Thursday, June 30, 2011

Red wine: Exercise in a bottle?

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New research in the FASEB Journal suggests that a daily intake of resveratrol prevents the ill effects of simulated weightlessness on muscle and bone metabolism

Bethesda, MD—As strange as it sounds, a new research study published in the FASEB Journal suggests that the "healthy" ingredient in red wine, resveratrol, may prevent the negative effects that spaceflight and sedentary lifestyles have on people. The report describes experiments in rats that simulated the weightlessness of spaceflight, during which the group fed resveratrol did not develop insulin resistance or a loss of bone mineral density, as did those who were not fed resveratrol.

According to Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal, "There are overwhelming data showing that the human body needs physical activity, but for some of us, getting that activity isn't easy. A low gravity environment makes it nearly impossible for astronauts. For the earthbound, barriers to physical activity are equally challenging, whether they be disease, injury, or a desk job. Resveratrol may not be a substitute for exercise, but it could slow deterioration until someone can get moving again."

Scientists studied rats that underwent simulated weightlessness by hindlimb tail suspension and were given a daily oral load of resveratrol. The control group showed a decrease in soleus muscle mass and strength, the development of insulin resistance, and a loss of bone mineral density and resistance to breakage. The group receiving resveratrol showed none of these complications. Study results further demonstrated some of the underlying mechanisms by which resveratrol acts to prevent the wasting adaptations to disuse-induced mechanical unloading. This study also suggests that resveratrol may be able to prevent the deleterious consequences of sedentary behaviors in humans.

"If resveratrol supplements are not your cup of tea," Weissmann added, "then there's good news. You can find it naturally in red wine, making it the toast of the Milky Way."

Wednesday, June 29, 2011

Fidgeting your way to fitness

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Walking to the photocopier and fidgeting at your desk are contributing more to your cardiorespiratory fitness than you might think.

Researchers have found that both the duration and intensity of incidental physical activities (IPA) are associated with cardiorespiratory fitness. The intensity of the activity seems to be particularly important, with a cumulative 30-minute increase in moderate physical activity throughout the day offering significant benefits for fitness and long-term health.

“It’s encouraging to know that if we just increase our incidental activity slightly--a little bit more work around the house, or walking down the hall to speak with a co-worker as opposed to sending an email--we can really benefit our health in the long-term,” says Ashlee McGuire, the study’s lead researcher and a graduate student in the School of Kinesiology and Health Studies. “Best of all, these activities don’t take up a lot of time, they’re not difficult to do, and you don’t have to go to a gym.”

Ms McGuire and fellow researcher Robert Ross, a professor in the School of Kinesiology and Health Studies, define IPA as non-purposeful physical activity accrued through activities of daily living, such as doing housework, climbing stairs or walking around the office.

MAKE BLADDER CANCER CELLS MORE SUSCEPTIBLE TO CHEMOTHERAPY

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Improving efficacy of drugs would boost post-surgery survivorship



Researchers at the UC Davis Cancer Center have discovered a way of sensitizing muscle-invasive bladder cancer cells so that they succumb to the toxic effects of chemotherapy. The finding adds to mounting evidence that tiny strands of RNA — called microRNA — play key roles in some of the deadliest types of cancer.
In the current study, published online June 28 in International Journal of Cancer, researchers boosted the production of a microRNA found in bladder cancer cell lines — encoded for by the gene miR-34a — and found that this resulted in more of the cells being killed by cisplatin, a chemotherapy drug used to treat many types of cancer.


Ralph deVere White
"When we took the bladder cancer cell lines and activated miR-34a, they were more responsive to chemotherapy," said Ralph deVere White, UC Davis Cancer Center director and professor of urology.

The study establishes, for the first time, a link between sensitivity of bladder cancer cells to chemotherapy and the expression of miR-34a. It suggests that miR-34a may be used as a predictor of response to chemotherapy, as well as a target for new drugs.

Currently, about 50 percent of patients with advanced bladder cancer will survive five years after diagnosis. Although clinical trials have demonstrated that chemotherapy before surgery can improve survival rates, it is rarely used because fewer than 50 percent of patients will respond favorably. Without knowing which patients will improve as a result of chemotherapy, physicians are generally reluctant to use a treatment that can cause their patients to suffer significant side effects.

"So, now we have to prove that it works to predict chemotherapy response in patients," deVere White said. To that end, UC Davis has entered into a partnership with Israel-based Rosetta Genomics to develop a microRNA profile for muscle-invasive bladder cancer that may be used to predict response to chemotherapy.

As part of the current study, deVere White and his colleagues studied 27 patients and found that many who expressed lower levels of miR-34a subsequently did not respond to the combined chemotherapy-surgery treatment. Because the finding was not statistically significant, however, further work in this area is needed.

The team also studied tumor samples taken from eight of the patients who did not respond to chemotherapy. They compared the expression of miR-34a before and after chemotherapy.

"We wanted to see, if you looked at the patient's tissue before chemotherapy, were there differentially expressed microRNAs in the patients who responded to the drugs versus those that didn't respond," deVere White explained.

The team found that expression of miR-34a increased after treatment in only two of the eight cases, suggesting that gene expression levels remained low during treatment and confirming the link between low gene expression and failure to respond to treatment.

"The combined data indicate that the elevation of miR-34a expression levels prior to chemotherapy would be of benefit to muscle-invasive bladder cancer patients, particularly in a setting of low mi-R-34a expression," the authors write.

Since their discovery in 1993, microRNAs have been found to be involved in a number of types of cancer, heart disease and diseases of the nervous system. In 2007, deVere White was part of a team that identified miR-125b, a gene that encodes for a microRNA that jump starts prostate cancer cell growth midway through the disease process, eventually causing it to become fatal.

The microRNA studied here was also recently found to play a role in medulloblastoma, an aggressive type of brain cancer. MicroRNAs, which are usually 22 to 33 nucleotides in length, are known as post-transcriptional regulators. That means they work by turning genes on or off during the part of the protein synthesis process that involves making a strand of RNA from a DNA template. The human genome encodes for an estimated 1,000 microRNAs.

According to the authors, future studies involving miR-34a will focus on testing its ability to increase sensitivity to chemotherapy and analysis of miR-34a expression in patients with muscle-invasive bladder cancer. With the currently low chemotherapy success rate and poor five-year survival rate for patients with this disease, "such studies are clearly warranted," the authors write.

"If we can prove what is causing chemotherapy resistance in patients with muscle-invasive bladder cancer, American ingenuity will come up with ways to overcome it," predicted deVere White.

Diet Soft Drink Consumption Is Associated with Increased Waist Circumference

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Consumption of diet soft drinks (DSDs) has been linked to increased incidence of obesity, metabolic syndrome, and diabetes. The authors examined the relationship between DSD consumption and long-term change in waist circumference (ΔWC) in 474 participants, aged 65-74 yrs at baseline, in the San Antonio Longitudinal Study of Aging (SALSA). Overall, DSD users experienced 70% greater increases in WC compared with non-users.

Measures of height, weight, waist circumference (WC), and DSD intake were recorded at baseline and at each of 3 follow-up exams, for an average follow-up interval of 3.6 yrs (9.5 yrs total). Using repeated-measures ANCOVA, we compared mean ΔWC for DSD users vs. non-users in all follow-up periods, adjusted for sex; baseline WC, age, ethnicity, education, neighborhood, leisure physical activity, diabetes and smoking status; and length of follow-up.

WC is widely used as a proxy measure of visceral adiposity, a major risk factor for diabetes, cardiovascular disease, cancer, and other chronic conditions. These results suggest that – amidst the national drive to reduce consumption of sugar-sweetened drinks – policies which would promote the consumption of DSDs may have unintended deleterious effects. Data from this and other prospective studies suggest that the promotion of diet sodas as healthy alternatives may be ill-advised: they may be free of calories, but not of consequences.

Tuesday, June 28, 2011

Strawberries Fight Diabetes and Nervous System Disorders

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A recent study from scientists at the Salk Institute for Biological Studies suggests that a strawberry a day (or more accurately, 37 of them) could keep not just one doctor away, but an entire fleet of them, including the neurologist, the endocrinologist, and maybe even the oncologist.

Investigations conducted in the Salk Institute's Cellular Neurobiology Laboratory (CNL) will appear in the June 27, 2011, issue of PLoS ONE. The report explains that fisetin, a naturally-occurring flavonoid found most abundantly in strawberries and to a lesser extent in other fruits and vegetables, lessens complications of diabetes. Previously, the lab showed that fisetin promoted survival of neurons grown in culture and enhanced memory in healthy mice. That fisetin can target multiple organs strongly suggests that a single drug could be used to mitigate numerous medical complications.

"This manuscript describes for the first time a drug that prevents both kidney and brain complications in a type 1 diabetes mouse model," says David Schubert, Ph.D., professor and head of the Cellular Neurobiology Laboratory and one of the manuscript's co-authors. "Moreover, it demonstrates the probable molecular basis of how the therapeutic is working."

Pam Maher, Ph.D., a senior staff scientist in the CNL, is the study's corresponding author. Maher initially identified fisetin as a neuroprotective flavonoid ten years ago. "In plants, flavonoids act as sunscreens and protect leaves and fruit from insects," she explains. "As foods they are implicated in the protective effect of the 'Mediterranean Diet.'"

Other celebrity flavonoids include polyphenolic compounds in blueberries and red wine.

Although her group's focus is neurobiology, Maher and colleagues reasoned that, like other flavonoids, fisetin might ameliorate a spectrum of disorders seen in diabetic patients. To test this, they evaluated effects of fisetin supplementation in Akita mice, a very robust model of type 1 diabetes, also called childhood onset diabetes.

Akita mice exhibit increased blood sugar typical of type 1 diabetes and display pathologies seen in serious human complications of both type 1 and 2 diabetes. Those include diabetic nephropathy or kidney disease, retinopathy, and neuropathies in which patients lose touch or heat sensations.

Mice fed a fisetin-enriched diet remained diabetic, but acute kidney enlargement-or hypertrophy-seen in untreated mice was reversed, and high urine protein levels, a sure sign of kidney disease, fell. Moreover, fisetin ingestion ameliorated anxiety-related behaviors seen in diabetic mice. "Most mice put in a large area become exploratory," says Maher. "But anxious mice tend not to move around. Akita mice showed enhanced anxiety behavior, but fisetin feeding restored their locomotion to more normal levels."

The study also defines a likely molecular mechanism underlying these effects. Researchers observed that blood and brain levels of sugars affixed to proteins known as advanced glycation end-products-or AGEs-were reduced in fisetin-treated compared to untreated Akita mice. These decreases were accompanied by increased activity of the enzyme glyoxalase 1, which promotes removal of toxic AGE precursors.

The discovery of an AGE-antagonizing enzyme upregulated by fisetin is very intriguing, because substantial evidence implicates high blood AGE levels with many if not most diabetic complications. "We know that fisetin increases activity of the glyoxalase enzyme and may increase its expression," says Maher. "But what is important is that ours is the first report that any compound can enhance glyoxalase 1 activity."

Interestingly, excessively high AGE levels also correlate with inflammatory activity thought to promote some cancers. In fact, studies published by others confirm that fisetin decreases tumorigenicity of prostate cancer cells both in culture and in animal models, which if supported would represent a major added incentive to eat your strawberries.

To ingest fisetin levels equivalent to those fed Akita mice, Maher estimates that humans would have to eat 37 strawberries a day, assuming that strawberry fisetin is as readily metabolizable by humans as fisetin-spiked lab chow is by mice. Rather than through diet, Maher envisions that fisetin-like drugs could be taken as a supplement.

Schubert notes that fisetin is also effective in mouse models of Alzheimer's disease. "We and others have shown that diabetes may be a risk factor for Alzheimer's disease, making identification of a safe prophylactic like fisetin highly significant," he says.

Maher acknowledges that the public may be suffering from flavonoid-fatigue, given media coverage of the promises of these compounds. "Polyphenolics like fisetin and those in blueberry extracts are found in fruits and vegetables and are related to each other chemically," she says. "There is increasing evidence that they all work in multiple diseases. Hopefully some combination of these compounds will eventually get to the clinic."

Schubert concurs that their findings only reinforce what common sense and our mothers told us was a healthy lifestyle. "Eat a balanced diet and as much freshly prepared organic food as possible, get some exercise, keep socially and mentally active and avoid sodas with sugar and highly processed foods since they can contain high levels of AGEs," he advises.

But he also worries that hoops that must be jumped through to bring a natural product like fisetin, as opposed to a totally synthetic drug, to clinical trials are daunting because it is difficult to protect patents on natural products. "We will never know if a compound like fisetin works in humans until someone is willing to support a clinical trial."

Monday, June 27, 2011

Alcohol drinking in the elderly: Risks and benefits

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The Royal College of Psychiatrists of London has published a report related primarily to problems of unrecognized alcohol misuse among the elderly. The report provides guidelines for psychiatrists and family physicians on how to find and how to treat elderly people with misuse of alcohol and drugs. Forum members consider it very important to identify abusive drinking among the elderly and this report provides specific and very reasonable recommendations to assist practitioners in both the identification and treatment of such problems.

There is no question that, on average, very elderly people may be more sensitive to the effects of alcohol (especially those individuals with chronic diseases, lower muscle mass, a poor diet, etc.) It should be made clear, however, that 65-year-olds are healthier than people of that age a generation ago - age-specific disability rates are decreasing, not increasing.

The report also recommends lower "sensible limits" for older people in comparison with younger people The International Forum on Alcohol Research scientific reviewers point out inherent difficulties in providing guidelines for a very non-homogenous group of individuals whose only criterion for inclusion, in this paper, is being above the age of 65 years Such a group includes individuals varying from marathon runners to very sick, frail people.

The report was conspicuously lacking in a discussion of the important role that moderate drinking can play in reducing the risk of coronary heart disease, ischemic stroke, diabetes, dementia, and osteoporosis. Advising healthy people aged 65 years or older who are moderate, responsible drinkers to stop drinking or to markedly reduce their intake would not be in their best health interests, especially in terms of their risk of cardiovascular diseases. Forum reviewers thought that advice to lower limits of drinking for everyone in this age group is not based on reliable research, and would certainly not apply to all in this age group. Of more importance, the absolute risk for cardiovascular diseases increases markedly with age, and therefore the beneficial or protective effect of light to moderate drinking on cardiovascular diseases is greater in the elderly than in younger people.

Evidence is also accumulating that shows that the risk of Alzheimer's disease and other types of dementia is lower among moderate drinkers than among abstainers. Neurodegenerative disorders are key causes of disability and death among elderly people. Epidemiological studies have suggested that moderate alcohol consumption, may reduce the incidence of certain age-related neurological disorders including Alzheimer's disease. Regular dietary intake of flavonoid-rich foods and/or beverages has been associated with 50% reduction in the risk of dementia, a preservation of cognitive performance with ageing,a delay in the onset of Alzheimer's disease and a reduction in the risk of developing Parkinson's disease.

Further, scientific data are consistent in demonstrating that quality of life is better and total mortality is lower among moderate drinkers than among abstainers. For example, analyses by Simons et al from a large population-based patient population in New South Wales demonstrated clearly that regular moderate alcohol consumption increases life span and quality of life for men up to 80 years of age and for women indefinitely.

In another paper, by Kirchner et al of almost 25,000 American adults over age 65 seen in primary care, those reporting between 8 and 14 drinks/week (A US drink is 14g, against 8g in the UK) did not differ significantly in their characteristics from drinkers consuming 1-7 drinks/week.. Heavier drinkers and binge drinkers did not do as well.

A particular interesting paper by White et al showed a direct dose-response relation between alcohol consumption and risk of death in women aged 16-54 and in men aged 16-34, whereas at older ages the relation is U shaped. These investigators used statistical models relating alcohol consumption to the risk of death from single causes to estimate the all-cause mortality risk for men and women of different ages. The authors state that their data suggest that women should INCREASE their intake to 3 units a day over age 75, and men rise from 3 units a day up to age 54 to 4 units a day up to age 84.

Since the absolute effects of moderate drinking on cardiovascular disease are much greater in older people than in younger adults, the current limitations to intake for the elderly may not be appropriate. Attempting to persuade elderly people who currently drink moderately to decrease their current intake may not be advisable. For healthy moderate and responsible drinkers, advice to reduce or stop all alcoholic beverage intake would not be in the best health interests of such individuals.

Soluble fiber, exercise reduce belly fat

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All fat is not created equal. Unsightly as it is, subcutaneous fat, the fat right under the skin, is not as dangerous to overall health as visceral fat, the fat deep in the belly surrounding vital organs.

According to a new study by researchers at Wake Forest Baptist Medical Center, the way to zero in and reduce visceral fat is simple: eat more soluble fiber from vegetables, fruit and beans, and engage in moderate activity.

The study found that for every 10-gram increase in soluble fiber eaten per day, visceral fat was reduced by 3.7 percent over five years. In addition, increased moderate activity resulted in a 7.4 percent decrease in the rate of visceral fat accumulation over the same time period.

"We know that a higher rate of visceral fat is associated with high blood pressure, diabetes and fatty liver disease," said Kristen Hairston, M.D., assistant professor of internal medicine at Wake Forest Baptist and lead researcher on the study. "Our study found that making a few simple changes can have a big health impact."

Ten grams of soluble fiber can be achieved by eating two small apples, one cup of green peas and one-half cup of pinto beans; moderate activity means exercising vigorously for 30 minutes, two to four times a week, Hairston added.

In the longitudinal study, published in the June 16 online issue of the journal Obesity, researchers examined whether lifestyle factors, such as diet and frequency of exercise, were associated with a five-year change in abdominal fat of African Americans and Hispanic Americans, populations at a disproportionally higher risk for developing high blood pressure and diabetes and accumulating visceral fat.

At the beginning of the study, which involved 1,114 people, the participants were given a physical exam, an extensive questionnaire on lifestyle issues, and a CT scan, the only accurate way to measure how much subcutaneous and visceral fat the participants had. Five years later, the exact same process was repeated.

Researchers found that increased soluble fiber intake was associated with a decreased rate of accumulated visceral fat, but not subcutaneous fat.

"There is mounting evidence that eating more soluble fiber and increasing exercise reduces visceral or belly fat, although we still don't know how it works," Hairston said. "Although the fiber-obesity relationship has been extensively studied, the relationship between fiber and specific fat deposits has not. Our study is valuable because it provides specific information on how dietary fiber, especially soluble fiber, may affect weight accumulation through abdominal fat deposits."

Hairston's next study, expected to be in clinical trials later this summer, will examine whether increasing soluble fiber with a widely available fiber supplement will produce similar results to those obtained in this study using soluble fiber from food.

Saturday, June 25, 2011

Jon's Health Tips - Latest Health Research

Lots of interesting stuff the last 3 weeks, mostly on diet:

1. I've got to cut down even more on carbs - almost all are whole grain now - maybe that's different? And eat even fewer potatoes (I LOVE hash browns) and corn (I LOVE sweet corn)

A, Cut Down On 'Carbs' to Reduce Body Fat


A modest reduction in consumption of carbohydrate foods may promote loss of deep belly fat, even with little or no change in weight, a new study finds.

When paired with weight loss, consumption of a moderately reduced carbohydrate diet can help achieve a reduction of total body fat.



B. Low-carbohydrate, high-protein diets may reduce both tumor growth rates and cancer risk


Eating a low-carbohydrate, high-protein diet may reduce the risk of cancer and slow the growth of tumors already present.


C. Dietary changes appear to lower risk of Alzheimer's disease

Following a low-saturated fat and low–glycemic index diet appears to modulate the risk of developing dementia that proceeds to Alzheimer’s disease (AD), and making a switch to this dietary pattern may provide some benefit to those who are already experiencing cognitive difficulty,




2. I should add salt to my diet, instead of avoiding it?

Salt Is Good For Those w/o High Blood Pressure?

A new eight year long European study concludes that salt consumption is not dangerous and may in fact be beneficial. What they concluded was that the less salt the participants ate, the more likely they would die from heart disease. In fact, the heart disease risk was 56% higher in the low salt group. This is certainly contrary to advice from American Medical Association, American Heart Association and the Center for Disease Control and Prevention, which says higher sodium consumption can increase the risk of heart disease. It’s not unusual to see differing opinions, but what are we ordinary folks to make of the controversy?


3. I don't eat potato chips, almost no french fries or most other potatoes, but I need to eat more yogurt:

For Your Weight - Potato Chips/ French Fries: Bad; Yogurt Good!

Potato chips were the worst culprit, causing people to gain 1.69 pounds, followed by potatoes in general, which caused people to gain 1.28 pounds. (French fries were worse than boiled or mashed potatoes.) This, explained Dr. Mozzafarian, could be because starches and refined carbohydrates produce bursts in blood glucose and insulin, increasing hunger and thus upping the total amount of food people eat at their next meal.

Sugary beverages accounted for a one pound weight gain, while alcohol caused people to gain an average of 0.41 pounds over four years. Unprocessed meats accounted for a 0.95-pound uptick in weight, while processed meats were right behind at 0.93 pounds

Increased daily servings of vegetables, whole grains, fruits, nuts, and yogurt were significantly inversely associated with weight change.


4. I really should start lifting weights:

Strength training for persons older than 60 years




People lose 30% of their muscle strength between the ages of 50 and 70 years. However, maintaining muscle strength in old age is enormously important in order to maintain mobility and to be able to lead an independent life and manage everyday tasks independently.


5. I'm glad I take a low dose statin, which is very good for me

Statins Helpful, BUT Take Time To Work


Over the long term, treatment with cholesterol-lowering statins reduces the rate of mortality and cardiovascular events such as heart attack, for people with and without heart disease.




and not a high dose, which can cause muscle damage and

increase diabetes risk

Intensive-Dose Statin Therapy Associated With Increased Risk of Diabetes



6. Other things I do/consume that are good for me:

Strawberries Boost Red Blood Cells


Blueberries Help Build Strong Bones

Review of resveratrol studies confirms potential health boost

More Evidence Vitamin D Boosts Immune Response

Olive oil in your diet may prevent a stroke

Broccoli and other cruciferous vegetables help prevent cancer


Apples increase muscle; reduce fat, blood sugar levels, cholesterol and triglycerides

Moderate to intense exercise may protect the brain


7. I really need to think about starting to drink coffee before I forget why it's a good idea:

Mystery ingredient in coffee boosts protection against Alzheimer's disease



8. I spend 2-3 hours most evenings reading and/or watching baseball, soccer or a movie. Is reading more healthy than watching TV - or are both quite dangerous to my health? I really have to get out more!

Extensive TV Watching Linked With Increased Risk of Diabetes, CVD and Death


In an analysis of data from several studies, watching television for 2-3 hours per day or more was associated with a higher risk of type 2 diabetes, fatal and nonfatal cardiovascular disease and all-cause death.


9. An important message to my employees:

Sucking up to the boss may keep you healthy



9. I'm sure glad I don't take any of these drugs:

Common drugs linked to cognitive impairment and possibly to increased risk of death


A large, long-term study confirms that medications with anticholinergic activity, which include many drugs frequently taken by older adults, cause cognitive impairment. The research is also the first to identify a possible link between these drugs – which include over-the-counter and prescription sleep aids and incontinence treatments – and risk of death.

Anticholinergics affect the brain by blocking acetylcholine, a nervous system neurotransmitter. Over-the-counter products containing diphenhydramine, sold under various brand names such as Benadryl®, Dramamine®, Excedrin PM®, Nytol®, Sominex®, Tylenol PM®, and Unisom®, have anticolinergic activity. Other anticholinergic drugs, such as Paxil®, Detrol®, Demerol® and Elavil® are available by prescription.


Recent Previous Reports

June 4

May 21

May 7

April 13

March 29

March 2

Cut Down On 'Carbs' to Reduce Body Fat

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A modest reduction in consumption of carbohydrate foods may promote loss of deep belly fat, even with little or no change in weight, a new study finds.

When paired with weight loss, consumption of a moderately reduced carbohydrate diet can help achieve a reduction of total body fat, according to principal author Barbara Gower, PhD, a professor of nutrition sciences at the University of Alabama at Birmingham.

"These changes could help reduce the risk of developing Type 2 diabetes, stroke and coronary artery disease," Gower said, noting that excess visceral, or intra-abdominal, fat raises the risk of these diseases.

Gower and her colleagues conducted the study, with funding from the National Institutes of Health, in 69 overweight but healthy men and women. Subjects received food for two consecutive eight-week periods: first a weight maintenance intervention, and then a weight loss intervention, which cut the number of calories that each person ate by 1,000 each day.

Subjects received either a standard lower-fat diet or a diet with a modest reduction in carbohydrates, or "carbs," but slightly higher in fat than the standard diet. The moderately carb-restricted diet contained foods that had a relatively low glycemic index, a measure of the extent to which the food raises blood glucose levels. This diet consisted of 43 percent calories from carbohydrates and 39 percent calories from fat, whereas the standard diet contained 55 percent of calories from carbohydrates and 27 percent from fat. Protein made up the other 18 percent of each diet.

At the beginning and end of each study phase, the researchers measured the subjects' fat deep inside the abdomen and their total body fat using computed tomography (CT) and dual-energy x-ray absorptiometry (DXA) scans.

After the weight maintenance phase, subjects who consumed the moderately carb-restricted diet had 11 percent less deep abdominal fat than those who ate the standard diet. However, when the researchers analyzed results by race, they found it was exclusive to whites. Whites have more deep abdominal fat than Blacks even when matched for body weight or percent body fat, and may benefit from loss of this metabolically harmful depot, Gower said.

During the weight loss phase, subjects on both diets lost weight. However, the moderately carb-restricted diet promoted a 4 percent greater loss of total body fat, Gower said. "For individuals willing to go on a weight-loss diet, a modest reduction in carbohydrate-containing foods may help them preferentially lose fat, rather than lean tissue," she said. "The moderately reduced carbohydrate diet allows a variety of foods to meet personal preferences."

Friday, June 24, 2011

Common drugs linked to cognitive impairment and possibly to increased risk of death

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A large, long-term study confirms that medications with anticholinergic activity, which include many drugs frequently taken by older adults, cause cognitive impairment. The research is also the first to identify a possible link between these drugs – which include over-the-counter and prescription sleep aids and incontinence treatments – and risk of death.

The two-year study of the impact of these medications on 13,000 men and women aged 65 and older is part of the Medical Research Council (UK) Cognitive Function and Ageing Studies (CFAS), a large UK-based longitudinal multi-center study initiative looking at health and cognitive function in older adults. Results of the study of anticholinergics appear June 24, 2011 in an advanced online publication of the Journal of the American Geriatrics Society.

Anticholinergics affect the brain by blocking acetylcholine, a nervous system neurotransmitter. Over-the-counter products containing diphenhydramine, sold under various brand names such as Benadryl®, Dramamine®, Excedrin PM®, Nytol®, Sominex®, Tylenol PM®, and Unisom®, have anticolinergic activity. Other anticholinergic drugs, such as Paxil®, Detrol®, Demerol® and Elavil® are available by prescription.

"Our findings make it clear that clinicians need to review the cumulative anticholinergic burden in people presenting with cognitive impairment to determine if the drugs are causing decline in mental status," said co-author Malaz Boustani, M.D., Regenstrief Institute investigator, Indiana University School of Medicine associate professor of medicine, and research scientist with the IU Center for Aging Research.

"Physicians should review with older patients all the over-the-counter and prescription drugs they are taking to determine exposure," said Dr. Boustani a geriatrician who sees patients at Wishard Health Services' Healthy Aging Brain Center in Indianapolis.

The researchers, led by Chris Fox, M.D., of the University of East Anglia and Carol Brayne, M.D. of the University of Cambridge, used the Anticholinergic Cognitive Burden Scale developed by Dr. Boustani and colleagues at the Regenstrief Institute, Indiana University and in the United Kingdom to evaluate the link between anticholinergic activity and cognitive decline.

Medications with anticholinergic effects are used for many diseases including hypertension and congestive heart failure. The study found that older age, lower income, and greater number of health conditions increased use of medications with anticholinergic activity. Women were more likely to report taking anticholinergic medications, due to the greater number of health conditions reported by women than by men. Participants living in institutions were more likely to report taking anticholinergic medications.

"We looked at drugs with either moderate and severe anticholinergic activity. After adjusting for age, sex, baseline mental status, education, income level, number of non-anticholinergic medications and health conditions, we found that taking anticholinergic medications was linked to cognitive impairment and for the first time to death," said study corresponding author Dr. Fox, a psychiatrist. "We need follow-up to determine the degree to which anticholinergics are being prescribed for diseases with significant risk of death and the impact of that on our findings."

Thursday, June 23, 2011

Salt Is Good For Those w/o High Blood Pressure?

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A new eight year long European study concludes that salt consumption is not dangerous and may in fact be beneficial. This is certainly contrary to advice from American Medical Association, American Heart Association and the Center for Disease Control and Prevention, which says higher sodium consumption can increase the risk of heart disease. It’s not unusual to see differing opinions, but what are we ordinary folks to make of the controversy?

The study followed 3,681 middle-aged Europeans who did not have high blood pressure or heart disease at the start of the study. They were divided into three groups: low salt; moderate salt; and high salt consumption. There were 50 deaths in the low salt group, 24 in the moderate consumption group and only 10 in the high consumption group. In fact, the heart disease risk in the low consumption group was 56% higher in the low salt group. What they concluded was that the less salt the participants ate, the more likely they would die from heart disease.

“The optimal level of salt in our diets has been a controversial subject for at least 20 years,” say co-authors Dian Griesel, Ph.D. and Tom Griesel of the new book, TurboCharged: Accelerate Your Fat Burning Metabolism, Get Lean Fast and Leave Diet and Exercise Rules in the Dust (BSH, 2011). The problem they say generally boils down to the effect (or lack thereof) salt has on blood pressure.

“There is no disagreement that high blood pressure (even moderately high) is a risk factor for heart disease and stroke,” say the Griesels. “However, salt consumption does not seem to have the same effect on everyone. In addition, there is usually no distinction on the type of salt used. There are many naturally harvested salts that also contain many trace minerals, which undoubtedly have an effect. Medical literature on salt consumption (like many other things) is inconsistent.”

The main take away from all this is the importance of knowing what your blood pressure is and making an effort to do whatever is necessary to have consistent readings in the healthy range of 120/70 or less. If you are a person who is sensitive to salt consumption, a reduction is definitely needed or perhaps even a switch to a natural alternative like sea salt might help. But beware of hidden salt. The biggest source of salt in our diet is the refined and processed foods purchased at the grocery store along with food served in restaurants, particularly fast-food which amounts to about 75% of salt consumption for the average person.

For Your Weight - Potato Chips/ French Fries: Bad; Yogurt Good!

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Specific dietary and lifestyle behaviors are independently associated with long-term weight gain, according to a study published in the June 23 issue of the New England Journal of Medicine.

The conventional weight-loss strategy, “eat less and exercise more” is not an adequate plan for preventing long-term weight gain.

Harvard researchers on the study, led by Dariush Mozaffarian, M.D., Dr.P.H, indicated that the quality of the food one eats, not necessarily the quantity, is a better indicator of weight gain over time. With the recent study, “Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men,” the researchers were able to connect particular foods to weight-gain predictions.

The research included 120,877 U.S. men and women, free of chronic disease, including baseline obesity. Follow-up periods on the study included 1986-2006; 1991-2003; and 1986-2006, for three separate cohorts. Relationships between lifestyle factors and weight change were evaluated at 4-year intervals, with various adjustments made for age, baseline BMI, and lifestyle factors. Researchers found that cohort-specific results, as well as sex-specific results, were similar.

"For diet, conventional wisdom often recommends 'everything in moderation,' with a focus only on total calories consumed," said Dr. Mozaffarian, an associate professor of medicine and epidemiology at Harvard Medical School and Brigham and Women's Hospital, reported Time Healthland. "Our results demonstrate that the quality of the diet — the types of food and beverages that one consumes — is strongly linked to weight

The investigators found that the participants gained an average of 3.35 lbs in every four-year period.

Potato chips were the worst culprit, causing people to gain 1.69 pounds, followed by potatoes in general, which caused people to gain 1.28 pounds. (French fries were worse than boiled or mashed potatoes.) This, explained Dr. Mozzafarian, could be because starches and refined carbohydrates produce bursts in blood glucose and insulin, increasing hunger and thus upping the total amount of food people eat at their next meal.

Sugary beverages accounted for a one pound weight gain, while alcohol caused people to gain an average of 0.41 pounds over four years. Unprocessed meats accounted for a 0.95-pound uptick in weight, while processed meats were right behind at 0.93 pounds

Increased daily servings of vegetables, whole grains, fruits, nuts, and yogurt were significantly inversely associated with weight change.

People who added a daily serving of vegetables lost an average of 0.22 pounds over four years, the researchers found. People who added whole grains lost 0.37 pounds, and those who ate fruits shed almost half a pound. Nuts and yogurt also resulted in weight loss. Yogurt, in fact, prevented 0.82 lbs. of weight gain over time, a finding that Mozaffarian indicated was unexpected and in need of additional study.

Combined dietary changes correlated with considerable differences in weight change. Physical activity, alcohol, smoking, sleep, and television watching were independently associated with weight change.

Those who exercised more tended to gain less, while those who slept less than six hours and more than eight hours tended to gain more. Data also indicated that each additional alcoholic beverage per day added 0.41 lbs. every four years.

"Specific dietary and lifestyle factors are independently associated with long-term weight gain, with a substantial aggregate effect and implications for strategies to prevent obesity," the authors write.

Wednesday, June 22, 2011

Intensive-Dose Statin Therapy Associated With Increased Risk of Diabetes

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An analysis of data from previously published studies indicates that intensive-dose statin therapy is associated with an increased risk of new-onset diabetes compared with moderate-dose therapy, according to a study in the June 22/29 issue of JAMA.

Compared with placebo, statin therapy significantly reduces cardiovascular events among individuals with and without a history of diabetes mellitus. Recently, findings of several trials comparing intensive- to moderate-dose statin therapy suggested an excess risk of new diabetes among those treated with intensive statin regimens, according to background information in the article. According to the authors, "Given the cardiovascular benefits of statins and the likely increasing use of intensive statin regimens, it is important to quantify any potential long-term risks to enable physicians and patients to make informed choices."

David Preiss, M.R.C.P., of the University of Glasgow, United Kingdom, and colleagues examined the associations of intensive-dose statin therapy vs. moderate-dose therapy with the development of diabetes and the occurrence of major cardiovascular events by conducting a meta-analysis of published and unpublished data from relevant clinical trials. The researchers identified 5 statin trials that met criteria for inclusion in the analysis.

The 5 randomized clinical trials provided data on 32,752 nondiabetic participants over a weighted average follow-up of 4.9 years. During follow-up, 2,749 participants (8.4 percent) developed diabetes (1,449 of whom were assigned intensive-dose therapy, 1,300 assigned moderate-dose therapy), and 6,684 (20.4 percent) experienced a major cardiovascular event (3,134 assigned intensive-dose therapy, 3,550 assigned moderate-dose therapy). There were 149 more cases of incident diabetes in participants assigned to intensive statin treatment than in those receiving moderate therapy and 416 fewer patients with cardiovascular events who received intensive-dose therapy.

An analysis of the data indicated that use of intensive-dose statin therapy compared with moderate-dose statin therapy was associated with a higher incidence of new-onset diabetes. However, intensive statin therapy was associated with fewer major cardiovascular events. As compared with moderate-dose statin therapy, the number needed to harm per year for intensive-dose statin therapy was 498 for new-onset diabetes while the number needed to treat per year for intensive-dose statin therapy was 155 for cardiovascular events.

"Our findings suggest that clinicians should be vigilant for the development of diabetes in patients receiving intensive statin therapy," the authors write. "In conclusion, this meta-analysis extends earlier findings of an increased incidence of diabetes with statin therapy by providing evidence of a dose-dependent association."

Strawberries Boost Red Blood Cells

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A group of volunteers ate half a kilo of strawberries every day for two weeks to demonstrate that eating this fruit improves the antioxidant capacity of blood. The study, carried out by Italian and Spanish researchers, showed that strawberries boost red blood cells' response to oxidative stress, an imbalance that is associated with various diseases.

Scientists have previously tried to confirm the antioxidant capacity of strawberries using in vitro laboratory experiments. Now, a team of researchers from the Marche Polytechnic University (UNIVPM, in Italy) and the University of Granada (UGR, in Spain) have demonstrated this effect in vivo, in a study on human volunteers published in the journal Food Chemistry.

Each day, the scientists fed 12 healthy volunteers 500 grams of strawberries (of the 'Sveva' variety) over the course of the day. They took blood samples from them after four, eight, 12 and 16 days, and also a month later. The results show that regular consumption of this fruit can improve the antioxidant capacity of blood plasma and also the resistance of red blood cells to oxidative haemolysis (fragmentation).

"We have shown that some varieties of strawberries make erythrocytes more resistant to oxidative stress. This could be of great significance if you take into account that this phenomenon can lead to serious diseases," Maurizio Battino, lead author of the study and a researcher at the UNIVPM, said.

The team is now analysing the variations caused by eating smaller quantities of strawberries (average consumption tends to be a 150g or 200g bowl per day). "The important thing is that strawberries should form a part of people's healthy and balanced diet, as one of their five daily portions of fruit and vegetables," Battino points out.

"Various strawberry varieties are also being analysed in the laboratory, since they each contain antioxidants in differing amounts and proportions," explains José Luis Quiles, the Spanish participant in the study and a researcher at the UGR.

The body has an extensive arsenal of very diverse antioxidant mechanisms, which act at different levels. These can be cellular tools that repair oxidised genetic material, or molecules that are either manufactured by the body itself or consumed through the diet, which neutralise free radicals. Strawberries contain a large amount of phenolic compounds, such as flavonoids, which have antioxidant properties.

These substances reduce oxidative stress, an imbalance that occurs in certain pathologies, (such as cardiovascular disease, cancer and diabetes) and physiological situations (birth, aging, physical exercise), as well as in the battles between "reactive kinds of oxygen" -- in particular free radicals -- and the body's antioxidant defences.

When the level of oxidation exceeds these antioxidant defences, oxidative stress occurs. Aside from causing certain illnesses, this is also implicated in phenomena such as the speed at which we may age, for example.

Tuesday, June 21, 2011

Mystery ingredient in coffee boosts protection against Alzheimer's disease

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A yet unidentified component of coffee interacts with the beverage's caffeine, which could be a surprising reason why daily coffee intake protects against Alzheimer's disease. A new Alzheimer's mouse study by researchers at the University of South Florida found that this interaction boosts blood levels of a critical growth factor that seems to fight off the Alzheimer's disease process.

The findings appear in the early online version of an article to be published June 28 in the Journal of Alzheimer's Disease. Using mice bred to develop symptoms mimicking Alzheimer's disease, the USF team presents the first evidence that caffeinated coffee offers protection against the memory-robbing disease that is not possible with other caffeine-containing drinks or decaffeinated coffee.

Previous observational studies in humans reported that daily coffee/caffeine intake during mid-life and in older age decreases the risk of Alzheimer's disease. The USF researchers' earlier studies in Alzheimer's mice indicated that caffeine was likely the ingredient in coffee that provides this protection because it decreases brain production of the abnormal protein beta-amyloid, which is thought to cause the disease.

The new study does not diminish the importance of caffeine to protect against Alzheimer's. Rather it shows that caffeinated coffee induces an increase in blood levels of a growth factor called GCSF (granulocyte colony stimulating factor). GCSF is a substance greatly decreased in patients with Alzheimer's disease and demonstrated to improve memory in Alzheimer's mice. A just-completed clinical trial at the USF Health Byrd Alzheimer's Institute is investigating GCSF treatment to prevent full-blown Alzheimer's in patients with mild cognitive impairment, a condition preceding the disease. The results of that trial are currently being evaluated and should be known soon.

"Caffeinated coffee provides a natural increase in blood GCSF levels," said USF neuroscientist Dr. Chuanhai Cao, lead author of the study. "The exact way that this occurs is not understood. There is a synergistic interaction between caffeine and some mystery component of coffee that provides this beneficial increase in blood GCSF levels."

The researchers would like to identify this yet unknown component so that coffee and other beverages could be enriched with it to provide long-term protection against Alzheimer's.

In their study, the researchers compared the effects of caffeinated and decaffeinated coffee to those of caffeine alone. In both Alzheimer's mice and normal mice, treatment with caffeinated coffee greatly increased blood levels of GCSF; neither caffeine alone or decaffeinated coffee provided this effect. The researchers caution that, since they used only "drip" coffee in their studies, they do not know whether "instant" caffeinated coffee would provide the same GCSF response.

The boost in GCSF levels is important, because the researchers also reported that long-term treatment with coffee (but not decaffeinated coffee) enhances memory in Alzheimer's mice. Higher blood GCSF levels due to coffee intake were associated with better memory. The researchers identified three ways that GCSF seems to improve memory performance in the Alzheimer's mice. First, GCSF recruits stem cells from bone marrow to enter the brain and remove the harmful beta-amyloid protein that initiates the disease. GCSF also creates new connections between brain cells and increases the birth of new neurons in the brain.

"All three mechanisms could complement caffeine's ability to suppress beta amyloid production in the brain" Dr. Cao said, "Together these actions appear to give coffee an amazing potential to protect against Alzheimer's -- but only if you drink moderate amounts of caffeinated coffee."

Although the present study was performed in Alzheimer's mice, the researchers indicated that they've gathered clinical evidence of caffeine/coffee's ability to protect humans against Alzheimer's and will soon publish those findings.

Coffee is safe for most Americans to consume in the moderate amounts (4 to 5 cups a day) that appear necessary to protect against Alzheimer's disease. The USF researchers previously reported this level of coffee/caffeine intake was needed to counteract the brain pathology and memory impairment in Alzheimer's mice. The average American drinks 1½ to 2 cups of coffee a day, considerably less than the amount the researchers believe protects against Alzheimer's.

"No synthetic drugs have yet been developed to treat the underlying Alzheimer's disease process" said Dr. Gary Arendash, the study's other lead author. "We see no reason why an inherently natural product such as coffee cannot be more beneficial and safer than medications, especially to protect against a disease that takes decades to become apparent after it starts in the brain."

The researchers believe that moderate daily coffee intake starting at least by middle age (30s – 50s) is optimal for providing protection against Alzheimer's disease, although starting even in older age appears protective from their studies. "We are not saying that daily moderate coffee consumption will completely protect people from getting Alzheimer's disease," Dr. Cao said. "However, we do believe that moderate coffee consumption can appreciably reduce your risk of this dreaded disease or delay its onset."

The researchers conclude that coffee is the best source of caffeine to counteract the cognitive decline of Alzheimer's because its yet unidentified component synergizes with caffeine to increase blood GCSF levels. Other sources of caffeine, such as carbonated drinks, energy drinks, and tea, would not provide the same level of protection against Alzheimer's as coffee, they said.

Coffee also contains many ingredients other than caffeine that potentially offer cognitive benefits against Alzheimer's disease. "The average American gets most of their daily antioxidants intake through coffee," Dr. Cao said. "Coffee is high in anti-inflammatory compounds that also may provide protective benefits against Alzheimer's disease."

An increasing body of scientific literature indicates that moderate consumption of coffee decreases the risk of several diseases of aging, including Parkinson's disease, Type II diabetes and stroke. Just within the last few months, new studies have reported that drinking coffee in moderation may also significantly reduce the risk of breast and prostate cancers.

"Now is the time to aggressively pursue the protective benefits of coffee against Alzheimer's disease," Dr. Arendash said. "Hopefully, the coffee industry will soon become an active partner with Alzheimer's researchers to find the protective ingredient in coffee and concentrate it in dietary sources."

New Alzheimer's diagnostic guidelines, now encompassing the full continuum of the disease from no overt symptoms to mild impairment to clear cognitive decline, could double the number of Americans with some form of the disease to more than 10 million. With the baby-boomer generation entering older age, these numbers will climb even more unless an effective preventive measure is identified.

"Because Alzheimer's starts in the brain several decades before it is diagnosed, any protective therapy would obviously need to be taken for decades," Dr. Cao said. "We believe moderate daily consumption of caffeinated coffee is the best current option for long-term protection against Alzheimer's memory loss. Coffee is inexpensive, readily available, easily gets into the brain, appears to directly attack the disease process, and has few side-effects for most of us."

According to the researchers, no other Alzheimer's therapy being developed comes close to meeting all these criteria.

"Aside from coffee, two other lifestyle choices -- physical and cognitive activity -- appear to reduce the risk of dementia. Combining regular physical and mental exercise with moderate coffee consumption would seem to be an excellent multi-faceted approach to reducing risk or delaying Alzheimer's," Dr. Arendash said. "With pharmaceutical companies spending millions of dollars trying to develop drugs against Alzheimer's disease, there may very well be an effective preventive right under our noses every morning – caffeinated coffee."

Blueberries Help Build Strong Bones

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Compounds in blueberries might turn out to have a powerful effect on formation of strong, healthy bones, if results from studies with laboratory rats turn out to hold true for humans.

Jin-Ran Chen and his colleagues are exploring this idea in research funded by the U.S. Department of Agriculture (USDA) at the Arkansas Children's Nutrition Center (ACNC) in Little Rock. Chen is a principal investigator and lead scientist at the center's Skeletal Development Laboratory, and an assistant professor in the department of pediatrics at the University of Arkansas for Medical Sciences, also in Little Rock.

Chen specializes in research on how what we eat during infancy, childhood and early adulthood affects growth and development of bones and the risk of developing osteoporosis or other degenerative bone diseases in later years.

Chen's studies with young, rapidly growing laboratory rats suggest that polyphenols, the compounds that give blueberries their blue, purple, and red coloration, might aid in building strong bones. The work has paved the way for new research that might reveal whether blueberries could be used in the future in treatments to boost development of bone mass and to help prevent osteoporosis.

Published in the Journal of Bone and Mineral Research in 2010, the investigation showed that animals fed rations that contained 10 percent freeze-dried blueberry powder had significantly more bone mass than their counterparts whose rations were blueberry-free.

When the researchers exposed laboratory cultures of bone-forming cells (osteoblasts) to blood (serum) from the animals, the scientists found that serum from the blueberry-fed rats was associated with an increase in development of osteoblasts into mature, functional bone cells.

Serum in the blueberry-fed rats was high in phenolic acids, derived from the color-impacting polyphenols. The research suggests that the phenolic acids may have had bone-building effects in the rats. Studies are needed to determine whether these benefits occur in humans, Chen noted.

Chen's research also suggests that the phenolic acids stimulated bone building via a pathway that may involve, for example, two genes, TCF and LEF, and a protein, beta-catenin. Beta-catenin is responsible for prompting osteoblasts to become mature and functional, while TCF and LEF are responsible for promoting synthesis of beta-catenin.

Exercise associated with longer survival after brain cancer diagnosis

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Brain cancer patients who are able to exercise live significantly longer than sedentary patients, scientists at the Duke Cancer Institute report.

The finding, published online Monday in the Journal of Clinical Oncology, adds to recent research that exercise improves how cancer patients feel during and after treatments, and may also extend their lives.

"This provides some initial evidence that we need to look at the effects of exercise interventions, not only to ease symptoms but also to impact progression and survival," said Lee W. Jones, PhD, associate professor in the Duke Cancer Institute and senior author of the study.

Although the study was not designed to test whether regular exercise actually causes longer survival among brain cancer patients, it established a strong correlation that could give doctors and patients a more accurate prognosis of long-term survival.

The study enrolled 243 patients at the Preston Robert Tisch Brain Tumor Center at Duke with advanced recurrent gliomas, lethal brain malignancies that typically result in a median life expectancy of less than six months.

The patients who reported participating in regular, brisk exercise ¬- the equivalent of an energetic walk five days a week for 30 minutes - had significantly prolonged survival, living a median 21.84 months vs. 13.03 months for the most sedentary patients.

The self-reported exercise behavior offered an important additional means of predicting survival among the glioma patients beyond other measures traditionally used for prognosis, including a six-minute walk test.

Jones said the walk test is a good way to gauge the functional capacity of people with heart failure or other cardiac or pulmonary disorders, but it may not be informative for brain cancer patients who frequently suffer dizzy spells and other neurological problems that hamper walking.

Jose Cortes, a Duke patient who has battled inoperable anaplastic astrocytoma since 2009, has been an avid proponent of the power of exercise during his treatment.

"I exercised regularly prior to my illness and I wanted to stay as active as possible," Cortes said. "But it was impossible for me to do things that I could do easily before. My first goals in physical therapy were to put on my shoes without tipping over and keep my equilibrium while walking and talking or walking and turning my head."

As he met and surpassed his early goals, he began walking for 30 minutes a day and last year joined a Zumba fitness-dance class at his local YMCA.

"I wanted to be able to exercise because it makes me feel alive again," Cortes said. He cautioned that exercise is no cure – his cancer has responded well to chemotherapy – but he said being active helps both physically and mentally.

"Exercise is a very good way to overcome the side effects of your disease," he said. "You can feel more positive about your life even if you are in a terminal state. The most important thing is to just do it at your own pace and do your best."

The Duke study demonstrates that if doctors know about their patients' exercise regimens, they will have a better way to assess long-term outcomes. Jones said an accurate prognosis is important to determine the overall health of patients, potential tolerance for certain types of treatment, and eligibility for clinical trials.

Jones said a major goal of his research is to discover why exercise may lead to improvements in survival following a cancer diagnosis.

"Discovering these mechanisms could provide new insights into cancer progression," Lee said. "It could also lead to novel studies where exercise is combined with certain cancer therapies to see if both interventions together are more effective at inhibiting cancer recurrence or progression, not just minimizing the adverse side effects of the cancer therapies."

Review of resveratrol studies confirms potential health boost

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A University of Florida review of research finds the polyphenol compound known as resveratrol found in red wine, grapes and other fruits may not prevent old age, but it might make it more tolerable.

News stories have long touted resveratrol as a cure for various diseases and a preventative against aging.

”We’re all looking for an anti-aging cure in a pill, but it doesn’t exist. But what does exist shows promise of lessening many of the scourges and infirmities of old age,” said UF exercise psychologist Heather Hausenblas, one of the researchers involved in the study.

A comprehensive review of human clinical research on resveratrol has found it has “anti-aging, anti-carcinogenic, anti-inflammatory and antioxidant properties,” but more research of its benefits is needed, she said.

The study, which appeared online this week in Molecular Nutrition and Food Research, examined results gleaned from thousands of laboratory studies with enzymes, cultured cells and laboratory animals. It was conducted by Hausenblas and fellow researchers James Smoliga of Marywood University and Joseph Baur of the University of Pennsylvania School of Medicine. Their review aimed to examine the current state of knowledge of the effects of resveratrol on humans and to use this information to guide much needed future human clinical trials.

Despite numerous clinical studies on resveratrol’s tonic effects on animals, there is little evidence that it benefits human health. That’s because “there haven’t been many studies on humans,” Hausenblas said.

However, she points out, for years many scientists have thought that a link between resveratrol and human health exists. The French people, for example, enjoy low levels of cardiovascular disease, even though their diets are rich in saturated fats and oils. Some researchers think the reason for this paradox lies in France’s national drink — red wine, which is the most important dietary source of resveratrol. The UF review, said Hausenblas, shows that the resveratrol has considerable potential to improve health and prevent chronic disease in humans. However, further research examining the long-term health effects of resveratrol is much needed.

Exactly how resveratrol works isn’t yet fully understood. Correlating factors such as metabolism, the chemical interplay of molecules, genetics, exercise, age, dosage, and many others all play a role.

Among resveratrol’s most intriguing aspects is how it functions as an antioxidant. Oxidation is a natural chemical process in living tissues that results in a transfer of electrons. When this happens, groups of atoms are formed called “free radicals” that can cause cell damage which in turn provides a pathway for diseases.

Antioxidants, however, suppress free radicals. “It’s not so easy to say resveratrol is the main factor,” Hausenblas said. “It’s one piece of the overall puzzle that reduces the free radicals.”

The UF study also reveals that resveratrol’s contribution to good health promises to be widespread. Various clinical trials, for example, indicate that this polyphenol — an antibiotic substance produced by plants as a defense against microorganisms — prevents the growth of some cancers in mice, inhibits enzymes that cause inflammation, shrinks tumors and increases blood flow, thus reducing cardiovascular diseases. In many cases, it also extends the life of obese animals. Some evidence also shows that resveratrol could one day be used to help regulate insulin sensitivity in diabetic patients.

Hausenblas and her colleagues think research that explores resveratrol’s potential to alleviate human infirmities will become increasingly more important as the nation’s 76 million baby boomers undergo the aging process. One trial under way at UF’s College of Medicine in the Institute on Aging examines the effect resveratrol may have on the physical and cognitive skills on older people.

Monday, June 20, 2011

More Evidence Vitamin D Boosts Immune Response

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Laboratory-grown gingival cells treated with vitamin D boosted their production of an endogenous antibiotic, and killed more bacteria than untreated cells, according to a paper in the June 2011 issue of the journal Infection and Immunity. The research suggests that vitamin D can help protect the gums from bacterial infections that lead to gingivitis and periodontitis. Periodontitis affects up to 50 percent of the US population, is a major cause of tooth loss, and can also contribute to heart disease. Most Americans are deficient in vitamin D.

His interest piqued by another laboratory's discovery that vitamin D could stimulate white blood cells to produce natural proteins that have antibiotic activity, Gill Diamond of the UMDNJ -- New Jersey Dental School, Newark, showed that vitamin D could stimulate lung cells to produce LL-37, a natural antibiotic protein, and kill more bacteria. That suggested that , vitamin D might help cystic fibrosis patients. Next, in the new research, he showed that vitamin D has the same effct on gingival cells.

Then, Diamond found that vitamin D also stimulates gingival cells to produce another protein, called TREM-1, which had not been well-studied, but which was thought to be made by white blood cells. He found that it boosts production of pro-inflammatory cytokines.

The new research also showed that vitamin D coordinates expression of a number of genes not previously considered to be part of the vitamin D pathway. Those genes may be involved in additional infection-fighting pathways. A more comprehensive understanding of how vitamin D carries out this regulation at the molecular level -- something Diamond hopes to investigate -- will enable targeted therapies using vitamin D, he says.

Interestingly, Diamond also found that lung and gum cells appear to have the ability to activate inactive forms of vitamin D, says Diamond. "This means that we may even be able to use vitamin D therapy topically, if that proves true."

Vitamin D has become a hot area of research in recent years. In addition to infectious diseases, studies suggest that it has protective effects against autoimmune diseases, and certain cancers.

Diamond says that after he began conducting research on vitamin D, he began taking it as a supplement. Since then, "I have had only one cold in four years, and that one lasted only three days," he says. "Other people I've met who have done the same have seen similar results. We are trying to figure out how it's working, and what other infectious diseases can be mitigated by it."

Taking Tamoxifen to Prevent Breast Cancer Can Save Lives

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Tamoxifen, taken by certain women as a preventive measure against breast cancer, saves lives and reduces medical costs. That is the conclusion of a new study published early online in Cancer, a peer-reviewed journal of the American Cancer Society. The study's results suggest that the benefits of tamoxifen to prevent cancer can sufficiently compensate for its side effects in post-menopausal women under age 55 years who have an increased risk of developing breast cancer.


Research has shown that tamoxifen can protect against breast cancer for years after treatment ends, but identifying the group of women who can most benefit from the drug as a cancer preventive agent, without experiencing serious side effects, is a challenge. Side effects of the drug can include pulmonary embolism, endometrial cancer, deep vein thrombosis, and cataracts, as well as hot flashes and early menopause.

To investigate those women who would benefit the most from taking tamoxifen as a cancer preventive drug, Peter Alperin, MD, of Archimedes Inc. in San Francisco, and his colleagues used a mathematical model to simulate a post-menopausal population under age 55 years in a virtual clinical trial comparing tamoxifen treatment with no treatment. The investigators modeled tamoxifen therapy based on an analysis of four randomized, placebo-controlled cancer prevention trials, and they assessed the effects that tamoxifen would have on women's breast cancer risk for 10 years following the end of treatment. Cancer incidences and survival information were taken from the Surveillance Epidemiology and End Results cancer registry, while factors such as non-cancer disease incidences, quality of life, and costs were taken from the medical literature.

The researchers found that in post-menopausal women ages 55 years and younger with a 5-year risk of developing breast cancer of 1.66 percent or greater, the benefits of tamoxifen are maximized while its side effects are minimized. "In this group of women, using tamoxifen to prevent breast cancer saves lives and has a low frequency of side effects," said Dr. Alperin. He added that it also saves medical costs. "Specifically, chemoprevention with tamoxifen prevents 29 breast cancer cases and 9 breast cancer deaths per 1,000 women treated, and it saves $47,580 per 1,000 women treated in the United States."

These findings may help physicians and their patients as they strive to identify optimal breast cancer prevention options for individual women based on their current health and demographic profile. In addition, investigators can use mathematical modeling and cost-effectiveness analyses, such as those described in this study, to explore different prevention strategies and evaluate their impact on health and economic outcomes.

Wednesday, June 15, 2011

Extensive TV Watching Linked With Increased Risk of Diabetes, CVD and Death

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In an analysis of data from several studies, watching television for 2-3 hours per day or more was associated with a higher risk of type 2 diabetes, fatal and nonfatal cardiovascular disease and all-cause death, according to a study in the June 15 issue of JAMA.

Television (TV) viewing is the most commonly reported daily activity apart from working and sleeping in many populations around the world. In the United States, the average number of daily hours of TV viewing has recently been reported to be 5 hours.

“Beyond altering energy expenditure by displacing time spent on physical activities, TV viewing is associated with unhealthy eating (e.g., higher intake of fried foods, processed meat, and sugar-sweetened beverages and lower intake of fruits, vegetables, and whole grains) in both children and adults,” according to background information in the article.

“Physical inactivity, various dietary factors, and smoking are well-established independent risk factors of type 2 diabetes, cardiovascular disease, and all-cause mortality. Because TV viewing is the most prevalent and pervasive sedentary behavior, there is a great deal of interest in quantifying its independent association with health outcomes. However, a systematic and quantitative assessment of published studies is not available.”

Anders Grontved, M.P.H., M.Sc., of the University of Southern Denmark, Odense, and Frank B. Hu, M.D., Ph.D., of the Harvard School of Public Health, Boston, conducted a meta-analysis to summarize data from published prospective cohort studies on the association between TV viewing and the incidence of type 2 diabetes, nonfatal or fatal cardiovascular disease and all-cause mortality. The researchers performed a search of the medical literature for relevant studies from 1970 to March 2011 and identified 8 studies that met criteria for inclusion in the analysis.

For type 2 diabetes (4 studies), the total number of individuals was 175,938 with 6,428 incident cases during an average follow-up of 8.5 years. For fatal or nonfatal cardiovascular disease (4 studies), the total number of individuals was 34,253 with 1,052 incident cases during an average follow-up of 10.4 years; and for all-cause mortality (3 studies), the total number of individuals was 26,509 with 1,879 deaths during an average follow-up duration of 6.8 years.

An analysis of data indicated that per 2 hours of TV viewing time per day was associated with a 20 percent higher risk for type 2 diabetes; a 15 percent increased risk for fatal or nonfatal cardiovascular disease; and a 13 percent higher risk for all-cause mortality. “While the associations between time spent viewing TV and risk of type 2 diabetes and cardiovascular disease were linear, the risk of all-cause mortality appeared to increase with TV viewing duration of greater than 3 hours per day,” the authors write.

Based on incidence rates in the United States, the researchers estimated that the absolute risk difference (cases per 100,000 individuals per year) per 2 hours of TV viewing per day was 176 for type 2 diabetes, 38 for fatal cardiovascular disease, and 104 for all-cause mortality.

“It is biologically plausible that prolonged TV viewing is associated with type 2 diabetes, cardiovascular disease, and all-cause mortality. Numerous prospective studies have reported associations of TV viewing with biological risk factors for these outcomes including obesity, adverse lipid levels, and clustered cardiovascular risk; however, some studies did not report these associations. Furthermore, associations of sedentary behaviors analogous to TV viewing (e.g., sitting during work or while driving) with type 2 diabetes, fatal or nonfatal cardiovascular disease, and all-cause mortality have been reported in cohort studies,” the authors write.

“Additional research quantifying the mediating influence of diet and physical inactivity is warranted. Future research also should assess the association of prolonged daily use of new media devices on energy balance and chronic disease risk.”

Statins Helpful, BUT Take Time To Work

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Over the long term, treatment with cholesterol-lowering statins reduces the rate of mortality and cardiovascular events such as heart attack, for people with and without heart disease. Still, it is unclear whether these drugs take effect rapidly when the risk of these dire events is highest.

A systematic review of randomized controlled trials found that death, stroke and heart attack did not decline significantly in the first few months after starting the drugs, but indicated that statins might reduce the likelihood of severe chest pain during this period and are quite safe in any case.

“Our findings suggest that there probably is a benefit with statin treatment early on, although it is small, and we know that it accumulates with time. And patients can be assured that serious side effects are very rare,” said Matthias Briel, M.D, an assistant professor at McMaster University, in Ontario, Canada, and senior review author.

The review appears in the latest issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Studies in the review included individuals who had undergone hospitalization with acute coronary syndrome—heart attack or the severe, uncontrolled chest pain of unstable angina. These patients are in imminent danger of another, potentially fatal, heart attack.

There is reason to hope that statins might help in these precarious situations. In addition to their cholesterol-lowering effects, the drugs appear to reduce vascular inflammation and clot formation, and some observational studies found that patients started on statins while still in the hospital were less likely to die within the next few months.

Yet, most randomized controlled trials of statin treatment after heart attack or unstable angina have initiated treatment three or more months after the episode, leaving the question of immediate benefit unsettled.

For the review, the authors pooled data from 18 randomized controlled trials on 14,303 patients, ages 53 to 69 and mostly male, who had been hospitalized for acute coronary syndrome. Researchers assigned patients, who had not been taking statins previously, to groups who began treatment with one of these drugs within 14 days of admission to the hospital, or underwent treatment with placebo or usual care.

The reviewers found no statistically significant difference in the combined rates of death, heart attack or stroke one month or four months later, between patients given statins and those who received placebo or standard care. However, patients on statins appeared slightly less likely to die or have heart attacks or strokes during this time.
There also were no significant differences in the incidence of new or worsening heart failure or of having revascularization procedures like bypass surgery, between the groups.

Patients who received statins were, however, significantly less likely to suffer episodes of unstable angina four months after treatment began.

Adverse effects were “very rare” in both statin and control groups, Briel said. Signs of muscle damage—the most severe risk of statin therapy—were limited to patients in a single study who received a particular statin, simvastatin, at a dosage known to carry a relatively high risk of this side effect. “These drugs may be considered quite safe,” even for these extremely ill patients, he said.

“This analysis focuses on such a short period of time, it probably shouldn’t surprise anyone that it was difficult to see much of a difference,” said Steven Nissen, M.D., chairman of cardiovascular medicine at Cleveland Clinic. “We give cholesterol-lowering drugs not to change short-term outcome, but long-term outcome: the purpose is to lower cardiovascular events over time.”

What’s more, Nissen said, the Cochrane meta-analysis mixed older studies using very small doses of weak statins with more recent studies in which clinicians prescribed large doses of potent drugs. “Virtually all the evidence for benefit comes from studies using high doses of drugs like atorvastatin (Lipitor)…which is the gold standard of how we treat these patients now,” he said.

Pooling data from such different regimens “is like mixing apples and oranges,” Nissen said. “A more interesting analysis might analyze high-dose and low dose-statins separately.” Most important, he said, is to not interpret the study to justify withholding statins from patients with acute coronary syndrome. “Waiting weeks to months after a heart attack to start cholesterol-lowering treatment is not wise,” he said. “We’ve learned getting people started right away is important in getting good compliance… that’s when we have the patient’s attention.”

Briel likewise concluded that the lack of a substantial immediate effect should not alter what has become the standard recommendation to begin statin treatment quickly. Whether or not the early benefit is small, “if you start earlier, you get the long-term benefit earlier,” he said.

Olive oil in your diet may prevent a stroke

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A new study suggests that consuming olive oil may help prevent a stroke in older people. The research is published in the June 15, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"Our research suggests that a new set of dietary recommendations should be issued to prevent stroke in people 65 and older," said study author Cécilia Samieri, PhD, with the University of Bordeaux and the National Institute of Health and Medical Research (INSERM) in Bordeaux, France. "Stroke is so common in older people and olive oil would be an inexpensive and easy way to help prevent it."

For the study, researchers looked at the medical records of 7,625 people ages 65 and older from three cities in France: Bordeaux, Dijon and Montpellier. Participants had no history of stroke. Olive oil consumption was categorized as "no use," "moderate use" such as using olive oil in cooking or as dressing or with bread, and "intensive use," which included using olive oil for both cooking and as dressing or with bread. Samieri said the study participants mainly used extra virgin olive oil, as that is 98 percent of what is available in France.

After a little over five years, there were 148 strokes.

After considering diet, physical activity, body mass index and other risk factors for stroke, the study found that those who regularly used olive oil for both cooking and as dressing had a 41 percent lower risk of stroke compared to those who never used olive oil in their diet (1.5 percent in six years compared to 2.6 percent).

Olive oil has been associated with potentially protective effects against many cardiovascular risk factors, such as diabetes, high blood pressure, high cholesterol and obesity. In an accompanying editorial, Nikolaos Scarmeas, MD, of Columbia University and a member of the American Academy of Neurology noted that it is not clear which particular elements of olive oil could be protective, while the effects of olive oil could even be indirect by making other healthy foods tastier. He also cautioned that only future clinical trials can increase confidence in the findings and potentially lead to stroke prevention recommendations.

Tuesday, June 14, 2011

Low-carbohydrate, high-protein diets may reduce both tumor growth rates and cancer risk

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Eating a low-carbohydrate, high-protein diet may reduce the risk of cancer and slow the growth of tumors already present, according to a study published in Cancer Research, a journal of the American Association for Cancer Research.

The study was conducted in mice, but the scientists involved agree that the strong biological findings are definitive enough that an effect in humans can be considered.

"This shows that something as simple as a change in diet can have an impact on cancer risk," said lead researcher Gerald Krystal, Ph.D., a distinguished scientist at the British Columbia Cancer Research Centre.

Cancer Research editor-in-chief George Prendergast, Ph.D., CEO of the Lankenau Institute for Medical Research, agreed. "Many cancer patients are interested in making changes in areas that they can control, and this study definitely lends credence to the idea that a change in diet can be beneficial," said Prendergast, who was not involved with the study.

Krystal and his colleagues implanted various strains of mice with human tumor cells or with mouse tumor cells and assigned them to one of two diets. The first diet, a typical Western diet, contained about 55 percent carbohydrate, 23 percent protein and 22 percent fat. The second, which is somewhat like a South Beach diet but higher in protein, contained 15 percent carbohydrate, 58 percent protein and 26 percent fat. They found that the tumor cells grew consistently slower on the second diet.

As well, mice genetically predisposed to breast cancer were put on these two diets and almost half of them on the Western diet developed breast cancer within their first year of life while none on the low-carbohydrate, high-protein diet did. Interestingly, only one on the Western diet reached a normal life span (approximately 2 years), with 70 percent of them dying from cancer while only 30 percent of those on the low-carbohydrate diet developed cancer and more than half these mice reached or exceeded their normal life span.

Krystal and colleagues also tested the effect of an mTOR inhibitor, which inhibits cell growth, and a COX-2 inhibitor, which reduces inflammation, on tumor development, and found these agents had an additive effect in the mice fed the low-carbohydrate, high-protein diet.

When asked to speculate on the biological mechanism, Krystal said that tumor cells, unlike normal cells, need significantly more glucose to grow and thrive. Restricting carbohydrate intake can significantly limit blood glucose and insulin, a hormone that has been shown in many independent studies to promote tumor growth in both humans and mice.

Furthermore, a low-carbohydrate, high-protein diet has the potential to both boost the ability of the immune system to kill cancer cells and prevent obesity, which leads to chronic inflammation and cancer.

Monday, June 13, 2011

Dietary changes appear to lower risk of Alzheimer's disease

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Following a low¬–saturated fat and low–glycemic index diet appears to modulate the risk of developing dementia that proceeds to Alzheimer’s disease (AD), and making a switch to this dietary pattern may provide some benefit to those who are already experiencing cognitive difficulty, according to a report in the June issue of Archives of Neurology, one of the JAMA/Archives journals.

Previous research has suggested multiple links between diet and cognitive ability, the authors note as background information. Health conditions in which insulin resistance (the body’s inability to use insulin effectively) is a factor—obesity, type 2 diabetes, cardiovascular disease and high cholesterol levels—have also been associated with “pathological brain aging.” However, studies of specific foods have not found conclusive evidence of an influence on Alzheimer’s risk. “Thus,” the authors write, “a more promising approach to the study of dietary factors in AD might entail the use of whole-diet interventions, which have greater ecologic validity and preserve the nutritional milieu in which fat and carbohydrate consumption occurs.”

Jennifer L. Bayer-Carter, M.S., from Veterans Affairs Puget Sound Health Care System, Seattle, and colleagues sought to compare a high–saturated fat/high–simple carbohydrate diet (a macronutrient pattern associated with type 2 diabetes and insulin resistance) with a low–saturated fat/low–simple carbohydrate diet; the interventions were named HIGH and LOW, respectively. The authors evaluated the effects of these diets in 20 older adults who were healthy and 29 older adults who had amnestic mild cognitive impairment (aMCI), meaning they experienced some memory problems; the latter condition is often considered a precursor to AD. In a four-week randomized, controlled trial, 24 participants followed the HIGH diet and 25 followed the LOW diet. The researchers studied participants’ performance on memory tests as well as their levels of biomarkers (biological substances indicative of AD), such as insulin, cholesterol, blood glucose levels, blood lipid levels and components of cerebrospinal fluid (CSF).

Results of the study were different for the group that had aMCI and the group of healthy participants. In the latter group, the LOW diet decreased some CSF biomarkers of AD as well as total cholesterol levels. However, among individuals with aMCI, the LOW diet increased levels of these biomarkers. Some changes to biomarkers, such as CSF insulin levels, were observed in both groups. Additionally, the LOW diet improved performance on delayed visual recall tests for both healthy and memory-impaired participants, but did not affect scores on other cognitive measures.

The findings indicate that “for healthy adults, the HIGH diet moved CSF biomarkers in a direction that may characterize a presymptomatic stage of AD,” explain the authors. They believe that the different results of the unhealthy diet in participants with aMCI may be due to the diet’s short duration. “The therapeutic effects of longer-term dietary intervention may be a promising avenue of exploration,” the authors conclude. “In addition, identification of the pathophysiologic changes underlying dietary effects may reveal important therapeutic targets that can be modulated through targeted dietary or pharmacologic intervention.”

Friday, June 10, 2011

Strength training for persons older than 60 years

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People lose 30% of their muscle strength between the ages of 50 and 70 years. However, maintaining muscle strength in old age is enormously important in order to maintain mobility and to be able to lead an independent life and manage everyday tasks independently. In the current issue of Deutsches Ärzteblatt International, Frank Mayer and colleagues from the University of Potsdam conclude that progressive strength (resistance) training counteracts muscular atrophy in old age (Dtsch Arztebl Int 2011; 108(21): 359-64).

The authors investigated the extent of the effects that can be achieved by strength (resistance) training in elderly persons and which intensities of exercise are useful and possible in persons older than 60 years. They found that regular strength (resistance) training increased muscle strength, reduced muscular atrophy, and that tendons and bones adapt too. These successes in turn had a preventive effect in terms of avoiding falls and injuries. Greater intensities of training yielded greater effects than moderate and low intensities. In order to increase muscle mass, an intensity of 60-85% of the one-repetition-maximum is required. In order to increase rapidly available muscle force, higher intensities (>85%) are required. The optimum amount of exercise for healthy elderly persons is 3 to 4 training units per week.

In the coming decades, the importance of maintaining the ability to work and to make a living will increase, as will the need for independence in everyday life and leisure activities. The increase in the retirement age to 67 years from 2012 means that one in three adults of working age will be older than 50 by 2020, and by 2050, the proportion of people older than 60 in Germany's population will rise to an estimated 40%. Currently, the proportion of elderly persons who practice strength (resistance) training is about 10-15%.

Thursday, June 9, 2011

Bursitis a common cause of painful hips, knees, heels and elbows

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Most conditions can be managed with simple, nonsurgical techniques

As warm weather arrives and the great outdoors beckons, more and more men and women will be taking to the trails, the beaches, or their yards and gardens, embarking on physical activities that may result in sore, aching, swollen joints. While it may be tempting to ignore these aches and pains or treat them with a little over-the-counter liniment, a wiser choice is to visit a physician who can determine if the symptoms are due to bursitis, inflammation of the fluid-filled bursae, or sacs, that surround and cushion the joints.

Bursitis occurs when the bursae become irritated or infected, often causing pain on movement. When infection is involved, medical intervention is necessary to fight the underlying infection and prevent it from spreading; when infection is not involved, prompt medical attention can prevent the condition from becoming worse over time.
Four of the most common types of bursitis, affecting the hips (trochanteric bursitis), knees (prepatellar bursitis), elbows (olecranon bursitis) and heels (retrocalcaneal bursitis), are examined in a new review article published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

"Bursitis is a common cause of musculoskeletal pain and often prompts orthopaedic consultation," said study author Daniel Aaron, MD, a clinical instructor in the department of orthopaedics at Brown University in Providence, R.I. "One of the challenges facing clinicians is to differentiate bursitis from conditions with similar symptoms, including arthritis, tendinitis, fracture, tendon or ligament injury and tumor. Additionally, bursitis arises from infectious and noninfectious causes, and distinguishing between the two can be challenging.

"A thorough history and physical examination is required for accurate diagnosis, and in some cases, medical tests also may be used to help the clinician identify bursitis and determine whether or not infection is involved," he added.

Trauma or infection is usually the root cause of all four types of bursitis, Dr. Aaron said.

"Hip and heel bursitis usually result from 'overuse' syndromes involving underlying structures related to the tendons," he noted. "Elbow and knee bursitis can be traumatic, due to either chronic low-level trauma or acute trauma, or infectious. Other inflammatory conditions can lead to bursitis as well."

Typical symptoms of bursitis include:

• pain with or without joint movement;
• swelling of the area surrounding the joint;
• redness of the skin near the joint;
• warmth of the area near the joint; or
• pain or tenderness when the bursa is touched.

Dr. Aaron noted not all types of bursitis will involve the same kinds of symptoms. For instance:

• Hip bursitis may involve pain on the side of the hip, often radiating to the thigh. The hip area may be painful to the touch. Although range of motion of the hip may appear normal during the physical exam, the symptoms of trochanteric bursitis may be exacerbated by lying on your side, walking (especially uphill), climbing stairs and standing up from a seated position.

• Knee bursitis may be due to specific predisposing factors, including a history of trauma to the area, such as repetitive or prolonged kneeling, immune system disorders, alcoholism, chronic obstructive pulmonary disease (COPD), kidney failure, prior use of local corticosteroid medication and previous inflammation of the bursa. Pain with movement is uncommon, except when the joint is significantly flexed.

• Elbow bursitis typically involves a history of minor or repetitive local trauma. Although swelling is often involved in patients with olecranon bursitis, usually this swollen area is only tender when infection is involved.

• Heel bursitis often involves pain surrounding the Achilles tendon and heel areas, which are often tender when squeezed. This type of bursitis is typically associated with overuse and is especially common in runners, especially those who regularly train on inclines.

All types of bursitis often can be successfully managed non-surgically, and possible treatments include:

• use of ice packs or compressive dressings;
• activity modification that may reduce stress or irritation;
• administration of nonsteroidal anti-inflammatory drugs (NSAIDs) or antibiotics;
• corticosteroid injections (knee and elbow);
• stretching exercises; and/or
• change of footwear (heel).

Surgery may be required in patients whose symptoms remain following these treatments and in certain situations when infection is involved.
Dr. Aaron said in most cases, the best way to prevent bursitis is to vary physical activity, avoiding repetitive activities that may increase stress and trauma on the joints. Padding surrounding the knee or elbow joints may help prevent repetitive trauma which could lead to bursitis in those areas. Finally, losing extra weight which may be causing stress on joints, particularly of the hips and knees, is also recommended.

"By recognizing the presence of bursitis and determining whether or not infection is involved, clinicians can identify the best mode of treatment which will resolve symptoms and help the patient regain mobility," Dr. Aaron said.