Wednesday, December 28, 2016
After all the lifting, hauling, and wrapping, worn out gift givers may blame the season's physical strain for any shoulder soreness they are feeling. It turns out there could be another reason. A new study led by investigators at the University of Utah School of Medicine finds that individuals with symptoms that put them at increased risk for heart disease could be more likely to have shoulder problems, including joint pain and rotator cuff injury.
"If someone has rotator cuff problems, it could be a sign that there is something else going on. They may need to manage risk factors for heart disease," says the study's lead author Kurt Hegmann, M.D., M.P.H., Professor of Family and Preventive Medicine and Director of the Rocky Mountain Center for Occupational and Environmental Health. The research was published in the Journal of Occupational and Environmental Medicine.
Repeated physical stress is most frequently blamed for aggravating shoulder joints and the muscles and tendons that surround them. Think about a pitcher who throws a baseball 100 times a day. While physical exertion can certainly be an irritant, accumulating evidence points other factors that could also be at play. Previous research found that people who had an increased risk for heart disease also had a tendency toward carpal tunnel syndrome, Achilles tendinitis, and tennis elbow, all musculoskeletal disorders.
The current study by Hegmann and colleagues adds shoulder problems to the list and takes the connection one step further. The more heart disease risk factors that each of the study participants had racked up - including high blood pressure, high cholesterol, diabetes - the more likely they were to have had shoulder trouble.
36 participants with the most severe collection of risk factors were 4.6 times more likely than those with none of the risk factors to have had shoulder joint pain. They were also nearly six times more likely to have had a second shoulder condition, rotator cuff tendinopathy. Participants with mid-level heart risk were less likely to have had either shoulder condition, at 1.5 to 3-fold. Shared trends bolster that there could be a relationship between heart risk and shoulder problems, but researchers will need to follow up with a prospective study to prove cause and effect.
It may seem like physical strain would be at least just as likely to cause shoulder pain but data from the 1,226 skilled laborers who took part in the study suggest otherwise. Ergonomists carefully monitored airbag manufacturers, meat, processors, cabinet makers and skilled laborers. Every forceful twist, push, and pull was factored into a strain index assigned to each worker. But a more straining job did not translate to an uptick in shoulder difficulties. Nor did more time spent doing other physical activities.
"What we think we are seeing is that high force can accelerate rotator cuff issues but is not the primary driver," says Hegmann. "Cardiovascular disease risk factors could be more important than job factors for incurring these types of problems."
He says it's possible that controlling blood pressure and other heart risk factors could alleviate shoulder discomfort, too.
Friday, December 23, 2016
Aspirin best choice in in preventing the recurrence of polyps that are the precursor of colorectal cancer
Mayo Clinic researchers and a team of collaborating scientists from across the country have determined the comparative effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin and several supplements in preventing the recurrence of advanced neoplasia (polyps that are the precursor of colorectal cancer) after polyp removal.
According to the World Cancer Research Fund, colorectal cancer is the third most common cancer in the world. In the U.S., more than one-third of people who develop colorectal cancer will die of the disease, with most of those cancers arising from advanced neoplasia (also known as advanced adenomas or adenomatous polyps).
In their study, published this month in The BMJ, the research team showed that, for most patients, nonaspirin NSAIDs (e.g., ibuprofen) work better than aspirin or a host of nutritional supplements to prevent the growth of advanced adenomas. In the paper, they say that due to most colorectal cancers developing from this type of polyps, preventing them is a good proxy for colorectal cancer prevention.
"Approximately 85 percent of all colorectal cancers are thought to result from untreated adenomatous polyps," says M. Hassan Murad, M.D., a clinical epidemiologist and preventive medicine physician at Mayo Clinic, and the study's senior author. "If we can find a way to stop their growth, we could prevent a majority of these cases."
"We knew that aspirin and other NSAIDs have a protective effect, and that a number of other nutritional supplements have also been studied for their effectiveness in preventing cancer," says Dr. Murad. "What we didn't know is how they compared to each other."
The team conducted a meta-analysis (a statistical research method that involves combining data from multiple studies to obtain a single consolidated observation) of clinical trial data from 15 randomized control trials, reviewing information from 12,234 patients. These studies included low- and high-dose aspirin therapy, calcium, vitamin D and folic acid, and compared them each alone or in various combinations.
Dr. Murad and his colleagues showed that nonaspirin NSAIDs are better than all the other compared therapies for preventing recurrence of adenomatous polyps within three to five years following initial polyp removal. However, because of some of the other health risks of nonaspirin NSAIDs, they may not be the best choice for everyone.
Aspirin had nearly as good of results, with much less additional risk. Dr. Murad and his colleagues cautioned that, although low-dose aspirin was ranked second in preventive capabilities, "the excess benefit over risk might therefore be favorable for many patients."
"It is important that patients and doctors have a discussion on the various risks and benefits of any medication or other therapy," says Dr. Murad. "While a research publication may contain promising findings, it is generalized information, and each individual is different. So their care will be individualized, as well."
• New study finds high prevalence of vitamin D inadequacy in 14 to 18 year olds at a time of the year when vitamin D levels should be at their peak (post-summer)
• Research identifies the level of vitamin D intake needed by adolescents to avoid vitamin D deficiency and ensure adequacy
• Vitamin D plays an essential role in bone growth during adolescent years, helping to achieve peak bone mass by late adolescence - believed to contribute to reducing age-related bone loss in later life
A study, published in the American Journal of Clinical Nutrition, has shown high levels of vitamin D inadequacy in UK adolescents, and - for the first time - identified the intake needed by adolescents in order to maintain adequate serum vitamin D levels during the winter time. The research was undertaken by academics from the University of Surrey's Department of Nutritional Sciences in collaboration with colleagues from the University of Copenhagen and University College Cork.
Adolescents are particularly vulnerable to vitamin D deficiency, and previous studies have shown that vitamin D levels decrease during puberty. With adolescents less likely to spend time outdoors than younger children, they experience less exposure to the sun, which is how we naturally obtain vitamin D. Low vitamin D levels are also a problem at northern latitudes during the winter months when the sun is not sufficient for us to make vitamin D within our bodies, so dietary intakes become more important.
Vitamin D optimises calcium absorption and therefore plays an essential role in bone mineralisation and skeletal development. Since most rapid bone growth occurs during the adolescent years, it is vital that teenagers have sufficient levels of vitamin D in order to achieve peak bone mass by late adolescence. This is thought to help reduce age-related bone loss in later life.
In the trial, 110 white male and female adolescents were given varying levels of vitamin D3 supplements, while some were given a placebo supplement, for a 20 week period during winter. This showed that vitamin D intakes of between 10 and ~30 ug/day are required to maintain an adequate level of vitamin D and avoid vitamin D deficiency.
The study forms part of a four-year EU-funded project, ODIN, which aims to investigate safe and effective ways of improving dietary vitamin D intakes through food fortification and bio-fortification. The key findings were presented by lead author Dr Taryn Smith of the University of Surrey at the National Osteoporosis Society Conference, due to be held from 7 to 9 November 2016 in Birmingham.
Nitrate supplementation in conjunction with Sprint Interval Training in low oxygen conditions could enhance sport performance a study has found.
Researchers from the University of Leuven in Belgium carried out a study with twenty-seven moderately trained participants. These were given nitrate supplements ahead of Sprint Interval Training (SIT), which took the form of short but intense cycling sessions three times a week.
Nitrate is commonly found in diets rich in leafy green foods, like spinach and is important for the functioning of the human body, especially during exercising.
To assess differences in performance in different conditions, the study included workouts in normal oxygen conditions and in hypoxia conditions, which are low oxygen levels such as those found in high altitudes
The observations published in Frontiers in Physiology were unexpected: after only five weeks, the muscle fiber composition changed with the enhanced nitrate intake when training in low oxygen conditions.
"This is probably the first study to demonstrate that a simple nutritional supplementation strategy, i.e. oral nitrate intake, can impact on training-induced changes in muscle fiber composition;" stated Professor Peter Hespel from the Athletic Performance Center at the University of Leuven.
For athletes participating in sports competitions which require energy production in conditions with limited amounts of oxygen, this study is particularly interesting. In fact, exercising at high altitudes has become a training strategy for many athletes, albeit the uncertainties about such methods.
In these conditions, performing intense workouts requires high input of fast-oxidative muscle fibers to sustain the power. Enhancing these muscle fiber types through nutritional intake could very well boost the performance in this type of events.
However, this remains a question mark for the time being. "Whether this increase in fast-oxidative muscle fibers eventually can also enhance exercise performance remains to be established;" said Professor Hespel.
He cautioned: "consistent nitrate intake in conjunction with training must not be recommended until the safety of chronic high-dose nitrate intake in humans has been clearly demonstrated".
In times where athletes push the limits of their bodies and thrive for ever greater performances, this is clearly only the beginning of the research into how athletes can improve their competitive edge through dietary supplements. Looking to the future, Professor Hespel suggested: "it would now be interesting to investigate whether addition of nitrate-rich vegetables to the normal daily sports diet of athletes could facilitate training-induced muscle fiber type transitions and maybe in the long term also exercise performance".
Researchers at the University of Colorado Anschutz Medical Campus have found that high doses of vitamin D reduce the incidence of acute respiratory illness (ARI) in older, long-term care residents.
The findings of the clinical trial, published in the Journal of the American Geriatrics Society, could help reduce one of the leading causes of serious illness, debilitation and death among patients in nursing homes and other long-term care facilities.
"After studying these patients for a year, we found a 40 percent reduction in acute respiratory illness among those who took higher doses of vitamin D," said the study's lead author, Adit Ginde, MD, MPH, professor of emergency medicine at the University of Colorado School of Medicine. "Vitamin D can improve the immune system's ability to fight infections because it bolsters the first line of defense of the immune system."
Ginde said in older people that first line of defense is often impaired. But vitamin D can reinforce it and prevent illnesses like pneumonia, influenza and bronchitis.
It may also prevent infections and exacerbations of Chronic Obstructive Pulmonary Disease (COPD) like emphysema.
At the same time, Ginde found that those who received higher doses of vitamin D also saw an increase in falls. The falls were lower in those given smaller doses rather than higher monthly doses of vitamin D.
The clinical trial, the first to examine vitamin D's impact on respiratory infections in nursing home residents, looked at 107 patients with an average age of 84 over a 12 month period. Of those, 55 received high doses of vitamin D or 100,000 units monthly (averaging 3,300-4,300 units daily). And 52 received lower doses averaging between 400-1,000 units daily. Those with higher doses saw ARIs cut nearly in half. They also had over double the incidence of falls, the study said.
"This finding requires a confirmatory trial, including whether high daily doses of vitamin D, rather than high monthly doses, makes patients less likely to fall," Ginde said.
But Ginde said the primary finding that vitamin D can reduce ARI is a major step forward in treating these dangerous infections.
"This is a potentially life-saving discovery," Ginde said. "There is very little in a doctor's arsenal to battle ARI, especially since most are viral infections where antibiotics don't work. But vitamin D seems able to potentially prevent these infections."
He cautioned that the study is not definitive proof that vitamin D can prevent ARI but it suggests that it can and at little risk to the patient.
"If our results are confirmed by a larger trial, high dose vitamin D, ideally using daily dosing to minimize fall risk, has the potential for substantial public health benefit through ARI prevention for the large and growing population of long term care residents," Ginde said.
Regular use of aspirin by people living in Shanghai, China, was associated with decreased risk for developing pancreatic cancer, according to data published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.
Data from the new study and meta-analysis of data from 18 other studies suggest that over the past two decades, as the general population's use of aspirin has increased, the effect of aspirin in decreasing pancreatic cancer risk has become more pronounced.
"Pancreatic cancer is one of the deadliest types of cancer -- fewer than 8 percent of patients survive five or more years after diagnosis -- so it is crucial that we find ways to prevent it," said Harvey A. Risch, MD, PhD, professor of epidemiology in the Department of Chronic Disease Epidemiology at the Yale School of Public Health, Yale School of Medicine, and Yale Cancer Center in New Haven, Connecticut. "We found that regular use of aspirin by a large group of people in Shanghai cut risk of pancreatic cancer almost in half."
"These new data are consistent with what has been seen in other populations around the world," continued Risch. "Pancreatic cancer is relatively rare -- just 1.5 percent of U.S. adults will be diagnosed with it at some point during life -- and regular aspirin use can cause appreciable complications for some. Therefore, a person should consult his or her doctor about aspirin use. Nevertheless, the balance of evidence shows that people who use aspirin to reduce risk for cardiovascular disease or colorectal cancer can feel positive that their use likely also lowers their risk for pancreatic cancer."
Risch and colleagues recruited patients newly diagnosed with pancreatic cancer at 37 Shanghai hospitals from December 2006 to January 2011. They also randomly selected controls from the Shanghai Residents Registry. The 761 patients with pancreatic cancer and 794 controls were interviewed in person to determine when they started using aspirin, the number of years they used aspirin, and when they stopped using aspirin, among other things. Almost all aspirin users used aspirin daily.
Among the patients with pancreatic cancer, 11 percent reported regular use of aspirin. Eighteen percent of the controls reported regular use of aspirin.
After adjusting for a number of factors, including body mass index, smoking history, and history of diabetes, the researchers found that ever having used aspirin regularly was associated with a 46 percent decreased risk for pancreatic cancer. Risk decreased by 8 percent for each year of aspirin use.
In reviewing the literature, Risch and colleagues found 18 other studies that had investigated aspirin use and pancreatic cancer risk. Meta-analysis of the data from these studies showed that if the studies were considered by the year at which the midpoint of when the aspirin exposures were ascertained in the study, the odds ratios for regular use of aspirin and pancreatic cancer risk significantly decreased by 2.3 percent per year through the present.
According to Risch, the main limitation of the Shanghai study is that it is a case-control study that relied on participants accurately reporting past aspirin use.
Thursday, December 22, 2016
In contrast to most previous studies on the topic, the researchers deliberately did not include grandparents who were primary or custodial caregivers. Instead, they compared grandparents who provided occasional childcare with grandparents who did not, as well as with older adults who did not have children or grandchildren but who provided care for others in their social network.
The results of their analyses show that this kind of caregiving can have a positive effect on the mortality of the carers. Half of the grandparents who took care of their grandchildren were still alive about ten years after the first interview in 1990. The same applied to participants who did not have grandchildren, but who supported their children - for example, by helping with housework. In contrast, about half of those who did not help others died within five years.
The researchers were also able to show that this positive effect of caregiving on mortality was not limited to help and caregiving within the family. The data analysis showed that childless older adults who provided others with emotional support, for example, also benefited. Half of these helpers lived for another seven years, whereas non-helpers on average lived for only another four years.
Too intense involvement causes stress
"But helping shouldn't be misunderstood as a panacea for a longer life," says Ralph Hertwig, Director of the Center for Adaptive Rationality at the Max Planck Institute for Human Development. "A moderate level of caregiving involvement does seem to have positive effects on health. But previous studies have shown that more intense involvement causes stress, which has negative effects on physical and mental health," says Hertwig. As it is not customary for grandparents in Germany and Switzerland to take custodial care of their grandchildren, primary and custodial caregivers were not included in the analyses.
The researchers think that prosocial behavior was originally rooted in the family. "It seems plausible that the development of parents' and grandparents' prosocial behavior toward their kin left its imprint on the human body in terms of a neural and hormonal system that subsequently laid the foundation for the evolution of cooperation and altruistic behavior towards non-kin," says first author Sonja Hilbrand, doctoral student in the Department of Psychology at the University of Basel.
Wednesday, December 21, 2016
A high dietary intake of cured and processed meats, such as ham and salami, is linked to worsening asthma symptoms, reveals research published online in the journal Thorax.
Four or more weekly servings seem to have the greatest impact on symptoms, the findings suggest.
Cured and processed meat is rich in nitrites, which may have a role in airway inflammation--a typical feature of asthma.
To find out if dietary processed meat intake was associated with the worsening of asthma symptoms over time, and what role, if any, obesity might have, the researchers drew on data from participants in the French Epidemiological study on the Genetics and Environment of Asthma (EGEA).
This has been tracking the health through surveys and medical examination of more than 2000 asthma patients, their close relatives, and a comparison group from five cities in France for more than 20 years.
The current study is based on 971 adults (49% men) for whom complete dietary, weight (BMI), asthma symptom score and demographic data were obtained up to 2011-13.
Dietary intake was measured using food frequency questionnaires encompassing 118 items in 46 food groups. Cured meat intake (ham, sausage, salami) was classified as low for 1 or fewer weekly servings; medium for 1-4 weekly servings; and high for 4 or more.
Asthma symptoms, such as difficulty breathing, chest tightness, and shortness of breath in the preceding 12 months, were scored from 0 to 5 (asthma symptom score).
Information was also gathered on other potentially influential factors, such as smoking, regular physical activity, age, sex, and educational attainment.
Between 2003 and 2007, 42% of the participants said they had had asthma at some point, and around half (51%) had never smoked. Just over a third (35%) were overweight, while nearly one in 10 (9%) were obese.
Participants said they ate an average of 2.5 servings of cured/processed meat intake a week.
By 2011-13, when the next checks were made, there had been no change in asthma symptom score for just over half the participants (53%; 513). In one in five (20%) symptoms had worsened and in around one in four (27%) symptoms had improved.
Among those who ate one or fewer weekly servings, the proportion of those with worsening asthma symptoms was 14%; among those eating 1-4, the proportion was 20%; and among those eating 4 or more, the proportion was 22%.
After taking account of potentially influential factors, such as smoking, regular physical activity, age, sex, and educational attainment, those who ate the most cured meats were 76% more likely to experience worsening asthma symptoms than those who ate the least.
Overweight/obesity, which has previously been linked to worsening asthma, accounted for just 14% of this association, the calculations showed, suggesting that processed meat intake may have an independent role in asthma symptoms, say the researchers.
This is an observational study, so no firm conclusions can be drawn about cause and effect. Furthermore, the survey responses relied on memory and the symptom score may have been affected by smoking or by COPD--chronic lung disease that shares many of its symptoms with asthma--say the researchers.
Nevertheless, research from other countries points to a potential role for cured/processed meats in lung function and health, say the researchers.
"This research extends the deleterious effect of cured meat on health, and the effect of diet on asthma in adults, and provides a novel analytic approach regarding the role of BMI in the diet-asthma association," they conclude.
Tuesday, December 20, 2016
Physical activity in week after concussion associated with reduced risk of persistent postconcussive
Among children and adolescents who experienced a concussion, physical activity within 7 days of injury compared with no physical activity was associated with reduced risk of persistent postconcussive symptoms at 28 days, according to a study appearing in the December 20 issue of JAMA.
Rest has long been considered the cornerstone of concussion management, and pediatric guidelines universally recommend an initial period of physical rest following a concussion until symptoms have resolved. No clear evidence has determined that avoiding physical activity expedites recovery. Roger Zemek, M.D., of Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada, and colleagues conducted a study that included 3,063 children and adolescents with acute concussion from 9 Pediatric Emergency Research Canada network emergency departments. Physical activity participation and postconcussive symptom severity were rated using standardized questionnaires in the emergency department and at days 7 and 28 postinjury. Persistent postconcussive symptoms (PPCS) were assessed at 28 days postenrollment.
The final study group included 2,413 participants, of whom PPCS at 28 days occurred in 733 (30 percent); 1,677 (70 percent) participated in physical activity within 7 days, primarily with light aerobic exercise. Of the patients who engaged in early physical activity, 31 percent were symptom free and 48 percent had at least 3 persistent or worsening postconcussive symptoms at day 7. Of those reporting engaging in no physical activity at day 7, 80 percent had at least 3 persistent or worsening postconcussive symptoms at day 7. Resumption of physical activity within 7 days postconcussion was associated with a lower risk of PPCS as compared with no physical activity. This finding was consistent across analytic approaches and intensity of exercise.
"Early physical activity could mitigate the undesired effects of physical and mental deconditioning associated with prolonged rest. Regardless of potential benefit, caution in the immediate postinjury period is prudent; participation in activities that might introduce risk for collision (e.g., resumption of contact sports) or falls (e.g., skiing, skating, bicycling) should remain prohibited until clearance by a health professional to reduce the risk for a potentially more serious second concussion during a period of increased vulnerability," the authors write.
Sunlight allows us to make vitamin D, credited with healthier living, but a surprise research finding could reveal another powerful benefit of getting some sun.
Georgetown University Medical Center researchers have found that sunlight, through a mechanism separate than vitamin D production, energizes T cells that play a central role in human immunity.
Their findings, published today in Scientific Reports, suggest how the skin, the body's largest organ, stays alert to the many microbes that can nest there.
"We all know sunlight provides vitamin D, which is suggested to have an impact on immunity, among other things. But what we found is a completely separate role of sunlight on immunity," says the study's senior investigator, Gerard Ahern, PhD, associate professor in the Georgetown's Department of Pharmacology and Physiology. "Some of the roles attributed to vitamin D on immunity may be due to this new mechanism."
They specifically found that low levels of blue light, found in sun rays, makes T cells move faster -- marking the first reported human cell responding to sunlight by speeding its pace.
"T cells, whether they are helper or killer, need to move to do their work, which is to get to the site of an infection and orchestrate a response," Ahern says. "This study shows that sunlight directly activates key immune cells by increasing their movement."
Ahern also added that while production of vitamin D required UV light, which can promote skin cancer and melanoma, blue light from the sun, as well as from special lamps, is safer.
And while the human and T cells they studied in the laboratory were not specifically skin T cells -- they were isolated from mouse cell culture and from human blood -- the skin has a large share of T cells in humans, he says, approximately twice the number circulating in the blood.
"We know that blue light can reach the dermis, the second layer of the skin, and that those T cells can move throughout the body," he says.
The researchers further decoded how blue light makes T cells move more by tracing the molecular pathway activated by the light.
What drove the motility response in T cells was synthesis of hydrogen peroxide, which then activated a signaling pathway that increases T cell movement. Hydrogen peroxide is a compound that white blood cells release when they sense an infection in order to kill bacteria and to "call" T cells and other immune cells to mount an immune response.
"We found that sunlight makes hydrogen peroxide in T cells, which makes the cells move. And we know that an immune response also uses hydrogen peroxide to make T cells move to the damage," Ahern says. "This all fits together."
Ahern says there is much work to do to understand the impact of these findings, but he suggests that if blue light T cell activation has only beneficial responses, it might make sense to offer patients blue light therapy to boost their immunity.
Anticholinergic medications, a class of drugs very commonly used by older adults, are linked to an increased rate of emergency department and hospital utilization in the United States, according to an Indiana University Center for Aging Research, Indiana University Center for Health Innovation and Implementation Science, and Regenstrief Institute study of community-dwelling Americans age 65 and older.
Drugs with anticholinergic properties are frequently prescribed or purchased over the counter for chronic conditions including depression, anxiety, pain, allergy, incontinence or sleep problems. These drugs are used by as many as half of older adults and it is not unusual for an older individual to be taking two or more anticholinergic medications regularly.
The new study, published in the November 2016 issue of the peer-reviewed journal Phamacotherapy, analyzed actual prescription dispensing data from the Regenstrief Medical Record System to determine how much anticholinergic medication each person used, known as anticholinergic burden, and utilization of healthcare services such as hospital, emergency department and ambulatory visits. Prescription dispensing data are known to be more reliable than self-reported information.
Fifty-eight percent of the 3344 study participants were African-American; 71 percent were female. Fewer than 10 percent were cognitively impaired. All were patients served by Eskenazi Health, an academic teaching health care system in Indianapolis.
"Anticholinergics, the medications that block acetylcholine, a nervous system neurotransmitter, have previously been implicated as a potential cause of cognitive impairment, by us and by other researchers," said IU Center for Aging Research and Regenstrief Institute investigator Noll Campbell, PharmD, who led the new research. "This is the first study to calculate cumulative anticholinergic burden and determine that as burden increases, so does healthcare utilization in the U.S. -- both outpatient and inpatient."
Dr. Campbell and colleagues report that taking a drug with mild anticholinergic effect daily increased the likelihood of inpatient admission by 11 percent over a year. Many drugs used to treat heart failure and hypertension fall into the mild group, such as diuretics. Taking a drug with a strong anticholinergic effect daily increased the likelihood of inpatient admission by 33 percent over a year. Sleeping pills, one of the most common medications used by elders, are in this category as are antihistamines, which are available without prescription.
The IU Center for Aging Research has studied patient safety harms from anticholinergic medications in diverse populations for over a decade.
In 2008, center scientists, led by the Chief Innovation and Implementation Officer of IU Center for Health Innovation and Implementation Science Malaz Boustani, MD, MPH, developed the Anti-Cholinergic Burden Scale, one of the most widely used tools to pinpoint the anticholinergic properties and anticholinergic load of specific drugs. Anticholinergic burden in this study was defined as the number of days someone was dispensed an anticholinergic medicine multiplied by the strength (mild versus strong) of the anticholinergic load.
The new study was the first time that the Anti-Cholinergic Burden Scale was employed to calculate a cumulative score weighted by both number of days dispensed and strength of anticholinergic effect using prescription dispensing databases.
In 2013 the IU Center for Aging Research investigators reported that continuously taking strong anticholinergics for as few as 60 days caused memory problems and other indicators of mild cognitive impairment. Taking multiple drugs with weaker anticholinergic effects, such as many common over-the-counter digestive aids, had a negative impact on cognition in only 90 days.
"As baby boomers age and the number of older adults increases, it is especially important to recognize the negative impact of anticholinergic medications on the aging brain and healthcare delivery cost," said Dr. Boustani. "There is a powerful association between these harmful medications and potentially avoidable cognitive impairment and increased visits to the doctor, the ER and the hospital."
"Individuals taking anticholinergics should talk with their doctors or pharmacists about possible alternatives," Dr. Campbell said. "This new study provides stronger motivation to design and conduct de-prescribing studies to determine safe ways to take individuals off anticholinergic medications in the interests of preserving brain health and decreasing healthcare utilization rates and their potential costs." Dr. Campbell is an assistant professor of pharmacy practice at Purdue University College of Pharmacy and a clinical pharmacy specialist with Eskenazi Health.
A new study from Keith Baar's Functional Molecular Biology Laboratory at the UC Davis College of Biological Sciences and the Australian Institute of Sport suggests that consuming a gelatin supplement, plus a burst of intensive exercise, can help build ligaments, tendons and bones. The study is published in the January issue of the American Journal of Clinical Nutrition.
Connective tissue and bone injuries are common in both athletes and the elderly, and interfere with peoples' ability (and enthusiasm) for exercise, whether they are an elite athlete or just trying to lose weight and maintain fitness and flexibility. Steps that can prevent injury and enhance recovery are therefore of great interest.
Obviously, it's difficult to assess the direct effect of a supplement on tissues without opening up someone's knee. But Baar's laboratory has been developing techniques to grow artificial ligaments in the laboratory. They used their lab-dish ligaments as a stand-in for the real thing.
Gelatin, Vitamin C and Exercise
Baar, Greg Shaw at the Australian Institute of Sport, and colleagues enrolled eight health young men in a trial of a gelatin supplement enhanced with vitamin C. The volunteers drank the supplement and had blood taken, and after one hour performed a short (five minute) bout of high-impact exercise (skipping).
The researchers tested the blood for amino acids that could build up the collagen protein that composes tendons, ligaments, and bones. They also tested blood samples for their effect on Baar's lab-grown ligaments at UC Davis.
The gelatin supplement increased blood levels of amino acids and markers linked to collagen synthesis, and improved the mechanics of the engineered lab-grown ligaments, they found.
"These data suggest that adding gelatin and vitamin C to an intermittent exercise program could play a beneficial role in injury prevention and tissue repair," the researchers wrote.
Monday, December 19, 2016
Something as seemingly harmless as a heartburn pill could lead cancer patients to take a turn for the worse. A University of Alberta study published in journal JAMA Oncology discovered that proton pump inhibitors (PPIs), which are very common medications for heartburn and gastrointestinal bleeding, decrease effects of capecitabine, a type of chemotherapy usually prescribed to gastric cancer patients.
The study by Department of Oncology's Michael Sawyer, Michael Chu and their team included more than 500 patients and the results were conclusive: PPIs affected progression-free survival by more than a month; the overall survival in cancer patients was reduced by more than two months, and the disease control rate decreased by 11 per cent.
Although this research was focused on gastric cancer patients, Sawyer's team has followed up with another study in early stage colorectal cancer and discovered that those who took PPIs and capecitabine were also at risk for decreased cancer treatment efficacy. In that study, patients who took PPIs while on capecitabine had a decreased chance of being cured of their colorectal cancer.
PPIs are very popular for their efficacy and many of them are over-the-counter drugs (some common brands are Nexium, Prevacid and Protonix). Sawyer explains the risk of this interaction is high as some cancer patients may not even have these medications prescribed by a physician, but could obtain them easily over-the-counter at a pharmacy and accidentally alter their chemotherapy treatment without knowing it: "This could be a very common and underappreciated side effect. One study estimated that at 20 per cent of cancer patients in general take proton pump inhibitors."
The explanation for the negative outcome may be in gastric pH levels. Previous studies had been done on the interaction of this type of chemo with the antacid medication Maalox, without obtaining any alarming results; but unlike Maalox, PPI's are able to raise pH to a point where they could affect disintegration of capecitabine tablets. "Given that PPIs are much more potent and can essentially abolish gastric acidity there may be a significant interaction between capecitabine and PPIs," says Sawyer.
Sawyer, a clinical pharmacologist and medical oncologist and member of the U of A's Faculty of Medicine & Dentistry since 2001, is currently conducting more research on this topic to unveil more about the interaction of chemotherapy with other medications.
This discovery may lead to change the usual procedures for prescription of PPIs. Some cancer patients cannot discontinue these medications in order to treat bleedings or other gastric conditions that must be kept under control. "In that case, there are alternatives for oncologists or family doctors that become aware of this risk," says Sawyer. "Physicians should use caution in prescribing PPIs to patients on capecitabine and, if they must use PPIs due to gastrointestinal bleeding issues, maybe they should consider using other types of chemotherapy that don't present this interaction."
Reducing our cholesterol levels to those of a new-born baby significantly lowers the risk of cardiovascular disease, according to new research.
Although previous studies have suggested lowering cholesterol levels may be associated with a lower risk of heart attack, recent evidence has questioned whether very low levels are beneficial.
In the latest study, led by scientists at Imperial College London, researchers analysed data from over 5,000 people taking part in cholesterol-lowering trials.
These studies utilised a new therapy to reduce cholesterol to much lower levels than previously possible.
The team, who published their research this week in the journal Circulation, wanted to assess whether reducing cholesterol as low as possible is safe, and whether it was more beneficial than the current levels achieved with existing drugs.
The scientists found that dropping cholesterol to the lowest level possible - to levels similar to those we were born with - reduced the risk of heart attack, stroke or fatal heart disease by around one third.
Professor Kausik Ray, lead author of the research from the School of Public Health at Imperial, said: "Experts have been uncertain whether very low cholesterol levels are harmful, or beneficial. This study suggests not only are they safe, but they also reduced risk of heart disease, heart attack and stroke."
In the paper, the scientists examined levels of low density lipoprotein (LDL) cholesterol. This is considered to be 'bad' cholesterol, as it is responsible for clogging arteries.
LDL carries cholesterol to cells, but when there is too much cholesterol for cells to use, LDL deposits the cholesterol in the artery walls.
Official advice suggests most people should aim to keep their LDL cholesterol at 100 mg/dL or below, though this number can vary depending on a person's risk of cardiovascular disease.
In the study, the team analysed data from 10 trials, involving around 5,000 patients. Most had cardiovascular disease, and already had some furring of the arteries, or were at very high risk of furred arteries.
All of the patients had previously been diagnosed with high cholesterol, and many were slightly overweight. The average age was 60, and the researchers tracked the patients for between three months and two years.
The average cholesterol reading was around 125 mg/dL, and they were all deemed at risk of heart problems or stroke.
Mostly patients were taking a cholesterol-lowering statin therapy, but just over half were also taking an additional novel drug, called alirocumab, every two weeks via a small injection, to further lower cholesterol levels.
This drug may be needed when patients' cholesterol levels are not sufficiently lowered by statins.
Some patients find their cholesterol levels aren't adequately reduced by statins, possibly because they carry a faulty gene.
The combined effect of the new drug and the statin in the trials meant that patients reached very low cholesterol - lower than 50mg/dL. This is comparable to the levels we are born with, but is only achievable in adulthood through medication - lifestyle and exercise alone would not drop levels so low.
The researchers found lowering levels of cholesterol reduced the risk of heart attack, stroke, angina or death from heart disease, and that for every 39mg/dL reduction in LDL, the risk reduced by 24 per cent.
Professor Ray added: "This study not only confirms that LDL can trigger heart problems, but also suggests reducing it in adults to very low levels - to those of a new-born baby - is both safe and beneficial."
He explained the team now need to gather longer-term data, to see if the beneficial effects continue. He added we need to wait until these trials have been fully analysed before we can fully assess the benefits of alirocumab.
Frequent sauna bathing can reduce the risk of dementia, according to a recent study carried out at the University of Eastern Finland. In a 20-year follow-up, men taking a sauna 4-7 times a week were 66% less likely to be diagnosed with dementia than those taking a sauna once a week. The association between sauna bathing and dementia risk has not been previously investigated.
The effects of sauna bathing on the risk of Alzheimer's disease and other forms of dementia were studied in the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD), involving more than 2,000 middle-aged men living in the eastern part of Finland. Based on their sauna-bathing habits, the study participants were divided into three groups: those taking a sauna once a week, those taking a sauna 2-3 times a week, and those taking a sauna 4-7 times a week.
The more frequently saunas were taken, the lower was the risk of dementia. Among those taking a sauna 4-7 times a week, the risk of any form of dementia was 66% lower and the risk of Alzheimer's disease 65% lower than among those taking a sauna just once a week. The findings were published recently in the Age and Ageing journal.
Previous results from the KIHD study have shown that frequent sauna bathing also significantly reduces the risk of sudden cardiac death, the risk of death due to coronary artery disease and other cardiac events, as well as overall mortality. According to Professor Jari Laukkanen, the study leader, sauna bathing may protect both the heart and memory to some extent via similar, still poorly known mechanisms. "However, it is known that cardiovascular health affects the brain as well. The sense of well-being and relaxation experienced during sauna bathing may also play a role."
Elderly hospitalized patients treated by female physicians are less likely to die within 30 days of admission, or to be readmitted within 30 days of discharge, than those cared for by male physicians, according to a new study led by researchers at Harvard T.H. Chan School of Public Health. It is the first research to document differences in how male and female physicians treat patients result in different outcomes for hospitalized patients in the U.S.
The researchers estimated that if male physicians could achieve the same outcomes as their female colleagues, there would be 32,000 fewer deaths each year among Medicare patients alone--a number comparable to the annual number of motor vehicle accident deaths nationally.
The study will be published online December 19, 2016 in JAMA Internal Medicine.
"The difference in mortality rates surprised us," said lead author Yusuke Tsugawa, research associate in the Department of Health Policy and Management. "The gender of the physician appears to be particularly significant for the sickest patients. These findings indicate that potential differences in practice patterns between male and female physicians may have important clinical implications."
Previous studies have found differences in the way female and male physicians practice -- for example, female physicians are more likely to adhere to clinical guidelines and provide more patient-centered communication--but this is the first national study to look at whether the differences in the way male and female physicians practice affect clinical outcomes.
The researchers analyzed data from more than 1 million Medicare beneficiaries age 65 years or older hospitalized with a medical condition and treated by general internists between 2011 and 2014. They adjusted for differences in patient and physician characteristics, and considered whether differences in patient outcomes varied by specific condition or by severity of illness.
The researchers found that the patients, if treated by a female physician, had a 4% lower relative risk of dying prematurely and a 5% lower relative risk of being readmitted to a hospital within 30 days. The association was seen across a wide variety of clinical conditions and variations in severity of illness. When the researchers restricted their analysis to hospitalists -- physicians focused on hospital care, to whom patients are randomly assigned based on work schedule--the results remained consistent, suggesting that patient selection, in which healthier patients might choose certain types of doctors, didn't explain the results.
Female physicians now account for approximately one third of the U.S. physician workforce and comprise half of all U.S. medical school graduates. There are important gender differences in how women physicians are treated--they are less likely to be promoted and are generally paid less, said senior author Ashish Jha, K.T. Li Professor of Health Policy and director of the Harvard Global Health Institute.
"There was ample evidence that male and female physicians practice medicine differently. Our findings suggest that those differences matter and are important to patient health. We need to understand why female physicians have lower mortality so that all patients can have the best possible outcomes, irrespective of the gender of their physician," said Jha.
Shortness of breath is an often overlooked symptom of what may be heart failure or COPD (Chronic Obstructive Pulmonary Disease). New research shows that with early intervention, patients can avoid suffering and the need for hospitalization decreases.
"The fact that people do not seek medical advice for their breathlessness is often due to people associating their symptoms with the natural process of aging. But if you notice that you experience increased shortness of breath during exertion, you should seek medical attention," declares Nasser Ahmadi, a researcher at the Sahlgrenska Academy and specialist in cardiology and general medicine at Capio Medical Center in Orust.
He studied breathlessness in several studies with different study designs and study populations. One study was population based and had about 1000 participants, while another one had about 100 patients who sought medical advice for their breathlessness in the primary healthcare setting.
It does not involve patients with acute shortness of breath, which can develop within a few days and should always be treated immediately. Instead, the focus is on chronic shortness of breath and adults who sought care after having shortness of breath for six weeks or more.
Like high blood pressure
"The patients who sought care for chronic breathlessness appeared to have a significantly impaired quality of life than the general population. They often had major problems completing everyday tasks. They suffered from different underlying diseases like a potential heart failure or a hidden obstructive lung disease that was developing," says Nasser Ahmadi.
He feels that chronic shortness of breath should be considered as an equally important warning signal as high blood pressure. In order to an early detection or a correct medication of potentially chronic diseases, we need more efficient models in the primary health care to identify those who are at risk.
"My point is that the faster we identify these patients, the better prognoses we will have and the lighter the load on the healthcare system later on. Shortness of breath is often a sign of heart or lung disease because these two organs are most closely involved in the respiratory system.
According to Nasser Ahmadi most of the studies on shortness of breath that have been conducted are associated with hospitalization, while there is significantly less research within the primary care system.
"In Sweden, few studies have been conducted in the primary care, which plays a central role in taking care of these patients," he says.
More than being out of shape
Previous research has shown that one out of three individuals over 65 years of age in Sweden may suffer from shortness of breath during exertion. The question is how to distinguish between chronic shortness of breath and poor general fitness.
"Very often, the patient recognizes that something is not right. People can compare their health with how it was previously, after all, one is his best health reference. What was I like a year ago? Was I able to do just as much or have things become considerably worse? If it is the latter, people should seek medical attention, even if you are over the age of 65 or 70," says Nasser Ahmadi.
Wednesday, December 14, 2016
People who were in a stable marriage, and had never been divorced or widowed, had the best prospects of survival after having a stroke, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.
"Our research is the first to show that current and past marital experiences can have significant consequences for one's prognosis after a stroke," said Matthew E. Dupre, Ph.D., lead author and associate professor in the Department of Community and Family Medicine and the Clinical Research Institute at Duke University in Durham, North Carolina. "We hope that a greater recognition and understanding of these associations may enable healthcare providers to better identify and treat patients who may be at a potentially high risk of dying after suffering a stroke."
Stroke, one of the leading causes of disability and death in the United States, affects nearly 800,000 adults each year. The risk factors associated with stroke -- high blood pressure, smoking and diabetes -- are well established, as are the factors related to recovering from stroke and improving survival, such as access to quality healthcare, reducing risk factors, and adhering to treatment plans. While studies have shown that social support, such as marriage, can have a significant impact on treatment of cardiovascular disease, the influence of marital status on stroke survival in adults remains poorly understood.
To determine whether one's marital history plays a role in survival after suffering a stroke, Dupre and Renato D. Lopes, M.D., Ph.D., professor of medicine at Duke University Medical Center, used data from a nationally representative sample of older U.S. adults. The sample was collected as part of the Health and Retirement Study (HRS), an ongoing, prospective, study of older U.S. adults sponsored by the National Institute on Aging and the Institute for Social Research at the University of Michigan. The HRS includes marital histories from more than 50 years of prospective and retrospective interview data.
For this study, the researchers selected respondents who reported a stroke from 1992 to 2010. The final sample included 2,351 adults aged 41 and older who were observed an average of 5.3 years over the 18-year study period. The researchers found:
The risks of dying after a stroke were 71 percent greater for adults who never married than for adults who were continuously married.
For patients who were divorced or widowed, the risks of dying after a stroke were 23 percent and 25 percent greater, respectively, than continuously married adults.
In patients who were divorced or widowed more than once, the risks of dying after a stroke were 39 percent and 40 percent greater, respectively, than for continuously married adults.
There was no evidence that the findings significantly differed between men and women or by race or ethnicity.
Analysis of the data suggests that some of these risks are affected by differences in psychological and social factors, such as lack of children, limited social support and depressive symptoms that may have impeded recovery after a stroke. Multiple marital losses in one's lifetime were especially detrimental to recovery, regardless of one's current marital status. Unexpectedly, the researchers found that remarriage did not reduce the risks from past divorce or widowhood. A limitation of the study is that it only included adults who survived to hospital discharge and did not include those who died shortly after having a stroke.
The results of this study have possible implications for public health awareness and practice, Dupre said. "More research is needed to know the full clinical implications of our findings. Greater knowledge about the risks associated with marital life and marital loss may be useful for personalizing care and improving outcomes for those who are recovering from a stroke."
As many as two-thirds of women in the United States over the age of 60 have some degree of hearing loss. Using data from the Nurses' Health Study, a team led by researchers from Brigham and Women's Hospital has found evidence that the duration of use of over-the-counter medications for pain relief, including ibuprofen or acetaminophen, is associated with higher risk of hearing loss. The new study, published on Dec. 14 in the American Journal of Epidemiology adds to a growing body of evidence linking the use of non-steroidal anti-inflammatory drugs (NSAIDS) or acetaminophen with loss of hearing, although the exact mechanism at play remains unknown.
"Hearing loss is extremely common in the United States and can have a profound impact on quality of life," said senior author Gary Curhan, MD, SCD, a physician in the Channing Division of Network Medicine at Brigham and Women's Hospital. "Finding modifiable risk factors could help us identify ways to lower risk before hearing loss begins and slow progression in those with hearing loss."
The research team examined data from more than 54,000 women between the ages of 48 and 73 enrolled in the Nurses' Health Study. They analyzed information on usage of aspirin, ibuprofen and acetaminophen, as well as self-reported hearing loss.
Longer duration of ibuprofen or acetaminophen use was associated with higher risk of hearing loss. The team did not find a significant association between hearing loss and duration of usual-dose aspirin use. (Hearing loss is an established side effect of high dosages of aspirin, but such dosages have become uncommon over the last two decades.)
"Although the magnitude of higher risk of hearing loss with analgesic use was modest, given how commonly these medications are used, even a small increase in risk could have important health implications. Assuming causality, this would mean that approximately 5.5 percent of hearing loss occurring in these women could be due to ibuprofen or acetaminophen use," said Curhan. The study's authors note that the NHS data are limited to mostly older, white women and that further investigation in larger groups and among other populations will be important to understand the connection between hearing loss and pain reliever usage. The team has previously published findings that indicate that higher frequency use of NSAIDs and acetaminophen are associated with higher risk of hearing loss in men and younger women.
Tuesday, December 13, 2016
What should healthy young men who want to watch their weight and manage their blood sugar levels drink? Can they risk something sugary or will they be hungrier after drinking calorie-free options containing natural or artificial non-nutritive sweeteners (NNS)? A new study published in Springer Nature's International Journal of Obesity shows that it doesn't really matter whether such drinks contain sugar, Stevia, monk fruit or aspartame. In the end, things even out in how the body reacts to these four options in terms of overall energy intake and the levels of glucose and insulin in the blood, says lead author Siew Ling Tey of the Agency for Science, Technology and Research (A*STAR) in Singapore. This is of interest given the growing popularity of natural plant-derived products, and the need to find out whether natural non-nutritive sweeteners are healthier than sugar or an artificial non-nutritive sweetener.
The effect of four different drinks was tested: one contained sugar (sucrose), another the artificial non-nutritive sweetener aspartame and two others the natural NNS made from either the plants Stevia (Rebaudioside A) or monk fruit (Mogroside V). These are the only two natural non-nutritive sweeteners approved by the US Food and Drug Administration, along with six other NNS including aspartame.
In this short term study, thirty healthy male study participants randomly consumed one of the four sweetened drinks on each of the different days of the investigation. On each test day, participants ate a standardized breakfast, and by mid-morning received one test beverage to tide them over until lunch. An hour later they were provided with a lunchtime meal and asked to eat until comfortably full. Their blood glucose and insulin concentrations were measured closely, while participants also kept a food diary of what they ate for the rest of the day.
Tey describes the findings as "surprising". There was no difference in the total daily energy intake across all four treatments, meaning that overall participants consumed the same amount of energy (calories) during the course of a day. They either reduced meal intake after the sucrose-sweetened drink or ate significantly more at lunchtime and the rest of the day to compensate for the three calorie-free drink options.
People sometimes worry that using non-nutritive sweeteners could increase their appetite, which may then lead them to overeat to make up for the energy they saved by not choosing sugar. The current study found that although participants felt slightly hungrier and looked forward more to eating something again when they drank non-nutritive sweetened beverages, they did not overindulge. They did however eat more following the NNS drinks than when they consumed the sugar sweetened drink.
"The energy 'saved' from replacing sugar with non-nutritive sweetener was fully compensated for at subsequent meals in the current study, hence no difference in total daily energy intake was found between the four treatments," explains Tey. "It appears that the source of non-nutritive sweeteners, whether artificial or natural, does not differ in its effects on energy intake, postprandial glucose and insulin," says Tey. However, a recent comprehensive meta-analysis2 of longer term studies has demonstrated that when non-nutritive sweeteners are consumed over time there is a sustained reduction in overall energy intake and it reduces body weight.
Consumption of lutein,found in leafy greens, linked to the preservation of "crystallized intelligence,"
A study of older adults links consumption of a pigment found in leafy greens to the preservation of "crystallized intelligence," the ability to use the skills and knowledge one has acquired over a lifetime.
The study is reported in the journal Frontiers in Aging Neuroscience.
Lutein (LOO-teen) is one of several plant pigments that humans acquire through the diet, primarily by eating leafy green vegetables, cruciferous vegetables such as broccoli, or egg yolks, said University of Illinois graduate student Marta Zamroziewicz, who led the study with Illinois psychology professor Aron Barbey. Lutein accumulates in the brain, embedding in cell membranes, where it likely plays "a neuroprotective role," she said.
"Previous studies have found that a person's lutein status is linked to cognitive performance across the lifespan," Zamroziewicz said. "Research also shows that lutein accumulates in the gray matter of brain regions known to underlie the preservation of cognitive function in healthy brain aging."
The study enrolled 122 healthy participants aged 65 to 75 who solved problems and answered questions on a standard test of crystallized intelligence. Researchers also collected blood samples to determine blood serum levels of lutein and imaged participants' brains using MRI to measure the volume of different brain structures.
The team focused on parts of the temporal cortex, a brain region that other studies suggest plays a role in the preservation of crystallized intelligence.
The researchers found that participants with higher blood serum levels of lutein tended to do better on tests of crystallized intelligence. Serum lutein levels reflect only recent dietary intakes, Zamroziewicz said, but are associated with brain concentrations of lutein in older adults, which reflect long-term dietary intake.
Those with higher serum lutein levels also tended to have thicker gray matter in the parahippocampal cortex, a brain region that, like crystallized intelligence, is preserved in healthy aging, the researchers report.
"Our analyses revealed that gray-matter volume of the parahippocampal cortex on the right side of the brain accounts for the relationship between lutein and crystallized intelligence," Barbey said. "This offers the first clue as to which brain regions specifically play a role in the preservation of crystallized intelligence, and how factors such as diet may contribute to that relationship."
"Our findings do not demonstrate causality," Zamroziewicz said. "We did find that lutein is linked to crystallized intelligence through the parahippocampal cortex."
"We can only hypothesize at this point how lutein in the diet affects brain structure," Barbey said. "It may be that it plays an anti-inflammatory role or aids in cell-to-cell signaling. But our finding adds to the evidence suggesting that particular nutrients slow age-related declines in cognition by influencing specific features of brain aging."
People deciding between low-carb and low-fat diets should know the research shows a slight advantage for low-carb diets when it comes to weight loss, according to an article published today in The Journal of the American Osteopathic Association.
Physicians from the Mayo Clinic in Arizona found low-carb diets (LCDs), including Atkins, South Beach and Paleo, to be safe for up to six months. Depending on the diet, participants lost between two and a half to almost nine more pounds than those who followed a low fat diet.
"The best conclusion to draw is that adhering to a short-term low-carb diet appears to be safe and may be associated with weight reduction," said Dr. Heather Fields, MD, an internal medicine physician at Mayo Clinic in Arizona and lead researcher on this study.
"However, that weight loss is small and of questionable clinical significance in comparison to low-fat diets. We encourage patient to eat real food and avoid highly processed foods, especially processed meats, such as bacon, sausage, deli meats, hot dogs, and ham when following any particular diet."
Analyzing research from January 2005 to April 2016, Dr. Fields reviewed articles that addressed potential adverse effects and overall safety of LCDs. Diets that heavily restrict carbohydrates often lead to greater consumption of meats--some of which have been implicated in worsened all-cause mortality and increased cancer risk.
While available studies did not consistently address the source or quality of proteins and fats consumed in LCDs, they did show short-term efficacy in weight loss without negative effects on blood pressure, glucose, and cholesterol, compared with other diets.
However, Fields says the findings come with a caveat.
"Physicians must keep in mind that the literature is surprisingly limited, considering the popularity of these diets and the claims of health benefits in the public press. Our review found no safety issues identified in the current literature, but patients considering LCDs should be advised there is very little data on long-term safety and efficacy."
A Limited Body of Research
Fields also notes that limitations in the previous research she reviewed made it difficult to draw broad conclusions. For example, studies did not address the type of weight lost, whether muscle, water, or fat; and studies primarily relied on dietary recall, which is highly susceptible to error.
Fields' review found even the definition of LCD to be highly variable. While all were based on carbohydrate restriction, diets allowed carbs to account for anywhere between 4% and 46% of daily calories--which convolutes the evidence.
"As an osteopathic physician, I tell patients there is no one size fits all approach for health," says Dr. Tiffany Lowe-Payne, DO, an osteopathic family physician. Factors like the patient's genetics and personal history should be considered, along with the diet programs they've tried before and, most importantly, their ability to stick to them."
Dr. Lowe-Payne acknowledges that carbohydrates are a mainstay of most people's diets and, after six months, weight loss is virtually the same as for people on a low-fat diet.
However, she noted low-carb diets deliver early benefits for patients trying to lower their blood sugar levels or manage insulin resistance.
"When you think of what dieters want--and what they need to stay motivated--it is the satisfaction of results. They want to see significant weight loss and fast. For many, a low-carb lifestyle provides the answer they are looking for," Dr. Lowe-Payne explained.
Meals based on legumes such as beans and peas are more satiating than pork and veal-based meals according to a recent study by the University of Copenhagen's Department of Nutrition, Excercise and Sports. Results suggest that sustainable eating may also help with weight loss.
Numerous modern dietary recommendations encourage high protein consumption to help with weight loss or prevent the age-related loss of muscle mass. Furthermore, consuming more vegetable-based protein from beans and peas, and less protein from meats such as pork, veal and beef, is recommended because meat production is a far greater burden on our climate than vegetable cultivation. Until now, we haven't known very much about how legumes like beans and peas stack up against meat in satiating hunger. As a result, little has been known about the impact of vegetables and the possibility of them catalyzing or maintaining weight loss.
High protein vegetables fill more
The recent study demonstrated that protein-rich meals based on beans and peas increased satiety more in the study participants than protein-rich veal and pork based meals. In the study, 43 young men were served three different meals in which patties - consisting of either beans/peas or veal/pork - were a key element. The study also demonstrated that when participants ate a protein-rich meal based on beans and peas, they consumed 12% fewer calories in their next meal than if they had eaten a meat-based meal.
"The protein-rich meal composed of legumes contained significantly more fiber than the protein-rich meal of pork and veal, which probably contributed to the increased feeling of satiety", according to the head researcher, Professor Anne Raben of the University of Copenhagen's Department of Nutrition, Exercise and Sports.
Sustainable eating can help weight loss
Most interestingly, the study also demonstrated that a less protein-rich meal based on beans and peas was as satiating and tasty as the protein-rich veal and pork-based meals.
"It is somewhat contrary to the widespread belief that one ought to consume a large amount of protein because it increases satiety more. Now, something suggests that one can eat a fiber-rich meal, with less protein, and achieve the same sensation of fullness. While more studies are needed for a definitive proof, it appears as if vegetable-based meals - particularly those based on beans and peas - both can serve as a long term basis for weight loss and as a sustainable eating habit", concludes Professor Raben.
The results are published in the scientific journal Food & Nutrition in the article: Meals based on vegetable protein sources (beans and peas) are more satiating than meals based on animal protein sources (veal and pork) - a randomized cross-over meal test study.