Exploring how diet and the gastric microbiome shape gastric cancer risk

Gastric cancer (GC), commonly known as stomach cancer, ranks as the world's fifth most common cancer and the third leading cause of cancer-related deaths, claiming over 784,000 lives annually. While historically more prevalent in older adults, GC is increasingly affecting younger individuals in developed countries. This has raised alarms among researchers, as it signals a shift in risk factors that are just now beginning to be understood.

Helicobacter pylori, a species of bacteria, is one of the main culprits behind GC. H. pylori bacteria currently infects roughly half of the global population. However, this infection alone does not explain why fewer than 3% of individuals harboring H. pylori actually develop cancer. Recent research has revealed the role of an additional factor: the complex community of microorganisms living in the digestive tract that may play a crucial role in determining who ultimately develops this deadly disease. Since diet strongly influences the gut microbiota, this interaction likely affects cancer risk.

 The researchers' analysis indicates that certain dietary patterns create an environment in the stomach that favors GC development. High-salt foods, particularly salt-preserved items common in many Asian cuisines, directly damage the stomach lining and create conditions that help harmful bacteria flourish. Similarly, processed meats generate cancer-causing compounds, such as heterocyclic amines and polycyclic aromatic hydrocarbons, when cooked at high temperatures. Heavy alcohol consumption contributes to GC development by producing toxic metabolites that damage cellular structures in the stomach, while high-fat diets promote inflammation and accelerate tumor progression.

Which therapy works best for knee arthritis?

Knee braces, water therapy, and exercise are the most beneficial non-drug therapies, per meta-analysis of more than 100 clinical trials involving nearly 10,000 people

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PLOS

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Knee braces, water therapy, and exercise are the most beneficial non-drug therapies, per meta-analysis of more than 100 clinical trials involving nearly 10,000 people.

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Credit: nattanan23, Pixabay, CC0 (https://creativecommons.org/publicdomain/zero/1.0/)

Knee braces, water therapy and exercise are the most promising non-drug therapies for treating knee osteoarthritis, according to a new meta-analysis publishing June 18, 2025 in the open-access journal PLOS One by Yuan Luo of the First People’s Hospital of Neijiang, China.

Knee osteoarthritis (KOA) is a common and often debilitating condition that affects millions of older adults, causing pain and stiffening of the knee joint. Treatment often includes anti-inflammatory drugs, which are linked to gastrointestinal and cardiovascular adverse events.

In the new study, researchers examined the current evidence on non-drug therapies for treating KOA. They looked at data from 139 clinical trials involving nearly 10,000 people to compare 12 different non-drug treatments. These included laser therapy, electrical stimulation, braces, insoles, kinesiology tape, water-based therapy, exercise, and ultrasound. By combining results from all these studies into a powerful network meta-analysis, the team could rank the therapies based on how well they worked.

Knee braces came out on top across most categories, including reducing pain, improving function, and relieving stiffness. Hydrotherapy—exercises or treatments performed in warm water—was particularly effective at easing pain and general exercise was also consistently effective, improving both pain and physical function. High-intensity laser therapy and shock wave therapy showed some benefits, while ultrasound consistently scored the lowest in effectiveness.

The authors caution that differences in study design, small sample sizes, and variability in treatment duration between the 139 included studies may limit the precision of the rankings. However, they conclude that physical therapy has promising effects on KOA, offering potential treatments without the risks of anti-inflammatory drugs. Future studies should examine the clinical efficacy of combined therapies, as well as their cost-effectiveness.

The authors add: “Knee braces, hydrotherapy, and exercise are the most effective non-drug therapies for knee osteoarthritis. They reduce pain and improve mobility without the gastrointestinal or cardiovascular risks linked to common pain medications. Patients and clinicians should prioritize these evidence-based options.”

“Our analysis of nearly 10,000 patients reveals that simple, accessible therapies like knee bracing and water-based exercise outperform high-tech options like ultrasound. This could reshape clinical guidelines to focus on safer, lower-cost interventions.”

 

The freely available article in PLOS One: https://plos.io/4k88Qsw

Intermittent fasting comparable to traditional diets for weight loss

 

Intermittent fasting diets appear to have similar benefits to traditional calorie-restricted diets for weight loss, suggests an analysis of trial evidence published by The BMJ today.

Alternate day fasting also demonstrates greater benefits compared with both calorie restriction and other intermittent fasting approaches, but the researchers say longer trials are needed to substantiate these findings.

According to the World Health Organization in 2022, approximately 2.5 billion adults, 43% of the global adult population, were overweight, and about 890 million (16%) lived with obesity. 

Weight loss can reduce cardiometabolic risk factors, such as high blood pressure, cholesterol and blood sugar levels, and consequently lower the burden of serious chronic conditions like type 2 diabetes and cardiovascular disease.

Intermittent fasting is an eating pattern that cycles between periods of eating and fasting on a regular schedule and is becoming a popular alternative to traditional calorie-restricted diets, which are often unsustainable in the long term.

While no clear definition exists for intermittent fasting, its various methods can fall under three broad categories: time restricted eating (eg, the 16:8 diet involving a 16 hour fasting period followed by an 8 hour eating window), alternate day fasting (a 24 hour fast on alternate days), and whole day fasting (eg, a 5:2 diet involving five days of unrestricted eating and two days of fasting).

But the health effects of intermittent fasting compared with continuous caloric restriction or an unrestricted (ad-libitum) diet remain unclear.

To address this, researchers analysed the results of 99 randomised clinical trials involving 6,582 adults (average age 45; 66% female) to compare the effect of intermittent fasting diets with continuous energy restriction or unrestricted diets on body weight and cardiometabolic risk factors.

Participants had an average body mass index (BMI) of 31 and almost 90% had existing health conditions.

The trials ranged from 3-52 weeks (average 12 weeks) and were of varying quality, but the researchers were able to assess their risk of bias and the certainty of evidence using recognised tools.

All intermittent fasting strategies and continuous energy restriction diets may lead to small reductions in body weight when compared with an unrestricted diet. 

Alternate day fasting was the only intermittent fasting diet strategy to show a small benefit in body weight reduction compared with continuous energy restriction (mean difference -1.29 kg).

Alternate day fasting also showed a small reduction in body weight compared with both time restricted eating and whole day fasting (mean difference -1.69 kg and -1.05 kg respectively).

However, these differences did not reach the minimally important clinical threshold of at least 2 kg weight loss for individuals with obesity, as defined by the study authors.

Alternate day fasting was also linked to lower levels of total and “bad” cholesterol compared with time restricted eating. Compared with whole day fasting, however, time restricted eating resulted in a small increase in cholesterol levels. No benefit was found for blood sugar or "good" cholesterol levels in any diet strategy comparison.

Estimates were similar among trials with less than 24 weeks follow-up. But longer trials of 24 weeks or more only showed weight loss benefits in diet strategies compared with an unrestricted diet.

The researchers point to several limitations, such as high variation (heterogeneity) among the diet strategy comparisons, small sample sizes of many included trials, and low to moderate certainty of evidence in most of the investigated outcomes.

Even so, this is highlighted as one of the first systematic reviews to combine direct and indirect comparisons across all dietary strategies, allowing for more precise estimates.

As such, they conclude: “The current evidence provides some indication that intermittent fasting diets have similar benefits to continuous energy restriction for weight loss and cardiometabolic risk factors. Longer duration trials are needed to further substantiate these findings.”

The value of this study is not in establishing a universally superior strategy but in positioning alternate day fasting as an additional option within the therapeutic repertoire, say researchers from Colombia in a linked editorial.

They point out that any structured intervention - including continuous energy restriction - could show benefits derived not only from the dietary pattern but also from professional support, planning, and nutritional education, while diet quality during free eating days could also affect alternate day fasting outcomes.

The focus should be on fostering sustainable changes over time, they say. “Intermittent fasting does not aim to replace other dietary strategies but to integrate and complement them within a comprehensive, patient centred nutritional care model.”

Cannabis use linked to doubling in risk of cardiovascular disease death

Treat it like tobacco: don’t criminalise it, discourage it, and protect bystanders, says editorial

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BMJ Group

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Cannabis use is linked to a doubling in the risk of dying from cardiovascular disease, with significantly heightened risks of having a stroke or acute coronary syndrome—sudden reduced or blocked blood flow to the heart—finds a pooled analysis of real world data, published online in the journal Heart.

The authors of a linked editorial call for the drug to be treated like tobacco—not criminalised, but actively discouraged, with protection of bystanders from secondhand vapour inhalation.

The use of cannabis and cannabinoids has soared over the past decade, note the researchers. Legalising cannabis in certain jurisdictions and expanding its use for medicinal purposes has probably changed people’s risk perceptions of the drug and helped drive its growing popularity, they suggest.

While previously published studies have linked cannabis use to cardiovascular problems, the magnitude of the risk hasn’t been clear. This is an important gap in light of the recent major changes in consumption and the increased potency of the drug, they add.

To strengthen the evidence base, therefore, the researchers scoured research databases looking for large observational studies, published between January 2016 and December 2023, which explored cannabis use and serious cardiovascular outcomes: cardiovascular disease death; and non-fatal acute coronary syndrome to include heart attack and stroke.

From an initial haul of 3012 articles, 24, involving around 200 million people, were included in a pooled data analysis of the results: 17 cross-sectional studies, 6 cohort studies, and 1 case-control study.

Study participants were mostly aged between 19 and 59. And in those studies where sex was recorded, cannabis users tended to be mostly male and younger than non-users.

The analysis revealed heightened risks for cannabis use: 29% higher for acute coronary syndrome; 20% higher for stroke; and a doubling in the risk of dying from cardiovascular disease.

The researchers acknowledge that there was a moderate to high risk of bias in most of the included studies, largely because of lack of information on missing data and imprecise measures of cannabis exposure. And most of the included studies were observational, precluding the ability to draw causal inferences from the data. Several used the same data.

Notwithstanding these caveats, the researchers say that theirs is an exhaustive analysis of published data on the potential association between cannabis use and major cardiovascular disease and provides new insights from real-world data.

In a linked editorial, Emeritus Professor Stanton Glantz of the University of California at San Francisco and Dr Lynn Silver of the Public Health Institute, Oakland, California, and Department of Epidemiology and Biostatistics, University of California at San Francisco, say the study “raises serious questions about the assumption that cannabis imposes little cardiovascular risk.”

More research is clearly needed to clarify whether cardiovascular risks are limited to inhaled products or extend to other forms of cannabis exposure, they suggest. Cannabis is now generally more potent and has diversified into a wide array of inhaled high potency cannabis concentrates, synthetic psychoactive cannabinoids, and edibles, they point out. 

“How these changes affect cardiovascular risk requires clarification, as does the proportion of risk attributable to cannabinoids themselves versus particulate matter, terpenes or other components of the exposure,” they say.

They conclude: “Cannabis needs to be incorporated into the framework for prevention of clinical cardiovascular disease. So too must cardiovascular disease prevention be incorporated into the regulation of cannabis markets. Effective product warnings and education on risks must be developed, required, and implemented. 

“Cardiovascular and other health risks must be considered in the regulation of allowable product and marketing design as the evidence base grows. Today that regulation is focused on establishing the legal market with woeful neglect of minimising health risks. 

“Specifically, cannabis should be treated like tobacco: not criminalised, but discouraged, with protection of bystanders from secondhand exposure.”

  

Hold the cream and sugar: black coffee linked to lower risk of death

While you’re probably not pouring your morning cup for the long-term health benefits, coffee consumption has been linked to lower risk of mortality. In a new observational study, researchers from the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University found the association between coffee consumption and mortality risk changes with the amount of sweeteners and saturated fat added to the beverage. 

The study, published online in The Journal of Nutrition, found that consumption of 1-2 cups of caffeinated coffee per day was linked to a lower risk of death from all causes and death from cardiovascular disease. Black coffee and coffee with low levels of added sugar and saturated fat were associated with a 14% lower risk of all-cause mortality as compared to no coffee consumption. The same link was not observed for coffee with high amounts of added sugar and saturated fat. 

“Coffee is among the most-consumed beverages in the world, and with nearly half of American adults reporting drinking at least one cup per day, it’s important for us to know what it might mean for health,” said Fang Fang Zhang, senior author of the study and the Neely Family Professor at the Friedman School. “The health benefits of coffee might be attributable to its bioactive compounds, but our results suggest that the addition of sugar and saturated fat may reduce the mortality benefits.” 

The study analyzed data from nine consecutive cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, linked to National Death Index Mortality Data. The study included a nationally representative sample of 46,000 adults aged 20 years and older who completed valid first-day 24-hour dietary recalls. Coffee consumption was categorized by type (caffeinated or decaffeinated), sugar, and saturated fat content. Mortality outcomes included all-cause, cancer, and cardiovascular disease. Low added sugar (from granulated sugar, honey, and syrup) was defined as under 5% of the Daily Value, which is 2.5 grams per 8-ounce cup or approximately half a teaspoon of sugar. Low saturated fat (from milk, cream, and half-and-half) was defined as 5% of the Daily Value, or 1 gram per 8-ounce cup or the equivalent of 5 tablespoons of 2% milk, 1 tablespoon of light cream, or 1 tablespoon of half-and-half.    

In the study, consumption of at least one cup per day was associated with a 16% lower risk of all-cause mortality. At 2-3 cups per day, the link rose to 17%. Consumption beyond three cups per day was not associated with additional reductions, and the link between coffee and a lower risk of death by cardiovascular disease weakened when coffee consumption was more than three cups per day. No significant associations were seen between coffee consumption and cancer mortality. 

“Few studies have examined how coffee additives could impact the link between coffee consumption and mortality risk, and our study is among the first to quantify how much sweetener and saturated fat are being added,” said first author Bingjie Zhou, a recent Ph.D. graduate from the nutrition epidemiology and data science program at the Friedman School. “Our results align with the Dietary Guidelines for Americans which recommend limiting added sugar and saturated fat.” 

Limitations of the study include the fact that self-reported recall data is subject to measurement error due to day-to-day variations in food intake. The lack of significant associations between decaffeinated coffee and all-cause mortality could be due to the low consumption among the population studied. 

Study: Eating more fruits and veggies could help you sleep better

 New research suggests that eating five cups of produce during the day may significantly improve sleep quality later that same night.

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The CDC Dietary Guidelines recommend 5 cups of fruit and vegetables daily for most adults.
Credit University of Chicago Medicine

From counting sheep to white noise and weighted blankets, people have tried innumerable ways to get a good night’s sleep. Sleep disruptions can have far-reaching negative consequences, impacting cardiovascular and metabolic health, memory, learning, productivity, mood regulation, interpersonal relationships and more.

It turns out that an important tool for improving sleep quality may have been hiding in plain sight…in the produce aisle. A new study led by researchers at the University of Chicago Medicine and Columbia University found that eating more fruits and vegetables during the day was associated with sleeping more soundly later that same night.

“Dietary modifications could be a new, natural and cost-effective approach to achieve better sleep,” said co-senior author Esra Tasali, MD, director of the UChicago Sleep Center. “The temporal associations and objectively-measured outcomes in this study represent crucial steps toward filling a gap in important public health knowledge.”

Uncovering the connection between diet and sleep

Studies have shown that inadequate sleep can cause people to gravitate towards unhealthier diets higher in fat and sugar. However, despite the far-reaching effects of sleep on public health and even economic productivity, doctors and scientists know far less about how diet can affect sleep patterns.

In previous observational studies, high fruit and vegetable intakes were associated with better self-reported overall sleep quality, but this new study was the first to draw a temporal connection between a given day’s dietary choices and objectively-measured sleep quality that same night.

Healthy young adults who participated in the study reported their food consumption each day with an app and wore a wrist monitor that allowed the researchers to objectively measure their sleep patterns. The researchers specifically looked at “sleep fragmentation,” an index that reflects how often someone awakens or shifts from deep to light sleep throughout the night.

Promising findings support dietary guidelines

The researchers found that each day’s diet was correlated with meaningful differences in the subsequent night’s sleep. Participants who ate more fruits and vegetables during the day tended to have deeper, more uninterrupted sleep that same night, as did those who consumed more healthy carbohydrates like whole grains.

Based on their findings and statistical modeling, the researchers estimate that people who eat the CDC-recommended five cups of fruits and veggies per day could experience a 16 percent improvement in sleep quality compared to people who consume no fruits or vegetables.

“16 percent is a highly significant difference,” Tasali said. “It’s remarkable that such a meaningful change could be observed within less than 24 hours.”

Future studies will help establish causation, broaden the findings across diverse populations, and examine the underlying mechanisms of digestion, neurology, and metabolism that could explain the positive impact of fruits and vegetables on sleep quality. But based on current data, the experts confidently advise that regularly eating a diet rich in complex carbohydrates, fruits, and vegetables is best for long-term sleep health.

“People are always asking me if there are things they can eat that will help them sleep better,” said co-senior author Marie-Pierre St-Onge, PhD, director of the Center of Excellence for Sleep & Circadian Research at Columbia. “Small changes can impact sleep. That is empowering — better rest is within your control.”

 

Eating one avocado a day may positively impact sleep.

A new study suggests that eating one avocado a day may positively impact sleep. Science now confirms sleep is as important for good health as nutrition and exercise. In a secondary analysis of the largest randomized controlled trial on avocados to date, researchers found adults who consumed one avocado daily for six months reported better sleep compared to those who ate fewer than two avocados per month.

As, per the CDC, getting enough sleep can help lower the risk factors for heart disease, these findings add to a growing body of evidence supporting avocados as a heart-healthy food and mark the first time avocado consumption has been associated with sleep. The American Heart Association (AHA) recognizes healthy sleep duration as one of eight health factors that, when optimized, can promote ideal cardiovascular health.

“Sleep is emerging as a key lifestyle factor in heart health, and this study invites us to consider how nutrition—and foods like avocado—can play a role in improving it,” said Dr. Kristina Petersen, study author and associate professor of nutritional sciences at Penn State University. “Cardiovascular health is influenced by many factors, and while no single food is a silver bullet, some—like avocados—offer a range of nutrients that support multiple aspects of heart health. This is an encouraging step in expanding the science around avocados and the potential benefits of consumption.”

Supported by the Avocado Nutrition Center, this study involved 969 racially and ethnically diverse American adults with elevated waist circumference, a cardiovascular risk factor that affects nearly 60% of U.S. adults. Participants were randomized to either consume one avocado per day or minimal avocado intake (less than two avocados per month) while continuing their usual diet for six months.

Cardiovascular health was assessed using the AHA’s Life’s Essential 8TM, a framework used by healthcare professionals as well as individuals to better understand and reduce risk factors. This tool identifies diet quality, physical activity, nicotine exposure, sleep, body weight, blood pressure, blood lipids, and blood glucose as leading behaviors and factors that when improved, can lead to better health outcomes.  

Daily avocado intake was associated with improved diet quality (measured by the Healthy Eating Index 2015), blood lipids (modest reductions in LDL-C and total cholesterol levels) and sleep health (increased self-reported sleep duration). No significant effects were found for the other Life’s Essential 8 components.

Though the study was not originally designed to examine sleep as a primary outcome, the results offer an exciting direction for future research with more rigorous methodology and tools to better understand the potential for how the nutrients in avocados may support aspects of cardiovascular health. There are several strengths to this study design, but the findings are not conclusive and cannot be generalized to all populations.

Avocados have the following nutrients per serving (1/3 medium avocado) that may play a role in sleep:  

• Tryptophan – 13mg, precursor to melatonin which plays a role in regulating sleep
• Folate – 45 mcg (10% DV), involved in the production of melatonin  
• Magnesium – 15mg (4% DV), involved in muscle contraction and relaxation 

Additionally, the combination of fiber and monounsaturated fats in avocados contributes to their beneficial impact on cardiovascular health.

• Fiber – 3g (11% DV), one-third of the fiber in avocado is soluble fiber, which prevents the digestive tract from absorbing cholesterol and reduces the risk of heart disease
• Monounsaturated fat – 5g, can help reduce LDL cholesterol levels, which can lower the risk of heart disease and stroke