New guidelines recommend earlier colorectal cancer screening

New guidelines developed by the American Cancer Society (ACS) recommend that screening for colorectal cancer for average-risk adults begin at age 45, five years earlier than the previous recommendation. The guideline update, published as an Early View paper in CA: A Cancer Journal for Clinicians available online here, was co-authored by Elizabeth T. H. Fontham, DrPH, Emeritus Professor and Founding Dean of LSU Health New Orleans School of Public Health and Co-Chair of the American Cancer Society's Screening Guideline Development Group.

The recommendations are based in part on research that found an increased incidence of colorectal cancer in younger adults. Among adults younger than 55 years, there was a 51% increase in the incidence of colorectal cancer (CRC) from 1994 to 2014 and an 11% increase in deaths 2005 to 2015.
The authors reported that colorectal cancer incidence has declined steadily over the past two decades in people 55 and older, partly due to screening that results in the removal of polyps. A recent analysis found that adults born around 1990 have twice the risk of colon cancer and four times the risk of rectal cancer compared with adults born around 1950, who have the lowest risk. Studies suggest that the increased risk for younger people will remain as they age.

Colorectal cancer is the 4th most commonly diagnosed cancer. It is the second leading cause of cancer deaths. When detected and treated early, the five-year survival rate is near 70%.

"The options for colorectal cancer screening are fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years," said Dr. Fontham. "It is important to note that all positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy."

The Guideline Committee also developed new materials to facilitate conversations between clinicians and patients to help patients decide which test is best for them.

"Given the evidence that adults vary in their test preferences, we believe that screening rates could be improved by endorsing the full range of tests without preference. People should have a conversation with their physicians to decide which type of screening is best for them," Fontham added.

The guidelines recommended in the paper focus on people at average risk. Those at high risk for colorectal cancer, including those with a family history, a personal history of inflammatory bowel disease or polyps diagnosed before age 60, should discuss their risk and appropriate screening with their physicians.

The authors conclude, "The ACS recommends that all US adults at average risk of CRC undergo regular screening with any of the 6 options outlined in this guideline, beginning at age 45 years. Adults in good health should continue screening until age 75 years, beyond which the decision to continue screening should be individualized based on patient preferences, health status, life expectancy, and screening history. Ascribing to the adage that the best CRC screening test is the one that gets done, and done well, the ACS recommends that patients initiating screening or previously nonadherent with screening be offered a choice of tests based on the availability of high-quality options. It is our hope that widespread adoption of this guideline will have a major impact on the incidence, suffering, and mortality caused by CRC."

Lecithin + NSAIDs = more anticancer properties and reduced side effects

When scientists at The University of Texas Health Science Center at Houston (UTHealth) applied a chemical found in soybeans to a non-steroidal anti-inflammatory drug (NSAID), they increased its anticancer properties and reduced its side effects. Findings of the preclinical study of phosphatidylcholine, also called lecithin, appear in the journal Oncology Letters.

"The results support the potential use of NSAIDs associated with phosphatidylcholine for the prevention and treatment of colorectal cancer," said Lenard Lichtenberger, Ph.D., the study's lead investigator and a professor of integrative biology and pharmacology at McGovern Medical School at UTHealth.

The NSAID indomethacin associated with phosphatidylcholine was studied in a head-to-head comparison with three other NSAIDs (one of them aspirin). According to the results, the combination provided superior colorectal cancer protection with less gastrointestinal bleeding. The study was conducted in a mouse model and in laboratory experiments.

Colorectal cancer is the third leading cause of cancer-related death in the United States and is expected to claim 50,630 lives this year.

NSAIDs work by decreasing the production of substances that promote inflammation, pain and fever. They are used to prevent heart disease and reduce arthritis pain. NSAIDs, notably aspirin, also guard against colorectal cancer.

"Many cancers are inflammation based," he said. "The anti-inflammatory drugs also have the potential use for cancer therapy."

However, when taken on a daily basis for months to years, NSAIDs can cause problems, Lichtenberger said. "The intestinal injury is worse than the stomach ulcers, for non-aspirin NSAIDs like indomethacin," he said.

"This is our latest preclinical study on the use of phosphatidylcholine to mitigate the side effects of using NSAIDs and protect against a number of cancers," he said.

52 hours exercise over six months for about an hour each = better their thinking skills

We know that exercise may help improve thinking skills. But how much exercise? And for how long? To find the answers, researchers reviewed all of the studies where older adults were asked to exercise for at least four weeks and their tests of thinking and memory skills were compared to those of people who did not start a new exercise routine. The review is published in the May 30, 2018, online issue of Neurology® Clinical Practice, an official journal of the American Academy of Neurology.

They found that people who exercised an average of at least 52 hours over about six months for about an hour each session may improve their thinking skills. In contrast, people who exercised for an average of 34 hours over the same time period did not show any improvement in their thinking skills.
The review did not find a relationship between a weekly amount of exercise and improved thinking skills.

"These results suggest that a longer-term exercise program may be necessary to gain the benefits in thinking skills," said study author Joyce Gomes-Osman, PT, PhD, of the University of Miami Miller School of Medicine in Florida. "We were excited to see that even people who participated in lower intensity exercise programs showed a benefit to their thinking skills. Not everyone has the endurance or motivation to start a moderately intense exercise program, but everyone can benefit even from a less intense plan."

The review included 98 randomized, controlled trials with a total of 11,061 participants with an average age of 73. Of the total participants, 59 percent were categorized as healthy adults, 26 percent had mild cognitive impairment and 15 percent had dementia. A total of 58 percent did not regularly exercise before being enrolled in a study.

Researchers collected data on exercise session length, intensity, weekly frequency and amount of exercise over time. Aerobic exercise was the most common type of exercise, with walking the most common aerobic exercise and others including biking and dancing. Some studies used a combination of aerobic exercise along with strength, or resistance training and some used strength training alone. A small number of studies used mind-body exercises such as yoga or Tai chi.

After evaluating all of the data, researchers found that in both healthy people and people with cognitive impairment longer term exposure to exercise, at least 52 hours of exercise conducted over an average of about six months, improved the brain's processing speed, the amount of time it takes to complete a mental task. In healthy people, that same amount of exercise also improved executive function, a person's ability to manage time, pay attention and achieve goals. However, researchers found no link between the amount of exercise and improved memory skills. Aerobic exercise, strength training, mind-body exercise and combinations of these were all found to be beneficial to thinking skills.

"Only the total length of time exercising could be linked to improved thinking skills," said Gomes-Osman. "But our results may also provide further insight. With a majority of participants being sedentary when they first enrolled in a study, our research suggests that using exercise to combat sedentary behavior may be a reason why thinking skills improved."

Future studies could further investigate which thinking abilities experience the greatest improvement with exercise. They could also look at the short-term and long-term effects of exercise in both sedentary and physically fit individuals.

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Benefits of plant-based diets for heart health

Credit: Physicians Committee for Responsible Medicine

Vegetarian, especially vegan, diets are associated with better cardiovascular health, according to a new review published in the journal Progress in Cardiovascular Diseases.

Researchers with the Physicians Committee for Responsible Medicine looked at multiple clinical trials and observational studies and found strong and consistent evidence that plant-based dietary patterns can prevent and reverse atherosclerosis and decrease other markers of cardiovascular disease (CVD) risk, including blood pressure, blood lipids, and weight.

The review found that a plant-based diet:

• Reduces the risk of death from cardiovascular disease by 40 percent.
• Reduces the risk of coronary heart disease by 40 percent.
• Fully or partially opens blocked arteries in up to 91 percent of patients.
• Reduces the risk of hypertension by 34 percent.
• Is associated with 29 mg/dL and 23 mg/dL lower total cholesterol and LDL-C levels, respectively, compared with non-vegetarian diets.
• Is associated with weight loss.

"A plant-based diet has the power to not only prevent heart disease, but also manage and sometimes even reverse it--something no drug has ever done," says study author Hana Kahleova, M.D., Ph.D., Physicians Committee director of clinical research.

The review notes that a healthy diet and lifestyle reduces the risk for a heart attack by 81-94 percent, while medications can only reduce the risk by 20-30 percent.

Plant-based diets benefit heart health because they're rich in fiber and phytonutrients--like carotenoids, anthocyanins, and lycopene--which reduce inflammation and oxidative stress. Animal products are packed with saturated fat, cholesterol, heme iron, and environmental pollutants and can harm heart health.

"Heart disease is the world's leading cause of death. This study proves it doesn't have to be," says Dr. Kahleova.

Around the globe, cardiovascular disease is responsible for 46 percent of non-communicable disease deaths, or 17.5 million deaths a year.

Positive effects of chewing gum while walking, especially in middle-aged and elderly men

New research presented at this year's European Congress on Obesity (ECO) in Vienna, Austria (23-26) May shows chewing gum while walking increases heart rate and energy expenditure. The study was conducted by Dr Yuka Hamada and colleagues at Waseda University, Graduate School of Sport Sciences, Saitama, Tokyo, Japan.

Although there have been a number of studies which have examined the effect of chewing gum on physiological functions while at rest, none have focused specifically on how it impacts the body while walking, which is the basis for this study.

The authors recruited 46 male and female participants aged 21-69 to participate in two trials in random order. In one trial, individuals were given 2 pellets of gum (1.5g and 3 kilocalories per pellet) to chew while walking at their natural pace for 15 minutes after a 1-hour rest period. The control trial involved the same 1-hour rest and 15 minute walk, however participants were given a powder to ingest which contained the same ingredients as gum, but did not require them to chew.

In each trial resting heart rate, mean heart rate during walking, distance covered, and cadence (rate at which they took steps) were measured. Mean walking speed was calculated from the distance travelled during the 15 minutes, and stride length was estimated from the mean walking speed and mean step count. Total energy expenditure during the walk was estimated based on the mean walking speed and the body mass of each participant.

The study found that in all participants, the mean heart rate while walking as well as the change in heart rate from being at rest was significantly higher in the gum trial than in the control trial.

The team then performed stratified analyses by sex and age, separating the group into male and female, as well as young (39 and under), middle-aged and elderly (40 and older). Both male and female participants in the gum trial had a significantly higher mean heart rate while walking and change in heart rate, however in males there was also a significant increase in the distance walked and mean walking speed when compared to the control trial. (see p627, full paper, link below).

While all ages experienced a significantly larger change in heart rate in the gum trial, middle-aged and elderly participants also had a significantly higher mean heart rate while walking compared to the control.

Combining these analyses to incorporate both sex and age showed that chewing gum had the greatest effect in middle-aged and elderly men who experienced a significant positive effect on distance walked, mean walking speed, mean step counts, mean heart rate while walking, change in heart rate, and total energy expenditure compared to the control trial.

The authors conclude: "Chewing gum while walking affects a number of physical and physiological functions in men and women of all ages. Our study also indicates that gum chewing while walking increased the walking distance and energy expenditure of middle-aged and elderly male participants in particular."

Most popular vitamin and mineral supplements provide no health benefit

The most commonly consumed vitamin and mineral supplements provide no consistent health benefit or harm, suggests a new study led by researchers at St. Michael's Hospital and the University of Toronto.

Published today in the Journal of the American College of Cardiology, the systematic review of existing data and single randomized control trials published in English from January 2012 to October 2017 found that multivitamins, vitamin D, calcium and vitamin C - the most common supplements - showed no advantage or added risk in the prevention of cardiovascular disease, heart attack, stroke or premature death. Generally, vitamin and mineral supplements are taken to add to nutrients that are found in food.

"We were surprised to find so few positive effects of the most common supplements that people consume," said Dr. David Jenkins*, the study's lead author. "Our review found that if you want to use multivitamins, vitamin D, calcium or vitamin C, it does no harm - but there is no apparent advantage either."

The study found folic acid alone and B-vitamins with folic acid may reduce cardiovascular disease and stroke. Meanwhile, niacin and antioxidants showed a very small effect that might signify an increased risk of death from any cause.

"These findings suggest that people should be conscious of the supplements they're taking and ensure they're applicable to the specific vitamin or mineral deficiencies they have been advised of by their healthcare provider," Dr. Jenkins said.

His team reviewed supplement data that included A, B1, B2, B3 (niacin), B6, B9 (folic acid), C, D and E; and β-carotene; calcium; iron; zinc; magnesium; and selenium. The term 'multivitamin' in this review was used to describe supplements that include most vitamins and minerals, rather than a select few.

"In the absence of significant positive data - apart from folic acid's potential reduction in the risk of stroke and heart disease - it's most beneficial to rely on a healthy diet to get your fill of vitamins and minerals," Dr. Jenkins said. "So far, no research on supplements has shown us anything better than healthy servings of less processed plant foods including vegetables, fruits and nuts."

High protein diet = increased heart failure risk in middle-aged men

For middle-aged men, eating higher amounts of protein was associated with a slightly elevated risk for heart failure than those who ate less protein, according to new research in Circulation: Heart Failure, an American Heart Association journal.

Despite the popularity of high protein diets, there is little research about how diets high in protein might impact men's heart failure risk.

"As many people seem to take the health benefits of high-protein diets for granted, it is important to make clear the possible risks and benefits of these diets," said Jyrki Virtanen, Ph.D., study author and an adjunct professor of nutritional epidemiology at the University of Eastern Finland in Kuopio.
"Earlier studies had linked diets high in protein - especially from animal sources -- with increased risks of Type 2 diabetes and even death."

The American Heart Association estimates that one in five Americans 40 and older will develop heart failure - the body is unable to pump enough blood and oxygen to remain healthy. Heart failure can shorten life expectancy. And with no cure, preventing heart failure through diet, lifestyle and more is vital.

Researchers studied 2,441 men, age 42 to 60, at the study's start and followed them for an average 22 years. Overall, researchers found 334 cases of heart failure were diagnosed during the study and 70 percent of the protein consumed was from animal sources and 27.7 percent from plant sources. Higher intake of protein from most dietary sources, was associated with slightly higher risk. Only proteins from fish and eggs were not associated with heart failure risk in this study, researchers said.

For this study, researchers divided the men into four groups based on their daily protein consumption.

When they compared men who ate the most protein to those who ate the least, they found their risk of heart failure was:

• 33 percent higher for all sources of protein;
• 43 percent higher for animal protein;
• 49 percent higher for dairy protein.
• 17 percent higher for plant protein.

"As this is one of the first studies reporting on the association between dietary protein and heart failure risk, more research is needed before we know whether moderating protein intake may be beneficial in the prevention of heart failure," said Heli E.K. Virtanen, M.Sc., first author of study, Ph.D. student and early career researcher at the University of Eastern Finland in Kuopio. "Long-term interventions comparing diets with differential protein compositions and emphasizing differential protein sources would be important to reveal possible effects of protein intake on risk factors of heart failure. More research is also needed in other study populations."

The American Heart Association recommends a dietary pattern that includes a variety of fruits and vegetables, whole grains, low-fat dairy products, poultry, fish, beans, non-tropical vegetable oils and nuts; and limits intake of sweets, sugar-sweetened beverages and red meats.

Seafood-rich diet may help couples get pregnant faster

Couples who eat more seafood tend to have sexual intercourse more often and get pregnant faster than other couples trying to conceive, according to a new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Seafood is an important source of protein and other nutrients for women who are or may become pregnant, but concerns about mercury have led some women to avoid fish when trying to conceive. According to the Food and Drug Administration and the Environmental Protection Agency, 90 percent of the fish eaten in the United States is low in mercury and safe to eat. Although the agencies recommend two to three servings of lower-mercury fish per week, 50 percent of pregnant women still eat far less than the recommended amount.

"Our study suggests seafood can have many reproductive benefits, including shorter time to pregnancy and more frequent sexual activity," said one of the study's authors, Audrey Gaskins, Sc.D., of Harvard T.H. Chan School of Public Health in Boston, Mass. "Our study found that couples who consume more than two servings of seafood per week while trying to get pregnant, had a significantly higher frequency of sexual intercourse and shorter time to pregnancy."

In the prospective cohort study, researchers from Harvard followed 500 Michigan and Texas couples from the Longitudinal Investigation of Fertility and the Environment (LIFE) Study for one year to determine the relationship between seafood intake and time to pregnancy. Participants recorded their seafood intake and sexual activity in daily journals.

The researchers found that 92 percent of couples who ate seafood more than twice a week were pregnant at the end of one year, compared to 79 percent among couples consuming less seafood. The association between seafood and faster time to pregnancy was not completely explained by more frequent sexual activity, suggesting other biological factors were at play. These could include effects on semen quality, ovulation or embryo quality, Gaskins said.

"Our results stress the importance of not only female, but also male diet on time to pregnancy and suggests that both partners should be incorporating more seafood into their diets for the maximum fertility benefit," she said.

Time spent sitting at a screen matters more if you aren't fit and strong

The impact of screen time on cardiovascular disease, cancer incidence and mortality may be greatest in people who have lower levels of grip-strength, fitness and physical activity, according to a study published in the open access journal, BMC Medicine.

Researchers at Glasgow University, UK, found that the amount of leisure time spent watching a television or computer screen had almost double the impact on the risk of mortality, cardiovascular disease and cancer in people with low grip strength or low fitness levels than on participants who had the highest levels of fitness and grip strength. Increasing strength and fitness may offset the adverse health consequences of spending a large proportion of leisure time sitting down and watching a screen, according to the authors.

Dr Carlos Celis, corresponding author of the study said: "Our study shows that the risks associated with sedentary behaviour are not the same for everyone; individuals with low physical activity experience the greatest adverse effects. "This has potential implications for public health guidance as it suggests that specifically targeting people with low fitness and strength for interventions to reduce the time they spend sitting down may be an effective approach."

The authors suggest that measuring grip strength could be an efficient way to target individuals that may benefit most from public health interventions to reduce screen time.

Dr Celis explained: "While fitness testing can be difficult in healthcare and community settings, grip strength is a quick, simple and cheap measure, therefore it would be easy to implement as a screening tool in a variety of settings."

The study analysed data from 391,089 participants from the UK Biobank, a large, prospective, population-based study that includes data on all-cause mortality, cardiovascular disease and cancer incidence, along with screen time, grip strength, fitness and physical activity.

The researchers caution that the use of self-reported screen time and physical activity data may have impacted on the strength of the associations drawn in this study. The observational nature of the study does not allow for conclusions about cause and effect.

Irregular sleep patters = increased mortality risk

In a recent Journal of Sleep Research study, short, but not long, weekend sleep was associated with an increased risk of early death in individuals under 65 years of age. In the same age group, either short sleep or long sleep on both weekdays and weekends showed increased mortality when compared with consistently sleeping 6-7 hours per day.

The link between sleep duration and mortality seems to be easier to understand when considering the analysis of the joint effects of weekday and weekend sleep, the authors noted. "The results imply that short (weekday) sleep is not a risk factor for mortality if it is combined with a medium or long weekend sleep," they wrote. "This suggests that short weekday sleep may be compensated for during the weekend, and that this has implications for mortality."

Antidepressant use may be linked to increased risk of weight gain

Long term use of antidepressants is associated with a sustained increase in risk of weight gain over at least five years, finds a study published in The BMJ today.

The findings show that patients prescribed any of the 12 most commonly used antidepressants were more likely to experience weight gain than those not taking the drugs. The risk was greatest during the second and third years of treatment.

Obesity and weight gain are global public health problems, with approximately 60% of UK adults currently overweight or obese. Depression is common in people who are severely obese and the rate of antidepressant prescribing is increasing, which could have potential impact on public health.

However, little research has been reported on the impact of widespread antidepressant treatment on weight gain.

So a UK based research team, led by Rafael Gafoor at King's College London, set out to investigate the association between the use of antidepressants and weight gain.

The researchers analysed body weight and body mass measurement data from the UK Clinical Practice Research Datalink (CPRD) for over 300,000 adults with an average age of 51, whose body mass index (BMI) had been recorded three or more times during GP consultations from 2004-2014.

Participants were grouped according to their BMI (from normal weight to severely obese) and whether or not they had been prescribed an antidepressant in a given year. Participants were then monitored for a total of 10 years.

The researchers found that the absolute risk of gaining at least 5% weight without antidepressant use was 8.1 per 100 person years; whereas the risk with antidepressant use was 9.8 per 100 person years.
To put this into context, this means that for every 59 people taking antidepressants, one extra person would gain at least 5% weight over the study period.

The risk was greatest during the second and third years of treatment. During the second year of treatment, the risk of gaining at least 5% weight was 46% higher than in the general population, but no association was found during the first 12 months of treatment.

They also found that people who were initially of normal weight had a higher risk of moving to either the overweight or obese groups, and people who were initially overweight had a higher risk of moving to the obese group if they were taking antidepressants.

Results remained largely unchanged after further analysis to take account of various factors including age, sex and whether the participants had other conditions such as diabetes, stroke and cancer.
This is an observational study, so no firm conclusions can be drawn about cause and effect, and the researchers outline some limitations that could have affected the results. However, strengths include the large number of participants and long term follow up.

The researchers say that the results suggest the widespread use of antidepressants "may be contributing to long term increased weight gain at a population level, and that the potential for weight gain should be considered when antidepressant treatment is indicated."

Lead author Dr Rafael Gafoor from King's College London, said: "It's important to stress that no patients should stop taking their medication and that if they have any concerns they should speak with their doctor or pharmacist."*

In a linked editorial, Alessandro Serretti and Stefano Porcelli, from the University of Bologna emphasise that doctors should give lifestyle advice on diet and exercise to minimise the risk of gaining weight and that weight should be measured during antidepressant treatment.

They say that whilst antidepressant treatment should always be offered to those with moderate or severe depression, alternative treatment such as group cognitive behavioural therapy may be preferable for people with milder depression.

"Currently, we are still unable to identify patients at higher risk of weight gain with antidepressants. Hopefully it will be possible in the not too distant future to identify a genetic predisposition and recognise those at higher risk before treatment is started", the authors conclude.

Evening use of light-emitting tablets may disrupt healthy sleep

A new Physiological Reports study reveals that evening use of light-emitting tablets can induce delays in desired bedtimes, suppress secretion of melatonin (the hormone that regulates sleep and wakefulness), and impair next-morning alertness.

Nine healthy adults participated in a randomized and counterbalanced study comparing 5 consecutive evenings of unrestricted use of light-emitting tablet computers versus evenings reading from printed materials.

On evenings when using light-emitting tablets, participants' self-selected bedtimes were on average half an hour later, and they showed suppressed melatonin levels, delayed timing of melatonin secretion onset, and later sleep onset. When using the tablets, participants rated themselves as less sleepy in the evenings and less alert in the first hour after awakening on the following mornings.

"These findings provide more evidence that light-emitting electronic devices have biological effects," said co-author Dr. Jeanne Duffy, of Brigham and Women's Hospital and Harvard Medical School. "Using light-emitting electronic devices in the late evening can postpone our decision to go to sleep, and make us more sleepy the next morning."

Nuts and peanuts can improve glycemic control and blood lipids in those with type 2 diabete

One of the largest studies to date on nuts and diabetes was published today in Diabetologia*, the journal of the European Association for the Study of Diabetes (EASD). The study shows that approximately two ounces of nuts a day, as a replacement for carbohydrate foods, can improve glycemic control and blood lipids in those with type 2 diabetes.

Researchers from the University of Toronto and St. Michael's Hospital in Toronto, Canada, found that tree nuts (almonds, Brazils, cashews, hazelnuts, pecans, pine nuts, pistachios, macadamias and walnuts) and peanuts improved blood lipid levels and blood sugar levels in individuals with non-insulin dependent diabetes.

This study, which was retracted by the authors at their request, was originally published in Diabetes Care**. It was a 3-month parallel design with 117 non-insulin dependent adults with diabetes (men and women with a mean age of 62 years) who were all being treated with oral hypoglycemic medications. The subjects were randomized to one of three diets for three months. The first diet included a supplement of 75g (~2½ ounces or ½ cup) of mixed nuts; the second diet included 38g (~1? ounces or ¼ cup) of mixed nuts and half portion of whole wheat muffins; and the third diet contained a full portion of whole wheat muffins.

Each supplement provided approximately 475 calories per 2,000 calorie diet. All of the diets contained roughly the same number of calories, but the nuts provided more unsaturated (i.e. healthy) fat and less carbohydrate.

The goal of the study was to determine if nuts improve glycemic control in non-insulin dependent diabetes, as assessed by HbA1c (a marker of blood sugar control over the previous three months), and also improve markers of cardiovascular health.

"The original findings revealed that the full dose nut group had a significant reduction in HbA1c compared to the other two groups," stated David Jenkins, MD, PhD, DSc, with the University of Toronto and St. Michael's Hospital. "The current study shows a reduction in HbA1c and the low-density lipoprotein (LDL)-associated cardiovascular disease (CVD) risk factor, apolipoprotein B (Apo-B), stated Dr. Jenkins. "We also found lower levels of small LDL cholesterol-- which is an emerging risk factor for CVD." He added, "The bottom line is, this study showed a modest but significant improvement in blood glucose control, despite the higher fat intake, and improvement in lipid risk factors for heart disease with increasing nut dose."

According to Cyril Kendall, Ph.D., co-investigator of the study, "The improvements in blood glucose control and blood lipid levels that can be achieved by dietary and lifestyle changes are significant and could make a substantial contribution to the treatment of those with type 2 diabetes. Nuts are a healthy and flavorful option for individuals with diabetes that also promote healthy body weight."

A number of studies have suggested that consuming tree nuts may reduce the risk of heart disease, confirmed by the PREDIMED trial in 2013. In 2003 tree nuts received a qualified health claim from the U.S. Food and Drug Administration (FDA) which states, "Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease." Interestingly, adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes.

Cheeseburger or salad? How music volume impacts your decision University

Music can be the ultimate mood setter. Faster beats ignite excitement, while slower songs help one relax. And that makes all the difference in what we order from restaurant menus.

A study published in the Journal of the Academy of Marketing Sciences finds the volume of ambient music has a systemic effect on consumers' preferences for healthy vs. non-healthy foods. That's because volume is proven to directly impact heart rate and arousal. Softer music has a calming effect, making us more mindful of what we order. This typically results in healthier choices, such as a salad. Louder environments increase stimulation and stress, inspiring diners to crave a greasy cheeseburger and fries instead.

"Restaurants and supermarkets can use ambient music strategically to influence consumer buying behavior," said Dipayan Biswas, PhD, marketing professor at the University of South Florida Muma College of Business."

Dr. Biswas conducted the study at a café in Stockholm, Sweden, which played various genres of music in a loop separately at 55Db and 70Db. The menu items were coded as healthy, non-healthy and neutral, the category used for items like coffee or tea. During the experiment conducted over several hours across multiple days, researchers found 20% more restaurant patrons ordered something unhealthy when exposed to louder ambient music compared to those who dined during a quieter time.


While previous studies have looked at varying aspects of ambience's impact on food sales such as lighting, scent and décor, this is the first study to look specifically at how volume dictates healthy vs. non-healthy food choices. These findings allow restaurant managers to strategically manipulate music volume to influence sales.

Protein supplements most effective when eaten with meals

People looking to manage their weight with strength-training and protein supplements should consume their supplements during a meal, according to a research review by nutrition experts at Purdue University.

"It may matter when you take your supplements in relation to when you eat meals, so people who consume protein supplements in between meals as snacks may be less likely to be successful in managing their body weight," said Wayne Campbell, professor of nutrition science and senior author on the study.

The findings are published in Nutrition Reviews. The study is led by Joshua Hudson, a Purdue postdoctoral research associate. Robert Bergia, a graduate research assistant, also contributed. The analysis was supported by Purdue's Department of Nutrition Science.

Protein supplements are available in ready-to-drink, powdered and solid forms, and often contain whey, casein or soy proteins. They can help with weight gain, weight loss or weight management based on how they are incorporated into an eating plan and taken with meals or as snacks.

"This is really the first time that the issue of timing when supplements are consumed in regard to meals has been looked at," Hudson said. "This review needs to be followed up by rigorous studies to better evaluate the timing of protein supplements in relationship to meals."

Their analysis of research studies found that while protein supplementation effectively increased lean mass for all groups, consuming protein supplements with meals helped maintain their body weight while decreasing their fat mass. In contrast, consuming protein supplements between meals promoted weight gain.

The timing likely makes a difference because a person may tend to adjust their calories at a meal time to include the protein supplement.

"Such dietary compensation is likely missing when protein supplements are consumed as snacks.

Calories at meal times may not be adjusted to offset the supplement's calories, thus leading to a higher calorie intake for that day," said Campbell, whose expertise integrates human nutrition, exercise physiology and geriatrics. "If the goal is to manage weight, then snacking on protein supplements may be less effective. People who are trying to gain weight may consider consuming protein supplements between meals."

More than 2,000 nutrition articles were screened across journal databases to identify 34 studies with 59 intervention groups that were related to this topic. The studies were selected based on specific factors including inclusion of healthy adults, evaluating consumption of protein supplements between meals or with meals, whether results showed a change in lean muscle mass, and a minimum of six weeks duration for each of the studies.

Perceived socioeconomic status can affect how old we feel

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A recent study finds that how older adults perceive their socioeconomic status influences how old they feel and their attitudes toward aging. Specifically, the lower people deem their relative socioeconomic status, the worse they feel about growing older.

"We're not talking about actual socioeconomic status, but about how people feel their socioeconomic status compares to others in their community," says Shevaun Neupert, an associate professor of psychology at North Carolina State University and co-author of a paper on the work.

"So, someone could be successful and affluent, but if they feel less successful and affluent than their peers, they are more likely to feel older and have more negative attitudes regarding aging," Neupert says.

"This is important because negative attitudes about aging, and how old we feel, determine how we respond to stress and can affect quality of life -- and health -- in a meaningful way."

For this study, researchers conducted an online survey of 296 adults over the age of 60 from across the United States. Study participants were asked a series of questions to assess their socioeconomic status, how they felt that status compared to others in their community, and their attitudes and experiences related to aging.

The researchers found that actual socioeconomic status, education and income, did not correspond to changes in aging attitudes. But the way people perceived their status relative to their community made a significant difference.

"We found that the effect was linear," Neupert says. "The higher one's perceived relative socioeconomic status, the younger people felt and the better their attitudes about aging; the lower one's perceived status, the older people felt and the worse they felt about aging. We found this effect regardless of age, physical health, sex or race.

"In short, the urge to 'keep up with the Joneses' appears to have real consequences as we grow older," Neupert says.

Mediterranean diet may protect harm of long-term exposure to air pollution, and reducerisk of dying from heart attacks, stroke and other causes

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"Previous studies have shown that dietary changes, particularly the addition of antioxidants, can blunt the adverse effects of exposure to high levels of air pollution over short time periods," said Chris C. Lim, MS, a doctoral student at the NYU School of Medicine. "What we did not know was whether diet can influence the association between long-term air pollution exposure and health effects."

Rich in antioxidants, the Mediterranean diet favors fruits, vegetables, whole grains, legumes, olive oils, fish and poultry over red meat and processed foods. Antioxidants are molecules that disarm oxidized and highly reactive molecules, or free radicals, that are known to cause cell and tissue damage.

The researchers analyzed data from the National Institutes of Health (NIH)-American Association of Retired Persons (AARP) Diet and Health Study. Over 17 years, the study followed 548,699 people (average age 62 at enrollment) from 6 states -- California, North Carolina, New Jersey, Florida, Louisiana and Pennsylvania -- and two cities -- Atlanta and Detroit. During that time, 126,835 people in the study group died.

The researchers created five groups of participants based on their level of adherence to a Mediterranean diet and linked participants to estimates of long-term exposure to fine particulate matter (PM2.5), nitrous oxide (NO₂) and ozone (O₃) based on census tract information.
When comparing those least and most adherent to a Mediterranean diet, the study found that:

• Deaths from all causes increased by 5 percent for every 10 parts per billion (ppb) increase in long-term average NO₂ exposure in those least adherent, compared to 2 percent among the most adherent.
• Cardiovascular disease deaths increased by 17 percent for every 10 micrograms per cubic meter (?g/m3) increase in long-term average PM2.5 exposure in those least adherent, compared to 5 percent among the most adherent.
• Cardiovascular disease deaths increased by 10 percent for every 10 ppb increase in NO₂. exposure in those least adherent, compared to 2 percent among the most adherent.
• Heart attack deaths increased by 20 percent for every 10 ?g/m3 increase in PM2.5 exposure in those least adherent, compared to 5 percent among the most adherent.
• Heart attack deaths increased by 12 percent for every single ppb increase in NO2 exposure in those least adherent, compared to 4 percent among the most adherent.

Adherence to a Mediterranean diet did not appear, however, to protect against the harmful effects of long-term exposure to O₃. The diet did not reduce deaths from all causes, heart attack or other cardiovascular diseases associated with O₃ exposure.

"Given the benefits we found of a diet high in anti-oxidants, our results are consistent with the hypothesis that particle air pollution caused by fossil fuel combustion adversely affects health by inducing oxidative stress and inflammation," said senior study author George Thurston, ScD, director of the Program in Exposure Assessment and Human Health Effects at the Department of Environmental Medicine, NYU School of Medicine. "On the other hand, the ozone effect was not significantly blunted by a Mediterranean diet, so ozone apparently affects cardiac health through a different mechanism."

With about one-fourth of the study population living where air pollution levels were 10 ?g/m3 or more above the lowest exposure, he added, "adoption of a Mediterranean diet has the potential to reduce the effects of air pollution in a substantial population in the United States."

Could intermittent fasting diets increase diabetes risk?

Fasting every other day to lose weight impairs the action of sugar-regulating hormone, insulin, which may increase diabetes risk, according to data presented in Barcelona at the European Society of Endocrinology annual meeting, ECE 2018. These findings suggest that fasting-based diets may be associated with long-term health risks and careful consideration should be made before starting such weight loss programmes.
Type-2 diabetes is a growing global epidemic that is often attributed to poor diet and a sedentary lifestyle, so is closely linked to obesity. Blood sugar is partially regulated by the hormone insulin, which is produced by the pancreas, if insulin levels are too low, or the body becomes resistant to its effects, type-2 diabetes results and high blood sugar levels can cause serious health issues, including heart, kidney and eye damage. In addition to medical strategies used to treat type-2 diabetes, patients are also advised to make lifestyle and dietary changes to lose weight. Recently, intermittent fasting diets have gained general popularity for weight loss, however, evidence on their success has been contradictory and there is a lack of knowledge and some debate on their potentially harmful long-term health effects. Previous research has also shown that short-term fasting can produce molecules called free radicals, which are highly reactive chemicals that can cause damage to the body at a cellular and may be associated with impaired organ function, cancer risk and accelerated aging.
In order to investigate whether an intermittent fasting diet could also generate damaging free radicals, Ana Bonassa and colleagues, from the University of Sao Paulo in Brazil, examined the effects of fasting every other day on the body weight, free radical levels and insulin function of normal, adult rats, over a 3-month period. Although the rats' body weight and food intake decreased as expected over the study period, the amount of fat tissue in their abdomen actually increased. Furthermore, the cells of the pancreas that release insulin showed damage, with the presence of increased levels of free radicals and markers of insulin resistance were also detected.
Ana Bonassa comments, "This is the first study to show that, despite weight loss, intermittent fasting diets may actually damage the pancreas and affect insulin function in normal healthy individuals, which could lead to diabetes and serious health issues."
The researchers now plan to investigate how this diet impairs pancreas and insulin function. There are many conflicting reports on the benefits and disadvantages, and many different types of intermittent fasting diets. Although these data were obtained in normal weight rats with positive effects on weight gain and food intake, the results suggest that in the long-term harm may be caused and that more investigation is needed to assess how people may be affected, particularly those with existing metabolic issues.
Ana cautions, "We should consider that overweight or obese people who opt for intermittent fasting diets may already have insulin resistance, so although this diet may lead to early, rapid weight loss, in the long-term there could be potentially serious damaging effects to their health, such as the development of type-2 diabetes."

Exercise to stay young: 4-5 days a week to slow down your heart's aging

Participating in exercise 4-5 days per week is necessary to keep your heart young, according to new research published in The Journal of Physiology. These findings could be an important step to develop exercise strategies to slow down such ageing.

The optimal amount of exercise required to slow down ageing of the heart and blood vessels has long been a matter of vigorous debate. As people age, arteries - which transport blood in and out of the heart - are prone to stiffening, which increases the risk of heart disease. Whilst any form of exercise reduces the overall risk of death from heart problems, this new research shows different sizes of arteries are affected differently by varying amounts of exercise. 2-3 days a week of 30 minutes exercise may be sufficient to minimise stiffening of middle sized arteries, while exercising 4-5 days a week is required to keep the larger central arteries youthful.

The authors performed a cross-sectional examination of 102 people over 60 years old, with a consistently logged lifelong exercise history. Detailed measures of arterial stiffness were collected from all participants, who were then categorised in one of four groups depending on their lifelong exercise history: Sedentary: less than 2 exercise sessions/week; Casual Exercisers: 2-3 exercise sessions per week; Committed Exercisers: 4-5 exercise sessions/week and Masters Athletes: 6-7 exercise sessions per week. (NB: an exercise session was at least 30 minutes).

Upon analysing the results, the research team found that a lifelong history of casual exercise (2-3 times a week) resulted in more youthful middle sized arteries, which supply oxygenated blood to the head and neck. However, people who exercised 4-5 times per week also had more youthful large central arteries, which provide blood to the chest and abdomen, in addition to healthier middle sized ones.

The fact the larger arteries appear to require more frequent exercise to remain youthful will aid the development of long-term exercise programmes. They also enable the research team to now focus on whether or not ageing of the heart can be reversed by exercise training over a long period of time.
The research may have been limited by the fact that individuals were allocated to groups based on past exercise frequency, as opposed to other components of exercise programmes such as intensity, duration or mode, all of which could have large impacts on vascular adaptations. Furthermore, additional, unmeasured factors such as dietary intake and social background could influence arterial compliance indirectly through reduced adherence, or by non-exercise related means.
Benjamin Levine, one of the authors of the study, is excited to investigate this in the future:
"This work is really exciting because it enables us to develop exercise programmes to keep the heart youthful and even turn back time on older hearts and blood vessels. Previous work by our group has shown that waiting until 70 is too late to reverse a heart's ageing, as it is difficult to change cardiovascular structure even with a year of training. Our current work is focussing on two years of training in middle aged men and women, with and without risk factors for heart diseases, to see if we can reverse the ageing of a heart and blood vessels by using the right amount of exercise at the right time".

Improving heart health could prevent frailty in old age

New research has shown that older people with very low heart disease risks also have very little frailty, raising the possibility that frailty could be prevented.

The largest study of its kind, led by the University of Exeter, found that even small reductions in risk factors helped to reduce frailty, as well as dementia, chronic pain, and other disabling conditions of old age.

Many perceive frailty to be an inevitable consequence of ageing - but the study, published in the Journal of Gerontology: Medical Sciences found that severe frailty was 85% less likely in those with near ideal cardiovascular risk factors.

It also found that those with fewer heart disease risk factors were much less likely to have other conditions unrelated to the heart - including chronic pain, incontinence, falls, fractures, and dementia.
Dr João Delgado, of the University of Exeter Medical School, joint lead author of the study, said:

"This study indicates that frailty and other age-related diseases could be prevented and significantly reduced in older adults. Getting our heart risk factors under control could lead to much healthier old ages. Unfortunately, the current obesity epidemic is moving the older population in the wrong direction, however our study underlines how even small reductions in risk are worthwhile." The study analysed data from more than 421,000 people aged 60-69 in both GP medical records and in the UK Biobank research study. Participants were followed up over ten years.

The researchers analysed six factors that could impact on heart health. They looked at uncontrolled high blood pressure, cholesterol and glucose levels, plus being overweight, doing little physical activity and being a current smoker.

Dr Janice Atkins, of the University of Exeter Medical School, joint lead author of the study, said: "A quarter (26%) of participants from UK Biobank, made of predominantly healthy volunteers, had near perfect cardiovascular risk factors compared to only 2.4% of the population via GP records. This highlights the huge potential for improvement in cardiovascular risk factors of the general population in the UK."

It is the first largescale study to show that older people with near-ideal cardiovascular risk factor profiles have better outcomes on a number of factors that are not directly linked to heart-disease.
Dr. George Kuchel, Director of the UConn Center on Aging at UConn Health, co-researcher on the study, said: "Individuals with untreated cardiovascular disease or other common chronic diseases appear to age faster and with more frailty. In the past, we viewed ageing and these common chronic diseases as being both inevitable and unrelated to each other. Now our growing body of scientific evidence on ageing shows what we have previously considered as inevitable might be prevented or delayed through earlier and better recognition and treatment of cardiac disease.

"This overall approach working at the interface of ageing and varied chronic diseases could be transformative in helping adults to maintain function and independence in late life, adding life to their years as opposed to just years to their life."

Dr Ivan Pavlov, Programme Manager for Systems Medicine at the MRC, said: "These findings are relevant to us all because they re-emphasise the importance of a healthy lifestyle for better quality of life in old age. These new results also show that age-related conditions may share common risk factors or mechanisms with cardiovascular diseases. We're living longer so it's crucial that we recognise this by taking care of our bodies and monitoring our risk for disease even earlier in life."

Vascular risk interacts with amyloid levels to increase age-related cognitive decline

Risk factors for heart disease and stroke appear to hasten the risk of cognitive decline in normal older individuals with evidence of very early Alzheimer's-disease-associated changes in the brain. Vascular risk factors increase the risk of cognitive impairment in older individuals and appear to have a negative synergistic effect with levels of brain amyloid-beta, the protein that aggregates into neurotoxic plaques in the brains of individuals with Alzheimer's disease. In their report published in JAMA Neurology, a team of Massachusetts General Hospital (MGH) investigators describes finding that the combination of increased vascular risk and higher brain amyloid levels predicted even faster cognitive decline in clinically normal older individuals than would be expected based on the independent effects of both factors.

"Our findings suggest that having vascular risk factors like diabetes, smoking, and high blood pressure may accelerate the rate of cognitive decline in normal older adults, and that the effect of vascular risk on decline is magnified in people with higher brain amyloid levels," says Jennifer Rabin, PhD, a clinical and research fellow in the MGH Department of Psychiatry, lead author of the paper. "Our findings support the rationale behind targeting modifiable vascular risk factors either alone or in combination with amyloid-lowering therapies to delay cognitive decline. Measures of vascular risk also may be able to complement existing biomarkers in identifying people at the greatest risk of cognitive decline."

Alzheimer's disease and cerebrovascular disease are probably the two most common causes of cognitive impairment in the elderly, but even though they often co-occur in individual patients, they are typically viewed as independent contributors. While the presence of amyloid plaques in the brain is considered a hallmark of Alzheimer's disease, some individuals with elevated amyloid levels never develop cognitive impairment. This has led to a search for additional markers beyond brain amyloid to help identify those at increased risk for cognitive decline.

The current study was designed to investigate whether the effects of increased brain amyloid and of vascular risk on cognitive decline are merely additive, reflecting a simple combination of the risks independently contributed by each factor, or synergistic, in which interaction of the two produces an even higher level of risk. Another goal was determining whether vascular risk remained a powerful predictor of cognitive decline, even when investigators also considered other cutting-edge measures of brain health derived from PET scans and MRIs.

The study analyzed data from 223 participants in the Harvard Aging Brain Study, an ongoing study of cognitively normal individuals ages 50 to 90 designed to improve understanding of brain changes affecting memory and cognition that occur with aging. Upon enrollment in the study, participants receive standard imaging biomarker studies, including PET scans with a compound that reveals amyloid deposits in the brain. Assessment of vascular risk is determined by the Framingham cardiovascular risk score, which is based on factors such as hypertension, body mass index, and histories of diabetes or smoking. Participants also receive standard tests of memory, attention and language, which are repeated at annual follow-up visits.

The results showed that both elevated brain amyloid levels and higher vascular risk, as measured upon study enrollment, were associated with more rapid cognitive decline, with the most rapid changes seen in participants with elevations in both factors. The extent of the interaction between the two measures suggested a synergistic, rather than simply an additive effect. Vascular risk remained a consistently strong predictor of cognitive decline, even after controlling for other biomarkers; and while the study did not directly compare the contributions of brain amyloid levels and vascular risk to the rate of cognitive decline, the predictive power of both factors was statistically similar.

Senior and corresponding author Jasmeer Chhatwal, MD, PhD, of the MGH Department of Neurology, says, "Recent findings suggest elevated brain amyloid is necessary but perhaps not sufficient on its own to predict imminent cognitive decline. Therefore, we need to find additional, complementary measures to identify individuals at the highest risk for cognitive decline, as these are the people we want to enroll in Alzheimer's-disease-prevention clinical trials. Remarkably, vascular risk appears to be useful in identifying risk of cognitive decline above and beyond a full slate of MRI and PET measures of brain health. Perhaps more importantly, we can reduce vascular risk factors through medical treatments and lifestyle interventions, and reducing these vascular risk factors might reduce memory loss over time - especially in people with high brain amyloid."

Keep saying yes to fish twice a week for heart health American

A new scientific advisory reaffirms the American Heart Association's recommendation to eat fish- especially those rich in Omega-3 fatty acids twice a week to help reduce the risk of heart failure, coronary heart disease, cardiac arrest and the most common type of stroke (ischemic). The advisory is published in the American Heart Association's journal Circulation.

"Since the last advisory on eating fish was issued by the Association in 2002, scientific studies have further established the beneficial effects of eating seafood rich in Omega-3 fatty acids, especially when it replaces less healthy foods such as meats that are high in artery-clogging saturated fat," said Eric B. Rimm, Sc.D., chair of the American Heart Association writing group and professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health in Boston.

The Association recommends eating two 3.5-ounce servings of non-fried fish, or about ¾ cup of flaked fish every week. Emphasis should be placed on eating oily fish like salmon, mackerel, herring, lake trout, sardines or albacore tuna, which are all high in omega-3 fatty acids.

The advisory was written by a panel of nutrition experts, who also reviewed studies about mercury in fish. Mercury is found in most seafood but is prevalent in large fish such as shark, swordfish, tilefish, king mackerel, bigeye tuna, marlin and orange roughy. The writing group concluded that while mercury contamination may be associated with serious neurological problems in newborns, existing scientific research finds that mercury contamination does not have adverse effects on heart disease risk in adults, and the benefits of eating fish substantially outweigh any risks associated with mercury contamination, especially if a variety of seafood is consumed.


The importance of environmentally sustainable fish farming techniques and other topics are also briefly discussed in the advisory. A previously published American Heart Association advisory on Omega-3 fish oil supplements noted that the supplements are not recommended for the general public to prevent clinical cardiovascular disease because of a lack of scientific evidence regarding any effect on cardiovascular risk.

Male depression may lower pregnancy chances among infertile couples

Among couples being treated for infertility, depression in the male partner was linked to lower pregnancy chances, while depression in the female partner was not found to influence the rate of live birth, according to a study funded by the National Institutes of Health.

The study, which appears in Fertility and Sterility, also linked a class of antidepressants known as non-selective serotonin reuptake inhibitors (non-SSRIs) to a higher risk of early pregnancy loss among females being treated for infertility. SSRIs, another class of antidepressants, were not linked to pregnancy loss. Neither depression in the female partner nor use of any other class of antidepressant were linked to lower pregnancy rates.

"Our study provides infertility patients and their physicians with new information to consider when making treatment decisions," said study author Esther Eisenberg, M.D., of the Fertility and Infertility Branch at NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which funded the study.

Citing previous studies, the authors noted that 41 percent of women seeking fertility treatments have symptoms of depression. In addition, a study of men seeking IVF treatments found that nearly 50 percent experienced depression. The authors conducted the current study to evaluate the potential influence of depression in couples seeking non-IVF treatments.

The researchers combined data from two previous studies funded by NICHD's Reproductive Medicine Network. One study compared the effectiveness of two ovulation-inducing drugs for establishment of pregnancy and live birth in women with polycystic ovary syndrome.

The other study compared the effectiveness of three ovulation-inducing drugs at achieving pregnancy and live birth in couples with unexplained infertility. In each study, men and women responded to a questionnaire designed to screen for depression. Only the women were asked whether they were taking any antidepressants.

From the two studies, the researchers analyzed data for 1,650 women and 1,608 men. Among the women, 5.96 percent were rated as having active major depression, compared to 2.28 percent of the men.

Women using non-SSRIs were roughly 3.5 times as likely to have a first trimester pregnancy loss, compared to those not using antidepressants. Couples in which the male partner had major depression were 60 percent less likely to conceive and have a live birth than those in which the male partner did not have major depression.

The study did not include couples who underwent in vitro fertilization because the authors thought that this procedure could potentially overcome some possible effects of depression, such as reduced sexual desire and lower sperm quality.

Biotin supplements caused misleading test results, almost led to unnecessary procedure

A new case report in the Journal of the Endocrine Society documents how a patient's use of a common biotin supplement, also known as vitamin B7, caused her to have clinically misleading test results, which prompted numerous consultations and unnecessary radiographic and laboratory testing.

The patient in the case report took a 5000 mcg dose of biotin daily. Biotin supplements in that dosage are commonly sold over-the-counter, without a prescription, in many grocery and drug stores for about $8-$20 a bottle. They are marketed as being good for healthy hair, skin and nails, but there is no scientific evidence to support this claim.

In this patient's case, "The negative clinical impact included weeks of psychological distress concerning the possibilities of hypercortisolemia or a testosterone-producing tumor. Most significantly, these abnormal test results nearly resulted in an unnecessary invasive procedure for a complex patient with a hypercoagulable state," the case report says. Hypercortisolemia is a condition involving a prolonged excess of cortisol -- a steroid hormone -- in blood.

Maya Styner, MD, associate professor of endocrinology and metabolism in the department of medicine, is the case report's corresponding author.

"The literature is lacking with regard to biotin interference with serum cortisol and testosterone immunoassays, as in our case-report," Styner said. "Patients are ingesting supplements in a higher frequency, and higher doses, and therefore this case is timely and relevant from both a clinical and basic-science perspective."


She added, "Our manuscript is a product of a collaboration between endocrinology, reproductive endocrinology/gynecology and clinical chemistry at UNC and at the Mayo Clinic. This collaboration enabled us to ascertain the underlying diagnosis and perform relevant research-based biotin quantification in our patient's sample."

FDA approves novel preventive treatment for migraine

The U.S. Food and Drug Administration today approved Aimovig (erenumab-aooe) for the preventive treatment of migraine in adults. The treatment is given by once-monthly self-injections. Aimovig is the first FDA-approved preventive migraine treatment in a new class of drugs that work by blocking the activity of calcitonin gene-related peptide, a molecule that is involved in migraine attacks.

“Aimovig provides patients with a novel option for reducing the number of days with migraine,” said Eric Bastings, M.D., deputy director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “We need new treatments for this painful and often debilitating condition.”

Patients often describe migraine headache pain as an intense pulsing or throbbing pain in one area of the head. Additional symptoms include nausea and/or vomiting and sensitivity to light and sound. Approximately one-third of affected individuals can predict the onset of a migraine because it is preceded by an aura – transient sensory or visual disturbances that appear as flashing lights, zig-zag lines or a temporary loss of vision. People with migraine tend to have recurring attacks triggered by a number of different factors, including stress, hormonal changes, bright or flashing lights, lack of food or sleep and diet. Migraine is three times more common in women than in men and affects more than 10 percent of people worldwide.

The effectiveness of Aimovig for the preventive treatment of migraine was evaluated in three clinical trials. The first study included 955 participants with a history of episodic migraine and compared Aimovig to placebo. Over the course of six months, Aimovig-treated patients experienced, on average, one to two fewer monthly migraine days than those on placebo. The second study included 577 patients with a history of episodic migraine and compared Aimovig to placebo. Over the course of three months, Aimovig-treated patients experienced, on average, one fewer migraine day per month than those on placebo. The third study evaluated 667 patients with a history of chronic migraine and compared Aimovig to placebo. In that study, over the course of three months, patients treated with Aimovig experienced, on average, 2 ½ fewer monthly migraine days than those receiving placebo.

The most common side effects that patients in the clinical trials reported were injection site reactions and constipation.

For older adults, a better diet may prevent brain shrinkage

People who eat a diet rich in vegetables, fruit, nuts and fish may have bigger brains, according to a study published in the May 16, 2018, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"People with greater brain volume have been shown in other studies to have better cognitive abilities, so initiatives that help improve diet quality may be a good strategy to maintain thinking skills in older adults," said study author Meike W. Vernooij, MD, PhD, of the Erasmus University Medical Center in Rotterdam, the Netherlands. "More research is needed to confirm these results and to examine the pathways through which diet can affect the brain."

The study included 4,213 people in the Netherlands with an average age of 66 who did not have dementia.

Participants completed a questionnaire asking how much they ate of nearly 400 items over the past month. Researchers looked at diet quality based on the Dutch dietary guidelines by examining intake of foods in the following groups: vegetables, fruit, whole grain products, legumes, nuts, dairy, fish, tea, unsaturated fats and oils of total fats, red and processed meat, sugary beverages, alcohol and salt. Researchers ranked the quality of diet for each person with a score of zero to 14. The best diet consisted of vegetables, fruit, nuts, whole grains, dairy and fish, but a limited intake of sugary drinks.

The average score of participants was seven.

All participants had brain scans with magnetic resonance imaging to determine brain volume, the number of brain white matter lesions and small brain bleeds. The participants had an average total brain volume of 932 milliliters.

Information was also gathered on other factors that could affect brain volumes, such as high blood pressure, smoking and physical activity.

Researchers found after adjusting for age, sex, education, smoking and physical activity that a higher diet score was linked to larger total brain volume, when taking into account head size differences. Those who consumed a better diet had an average of two milliliters more total brain volume than those who did not. To compare, having a brain volume that is 3.6 milliliters smaller is equivalent to one year of aging.

Diet was not linked to brain white matter lesions or small brain bleeds.

For comparison, researchers also assessed diet based on the Mediterranean diet, which is also rich in vegetables, fish and nuts, and found brain volume results were similar to those who adhered closely to Dutch dietary guidelines.

Vernooij said the link between better overall diet quality and larger total brain volume was not driven by one specific food group, but rather several food groups.

"There are many complex interactions that can occur across different food components and nutrients and according to our research, people who ate a combination of healthier foods had larger brain tissue volumes," Vernooij said.

She noted that because the study was a snapshot in time, it does not prove that a better diet results in a larger brain volume; it only shows an association.

Limitations of the study include that diet was self-reported and relied on someone's ability to remember what they ate over one month, and the study was conducted in a Dutch population and therefore other populations may not have similar results.

Exercise beats genetics in determining amount of body fat

With obesity now a global epidemic, there is increased focus on risk factors that contribute to weight gain, especially in postmenopausal women. Although many women may blame genetics for their expanding waistlines, a new study shows that as women age they are more likely to overcome genetic predisposition to obesity through exercise. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Previous studies have suggested that the genetic influence on body mass index (BMI) increases from childhood to early adulthood. However, there has been little research on the effect of obesity genes later in life and whether they can be overcome through lifestyle modification, including exercise.

In the article "Physical activity modifies genetic susceptibility to obesity in postmenopausal women," results are published from the linear regression analysis of more than 8,200 women from the Women's Health Initiative. Those results suggest that physical activity reduces the influence of genetic predisposition to obesity, and this effect is more significant in the oldest age group (women aged 70 years and older).

These findings additionally support guidelines for promoting and maintaining healthy behaviors, especially in older adults, to maximize quality and longevity of life.

"We are born with our genes, but this study suggests that we can improve our lives and health with exercise, regardless of genetics," says Dr. JoAnn Pinkerton, NAMS executive director. "As women age, exercise has been shown to improve muscle mass, balance, and bone strength. It also invigorates brain cells, is associated with less arthritic pain, and improves mood, concentration, and cognition. Regardless of age, genes, and amount of abdominal fat or BMI, regular exercise can improve health."

Sexual activity and emotional closeness are unrelated to the rate of cognitive decline

Older people who enjoy a sexually active and emotionally close relationship with their partner tend to perform better at memory tests than sexually inactive older adults on a short-term basis, but this is not the case over a longer period of time. This is according to a study using data from more than 6000 adults aged 50 and over. The research by Mark Allen of the University of Wollongong in Australia is published in Springer's journal Archives of Sexual Behavior.

Age-related cognitive decline varies considerably and can range from mild to severe - in the case of people living with dementia. Lifestyle factors, such as someone's level of education, smoking and drinking habits, and level of physical activity have all been found to play a role in the rate and extent of age-related cognitive decline. This study now shows that there is no link between sexual activity and rate of cognitive decline.

Allen investigated whether ongoing sexual activity and the experience of emotional closeness with a partner has any effect on memory. He analyzed and compared data from 2012 and 2014 contained in the English Longitudinal Study of Aging (ELSA), which includes information about the health, diet, well-being and socio-economic status of adults older than 50 living in England. Participants in the ELSA completed an episodic memory task and a questionnaire where they reported the frequency of intimate activities such as kissing, sexual touching and intercourse.

Allen found an overall decline in all participants' score on the memory test over time.

"Decline in memory performance over time was unrelated to sexual activity or emotional closeness during partnered sexual activity" says Allen.

Yogurt may dampen chronic inflammation linked to multiple diseases-

Inflammation can be good. It's part of the body's innate immune system, our first line of defense against illness and injury.

However, if the inflammatory response goes on for too long, it can lead to a condition called chronic inflammation, where the body essentially attacks itself, wreaking biological havoc on our organs and systems. Chronic inflammation is a factor in inflammatory bowel disease, arthritis and asthma. It is also associated with obesity, metabolic syndrome, cardiovascular disease, and other chronic diseases.

A recent study--described in two papers, including one published today (May 14) in the Journal of Nutrition--provides new evidence that yogurt may help dampen chronic inflammation. The study explored the hypothesis that yogurt may help reduce inflammation by improving the integrity of the intestinal lining, thus preventing endotoxins -- pro-inflammatory molecules produced by gut microbes -- from crossing into the blood stream.

"I wanted to look at the mechanism more closely and look specifically at yogurt," says Brad Bolling, University of Wisconsin-Madison Assistant Professor of Food Science, whose research focuses on the role of food in preventing chronic disease.

While anti-inflammatory medications like aspirin, naproxen, hydrocortisone and prednisone can help mitigate the effects of chronic inflammation, each comes with its own risks and side effects. There is a need for additional options -- particularly safe, gentle, long-term treatments. Researchers have been exploring dairy products as a potential dietary treatment for more than two decades. Findings have been mixed, setting up a scientific debate about whether dairy products are pro-inflammatory or anti-inflammatory.

"There have been some mixed results over the years, but [a recent article] shows that things are pointing more toward anti-inflammatory, particularly for fermented dairy," notes Bolling, citing a 2017 review paper that assessed 52 clinical trials.

Bolling's study enrolled 120 premenopausal women, half obese and half non-obese. Half of the participants were assigned to eat 12 ounces of low-fat yogurt every day for nine weeks; a control group ate non-dairy pudding for nine weeks.

This investigation, among the largest human intervention studies to look at yogurt's impact on chronic inflammation, was funded by the National Dairy Council, a non-profit organization supported by the U.S. Department of Agriculture's national dairy checkoff program.

At various points during the study, Bolling and his team took fasting blood samples from participants and evaluated an assortment of biomarkers that scientists have used over the years to measure endotoxin exposure and inflammation. As described in the British Journal of Nutrition this past December, the results showed that while some of the biomarkers remained steady over time, the yogurt-eaters experienced significant improvements in certain key markers, such as TNF-, an important inflammation-activating protein.

"The results indicate that ongoing consumption of yogurt may be having a general anti-inflammatory effect," says Bolling.

The new Journal of Nutrition article focuses on a different aspect of the study. Participants were also involved in a high-calorie meal challenge at the beginning and end of their nine-week dietary intervention. The challenge, meant to stress an individual's metabolism, started with either a serving of yogurt or non-dairy pudding followed by a large high-fat, high-carb breakfast meal.

"It was two sausage muffins and two hash browns, for a total of 900 calories. But everybody managed it. They'd been fasting, and they were pretty hungry," Bolling explains with a smile.

For both challenges, blood work showed that the yogurt "appetizer" helped improve some key biomarkers of endotoxin exposure and inflammation as participants digested the meal over the ensuing hours. It also helped improve glucose metabolism in obese participants, by speeding the reduction of post-meal blood glucose levels.

"Eating eight ounces of low-fat yogurt before a meal is a feasible strategy to improve post-meal metabolism and thus may help reduce the risk of cardiovascular and metabolic diseases," says Ruisong Pei, a UW-Madison food science postdoctoral researcher involved in the studies.

The findings help expand the overall body of scientific knowledge about how foods impact inflammation.

Bolling's study doesn't identify which compounds in yogurt are responsible for the shift in biomarkers associated with the health-promoting effect -- or how they act in the body. Solving that piece of the puzzle will require more research, Bolling notes.

"The goal is to identify the components and then get human evidence to support their mechanism of action in the body. That's the direction we are going," he says. "Ultimately, we would like to see these components optimized in foods, particularly for medical situations where it's important to inhibit inflammation through the diet. We think this is a promising approach."

High levels of workplace exercise linked to early death

Men with highly physical jobs appear to have a significantly higher risk of early death compared with men who have largely inactive jobs, suggests a study published in the British Journal of Sports Medicine.

Physical activity is generally considered to be an important preventive behaviour for non-communicable diseases while physical inactivity has been estimated to account for around 7% of the global health burden.

Accordingly, international guidelines encourage people to engage in up to 30 minutes of at least moderate intensity physical activity daily, but such guidelines do not distinguish between occupational, leisure time and transportation related activity.

Recent research has suggested that there is evidence of a physical activity paradox, with beneficial health outcomes associated with leisure time physical activity, but detrimental health outcomes for people engaging in high level occupational physical activity.

An international team of researchers led by Dr Pieter Coenen from the VU University Medical Center in Amsterdam, The Netherlands, decided to carry out a systematic review of evidence regarding the association between occupational physical activity and all-cause mortality.

They searched existing studies that had assessed the association of occupational physical activity with all-cause mortality and identified 17 studies from which pooled data on 193,696 participants were used in a meta-analysis.

The various studies collectively covered the period from 1960 to 2010.

This analysis showed that men with high level occupational physical activity had an 18% higher risk of early death compared with men engaging in low level occupational physical activity. This was still the case even when levels of leisure time physical activity were taken into account.

No such association was observed among women. Indeed, the opposite seemed to be the case for females.

The authors described the new study as the first to find evidence consistent with the physical activity paradox in this systematic review with meta-analysis of studies with a large number of participants.

The researchers concluded: "The results of this review indicate detrimental health consequences associated with high level occupational physical activity in men, even when adjusting for relevant factors (such as leisure time physical activity).

"This evidence indicates that physical activity guidelines should differentiate between occupational and leisure time physical activity."

Exergaming may help those at risk of Alzheimer's or related dementias

Older adults with mild cognitive impairment (MCI), often a precursor to Alzheimer's, showed significant improvement with certain complex thinking and memory skills after exergaming, according to a new study.

The results could encourage seniors, caregivers and health care providers to pursue or prescribe exergames (video games that also require physical exercise) in hopes of slowing the debilitating effects of those with MCI, sometimes a stage between normal brain aging and dementia.

"It's promising data," said Cay Anderson-Hanley, associate professor of psychology at Union College and the study's lead author. "Exergaming is one more thing that could be added to the arsenal of tools to fight back against this cruel disease."

The study appears in the current issue of Frontiers in Aging Neuroscience.

Previously published research by Anderson-Hanley and others found that seniors who exercise using the features of interactive video games experienced greater cognitive health benefits than those who rely on traditional exercise alone.

For the latest study, researchers wanted to target older adults diagnosed with or at risk for MCI. MCI is most common in people over age 55. By age 65, approximately 15 to 20 percent of the population shows signs of MCI, according to the Alzheimer's Association.

Researchers initially enrolled more than 100 seniors for the study, which was funded through a grant from the National Institute on Aging. Over six months, 14 (evenly split between men and women) persisted with regular exergaming. The average age was 78.

The first group of seven was assigned to pedal along a scenic virtual reality bike path several times a week. The second group was given a more challenging task for the brain: pedal while playing a video game that included chasing dragons and collecting coins.

The special bikes were placed at a number of sites, including hospitals, community centers and independent living centers.

The results were compared against data collected from a separate group of eight seniors who played video games on a laptop but did not pedal, and also a group from the previous research who only rode a traditional stationary bike with no gaming component.

At the end of the randomized clinical trial, participants in both the group that pedaled along a virtual bike path and those that chased dragons and collected coins experienced significantly better executive function, which controls, in part, multi-tasking and decision making.

"Executive function is like the CEO of the brain. It is key to remaining independent in later life," said Anderson-Hanley. "For example, it allows you to cook two things on the stove at once. It makes sure you don't forget that you are boiling water while also having something in the oven."

Benefits for both groups were also seen for verbal memory and physical function, suggesting it may be worth the effort for seniors to incorporate exergaming into a daily exercise regime.

Anderson-Hanley acknowledged that further research with a larger sample size is needed to confirm the team's findings. One of the challenges faced was getting older adults in the habit of going to the gym or another venue to exergame. The team is working on a way to have seniors stay home and upload a video game to an iPad that can be used with a stationary bike.

In the meantime, the research suggests benefits of exercising while also stimulating the brain with some mental challenge, such as navigating a scenic bike path or interactively playing a video game.

"The goal is to explore even more effective ways to prevent or ameliorate cognitive decline in older adults by tailoring accessibility and level of mental engagement in interactive cognitive and physical exercise," she said. "The results suggest that the best outcome for brain health may result when we do both: move it and use it."

Six years of exercise -- or lack of it -- may be enough to change heart failure risk

By analyzing reported physical activity levels over time in more than 11,000 American adults, Johns Hopkins Medicine researchers conclude that increasing physical activity to recommended levels over as few as six years in middle age is associated with a significantly decreased risk of heart failure, a condition that affects an estimated 5 million to 6 million Americans.

The same analysis found that as little as six years without physical activity in middle age was linked to an increased risk of the disorder.

Unlike heart attack, in which heart muscle dies, heart failure is marked by a long-term, chronic inability of the heart to pump enough blood, or pump it hard enough, to bring needed oxygen to the body. The leading cause of hospitalizations in those over 65, the disorder's risk factors include high blood pressure, high cholesterol, diabetes, smoking and a family history.

"In everyday terms our findings suggest that consistently participating in the recommended 150 minutes of moderate to vigorous activity each week, such as brisk walking or biking, in middle age may be enough to reduce your heart failure risk by 31 percent," says Chiadi Ndumele, M.D., M.H.S., the Robert E. Meyerhoff Assistant Professor of Medicine at the Johns Hopkins University School of Medicine, and the senior author of a report on the study. "Additionally, going from no exercise to recommended activity levels over six years in middle age may reduce heart failure risk by 23 percent."

The researchers caution that their study, described in the May 15 edition of the journal Circulation, was observational, meaning the results can't and don't show a direct cause-and-effect link between exercise and heart failure. But they say the trends observed in data gathered on middle-aged adults suggest that it may never be too late to reduce the risk of heart failure with moderate exercise.

"The population of people with heart failure is growing because people are living longer and surviving heart attacks and other forms of heart disease," says Roberta Florido, M.D., cardiology fellow at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. "Unlike other heart disease risk factors like high blood pressure or high cholesterol, we don't have specifically effective drugs to prevent heart failure, so we need to identify and verify effective strategies for prevention and emphasize these to the public." There are drugs used to treat heart failure, such as beta blockers and ACE inhibitors, but they are essentially "secondary" prevention drugs, working to reduce the heart's workload after dysfunction is already there.

Several studies, Florido says, suggest that in general people who are more physically active have lower risks of heart failure than those who are less active, but little was known about the impact of changes in exercise levels over time on heart failure risk.

For example, if you are sedentary most of your life but then start exercising in middle age, does that decrease your risk of heart failure? Or, if you are active much of your life but then stop being active at middle age, will that increase your risk?

To address those questions, the researchers used data already gathered from 11,351 participants in the federally funded, long term Atherosclerosis Risk in Communities (ARIC) study, recruited from 1987 to 1989 in Forsyth County, North Carolina; Jackson, Mississippi; greater Minneapolis, Minnesota; and Washington County, Maryland.

The participants' average age was 60, 57 percent were women and most were either white or African-American.

Participants were monitored annually for an average of 19 years for cardiovascular disease events such as heart attack, stroke and heart failure using telephone interviews, hospital records and death certificates. Over the course of the study there were 1,693 hospitalizations and 57 deaths due to heart failure.

In addition to those measures, at the first and third ARIC study visits (six years apart), each participant filled out a questionnaire, which asked them to evaluate their physical activity levels, which were then categorized as poor, intermediate or "recommended," in alignment with guidelines issued by the American Heart Association.

The "recommended" amount is at least 75 minutes per week of vigorous intensity or at least 150 minutes per week of moderate intensity exercise. One to 74 minutes per week of vigorous intensity or one to 149 minutes per week of moderate exercise per week counted as intermediate level activity. And physical activity qualified as "poor" if there was no exercise at all.

After the third visit, 42 percent of participants (4,733 people) said they performed recommended levels of exercise; 23 percent (2,594 people) said they performed intermediate levels; and 35 percent (4,024 people) said they had poor levels of activity. From the first to the third visit over about six years, 24 percent of participants increased their physical activity, 22 percent decreased it and 54 percent stayed in the same category.

Those with recommended activity levels at both the first and third visits showed the highest associated heart failure risk decrease, at 31 percent compared with those with consistently poor activity levels.

Heart failure risk decreased by about 12 percent in the 2,702 participants who increased their physical activity category from poor to intermediate or recommended, or from intermediate to recommended, compared with those with consistently poor or intermediate activity ratings.

Conversely, heart failure risk increased by 18 percent in the 2,530 participants who reported decreased physical activity from visit one to visit three, compared with those with consistently recommended or intermediate activity levels.

Next, the researchers determined how much of an increase in exercise, among those initially doing no exercise, was needed to reduce the risk of future heart failure. Exercise was calculated as METs (metabolic equivalents), where one MET is 1 kilocalorie per kilogram per hour. Essentially, sitting watching television is 1 MET, fast walking is 3 METs, jogging is 7 METs and jumping rope is 10 METs. The researchers calculated outcomes in METs times the number of minutes of exercise.

The researchers found that each 750 MET minutes per week increase in exercise over six years reduced heart failure risk by 16 percent. And each 1,000 MET minutes per week increase in exercise was linked to a reduction in heart failure risk by 21 percent.

According to the American Heart Association, fewer than 50 percent of Americans get recommended activity levels.