InSightec Ltd has submitted a premarket approval application (PMA) to the U.S. Food and Drug Administration (FDA) for its ExAblate treatment of pain palliation of bone metastases. Over 60% of cancer patients suffer from painful bone metastases and 30% of these patients will not respond to radiation therapy. ExAblate uses MR guided focused ultrasound (MRgFUS) to treat the pain caused by bone metastases non-invasively and without ionizing radiation. It combines high intensity focused ultrasound to thermally ablate tumors and continuous MRI to visualize the anatomy, plan treatment, and monitor treatment outcomes in real time. The PMA submission was based on a two-arm randomized controlled trial comparing patients undergoing ExAblate’s MR guided focused ultrasound for palliation of painful bone metastases with patients undergoing a sham treatment. Patients who had no response to the sham treatment were later allowedtoundergoanExAblatetreatment. Currently, ExAblate is the only MRgFUS system with FDA approval, which was granted in 2004 for uterine fibroids.
Dr Richard Nahas, md
Dr Richard Nahas, md
Seekers Centre for Integrative Medicine
In downtown Ottawa operates an exceptional facility of integrative medicine, established by the husband and wife team of Dr Shadi Nahas, PhD, Director of Research, and Dr Richard Nahas, MD, Medical Director. Richard’s training and continued commitment as an ER physician may not seem to be a typical path upon which a physician comes to embrace integrative medicine, yet it is precisely this path that the doctor credits with driving his vision of the facility existing today.
Following an undergraduate degree in biochemistry from Ottawa University, Richard attended medical school at the University of Toronto, completing his training in 1998. Typical of conventionally- trained physicians who go on to embrace integrative medicine, Richard felt there were gaps in knowledge during his training. His interest in integrative medicine began in his teen years in relation to application of principles of clinical nutrition in performance enhancement, sports psychology, and the notion of training the mind along with the body. He chose medicine as his path eager to learn the intricacies of the human body and was disappointed with the relative lack of knowledge academia was able to impart. The focus was on describing disease, with very poor understanding of the underlying causes of the diseases being studied.
He found himself gravitating towards emergency medicine, feeling it was what conventional medicine did best. Seeking an opportunity to learn a broader understanding of medicine, Richard began to travel the world delivering his ER skills to areas that seemed to require them most. His travels included elective study in Egypt, clinical rotation in Gaza, as well as service with Doctors Without Borders taking him to Johannesburg, Africa and the Amazon of South America. These travels further spurred his interest in integrative medicine. He found conventional medicines helped people in these settings in the short term, but felt the people were better served by their local medicines in terms of long term feasibility as well as chronic disease management. Travel experiences taught Richard that political/ economic factors are at the heart of healthcare issues in developing nations, as opposed to more medicine serving as a viable solution. Also, the experiences exposed Richard to a wide array of local, traditional healing systems that he found intriguing.
Richard returned to his home town of Ottawa resolved to serve his community with integrated systems of healing. While conventional medicine inarguably offers world- class care in emergency settings, Canada is entrenched in epidemics of chronic illness- the arena where integrative medicine demonstrates its greatest strength. Richard’s opinions and perspective on the integrative versus conventional medicine debate are certainly strong, however shortcomings of conventional models of care are not where he chooses to apply his focus. “I must balance my feelings of how much change is required”, Richard describes.
“There are many challenges that surface in operating an integrative practice, including lack of recognition and understanding from peers, the reality of practicing in isolation and an inability to consult with colleagues for direction on difficult cases, but this is typical of individuals who choose the path of a pioneer”.
So we pose the question to Richard that surely it would be easier to remain in ER practice… “When you believe in what you are doing, you see results, you know in your heart it is a better system of medicine… you don’t have a choice, you can’t go back”, he replied.
Being critical of conventional medicine does not improve the situation, and in fact serves little purpose other than to make things worse. An integrative physician truly hoping to impact the healthcare system must make effort to work with the system around them, regardless of obstacles that may present before them. Richard describes one example that exemplifies the requirement for integrative practitioners to consider efforts of collaboration among their highest priorities:
“The Seekers Centre of Integrative Medicine served as one centre for the TACT trial of chelation in secondary coronary prevention. One patient wanted to join the trial, but their local cardiologist instructed them not to join, stating that he did not believe in chelation. The cardiologist ended up being the chief cardiologist at the Ottawa Heart Institute. I undertook the task of contacting the cardiologist to discuss the role of chelation and the outcomes I had already witnessed it achieve in terms of angina treatment. We have since ended up being collaborators in many areas, he referred 50-60 patients that ended up as participants in the trial, and we are discussing conducting a trial together to assess vascular compliance at the Ottawa Heart Institute”.
Fredericton Naturopathic Clinic
Excellence in naturopathic medicine delivered to an under-serviced community
IHP is striving to highlight clinics from across Canada, which brings us to the Fredericton Naturopathic Clinic in New Brunswick. Opened by Naturopathic Doctors Parissa and Judah Bunin in 2003, the clinic can be found in the Kchikhusis Centre, which is located on a First Nation’s reserve within the city of Fredericton, and is easily accessible from both the north and south sides of the beautiful Saint John River that runs through the city.
After becoming naturopathic doctors, this husband and wife team moved to Fredericton to open up their clinic because they felt a need to strengthen the profession in New Brunswick. At that time, the population was very conservative regarding naturopathic medicine and relatively few naturopathic doctors focused on evidence-based medicine. Therefore, the Bunins considered themselves “pioneers” and decided to focus their treatment approach on those naturopathic therapies with the most scientific support. As the clinic has evolved, they have witnessed an evolution in the public’s perception of the profession. The clinic staff has been working hard to develop trust in their community. This trust continues to strengthen as evidenced by increasing numbers of referrals in recent years from medical doctors, pharmacists, physiotherapists, acupuncturists, and massage therapists, among others.
In addition to being a naturopathic doctor, Parissa is also a registered massage therapist. Her strong background in physical medicine has influenced the modalities practiced at the clinic where physical modalities, such as ultrasound and electrical stimulation are employed frequently. The clinic also expanded to include another registered massage therapist, Emily Durling.
The Fredericton Naturopathic Clinic has seen a slow, steady growth over the past 11 years and currently, 40 to 50 patients are seen each week. Judah and Parissa are happy with this rate of growth because upon opening their practice, they agreed that they did not want the clinic to grow too big too quickly as they had young children and placed a great importance on family life and community involvement.
The small clinic is now at the point where it is advancing into different special areas of focus. Parissa recently completed a parenteral therapy course in Ontario, while Judah plans to focus more on oncology and recently attended the Oncology Association of Naturopathic Physician’s inaugural convention. Judah notes that no naturopathic doctors in the Fredericton area have expertise in oncology, so there is a void that needs to be filled.
The Fredericton Naturopathic Clinic is 850 square feet with two large treatment rooms, a reception area, and a dispensary. The dispensary carries a variety of different products that include both professional and retail lines, such as AOR, Thorne, Seroyal, Vitazan, St. Francis, Sisu, Natural Factors, and Trophic. The practitioners felt that it was necessary to carry retail lines in an effort to increase convenience for patients while also providing some affordable alternatives to potentially more expensive items. Being cognizant of financial realities in Fredericton, a limited number of integrative tests are performed, such as food sensitivities, salivary hormones, urinary neurotransmitters, stool analyses, and finger-prick vitamin D from such laboratories as Rocky Mountain Analytical, Neuroscience, Doctor’s Data, and ZRT.
Judah and Parissa are registered with the Board of Directors of Drugless Therapy-Naturopathy (BDDT-N) in Ontario, since naturopathic medicine is unregulated in New Brunswick. They wanted to register with the BDDT-N as it provides assurance to the public that they have, in fact, received the necessary education and passed the board exams required of naturopathic doctors in regulated provinces. They are also actively involved with the New Brunswick Association of Naturopathic Doctors, where Parissa has served as Treasurer and Judah is the current President. This association is working hard to achieve the goal of regulating naturopathic medicine, which has required a significant investment of time and energy by the Bunins, but they are optimistic that regulation might be a reality within the next one to two years.
The Bunins also keep busy by teaching science-based courses at the Atlantic College of Therapeutic Massage. Judah teaches biology, physiology, pathology, nutrition, and research literacy, while Parissa teaches pharmacology, microbiology, and communications. Judah also dedicates a few hours each week conducting research at the college. In fact, he is currently involved in a joint project with the Kinesiology Department at the University of New Brunswick to study the physiological effects of massage on circulation in fibromyalgia patients. As the research coordinator at the college, he was heavily involved in designing the study and writing the grant that ultimately awarded the research team $15 000 to conduct this research. The team has presented its findings at three different conferences, including last year’s Health Fusion in Calgary, and will soon be submitting a manuscript to a peer-reviewed journal.
IHP has great respect for practitioners who are trying to increase awareness and acceptance of evidence-based integrated therapeutics, so we commend the Fredericton Naturopathic Clinic for all of its efforts. We wish them much success and thank them for allowing us to draw attention to a successful naturopathic practice in an under-serviced province.
Green tea
successful completion of the questions at the end of this paper has been approved for continuing education by the bddt–n; 1.0 credit botanical medicine and by the cnpbc; one ce hour.
Antiviral effects
Abstract
Green tea (Camellia sinensis) and its extracts are well-recognized for their antioxidant content and associated human health benefits. In recent years, evidence from in vitro and human clinical trials has accumulated to indicate that green tea-derived antioxidants, including its chief catechin, epigallocatechin gallate (EGCG), may have potentially beneficial antimicrobial activity against various strains of pathogenic yeast, bacteria and viruses. This article aims to synthesize the available evidence concerning the use of green tea extracts in the prevention or treatment of human viral illnesses. The human viral illnesses on which the majority of the research is focused with respect to the use of green tea include viral upper respiratory tract infections (oral or buccal use), and human papilloma virus (HPV)-induced anogenital warts (topical use). Five human observational and randomized controlled trials support the use of green tea in the prophylaxis or treatment of influenza and/or the common cold. A recent systematic review and meta-analysis involving 1247 men and women found a proprietary green tea catechin formula to be effective in the topical treatment and prevention of recurrences of condylomata acuminata due to HPV.
Introduction
Besides water, tea is the most commonly consumed beverage worldwide (Mazzanti 2009). Prepared from fresh Camellia sinensis leaves, green tea is dry-heated or steamed, then rolled, dried and roasted (Mazzanti 2009). Constituents of unfermented Camellia sinensis leaves include polyphenols (20%-45% of dry weight), caffeine (2%-5%), amino acids (4%), lignin (6.5%), organic acids (1.5%), protein (15%) and chlorophyll (0.5%) (Mazzanti 2009, Meltzer 2009, Sarma 2008, Schneider 2009). EGCG ((-)-epigallocatechin gallate) is the most potent green tea antioxidant (Mazzanti 2009) and comprises 60%-80% of its catechin content (Schneider 2009).
Green Tea as an Antiviral Agent
In vitro and human evidence supports the potential antiviral prophylactic and treatment uses of green tea (Meltzer 2009, Rowe 2007, Schutz 2010). Green tea polyphenols, chiefly the catechins, are antioxidants to which a majority of the anti-microbial, anti-inflammatory, anti-tumor and immunostimulatory properties of green tea have been ascribed (Mazzanti 2009, Meltzer 2009, Schneider 2009). EGCG has direct in vitro viricidal, inhibitory and anti-infective properties against several viruses, including HIV (Hauber 2009, Nance 2009), herpes simplex virus (HSV-1) (Isaacs 2008), hepatitis A (Kuzuhara 2009) and B viruses (Xu 2008). Green tea catechin derivatives have been shown to have in vitro inhibitory effects on six influenza virus subtypes (Song 2007). EGCG is also highly anti-inflammatory and inhibits pro-inflammatory chemokines, prostaglandins and tumor necrosis factor (TNF), which contribute to symptom production during human viral infections (Rowe 2007).
Viral Upper Respiratory Tract Infections
A prospective cohort study reported influenza prophylaxis in nursing home residents who gargled with a green tea catechin solution. Seventy-six elderly nursing home residents in Japan gargled with a 200 μg/mL green tea catechin or control solution, three times daily for three months, while 48 age- and sex-matched
control participants gargled with a placebo solution. The catechin solution (60% EGCG) was approximately half the concentration of commercially available green tea beverages (Yamada 2006). All participants had received the World Health Organization (WHO)-recommended seasonal influenza vaccine prior to enrollment. Influenza A and B rapid assay was performed on nasal secretions of any resident who presented with influenza-like illness. Significantly fewer residents developed influenza B with treatment (1.3%) than control (10%), (p=0.028). None of the residents developed influenza A infection. This relatively small study was limited by the lack of dose-response determination for the treatment and non-randomization, which allowed residents to choose whether they would receive catechin or control solutions at the outset of the study (Yamada 2006).
Green tea constituents were identified to reduce incidence of influenza in health care workers in a recent, randomized, double-blind trial (Matsumoto 2011). Participants (n=197) were randomized to receive six capsules daily containing either a total of 378 mg catechin and 210 mg theanine, or placebo throughout influenza season (five months). The incidences of clinically-defined and laboratory-confirmed influenza infection and each individual’s symptom-free period were recorded. Treatment significantly decreased clinically-defined influenza (n=4, 4.1%) compared to placebo (n=13, 13%), (p=0.022). The incidence of laboratory-confirmed influenza was lower with treatment but did not significantly differ from control (p=0.112) (Matsumoto 2011). The high rate of influenza vaccination (92.9%) among all participants may have caused an underestimation of the prophylactic efficacy of catechin/theanine treatment and the need was suggested for further, large-scale randomized trials to confirm effects (Matsumoto 2011).
A large observational study reported an inverse relationship between green tea consumption and influenza infection in children (Park 2011). Elementary school students (n=2050) completed a series of two questionnaires during Japan’s endemic influenza A season. The consumption of 1-5 cups (200 mL/cup) of green tea daily compared with <1 cup per day was associated with a significantly lower risk of developing influenza. The incidence of clinically- and laboratory-confirmed influenza infection was also inversely related to consumption of green tea almost daily (i.e. ≥6 days per week) compared with <3 days per week. In contrast, no associations were observed between influenza incidence and conventional preventive measures such as hand hygiene, use of facemasks, or seasonal influenza vaccination in these children (Park 2011).
Rowe et al. (2007) conducted a randomized, double-blind, placebo-controlled study investigating whether a standardized green tea extract containing L-theanine and EGCG would prevent the development of influenza and common cold symptoms in healthy adults. Participants were randomized to receive either one treatment capsule containing a proprietary preparation of L-theanine and EGCG (ImmuneGuard; standardization not reported) (n=53), or placebo (n= 55) capsule twice daily with food. Participants were asked to log daily cold and flu symptoms, including fever, runny nose, sore throat, cough, headache, diarrhea and nausea during the 12-week study. During the 12-week study period, there was a 32.1% lower rate of symptom development in the treatment group (43.2%) versus control (63.6%), (p=0.035). There were 33.3% fewer symptomatic days in the treatment group versus placebo (p<0.022). There was a 22.9% lower incidence of illness (p=0.092) in the treatment group during the study period, but no significant differences in illness incidence from month to month (February to May). In the same study, peripheral blood mononuclear cells (PBMC) obtained from all subjects at baseline and on study day 21 were cultured for 24 hours in either media containing ethylamine (a catabolic product of L-theanine and a γδ T cell antigen) or control media.
PBMC obtained from participants after 21 days of treatment secreted 26% more IFN-γ in response to ethylamine than those from the placebo group (p=0.046), supporting the hypothesis that L-theanine could prime human γδ T cells to secrete more antimicrobial IFN-γ ex vivo (Rowe 2007). Adverse effects were mild and transient, with similar rates between treatment and control groups. A limitation of this study was the self-reporting of symptoms, which precluded both objective clinical diagnosis and the ability to rule out causation of symptoms by other illnesses such as asthma, bronchitis or allergy (Rowe 2007). Results of this study were consistent with previous work cited by the same authors, wherein PBMC obtained from subjects who had begun drinking five to six cups of green tea daily for one week secreted significantly more IFN-γ in response to γδ T cell antigens compared to baseline (Rowe 2007).
A multi-ingredient formulation containing green tea has been demonstrated to provide symptomatic benefits in the common cold (Schutz 2010). In a randomized, double-blind, placebo-controlled, multi-centre trial, participants with symptoms of a general feeling of sickness, headache and/or joint aches, sore throat and/or difficulty swallowing, hoarseness and/or cough, and stuffy nose/sniffle were randomly assigned to receive either a polyphenol-rich beverage containing green tea extract (3g/L), grape skin extract (12 g/L), grape seed extract (0.5 g/L), shiitake mushroom extract (0.05 g/L) and vitamin C (0.3 g/L) or placebo beverage containing water, sugar, citric acid and flavour, twice daily for 10 days. Participants underwent a total of three clinical examinations during the study period and logged their symptoms daily. By the third scheduled clinical examination, 19 of 49 treatment patients (38.8%) and 4 of 47 placebo patients (8.3%) who completed the study were asymptomatic (p<0.001). By their own evaluations, 41.9% of treatment patients and 5.0% of placebo patients were complaint-free by day seven of the study (p<0.001). Significant differences in sleep disorders, disturbances of daily activities and tissue use were also reported with treatment beverage (Schutz 2010). Blinded patient and physician ratings of the efficacy of the beverages received supported the superiority of the polyphenol treatment (Schutz 2010). Interestingly, the incidence of herpes labialis, a common concomitant symptom of the common cold, was significantly lower in the treatment group at the end of the study than that in the placebo group (Schutz 2010). The observed improvements in all common cold symptoms assessed suggested a general increase in defense and immunity rather than symptom-specific effects of the polyphenol beverage (Schutz 2010). This study supports the use of green tea extract in a multi-agent immunomodulatory approach to treatment of the common cold, although the presence of several antioxidant and immunomodulatory substances precludes the conclusion that the observed benefits could be solely attributed to green tea.
Human Papilloma Virus (HPV)
A recent meta-analysis demonstrated the efficacy of a Camellia sinensis leaf extract known as Polyphenon E (MediGene AG, Germany) in the topical treatment of anogenital warts (condylomata acuminata, HPV-6 and -11) (Tzellos 2011). Polyphenon E contains > 80% green tea catechins (Stockfleth 2008), which appear to inhibit HPV viral transcription and binding to cell receptors; have antiproliferative effects; and promote apoptosis when applied topically (Tzellos 2011 citing others). Three randomized, double-blind, placebo-controlled, multicentre studies enrolling a total of 660 men and 587 women met inclusion criteria for the meta-analysis; all three studies used Polyphenon E 15% or 10% (green tea catechins) ointment for HPV-induced anogenital warts. Both Polyphenon E formulations were found to be efficacious for clearance of lesions in both men and women, and compared to conventional therapies showed a low recurrence rate (Tzellos 2011). The treatment was generally well tolerated in all trials, with mild local skin reactions peaking at weeks two to four of treatment being considered essential to achieving a clinical response (Tzellos 2011).
Safety
Green tea infusion has been widely consumed throughout the world, at typical intake levels of one to three cups per day in the U.S. and up to nine cups per day in Japan, with a low incidence of adverse effects in adults (Sarma 2008 citing Imai 1997) and children (Park 2011). The most common adverse effects of green tea are gastrointestinal upset and central nervous stimulation from caffeine (Schneider 2009). As of 2009, two systematic reviews had identified 34 cases of possible or probable hepatotoxicity following intake of green tea products (Mazzanti 2009, Sarma 2008). Some of the case reports were confounded by the concomitant use, or non-reporting of other potentially hepatotoxic substances (Mazzanti 2009). The mechanism of liver damage is theoretically ascribed to paradoxical pro-oxidant activities of EGCG when present in high concentrations (Mazzanti 2009). Oral bioavailability of catechins is generally low but increases with fasting and repeated administration (Mazzanti 2009). Therefore, green tea extracts should be consumed with food (Sarma 2008). Extracts providing up to 690 mg total catechins and up to 150 mg caffeine per day are considered safe for adult use for up to 12 weeks; green tea extracts are contraindicated in individuals with liver disorders (Health Canada 2008).
References
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Physical activity and performance at school: a systematic review
The current study was conducted to describe the prospective relationship between physical activity and academic performance. Prospective studies reporting at least one physical activity or physical fitness measurement and at least one academic performance or cognition measure during childhood or adolescence were identified from searches in PubMed, PsycINFO, Cochrane Central, and Sportdiscus from 1990 through 2010. Titles and abstracts were screened for eligibility and the methodological quality of the studies was rated. Ten observational and four intervention studies were identified. The quality score of the studies ranged from 22% to 75% and two studies were scored as high quality. Methodological quality scores were particularly low for the reliability and validity of the measurement instruments. Based on the results of the best-evidence synthesis, the authors found evidence of a significant longitudinal positive relationship between physical activity and academic performance and concluded that participation in physical activity is positively related to academic performance in children. Because only two high-quality studies were found, future high-quality studies should be conducted to confirm these findings. These studies should thoroughly examine the dose-response relationship between physical activity and academic performance and provide explanatory mechanisms for this relationship. Arch Pediatr Adolesc Med. 2012 Jan;166(1):49-55. PMID: 22213750
Acupuncture improves pregnancy rates in women undergoing IVF: a systematic review and meta-analysis
The current systematic review and meta-analysis of 24 trials (n = 5807 participants) was conducted to evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes. Subjects included women undergoing IVF in randomized controlled trials who were evaluated for the effects of acupuncture on IVF outcomes. The intervention groups used manual, electrical, and laser acupuncture techniques and the control groups consisted of no, sham, and placebo acupuncture. The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). The pooled CPR (23 studies), but not the LBR (six studies) from the acupuncture groups was significantly greater than that from all of the control groups. The results differed with type of control used; the CPR and LBR differences between groups were more obvious and the LBR results tended to be significant when the acupuncture was performed around the time of oocyte aspiration or controlled ovarian hyperstimulation when the studies using the Streitberger control were ignored. The authors concluded that based on the results of studies that do not include the Streitberger control, acupuncture seems to improve CPR and LBR among women undergoing IVF. Fertil Steril. 2012 Jan 11. PMID: 22243605
Ursodeoxycholic acid with vitamin E is a potential treatment for nonalcoholic steatohepatitis
Randomized controlled studies investigating the effect of ursodeoxycholic acid (UDCA) and vitamin E on nonalcoholic steatohepatitis (NASH) have produced inconsistent results. The long-term tolerability and efficacy of this therapeutic combination were investigated in this study. Subjects included adult patients (n = 101) with persistent elevation of serum aminotransferases (AST and ALT) and/or γ glutamyl-transferase (GGT), in whom a histological diagnosis of NASH was made between 1998 and 2009, and who were treated with a combination of UDCA and vitamin E. UDCA and vitamin E were well tolerated (5% withdrawal for side effects). Mean serum AST, ALT, and GGT levels (expressed as times of Upper Normal Limit) diminished significantly (1.39 ± 0.74 to 0.78 ± 0.34 for AST; 1.72 ± 0.92 to 0.91 ± 0.69 for AST; and 3.25 ± 2.85 to 1.30 ± 1.30 for GGT). AST, ALT, and GGT reached normal range in 80%, 70%, and 65% of the patients, respectively. From the ten patients who had a second liver biopsy during follow-up, NAFLD activity score improved in seven, and worsened in one. The combination of UDCA with vitamin E is well tolerated and seems to improve liver function tests. Clin Res Hepatol Gastroenterol. 2011 Dec 7. PMID: 22154224
Body dissatisfaction is found among adolescents with severe dysmenorrhea
This cross-sectional study aimed to determine whether adolescent girls with severe dysmenorrhea (SD) have different psychological characteristics from their peers. Subjects included a nationally representative sample of 16 to 20 year old adolescents attending post-mandatory education in Switzerland (n = 7548; 3340 females). Subjects were administered an anonymous survey consisting of 565 items on four main topics, including sociodemographic determinants of health, health status, health behaviors, and health care use. A total of 12.4% (95% CI 11.0-14) of the subjects declared SD. Compared to their peers, subjects with SD were more likely to report depressive symptoms [adjusted odds ratio (AOR) 1.73; 95% CI 1.38-2.15], have a higher gynecological age (AOR 1.13; 95% CI 1.05-1.20), and attend vocational school (AOR 1.33; 95% CI 1.00-1.76). Moreover, the proportion of those reporting dissatisfaction with body appearance was higher (AOR 1.50; 95% CI 1.02-2.22). Patients with SD not only show a different profile from their peers in terms of mental health academic track and gynecological age but they are also more dissatisfied with their body appearance. Therefore, clinicians should offer patients with SD a global evaluation, bearing in mind what factors can be associated with SD. J Pediatr Adolesc Gynecol. 2012 Feb;25(1):19-22. PMID: 22217652
Intakes of lignans are associated with clinical breast tumor characteristics
The current study investigated usual dietary intakes of total and specific lignans with tumor characteristics. Dietary lignan intakes were calculated from food frequency questionnaires in 683 women with breast cancer and 611 healthy women without breast cancer enrolled in the Data Bank and BioRepository at Roswell Park Cancer Institute (RPCI). Clinicopathologic data were abstracted from the RPCI breast cancer database. Women in the highest versus the lowest tertile of total lignan intakes had a 40–50% lower odds of breast cancer regardless of menopausal status and substantially reduced odds of an invasive tumor, especially among premenopausal women (OR 0.48; 95% CI 0.26–0.86). Lignan intakes were inversely associated with the odds of grade three tumors among premenopausal women and with the risk of estrogen receptor (ER) negative (ER−) breast cancer among premenopausal women (OR 0.16; 95% CI 0.03–0.44) and particularly triple negative tumors (ER−, progesterone receptor negative, HER2 negative; OR 0.16; 95% CI 0.04–0.62). Significant differences in the contribution to these effects by specific lignans were found, especially matairesinol and lariciresinol. The authors concluded that higher lignan intakes were associated with lower risks of breast cancer with more favorable prognostic characteristics. J Nutr. 2012 Jan;142(1):91-8. PMID: 22113872
Savings from the use of probiotics in the prophylaxis of antibiotic-associated diarrhea
Antibiotic-associated diarrhea (AAD) and Clostridium difficile-associated diarrhea (CDAD) are the most common causes of healthcare-associated infectious diarrhea. Results from a double-blind, dose-response, placebo-controlled trial of the probiotic formula, Bio-K+ (i.e., containing Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R) published in 2010 revealed that the incidence of AAD and CDAD were lower for patients assigned to the probiotic formula compared to placebo. This study aimed to estimate the savings in direct medical costs that might result from the use of two different doses of the probiotic formula versus placebo. Economic analyses showed that the use of the probiotic formula would result in estimated mean per patient savings of US$1968 and US$2661 for the single and double dose, respectively, compared with placebo if used an average of 13 days by all patients at risk of developing AAD and CDAD. Using this product in the prophylaxis of AAD and CDAD could lead to estimated savings in direct medical costs that would substantially offset its acquisition cost. Treating 1000 hospitalized patients on antibiotics with the double dose of this product compared to current practice would save a single payer system over $2.5M. J Med Econ. 2012;15(1):53-60. PMID: 22023067
