlling for cumulative alcohol intake.

The authors add that although the exact mechanism for the association between alcohol consumption and breast cancer is not known, one probable explanation may involve alcohol's effects on circulating estrogen levels.

"In summary, our study provides a comprehensive assessment of the relationship between alcohol intake and breast cancer risk in terms of timing, frequency, quantity, and types of alcohol in a large prospective cohort with detailed information on breast cancer risk factors," the researchers write. "Our results highlight the importance of considering lifetime exposure when evaluating the effect of alcohol, and probably other dietary factors, on the carcinogenesis process. However, an individual will need to weigh the modest risks of light to moderate alcohol use on breast cancer development against the beneficial effects on cardiovascular disease to make the best personal choice regarding alcohol consumption."