ABSTRACTS

PISA, ITALY. Italian researchers report an inverse correlation between blood level of lycopene and the severity of atherosclerosis. Their study involved 11 healthy subjects with no indication of hypertension or atherosclerosis, 11 patients with hypertension, and 11 patients with hypertension and peripheral vascular disease (intermittent claudication). All participants had their blood plasma level of lycopene, gamma- tocopherol, alpha-tocopherol, beta-carotene, and coenzyme Q10 (ubiquinone) measured. They also underwent ultrasonography in order to measure the thickness of the wall in the carotid artery. The maximum thickness of the wall, IMTmax, provides a reliable indication of the extent of atherosclerosis. As expected IMTmax was significantly higher (2.56 mm) in patients with peripheral vascular disease (PVD) than in controls (1.05 mm) and in patients with uncomplicated hypertension (1.24 mm).
The researchers also found a significant inverse association between IMTmax and lycopene levels. Patients with PVD had an average lycopene level of 0.74 micromol/L as compared to controls at 1.19 micromol/L. Combining all three groups of participants a clear inverse association between IMTmax and lycopene also emerged. The researchers found no association between IMTmax and blood levels of alpha-tocopherol, gamma-tocopherol, beta-carotene or coenzyme Q10. They speculate that lycopene may be protective against atherosclerosis and urge further trials to determine the potential benefits of supplementation.
Gianetti, Jacopo, et al. Inverse association between carotid intima-media thickness and the antioxidant lycopene in atherosclerosis. American Heart Journal, Vol. 143, March 2002, pp. 467- 74

BOSTON, MASSACHUSETTS. Ma huang is a popular herbal supplement used for weight loss, energy enhancement, body building or merely as a stimulant. It is estimated that 12 million people in the United States consumed ma huang-containing products in 1999. The main active component in ma huang is the alkaloid ephedrine, a powerful drug in its own right. Ephedrine causes constriction of blood vessels and is used in the treatment of asthma. Ma huang increases blood pressure and sympathetic activity in the autonomic nervous system.
Researchers at the New England Medical Center now report that ma huang can have serious, even fatal, adverse effects. A survey of the Food and Drug Administration (FDA) database revealed a total of 926 cases of possible ma huang toxicity reported between 1995 and 1997. Thirty-seven of these cases involved serious cardiovascular events; 10 heart attacks, 16 strokes (3 fatal), and 11 sudden cardiac deaths. Only one of the 37 cases had a history of cardiovascular problems and the majority of cases were between the ages of 40 and 44 years. The researchers conclude that their investigation casts suspicion on ma huang, but does not establish a definite relationship between ma huang use and cardiovascular events. They, nevertheless, caution that people considering using ma huang should be informed of the possibility of serious adverse cardiovascular effects.
Samenuk, David, et al. Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine. Mayo Clinic Proceedings, Vol. 77, January 2002, pp. 12-16

BOSTON, MASSACHUSETTS. Several studies have concluded that a high intake of animal protein can lead to a greater loss of bone mass from the thigh bone (femoral neck) and an increased risk of hip fracture. Other studies have found no such connection. Researchers at Tufts University now report that the effect of protein intake on bone mass is highly dependent on the concurrent intake of calcium and vitamin D. Their study involved 342 healthy men and women aged 65 years or older who participated in a three-year, randomized, placebo-controlled trial of calcium and vitamin D supplementation.
The calcium group received 500 mg of calcium citrate maleate and 700 IU (17.5 micrograms) of vitamin D daily in the form of supplements. The average total daily calcium intake in the supplement group was 1346 mg/day as compared to 871 mg/day in the control group. The average total protein intake was 79 grams/day varying between 14 and 20 per cent of total energy intake. Plant protein intake was about 5 per cent of energy. Bone mineral density (BMD) was measured every six months at the femoral neck, spine and total body. At the end of the three-year supplementation period the researchers observed that the BMD for total body and femoral neck had increased significantly amongst those in the calcium/vitamin D supplement group who had the highest intake of protein (greater than 20 per cent of total energy on average). BMD in total body and femoral neck decreased in the placebo group irrespective of protein intake. The researchers conclude that a high protein intake is associated with an increase in BMD provided it is accompanied by supplementation with calcium citrate maleate and vitamin D.
Dawson-Hughes, Bess and Susan S. Harris. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. American Journal of Clinical Nutrition, Vol. 75, April 2002, pp. 773-79
Heaney, Robert P. Protein and calcium: antagonists or synergists? American Journal of Clinical Nutrition, Vol. 75, April 2002, pp. 609-10 [editorial]

STOCKHOLM, SWEDEN. Swedish researchers have reviewed the results of four mammography- screening trials carried out in Sweden up to and including 1996. The studies included 129,750 women who were invited to undergo screening (actual attendance rate was about 80 per cent) and 117,260 controls. The women were followed up for an average 15.8 years from time of entry to the study. During the follow-up there were a total of 22,398 deaths in the screening group of which 795 (3.5 per cent) were ascribed to breast cancer. The corresponding numbers for the control group was 20,945 total deaths of which 847 (4.0 per cent) were ascribed to breast cancer.
A closer examination of the data revealed that the benefits of mammography were limited to women between the ages of 55 and 69 years at the start of the study. The reduction in breast cancer mortality ascribed to mammography screening was 24 per cent (29 deaths per 100,000 women years versus 38 deaths per 100,000 women years in the control group) for the ages 55 to 59 years. It rose to 32 per cent for the age groups 60 to 64 years and 65 to 69 years. No statistically significant benefits were seen outside the age range of 55 to 69 years.
Dr. Karen Gelmon of the British Columbia Cancer Agency says that, "the data confirm that screening mammography has a real but modest effect to decrease mortality from breast cancer and that effect varies with age." She points out that it is still debatable whether mammography screening is of value for women under 50 years of age.
Nystrom, Lennarth, et al. Long-term effects of mammography screening: updated overview of the Swedish randomized trials. The Lancet, Vol. 359, March 16, 2002, pp. 909-19
Gelmon, Karen A. and Olivotto, Ivo. The mammography screening debate: time to move on. The Lancet, Vol. 359, March 16, 2002, pp. 904-05 (commentary)

AALBORG, DENMARK. It is increasingly clear that atherosclerosis is, at least partially, an inflammatory disease. There is also growing evidence that high blood levels of C-reactive protein (CRP) are associated with an increased risk of coronary heart disease and heart attacks. Danish researchers now report a direct correlation between CRP levels and severity of atherosclerosis. They also suggest that CRP levels can be kept in check by frequent consumption of fish or fish oils. Their study involved 269 patients referred for angiography because of suspected coronary artery disease. Besides undergoing angiography the patients had their CRP levels measured and were also tested for the level of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in their granulocytes (a type of white blood cell). They also filled out a questionnaire about their fish consumption.
The researchers found that patients with one or more coronary arteries blocked by 50 per cent or more had significantly higher CRP levels in their blood than had patients with no significant blockages. They also observed an inverse correlation between CRP levels and the level of DHA in granulocytes. The level of DHA in granulocytes, in turn, was closely related to fish consumption. The researchers conclude that DHA has an anti-inflammatory effect which results in lower CRP levels and suggest that fish consumption may decrease the risk of coronary artery disease.
Madsen, Trine, et al. C-reactive protein, dietary n-3 fatty acids, and the extent of coronary artery disease. American Journal of Cardiology, Vol. 88, November 15, 2001, pp. 1139-42

BOSTON, MASSACHUSETTS. Cataract removal is the most commonly performed surgery among older people. It is estimated that about 45 per cent of all people over the age of 75 years have cataracts that impair their vision. Several studies have shown a protective effect of certain antioxidant vitamins specifically vitamin C, Vitamin E and carotenoids. Researchers at Tufts University have just released the results of a large study designed to evaluate the effect of vitamins on the incidence of two specific types of cataracts, cortical cataracts and posterior subcapsular (PSC) cataracts. Because the two types occur in different part of the eye's lens the researchers reasoned that the vitamins required for protection might be different.
The study involved 492 non-diabetic women aged 53 to 73 years who were part of the large Nurses' Health Study begun in 1976. All participants had completed food frequency and supplement usage questionnaires every second year for 13 to 15 years. The researchers found lens opacities in 55 per cent of the participants with 37 per cent being cortical opacities and 6.3 per cent being PSC opacities. They also observed that women under the age of 60 years whose daily vitamin C intake exceeded 360 mg/day had a 57 per cent lower risk of developing a cortical cataract than did women whose intake was below 140 mg/day. Women under the age of 60 years who had supplemented with vitamin C for 10 years or more had a 60 per cent lower risk of cortical cataracts than did women who had not supplemented. Vitamin C did not appear to protect against the much less common PSC opacities, but carotenoids and, to a lesser extent, folic acid did seem to confer some protection amongst women who had never smoked. NOTE: The current Recommended Daily Allowance (RDA) for vitamin C is 75 mg/day for women – clearly totally inadequate for providing any meaningful protection against cataracts.
Taylor, Allen, et al. Long-term intake of vitamins and carotenoids and odds of early age-related cortical and posterior subcapsular lens opacities. American Journal of Clinical Nutrition, Vol. 75, March 2002, pp. 540-49

SEATTLE, WASHINGTON. Almost two thirds of deaths from heart disease are sudden and almost half of all heart disease deaths occur before the patient reaches the hospital. What is perhaps even more disturbing is that 50 per cent of people dying suddenly from cardiac arrest never knew they had a heart problem. It is clear that finding the cause(s) of sudden cardiac death is a high priority. Researchers at the University of Washington now report that high levels of trans-fatty acids are strongly associated with an increased risk of sudden cardiac death.
Their study involved 179 sudden death victims between the ages of 25 and 74 years and 285 age- and sex- matched controls. Both cases and controls had blood samples drawn and analyzed for fatty acid levels in red blood cell membranes. The researchers found that cardiac arrest victims tended to have significantly higher overall levels of trans-fatty acids than did the controls. Specifically, they had higher levels of 18:1 (oleic) and 18:2 (linoleic) trans-fatty acids and significantly lower levels of beneficial long chain omega-3 fatty acids (EPA and DHA). After adjusting for EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) and other factors which could affect heart disease risk they concluded that people with a high 18:2 (linoleic) trans-fatty acid level had a three times higher risk of sudden cardiac death than did people with lower levels. High levels of 18:1 (oleic) trans-fatty acids were not associated with increased risk. Linoleic trans-fatty acids are formed when vegetable oils are partially hydrogenated or used for frying and are also found in beef and chicken. Commercially prepared pizza and cookies are other potent sources of 18:2 acids.
Lemaitre, Rozenn N., et al. Cell membrane trans-fatty acids and the risk of primary cardiac arrest. Circulation, Vol. 105, February 12, 2002, pp. 697-701
Katz, Arnold M. Trans-fatty acids and sudden cardiac death. Circulation, Vol. 105, February 12, 2002, pp. 669-71 (editorial)

BONN, GERMANY. High cholesterol levels are a potent risk factor for death from heart disease. It is estimated that a decrease of 10 per cent in cholesterol levels corresponds to a 13 per cent decrease in coronary heart disease mortality. It is also estimated that about 5.5 million Americans ought to be treated for high cholesterol levels, but that only a small proportion actually receives treatment. One of the main reasons for this is that people are becoming increasingly leery of long-term treatment involving powerful drugs with the potential for serious and often fatal adverse events. Recent reports of deaths caused by statins and their cousins have heightened this concern.
A group of researchers from the University of Bonn now report that policosanol, a natural product, is as effective as the statins and much safer. The researchers reviewed 21 clinical trials of policosanol and found that at dosages of 10 to 20 mg/day (taken with the evening meal) it lowered total cholesterol by 17 to 21 per cent, low-density lipoprotein (LDL) cholesterol (the "bad" kind) by 21 to 29 per cent, and raised high-density lipoprotein (HDL) cholesterol (the "good" kind) by 8 to 15 per cent. Daily dosages of 10 mg were found to be as effective as 10 mg doses of simvastatin (Zocor) and pravastatin (Pravachol). All studies showed that policosanol is safe in dosages up to 20 mg/day taken long-term. Policosanol was found to be particularly effective in people with type 2 diabetes. It was noted that it did not increase triglyceride, glucose or hemoglobin (Hb)A1 levels in diabetics. A study of patients with hypertension showed that policosanol could lower systolic blood pressure by as much as 10 mm Hg. Another study found that 20 mg/day of it was highly beneficial for patients with intermittent claudication.
Policosanol is a natural mixture of aliphatic long-chain alcohols isolated from purified sugar cane. The German researchers conclude that, "policosanol is in our opinion a fascinating new agent for the prevention and treatment of atherosclerotic disease."
Gouni-Berthold, Ioanna, et al. Policosanol: clinical pharmacology and therapeutic significance of new lipid- lowering agent. American Heart Journal, Vol. 143, February 2002, pp. 356-65

FRANKFURT, GERMANY. One of the key symptoms of congestive heart failure (CHF) is exercise intolerance. It is believed that this condition is caused by impaired endothelial function. Endothelial dysfunction, in turn, is a disorder of the lining of blood vessels manifesting itself by reduced arterial blood flow and greater platelet adhesiveness. Recent research has established that oxidative stress contributes to endothelial dysfunction by promoting premature cell death (apoptosis). A group of French and German researchers now report that vitamin C supplementation is highly effective in suppressing apoptosis in CHF patients. Their study involved 34 patients (26 men and 8 women ages 28 to 76 years) who were randomized to receive 2500 mg of vitamin C by infusion followed by 2000 mg/day of an oral vitamin C supplement for three days or a placebo. The researchers measured apoptotic membrane microparticles (a marker of apoptosis) in all patients and found that those given vitamin C had reduced their level of these particles by almost 70 per cent. The vitamin C supplemented patients also showed a substantially lower level of oxidative stress as measured by plasma TBARS. The researchers conclude that vitamin C supplementation suppresses endothelial dysfunction in CHF patients.
Rossig, Lothar, et al. Vitamin C inhibits endothelial cell apoptosis in congestive heart failure. Circulation, Vol. 104, October 30, 2001, pp. 2182-87

PALO ALTO, CALIFORNIA. Numerous studies have reached the conclusion that regular exercise provides significant health benefits. Researchers at the Stanford University medical Center have just completed a study aimed at determining exactly how beneficial being fit and having a high exercise capacity really is. Their study involved 6213 men who had been referred for treadmill testing for clinical reasons. They were followed for an average of six years during which 1256 of them died. The treadmill testing showed that peak exercise capacity was a strong predictor of the risk of death. An increase of 1 MET in exercise conferred a 12 per cent improvement in survival. One MET is defined as the energy expended in sitting quietly. The overall age-adjusted risk of death was 4.5 per cent for men without heart disease whose peak exercise capacity was between 1 and 5.9 MET as compared to 1 per cent for men with a peak exercise capacity of more than 13 MET. Similar results were found for men with diagnosed cardiovascular disease. Being on beta-blockers did not affect the correlation between exercise capacity and mortality. The researchers conclude that low peak exercise capacity is a stronger predictor of risk of death than other well established risk factors such as hypertension, diabetes, smoking, and certain heart rhythm abnormalities in both healthy men and men with heart disease.
Myers, Jonathan, et al. Exercise capacity and mortality among men referred for exercise testing. New England Journal of Medicine, Vol. 346, March 14, 2002, pp. 793-801

GAINESVILLE, FLORIDA. Cardiorespiratory fitness measured as the maximum oxygen consumption (VO2max) during treadmill testing is strongly associated with the risk of heart disease, stroke, hypertension, and overall mortality. Low cardiorespiratory fitness (low VO2max) equates to an increased risk and mortality. It is generally believed that the best, if not the only, way of improving cardiac fitness is by endurance (aerobic) exercise (running, jogging, tennis, cycling, etc.) vigorous enough to bring the heart rate into the appropriate training range. Whilst this may be true for young and middle-aged people there is now a strong indication that resistance training (weight lifting) can markedly improve cardiorespiratory fitness in elderly people.
Researchers at the University of Florida have just released a study involving 62 men and women between the ages of 60 and 85 years. The participants were randomly assigned to a control group, a low-intensity exercise group or a high-intensity group. For the next six months the participants took part in resistance training three times a week. The exercises used were abdominal crunch, leg press, leg extension, leg curl, calf press, seated row, chest press, overhead press, biceps curl, seated dip, leg abduction, leg adduction, and lumbar extensions. The low-intensity group did 13 repetitions at 50 per cent of the maximum weight they had been able to move at the beginning of the trial period whilst the high-intensity group did 8 repetitions at 80 per cent of their initial maximum performance.
At the end of the six-month period all participants were evaluated for muscle strength and cardiovascular fitness. Muscle strength had increased by an average of 17.2 per cent and 17.8 per cent in the low-intensity and high-intensity groups respectively. The peak oxygen consumption during treadmill testing increased by 23.5 per cent and the treadmill time to exhaustion by 26.4 per cent in the low-intensity group. The comparable increases in the high-intensity group were 20.1 per cent and 23.3 per cent. There was no change in peak oxygen consumption and only a slight increase (5 per cent) in treadmill time to exhaustion in the control group.
The researchers conclude that high or low intensity resistance training will increase cardiorespiratory fitness in elderly people. This is excellent news since jogging can be very hard on the knees – particularly elderly ones!
Vincent, Kevin R., et al. Improved cardiorespiratory endurance following 6 months of resistance exercise in elderly men and women. Archives of Internal Medicine, Vol. 162, March 25, 2002, pp. 673-78

TURKU, FINLAND. The incidence of atopic eczema and other atopic diseases are increasing throughout the western world. Atopy is a form of allergy in which the hypersensitivity reaction may be in a region other than the region in direct contact with the offending substance. For example, ingesting a food to which one is allergic may give rise to a skin rash called atopic eczema or atopic dermatitis.
Although there is a strong genetic component in atopic eczema there is some indication that early diet (fetus and infant) can affect the risk of the disease. Researchers at the University of Turku now report that atopic eczema is substantially less prevalent in infants born to mothers who have been supplementing with probiotics. Their double-blind, placebo-controlled clinical trial involved 62 mother-infant pairs. The mothers were randomized to receive either a placebo or a probiotic supplement (Lactobacillus rhamnosus, 10 billion units/day) for the last four weeks of pregnancy and during breast-feeding until the infant was three months old. The infants were followed for a two-year period. The researchers fond that infants born to mothers who themselves had atopic disease were four times more likely to develop chronic relapsing atopic eczema than were children born to healthy mothers. They also found that probiotics supplementation was highly effective in preventing eczema. Infants born to mothers who had supplemented had an incidence rate of only 15 per cent as compared to 47 per cent among infants born to mothers who had taken the placebo. The probiotics even reduced the risk in infants born to mothers who themselves had atopic disease. In this group infants born to supplementing mothers had an incidence rate of 25 per cent as compared to 55 per cent in the placebo group. No infants born to non-atopic mothers who took probiotics developed atopic eczema during the first two years of their life. The researchers conclude that administration of probiotics to the mother during pregnancy and breast-feeding appears to be a safe and effective mode of enhancing the immunoprotective potential of breast milk and preventing atopic eczema in the infant.
Rautava, Samuli, et al. Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. Journal of Allergy and Clinical Immunology, Vol. 109, January 2002, pp. 119-21 (brief communication)

NEWSBRIEFS

White wine and heartburn
German researchers report that white wine is a powerful initiator of gastroesophageal reflux (GER) both in healthy people and in people with gastroesophageal reflux disease (GERD). They found that drinking white wine significantly increases the frequency and duration of acid reflux. Whiskey and vodka have also been implicated in the initiation of GER.
American Journal of Gastroenterology, Vol. 97, March 2002, pp. 561-67

Sudden cardiac death on the rise
The US National Center for Chronic Disease Prevention reports that 63 per cent of the more than 700,000 deaths associated with heart disease in 1998 were sudden, that is, they occurred within one hour of onset of symptoms and, in most cases, without any prior warning that something was wrong with the heart. The incidence of sudden cardiac death has increased by 12 per cent over the period 1989 to 1998 with an increase of 21 per cent among women aged 35 to 44 years being particularly worrisome. The researchers suspect that women are much less aware of the risks of heart disease and the majority (over 70 per cent) does not discuss heart disease with their doctor. It does not help that the symptoms of heart disease in women are often atypical (neck, back or jaw pain or nausea) and much less well published than the symptoms for men.
Circulation, Vol. 104, October 30, 2001, pp. 2158-63

Smoking implicated in mental illness
It is well established that smoking increases the risk of high blood pressure, heart disease, cancer, and birth defects. A group of American medical researchers now reports a strong association between smoking in adolescence and the later development of mental illness. Dr. Jeffrey Johnson and his team at Columbia University found that youths in good mental health who smoked a packet or more of cigarettes daily were more than 16 times likely to later develop panic disorder and 5 times more likely to develop generalized anxiety disorder than peers who smoked less than a pack per day. Other researchers have found a strong association between smoking and the later development of agoraphobia and depression.
New Scientist, April 13, 2002, pp. 31-33

Consumer rights trampled again!
A task force of the UN Codex Alimentarius Commission has decided that consumers have no right to know if their food contains genetically modified organisms (GMOs) and that sovereign, national governments can not demand that food producers be forced to divulge the genetic origin of their products. The only exception would be if a GMO proves to be a serious health hazard, i.e. closing the barn door after the horse has bolted! Says Bruno Heinzer of Greenpeace, "This decision will increase the risk of a plant-food equivalent of mad cow disease." He also fears that some governments will interpret the ruling as a go ahead to ignore checking of GMOs until after a health risk becomes apparent.
New Scientist, March 16, 2002, p. 12

Shampoo implicated in early puberty
Girls, at least in the Western world, tend to reach puberty earlier than ever before. The phenomenon is particularly apparent among African-American girls in the USA half of whom now reach puberty at the age of eight years. Only 15 per cent of white girls have entered puberty by this age. Dr. Chandra Tiwary, former chief of pediatric endocrinology at Brooke Army Medical Center in Texas, believes that the reason for the early puberty can be found in the shampoo used by many girls, particularly in the black community. Dr. Tiwary found that some "hormone enriched" shampoos contain large amounts of estrogen hormones and points out that these hormones are easily transferred through the skin (hormone therapy is often delivered through skin patches). Hormone-rich shampoos are banned in Europe, but are still sold in the United States and are widely available on the Internet.
New Scientist, April 6, 2002, pp. 6-7

Fathers-to-be need folic acid too
An increasing number of couples have difficulty conceiving a child. A major reason for this is the declining sperm quality in men. Dutch researchers have just discovered that supplementing with a combination of folic acid and zinc can increase the perm count in infertile men by as much as 74 per cent. "An importance advance", says Dr. Bruce Ames of the University of California who last year found not only that a folic acid deficiency is associated with low sperm count and quality, but that a lack of vitamin C, especially in smokers, can lead to a poor sperm as well. Folic acid supplementation has also been found to reduce homocysteine levels and thus help prevent stroke and heart attack. There is also evidence that folic acid reduces the risk of Alzheimer's disease and colon cancer.
New Scientist, March 23, 2002, p. 11