Turmeric Extract Relieves Pain of Knee Osteoarthritis and Improves Function Comparably to Ibuprofen

Kuptniratsaikul V, Thanakhumtorn S, Chinswangwatanakul P, Wattanamongkonsil L, Thamlikitkul V. Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis. J Altern Complement Med. 2009;15(8): 891-897.

Osteoarthritis (OA), a degenerative joint disorder, is a common cause of disability for both men and women. Although nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common treatment for pain relief associated with OA, they can cause serious adverse side effects that impact gastrointestinal, renal, and cardiac health. Curcumin present in turmeric (Curcuma longa syn. C. domestica) extracts has been reported to have anti-inflammatory and antioxidant properties. These authors, from Mahidol University in Bangkok, Thailand, conducted a study to determine the efficacy and safety of a turmeric extract in reducing pain and improving function in patients with knee OA.

Conducted at Siriraj Hospital in Bangkok from April 2005 to May 2006, the study included adult subjects with primary knee OA according to the American Rheumatism Association criteria. To be included in the study, patients had to have knee pain and radiographic osteophytes and at least 1 of the following characteristics: older than 50 years, suffering from morning stiffness lasting less than 30 minutes, and experiencing crepitus (crackling in joints) on motion. Patients reporting a pain score of ≥ 5 of 10 in a numerical rating scale were recruited.

The patients were asked to discontinue their medications for knee OA 1 week before randomization. All patients were randomly allocated to receive either ibuprofen (400 mg twice daily) or turmeric extract (500 mg curcuminoids 4 times daily) for 6 weeks.

According to the authors, the turmeric extracts were produced by the Thai Government Pharmaceutical Organization under the Good Manufacturing Practices standard. Dried rhizomes of C. longa were ground into powder. The turmeric powder was extracted with ethanol and then evaporated at low pressure to obtain ethanolic extracts containing oil and curcuminoids. The oil was then removed. Each capsule of extract contained 250 mg curcuminoids.

The patients were assessed every 2 weeks. The main outcomes were pain on level walking and pain on stair climbing, measured by a numerical rating scale, and knee functions assessed by the time spent on a 100-m walk and going up and down 10 steps.

All patients had blood tests including complete blood count, liver function, and renal function at week 0 and week 6. At week 6, the patients’ satisfaction with treatment was evaluated by a 5-category scale (high, moderate, little, same, or dissatisfaction).

Of 190 patients screened, 107 were selected for the study; 52 were randomly assigned to the curcuminoid group and 55 to the ibuprofen group. Of those, 45 patients in the curcuminoid group and 46 patients in the ibuprofen group completed the study. Most of the patients were overweight elderly women. The duration of symptoms before entering the trial was approximately 20 months. Half of the patients had bilateral knee OA. At baseline, the mean pain scores on level walking and on the stairs, as well as the time spent on the 100-m walk and on the flight of stairs, were similar between the 2 groups.

The authors report that in both groups, the mean scores of all outcomes at week 6 were significantly improved when compared with the baseline values. For example, from week 0 to week 6, the scores for pain on level walking dropped from 5.3 ± 2.3 to 2.7 ± 2.5 for the curcumin group and from 5.0 ± 1.9 to 3.1 ± 2.3 in the ibuprofen group. There was no significant difference in those parameters between the 2 groups, except that pain on stair climbing was less for those taking curcuminoids (P = 0.016). Also, the curcuminoid group seemed to spend less time on the 100-m walk and going up and down a flight of stairs. No significant differences were found for adverse events between the 2 groups, with dyspepsia (curcuminoids 20.8% and ibuprofen 26.9%) most common. Interestingly, many patients in the curcuminoid extract group who experienced bloating symptoms and passing gas described these symptoms as beneficial gastrointestinal effects, whereas those in the ibuprofen group reported gastrointestinal irritation symptoms.

Regarding satisfaction, most patients rated themselves as having moderate to high satisfaction (91.1% in the curcuminoid group and 80.4% in the ibuprofen group). The patients’ satisfaction with treatment was not statistically significantly different (P = 0.15) between the groups. The patients in the ibuprofen group had better compliance to the treatment regimen than those in the curcuminoid extract group (90.1% versus 82.8%, P = 0.001). This finding was attributed by the researchers to the fact that ibuprofen was given twice a day, whereas curcuminoid extract had to be taken 4 times a day.

These results suggest that curcuminoid extracts of turmeric might be as effective as ibuprofen in alleviating knee pain and improving knee functions, with a trend toward a greater effect in patients receiving curcumin extracts. However, the wide range of 95% confidence interval (CI) indicated that the study had an inadequate sample size. Based on the standard deviation (SD) of 2.36, the proper sample size should be 70 patients per group. The authors recommend more studies with an adequate sample, a higher dose of ibuprofen in the comparison group, and double-blind technique to demonstrate the efficacy of turmeric extracts in alleviating knee pain and improving knee function.

―Shari Henson

Source: American Botanical Council, 6200 Manor Rd, Austin, TX 78723
Phone: 512-926-4900 | Fax: 512-926-2345 | Email: abc@herbalgram.org

Healing Properties of Saffron

Ferrence S, Bendersky G. Therapy with saffron and the goddess at Thera Perspectives in biology and medicine. 2004;47(2):199-226.

In approximately the mid-17th century, a devastating volcanic eruption buried the town of Akrotiri on the Greek island of Thera. In 1967, the excavation of the town under the auspices of the Archeological Society of America revealed many well-preserved wall paintings and frescoes, which were cleaned and conserved. The frescoes uncovered at this site ‘suggest that the Therans of ancient Akrotiri developed saffron (Crocus sativus) as a versatile medicine more than 3,600 years ago.’ The interpretation of the meaning of one of these frescoes, found in a building known as Xeste 3, is the subject of this article.

The Xeste 3 frescoes span two adjacent walls and, in one section, portray an elevated, jewelry-clad, woman (goddess) surrounded by animals and young girls in a landscape of crocuses (Crocus spp.). A basket of saffron sits at the feet of the goddess. A blue monkey is depicted extending crocus blooms to the goddess, whereas the girls in the frescoes are picking crocus blooms, carrying crocus blooms, or emptying crocus blooms from a small basket into a large basket on the ground. In another portion of the frescoes, a woman is seen extending one hand toward her bleeding foot as two crocus stigmas fall toward her foot. The artist of this painting depicted the female reproductive portion of the plant—the stigma—in elaborate detail. Although some scholars have interpreted the painting to represent fertility rituals, marriage ceremonies, or local industry, most researchers conclude that ‘crocuses and saffron are at the heart of the matter.’ The authors of this article propose that ‘the program of Xeste 3 does not merely include the secondary medicinal value of saffron as a secondary element, but, in fact, emphasizes its primary therapeutic function, and exhibits the production sequence in cultic recognition of its precious curative value.’

The focus of the Xeste 3 frescoes appears to be the women and the crocuses, which are linked to the healing properties of saffron. The Aegean crocus (Crocus cartwrightianus) is the species depicted, which is an autumnal flower with three large crimson stigmas that can be picked, dried, and ground to make saffron. Of the many medicinal plants developed in the ancient Near East and Mediterranean, saffron has had the greatest number of applications over nearly four millennia. The proven safety, efficacy, and availability of saffron for a large variety of symptoms may be the reason for its prominent portrayal in the Xeste 3 frescoes. The authors ‘hypothesize that the frescoes express a divinely encouraged concept: the medicinal healing that is the major function of the crocus/saffron.’ This hypothesis is based on three observations: the crocus and its stigma are the dominant motif; the medicinal phytoactivity of crocuses is concentrated in the stigma; and the closeness of the basket of saffron to the goddess (which indicates the importance of this substance). Ancient Eastern Mediterranean healers and worshipers often invoked the help of a deity to potentiate a medicine; therefore, the painting may promote the belief that the goddess depicted has conferred curative properties to the saffron or has given the gift of saffron to humans. Thus, it may be interpreted that the introduction of saffron as a medicine may have originated at Akrotiri.

The first known mention of saffron (azupiranu) is in an Assyrian dictionary of botany written in 668-633 BCE, in which it is described as being used to treat dyspnea (breathing difficulty), painful urination, menstrual disorders, and ‘diseases of the head.’ Following the Bronze Age, the use of saffron for medicinal purposes has continued up to the present day. Saffron also has a history of use for the treatment of cutaneous ulcers, wounds, thrush, palpitations, smallpox, measles, jaundice, constipation, eye diseases, liver diseases, joint pain, earaches, diarrhea, vomiting, and headaches. In addition, saffron has long been valued for its effectiveness in treating gynecological conditions. Saffron concoctions have been used to regulate menses and fertility and to induce abortions. Studies conducted since the early 20th century have identified steroidal estrogens and non-steroidal substances in saffron that mimic female sex hormones. In the late 20th and early 21st centuries, saffron or its derivatives (e.g., crocin and crocetin) were shown to have antitumor activity against different malignancies in humans and animals both in vivo and in vitro. Only in the past few decades, however, has the ‘potential success’ of saffron in the treatment of many of the abovementioned conditions been confirmed by phytochemical studies and experimental evidence.

The dominant portrayal of saffron in the Theran frescoes of Akrotiri likely implies that this culture had discovered medicinal uses for saffron. The women participating in the saffron activities in the frescoes ranged in age from young girls to older women. ‘This multi-generational spectrum is consistent with the age range appropriate for diseases extending from menstrual disorders to malignancy.’ On the basis of both modern pharmacology and ancient medical texts, however, saffron therapy is generally efficacious for non-reproductive-related problems as well and for disorders experienced by male patients. The Xeste 3 frescoes appear to ‘anthropomorphize the medicinal plant [saffron] into the persona of a female divinity of medicine.’ Betancourt1 suggests that the Theran artist who created the frescoes ‘created a powerful, unified composition that contains ‘the first true perspective in ancient wall painting’.’

—Brenda Milot, ELS

Reference
1Betancourt PP. Concept of space in Theran compositional systemics. In: Sherratt S, ed. The wall paintings of Thera: Proceedings of the first international symposium. Athens: Thera Foundation, 2000:359–63.

American Botanical Council, 6200 Manor Rd, Austin, TX 78723

Ephedra and Caffeine’s Impact on Heart Rate and Systolic Blood Pressure

McBride B, Karapanos A, Krudysz A, et al. Electrocardiographic and hemodynamic effects of a multicomponent dietary supplement containing ephedra and caffeine JAMA. 2004;291(2):216-221.

Dietary weight-loss supplements often contain both ephedra and caffeine along with other natural ingredients. Anecdotal cases of sudden cardiac death and cerebrovascular adverse events associated with the combination of ephedra and caffeine have been reported. Consumers consider the herbal preparations as safe; however, safety data is lacking. Metabolife 356® (Metabolife International Inc, San Diego, CA) was one of the top selling dietary supplement containing ephedra and caffeine. It also contained a variety of ingredients, such as eleuthero (a.k.a. Siberian ginseng; Eleutherococcus senticosus), ginger (Zingiber officinale), and goldenseal (Hydrastis canadensis) in proprietary amounts.

An electrocardiogram (abbreviated as ECG or EKG) can be used to record the electrical activity of the heart during contraction. Waves (labeled as P, Q, R, S, T, and U) are generated on paper showing the activity of the atria and ventricles of the heart. The QT interval shows the excitation and relaxation of the ventricles. This study evaluated the impact of ephedra plus caffeine on the corrected QT (QTc) interval and on systolic blood pressure.

Fifteen healthy men and women participated in this randomized, double-blind, placebo-controlled, crossover study. Participants received either 1 capsule of Metabolife 356 or placebo. This was followed by a 7-day washout period after which they received the opposite treatment. Hemodynamic and electrocardiographic variables were evaluated immediately before and after ingestion of the capsules.

After dosing, the maximum QTc interval was 5.9% higher with Metabolife 356 than with placebo (P<0.001). The average QTc interval increased from baseline by 27.20 milliseconds when Metabolife 356 was consumed compared to 2.63 milliseconds when placebo was consumed (P=0.03). Fifty-three percent of the participants had QTc interval increases of at least 30 seconds while taking Metabolife 356. The QTc interval was greater in the Metabolife 356 group for every time point. The Metabolife group also had a higher post-dosing systolic blood pressure at 5 hours (P = 0.009). All patients receiving Metabolife 356 reported nonspecific adverse events, such as jitteriness, queasiness, or 'not feeling quite right.' No adverse events were reported while participants were taking placebo. One participant developed tachycardia (increased heart rate), one developed a hand tremor, and another developed premature ventricular complexes while taking Metabolife 356. The European Center for Proprietary Medicinal Products recognizes a drug induced increase in the QTc interval of at least 30 milliseconds as a potential cause of concern for developing ventricular tachycardia. Ventricular tachycardia is a potentially unstable rhythm that may result in fainting, low blood pressure, shock, or sudden death. The FDA has no official standards regarding products and ventricular tachycardia. However, the drugs cisapride and terfenadine were removed from the U.S. market due to cases of prolonged QTc intervals in the range of 13 to 17 milliseconds. Overall, this study showed that a single dose of a dietary supplement containing ephedra and caffeine significantly prolongs the QTc interval, which is a risk factor for developing heart arrhythmias (abnormal heart rhythm). The supplement also increased systolic blood pressure. The authors conclude that Metabolife 356 and other products with similar ingredients should be avoided until more information is known. —Heather S. Oliff, Ph.D American Botanical Council, 6200 Manor Rd, Austin, TX 78723

Consumption of Flavanol-Containing Cocoa Reverses Vascular Dysfunction in Diabetic Patients

Balzer J, Rassaf T, Heiss C, et al. Sustained benefits in vascular function through flavanol-containing cocoa in medicated diabetic patients: a double-masked, randomized, controlled trial. J Am Coll Cardiol. 2008;51(22): 2141-2149.

The prevalence of type 2 diabetes mellitus is increasing worldwide and is accompanied by an increasing risk of cardiovascular disease and mortality. Prescription medications are often used extensively in an attempt to prevent and/or treat complications of type 2 diabetes; however, they are often inadequate. Observational studies have shown that lifestyle modification (e.g., increased physical activity, weight loss, and dietary changes) can prevent diabetes and its associated complications. Epidemiologic studies have recently shown an inverse correlation between flavanol consumption and mortality from cardiovascular disease and the incidence of diabetes. Flavanols are predominantly found in fruit, vegetables, tea (Camellia sinensis), red wine (Vitis vinifera), and especially cocoa (Theobroma cacao). The results of dietary intervention trials have shown beneficial effects of flavanols on low-density-lipoprotein (LDL) oxidation, platelet aggregation, insulin sensitivity, endothelial function, and blood pressure. The objective of the present study was to investigate the feasibility and efficacy of a dietary intervention with flavanols from cocoa on improving vascular function in diabetic patients.

Men and women aged 50-80 years on hypoglycemic medication with a history of stably treated type 2 diabetes for at least 5 years were screened for eligibility. Ten patients were enrolled in a feasibility study, and 41 patients were enrolled in an efficacy study. Both studies had a randomized, double-masked design. In the feasibility study, the subjects consumed a single cocoa drink providing 75 mg (control), 371 mg (medium content), or 963 mg (high content) flavanols on 3 separate occasions (crossover design). Flow-mediated dilation (FMD), a measure of endothelial function, was measured an hour before and 1, 2, 3, 4, and 6 hours after ingestion of the cocoa drink. Blood samples were collected 2 hours after ingestion for the measurement of plasma flavanol concentrations. In the efficacy study, the subjects consumed 3 doses daily of either 321 mg flavanols (treatment group; 963 g/day total) or 25 mg of flavanols (control group; 75 mg/day total) for 30 days. FMD, blood pressure, heart rate, clinical variables, and plasma flavanol metabolites were measured at baseline and again on the same day 2 hours after ingestion of the day’s first amount of cocoa on days 0, 8, and 30. The cocoa drinks were prepared from a dry cocoa beverage mix (made using CocoaPro® cocoa powder; Mars Inc.; Hackettstown, New Jersey), and all of the cocoa drinks were similar in other macro- and micro-nutrient, caloric and alkaloid content, taste, and appearance. The primary outcome measure was endothelial function, which was determined on the basis of FMD of the brachial artery. Secondary outcome measures included changes in plasma flavanol metabolites 2 hours after ingestion of cocoa, blood pressure, and fasting plasma glucose, plasma lipid, and glycated hemoglobin concentrations.

In the feasibility study, the mean FMD of the study population was 3.8 ± 0.3%. A dose-dependent increase in FMD was observed after consumption of 371 and 963 mg flavanols, but not after ingestion of 75 mg flavanols (control). The highest FMD (5.5 ± 0.4%; P < 0.001 compared with baseline) occurred 2 hours after ingestion of the highest flavanol intake (963 mg). Plasma flavanols and FMD increased significantly in all of the subjects who ingested 963 mg flavanols. In the efficacy study, fasting FMD in the treatment group increased significantly from 3.3 ± 1.1% at baseline to 4.1 ± 1.1% on day 8 (P < 0.001) and to 4.3 ± 1.2% on day 30 (P < 0.0001). Significant acute-on-chronic increases (increases after consumption of the day's first amount) in FMD after flavanols ingested continued throughout the duration of the study (P < 0.0001). Plasma flavanol metabolites did not increase significantly in the control group but did increase significantly in the treatment group, from 1473.2 ± 670.9 nmol/L at baseline to 2177.7 ± 995.1 nmol/L (P = 0.0027) on day 30. No significant changes in blood pressure or in fasting plasma glucose and plasma lipid concentrations were observed in either the treatment or the control group on day 30, except for a significant decrease (P = 0.0063) in the LDL concentration in the treatment group. Glycated hemoglobin on day 30 was significantly lower than that at baseline in both the treatment (P = 0.0480) and control (P = 0.0038) groups. The authors conclude that their study "clearly establishes improvements of endothelial function after regular consumption of flavanol-containing cocoa in patients with type 2 diabetes." Flavanol consumption was well tolerated with no evidence of tachyphylaxia (desensitization to the treatment). The findings indicate the therapeutic potential of flavanols for helping reduce the risk of cardiovascular disease in type 2 diabetics on medication. —Brenda Milot, ELS American Botanical Council, 6200 Manor Rd, Austin, TX 78723

Vitamin D and intervention trials in prostate cancer: from theory to therapy.

Schwartz GG.

Departments of Cancer Biology and Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA. gschwart@wfubmc.edu

Studies of vitamin D and prostate cancer have advanced rapidly from the hypothesis that vitamin D deficiency increases the risk of prostate cancer to intervention trials of vitamin D administration in clinical cancer. The hormonal form of vitamin D, 1,25(OH)(2)D, exerts prodifferentiating, antiproliferative, anti-invasive, and antimetastatic effects on prostate cells. Moreover, normal prostate cells synthesize 1,25(OH)(2)D from serum levels of the prohormone, 25-hydroxyvitamin D. The autocrine synthesis of 1,25(OH)(2)D by prostatic cells provides a biochemical mechanism whereby vitamin D may prevent prostate cancer. Many prostate cancer cells have lost the ability to synthesize 1,25(OH)(2)D but still possess 1,25(OH)(2)D receptors. This suggests that whereas vitamin D (e.g., cholecalciferol) might prevent prostate cancer, existing prostate tumors likely would require treatment with 1,25(OH)(2)D and/or its analogs. The major obstacle to the use of 1,25(OH)(2)D in patients therapeutically is the risk of hypercalcemia. Several maneuvers to reduce this risk, including pulse dosing and the use of less calcemic 1,25(OH)(2)D analogs, have been explored in Phase I-III clinical trials. Once merely a promise, vitamin D-based therapies for prostate cancer may soon be medical practice.

PMID: 18619854 [PubMed – indexed for MEDLINE]

ABC Responds to Article on Herb-Drug Interactions in Journal of the American College of Cardiology

(Austin, TX) At least several times per year an article is published in a medical journal that purports to provide health professionals and the public with useful information on the safety of herbs and herbal dietary supplements. Instead, what sometimes occurs is an article written by people with apparently little to no expertise in the subject area of herbal medicine and medicinal plant research and likewise apparently peer reviewed—if peer reviewed at all—by reviewers with little botanical knowledge or expertise. Yesterday, the Journal of the American College of Cardiology published such an article.1

This particular article has so many flaws and errors that it is difficult to know where to begin to critically review it.

First, Latin names for the herbs discussed are missing, a disservice to any readers who may not be familiar with common names used in the United States.

Second, some of the tables in the article contain entries for “commonly used herbs,” which include the toxic plant oleander (Nerium oleander, a toxic herb with cardioactive glycosides not sold to consumers in the US dietary supplement market); chan su (presumably dried Chinese toad venom—not an herb nor generally available as a dietary supplement!); and uzara root (Xysmalobium undulatum), an anti-diarrhea herbal drug approved in Germany. None of these are “commonly” found in the US herbal dietary supplement market.

Grapefruit juice, which is well known for increasing serum levels of many pharmaceutical drugs, is referred to as an herb.

The authors refer to “ginseng” without clarifying which species of the genus Panax they are referring, many of which cause varying pharmacological effects. Also, with respect to “ginseng,” the authors unfortunately repeat the highly erroneous adverse effect information from the widely discredited 1979 uncontrolled study by RK Siegel on the “Ginseng Abuse Syndrome,” stating that “ginseng” can cause “hypertension, behavioral changes and diarrhea.”

Capsicum is listed in a table as being used for shingles, trigeminal, and diabetic neuralgia, when it is actually the US Food and Drug Administration-approved over-the-counter and prescription drug capsaicin, the vanillanoid compound derived from chili peppers (Capsicum spp.), which is used for such purposes.

There are more; the errors and problems in this paper are too numerous to list completely at this time.

While there are potential and actual interactions that various herbs can have with drugs used by patients with cardiovascular diseases, this paper will do little to improve professional awareness and skill in this area. However, the resulting media coverage will undoubtedly increase public confusion over what is an already confused subject. This paper should not have been published in its present form without serious additional edits, revisions, and deletions, and the Journal of the American College of Cardiology would be advised to retract it.

Reference

Tachjian A, Maria V, Jahangir A. Use of herbal products and potential interactions in patients with cardiovascular diseases. J Amer Coll Cardiol. 2010;55(6). [DOI:10.1016/j.jacc.2009.07.074].

Vitamin D reverses diabetic neuropathy

by Dr Linda Calabresi
15 April 2008

Vitamin D supplementation is an effective treatment of neuropathic pain in Type 2 diabetes patients, new Australian research suggests.

Previous research has found that vitamin D deficiency is common in patients with Type 2 diabetes, but its effect on neuropathic pain has not previously been tested, say study authors Drs Paul Lee and Roger Chen from Concord Repatriation General Hospital.

Their study, published in today’s Archives of Internal Medicine (168:771-772) involved 51 patients with Type 2 diabetes and typical neuropathic pain. All patients were vitamin D deficient with a mean serum 25D concentration of 18 ng/mL.

After three months, vitamin D repletion with cholecalciferol (vitamin D3) tablets resulted in a significant reduction in pain scores using two separate assessments, one suggesting the pain severity was reduced by 40% the other suggesting pain severity had been halved.

How vitamin D reduces the severity of diabetic neuropathic pain is uncertain, but the researchers suggest that vitamin D insufficiency may potentiate diabetic nerve damage and impair nociceptor function. The results could not be explained by a decrease in parathyroid hormone as testing did not show any statistically significant difference in hormone level following the vitamin D repletion, they say.

Vitamin D is known to have a role in the prevention of osteoporosis. It is also increasingly being recognised for its ability to improve glycaemic control, the endocrinologist researchers said. In addition, vitamin D repletion is free of adverse effects.

Therefore, the researchers said they would advocate a trial of vitamin supplementation in vitamin D-deficient patients with neuropathic pain.

“It is unlikely to have any harmful effects and may offer not only pain relief but also beneficial effects on bone health and glycaemic control.”

Source: www.sci.rutgers.edu/forum/showthread

Glycemic Index Education May Lead to Better Diabetes Control

Nine weeks of education about the glycemic index in foods is enough to encourage adults with type 2 diabetes to adopt better dietary habits that result in improvements to their health, suggests recent research published in Public Health Nutrition.

Participants in a clinical trial attended weekly sessions to learn about the potential benefits of low­–glycemic-index foods. After nine weeks, the participants had adopted a lower glycemic-index diet and recorded lower weight, smaller waists, and improved blood sugar levels. When they were tested again another nine weeks later—during which time they received no additional education—the participants had maintained most of those improvements.

The research addresses a controversy in the nutrition community: Some practitioners believe the principles behind maintaining a low–glycemic-index diet are too complicated for average consumers.

“We found that with education, people with diabetes were able to adopt a lower glycemic-index diet. And it had a significant improvement in their weight control and glucose control,” says Carla Miller, senior study author and an associate professor of human nutrition at Ohio State University. “A vast majority of people with diabetes don’t get sufficient education about their condition when they are diagnosed. And yet for many patients, that’s the only time they receive nutrition education. What they really need is continued education and support to help them maintain good control.”

In the study, people with diabetes were randomized to one of two groups. One group immediately participated in the nine-week intervention, and the other group waited for nine weeks before undergoing the same intervention.

The 103 participants who completed the study were between the ages of 40 and 70, had been diagnosed with type 2 diabetes for at least one year, and did not require insulin therapy for diabetes management. For the most part, participants were already doing a good job of controlling their blood glucose levels.

Each group education session lasted between 90 minutes and two hours. Session topics included self-monitoring of food intake and portion sizes, carbohydrate counting, and maintaining behavioral change. Overall, the intervention emphasized selecting lower glycemic-index foods rather than restricting overall carbohydrate intake.

“The emphasis historically has been to control how much carbohydrate people with diabetes eat rather than the type of carbohydrate they choose. And the controversy has been that the glycemic index is so complicated, it’s just another thing that we are asking people to worry about,” Miller says. “And they do have to balance many different variables to get all of these blood parameters under control. That’s another reason they need a lot more education than they receive.”

Researchers collected health measures and diet and physical activity information before and after the intervention period. During the intervention, participants tested their blood glucose levels before and after meals four days per week. To track the participants’ food choices, researchers made periodic unannounced phone calls and asked patients to recall what they had eaten in the previous 24 hours.

After nine weeks of intervention, participants in the first group lost an average of about 5.1 lbs, decreased their waist circumference by 1.1 inches, reduced their body mass index by almost 1 point, and lowered their blood glucose concentration after eating by almost 18 mg/dL. Another nine weeks later, even with no additional intervention, these participants had maintained those health benefits, with the exception of a slight average gain in waist circumference among women.

The participants who waited nine weeks for the intervention recorded similar health improvements after they attended the education sessions. But Miller notes that while they waited, this group also gained weight and recorded expansions of their waists—yet another sign that education can’t start soon enough for many patients with diabetes.

“They had a trajectory of change that was getting worse,” she says. “People with diabetes do need continued support to sustain optimal glycemic control because the disease progresses as they live longer.”

Based on self-reports of food choices, the study showed that participants’ fiber intake improved and they ate less fat. And they did not restrict carbohydrates but instead made different carbohydrate choices.

“We were not putting people on a strict diet. They consumed the same amount of carbohydrate that they normally would but selected lower glycemic-index foods within that carbohydrate allotment,” Miller says. “That addresses another controversy in nutrition. People with diabetes do not have to go on a low-carb diet, which typically is accompanied by a high intake of fat. What these participants ate was closer to [what] the dietary guidelines generally recommend for Americans, with less than 30% of calories coming from fat. The quantity of carbohydrate does matter to some extent, but the type of carbohydrate makes a big difference.”

— Source: The Ohio State University

Source: www.todaysdietitian.com

Anti Oxidant Activity of Tumeric

Turmeric (Curcuma longa) is a major culinary spice of India and other Asian countries, and has been shown to have anti-cancer, anti-coagulative, and anti-hepatotoxic properties. As an anti-oxidant, it is sometimes added (at 0.5-1.0% levels) to ground nut oils to reduce the formation of peroxides and to increase shelf-life. This study was conducted to determine the nature of the anti-oxidant principle in turmeric. From an aqueous extract of powdered turmeric tubers, a heat-stable protein with anti-oxidant properties was isolated. This turmeric anti-oxidant/protein (TAP) was found to inhibit lipid peroxidation in both of the environments in which it was incubated: in vitro in rat brain tissue, and in cod liver oil.

In previous studies, turmeric has been shown to be as effective an anti-oxidant as butylated hydroxy anisole, which is used in the preservation of foods. But whereas high concentrations of butylated hydroxy anisole have been shown to be toxic, high concentrations of turmeric have been reported to be non-toxic. These findings, therefore, are significant in areas where turmeric is consumed in the diet. The ability of TAP to protect tissues from peroxidation merits further study.

January 8. 1996

Selvam, R., Lalitha Subramanian, R. Gayathri, and N. Angayarkanni. The anti-oxidant activity of turmeric (curcuma longa) Journal of Ethnopharmacology. Vol 47, 1995:.

Source: The American Botanical Council

Celiac Disease

Disease characteristics. Celiac disease is a systemic immune disease that can be associated with gastrointestinal findings (diarrhea, weight loss, abdominal pain, anorexia, lactose intolerance, abdominal distention, and irritability) and/or highly variable non-gastrointestinal findings (iron-deficiency anemia, dermatitis herpetiformis, chronic fatigue, joint pain/inflammation, migraines, depression, attention-deficit disorder, epilepsy, osteoporosis/osteopenia, infertility and/or recurrent fetal loss, vitamin deficiencies, short stature, failure to thrive, delayed puberty, dental enamel defects, and autoimmune disorders). Classic celiac disease, characterized by mild to severe gastrointestinal symptoms, is less common than nonclassic celiac disease, characterized by absence of gastrointestinal symptoms.

Diagnosis/testing. The diagnosis of celiac disease relies on characteristic histologic findings on small-bowel biopsy and clinical and/or histologic improvement on a gluten-free diet. Most individuals with celiac disease have celiac disease-associated antibodies and specific pairs of allelic variants in two HLA genes, HLA-DQA1 and HLA-DQB1. Because 30% of the general population has one of the celiac disease-associated HLA alleles and only 3% of individuals with one or both of these alleles develop celiac disease, presence of celiac disease-associated HLA alleles is not diagnostic of celiac disease; however, their absence essentially excludes a diagnosis of celiac disease.

Management. Treatment of manifestations: lifelong adherence to a strict gluten-free diet (avoidance of wheat, rye, and barley); treatment of nutritional deficiencies (iron, zinc, calcium, fat-soluble vitamins, folic acid); standard treatment of osteoporosis. Prevention of primary manifestations: lifelong gluten-free diet. Surveillance: for symptomatic individuals responsive to a gluten-free diet, periodic physical examination and assessment of growth, nutritional status, and non-gastrointestinal disease manifestations; repeat small-bowel biopsy one to three years following diagnosis. For symptomatic individuals unresponsive to a gluten-free diet, periodic evaluation for refractory sprue, ulcerative enteritis, T-cell lymphoma, and other gastrointestinal cancers. Agents/circumstances to avoid: dietary gluten. Testing of relatives at risk: when the celiac disease-associated HLA alleles in the family are known, molecular genetic testing of first-degree relatives (including young children) to monitor those with known celiac disease-susceptibility alleles for early evidence of celiac disease in order to institute gluten-free diet early in the disease course.

Genetic counseling. Celiac disease is a multifactorial disorder resulting from the interaction of HLA-DQA1 and HLA-DQB1 gene variants known to be associated with celiac disease susceptibility, less well-recognized variants in non-HLA genes, gliadin (a subcomponent of gluten), and other environmental factors. Some empiric risk data are available for at-risk relatives.

Diagnosis

Clinical Diagnosis

The diagnosis of celiac disease is made through the combination of the following [Hill et al 2005, NIH Consensus Committee 2005, Green & Cellier 2007]:

· Small-bowel biopsy that shows characteristic histologic abnormalities

· Subsequent improvement (clinical and/or histologic) on a gluten-free diet

· Additional findings in most affected individuals:

· Clinical findings or abnormal laboratory findings (although some individuals are asymptomatic and lack laboratory abnormalities)

· Celiac disease-associated antibodies
Note: Although positive specific antibody testing is highly associated with celiac disease and greatly facilitates its diagnosis [Fasano 2001, Farrell et al 2002], small-bowel biopsy remains the gold standard in confirming the diagnosis of celiac disease.

· Celiac disease-associated human leukocyte antigen (HLA) alleles

Testing

Celiac-associated antibody testing

Note:

(1) It is important for the individual being tested to remain on a gluten-containing diet before celiac disease-associated antibody testing and small-bowel biopsy are performed because antibody levels and histologic abnormalities gradually revert to normal on a gluten-free diet.

(2) For individuals on a gluten-free diet, diagnostic celiac disease-associated antibody testing and small-bowel biopsy should follow a gluten challenge (i.e., eating gluten-containing foods [the equivalent of one to three slices of bread per day] for one to three months and sometimes longer if no symptoms are observed). However, the gluten challenge can make some individuals very ill.

· Tissue transglutaminase (tTG) IgA. Measurement of serum concentration of tissue transglutaminase (tTG) immunoglobulin A (IgA) is often recommended for initial testing because of its high sensitivity and specificity for celiac disease, relatively low cost, and ease of test performance and reliability. However, the sensitivity and specificity differ among laboratories [Abrams et al 2006]. False positive test results may occur in persons with acute coronary syndromes and in individuals with cirrhosis and chronic liver disease.

· Endomysial antibody (EMA) IgA. Serum concentration of endomysial antibody (EMA) IgA has the highest specificity (~99%), but is more expensive and more time-consuming to perform and is potentially more prone to false negative results than serum concentration of tTG IgA. Because it is determined by indirect immunofluorescence, serum concentration of EMA IgA is subject to observer variability, which affects its sensitivity [Murray 2004]. When performed in an experienced laboratory, this test has a higher specificity (approaching 100%) than tTG antibody testing and is useful in individuals with cirrhosis.

· Anti-deamidated gliadin-related peptide (a-DGP) antibodies IgA and IgG. This new test detects antibodies binding synthetic deamidated gliadin-related peptides (DGPs). In preliminary studies examining groups with a high prevalence of celiac disease, both isotypes (IgA and IgG) were shown to be highly sensitive and specific for active celiac disease. Specificity is greater than in antigliadin (AGA) testing and similar to that for tTG testing. An increase in DGP antibody levels may precede an increase in serum concentration of tTG-IgA in young children [Liu et al 2007, Niveloni et al 2007]. However, as in all antibody tests, a minority of individuals have false negative results.

· Measurement of serum concentration of total IgA to evaluate for selective IgA deficiency. The prevalence of selective IgA deficiency, a condition of unknown cause, is 1:700 in the general population. For unknown reasons the prevalence of selective IgA deficiency is higher (1:50) in individuals with celiac disease than in the general population [Wong el al 2003, Alaedini & Green 2005].
Note: Because individuals with selective IgA deficiency do not produce IgA antibodies, the celiac-associated IgA antibodies tTG IgA and EMA IgA are not present in these individuals. Therefore, in these individuals, testing for celiac-associated IgG antibodies (tTG IgG) or DGP-IGG should be performed instead.

· Antigliadin antibody (AGA) IgA and IgG. The NIH Consensus Development Conference on Celiac Disease recommended against the use of AGA in the diagnosis of celiac disease because of the low specificity of this assay and the availability of more specific and sensitive tests, including tTG and EMA IgA [Hill et al 2005].

Note: (1) The overall sensitivity of celiac disease-associated antibody testing may be slightly increased when all four tests (serum concentrations of tTG IgA, EMA IgA, total IgA, and AGA IgA and IgG) are performed. However, the use of panels that incorporate AGA markedly increase the false positive rate as a result of a lone positive AGA antibody and drop the positive predictive value to low levels except in the case of a very high pre-test prevalence. (2) Although a positive result on celiac disease-associated antibody testing is likely to be diagnostic of celiac disease, false positive results occur. (3) Conversely, normal celiac-associated antibody test results do not exclude the diagnosis of celiac disease, especially in the presence of lesser degrees of villous atrophy or in persons on a gluten-free diet prior to testing.

Small-bowel biopsy generally refers to multiple (four or more) biopsies taken endoscopically from the post-bulbar duodenum.

Characteristic histologic findings that are the gold standard for the diagnosis of celiac disease include partial or complete villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes (IELs). Based on the dynamic development of the pattern of the intestinal lesions and the frequency of mild lesions in celiac disease, Marsh [1992] proposed a four-stage grading classification to establish the diagnosis and to assess improvement in response to a gluten-free diet (Table 1). Although these changes are not unique to celiac disease, reversion of intestinal damage after gluten withdrawal is unique to celiac disease. The positive predictive nature of the biopsies depends on the relative prevalence of celiac disease as compared to other causes of enteropathy in the population.

Authored by:

Cara L Snyder, MS, CGC

Certified Genetic Counselor
Kimball Genetics, Inc
Denver

Danielle O Young, MS, CGC

Certified Genetic Counselor
Kimball Genetics, Inc
Denver

dyoung@kimballgenetics.com

Peter HR Green, MD

Director, Celiac Disease Center
Professor of Clinical Medicine
Columbia University
New York

pg11@columbia.edu

Annette K Taylor, MS, PhD, FACMG

President and CEO
Kimball Genetics, Inc.
Denver

aktaylor@kimballgenetics.com 03072008celiac
Initial Posting: July 3, 2008.

Source: Gene Reviews; funded by the NIH Developed at the University of Washington, Seattle 1993-2009

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