Study coauthor Shelly Gray, of the School of Pharmacy at the University of Washington, and colleagues publish their findings inThe BMJ.

Benzodiazepines are a class of drugs that increase the level of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain, producing sedative, anti-convulsant, anti-anxiety, hypnotic and muscle relaxant effects.

Benzodiazepines are most commonly used to treat anxiety andinsomnia, though they are used for a number of other conditions, including alcohol withdrawal, panic disorders and seizures. Common types of benzodiazepines include diazepam, alprazolam and flurazepam.

In the US, benzodiazepine use is highest among older individuals; a 2014 study from the National Institutes of Health (NIH) found that around 8.7% of adults aged 65-80 received a benzodiazepine prescription in 2008, compared with 2.6% of those aged 18-35.

Numerous studies, however, have associated benzodiazepine use in seniors with increased risk of dementia. A 2012 study reported by Medical News Today, for example, suggested adults aged 65 and older are 50% more likely to develop dementia within 15 years of using benzodiazepines, while a more recent study suggested benzodiazepine use for at least 3 months increases older adults' risk of Alzheimer's disease by 51%.

However, Gray and colleagues note that research assessing benzodiazepine use in older adults has been conflicting, with some studies finding no link with dementia.

"Given the enormous public health implications, we need a better understanding of the potential cognitive risks of cumulative benzodiazepine use," say the authors.

No dementia link, but seniors should still avoid benzodiazepines

With this in mind, the team set out to determine whether higher cumulative use of benzodiazepines among older adults is associated with increased risk of dementia or faster cognitive decline.

To do so, the researchers analyzed the data of 3,434 adults aged 65 and older who were part of the Adult Changes in Thought study, conducted within Group Health - a non-profit health care system in Seattle, WA.

All participants were free of dementia at study baseline, and cognitive screening was conducted at enrollment and every 2 years thereafter. Subjects were followed-up for an average of 7 years.

Pharmacy data from Group Health was analyzed to assess participants' daily use of benzodiazepines over a 10-year period.

During follow-up, 797 of the participants developed dementia. Of these, 637 developed Alzheimer's disease. The median level of benzodiazepine use among participants was the equivalent to 1 year of daily use.

The researchers found that subjects with the highest benzodiazepine use were at no higher risk for dementia or Alzheimer's than those with lower benzodiazepine use, nor did they experience faster cognitive decline.

While the researchers did identify a small increased risk of dementia among participants with low or moderate benzodiazepine use - the equivalent of up to 1 month of use or 1-4 months use, respectively - they suggest this may "represent treatment of prodromal symptoms" of dementia.

"It is also possible that people with prodromal dementia, even years before diagnosis, could be more sensitive to benzodiazepine induced acute cognitive adverse events (for example, delirium), resulting in discontinuation of the drug and avoidance, in turn leading to low levels of use," they add.

Commenting on their findings, the researchers say:

"Overall, our pattern of findings does not support the theory that cumulative benzodiazepine use at the levels observed in our population is causally related to an increased risk for dementia or cognitive decline."

Still, the team says that considering the other adverse effects associated with benzodiazepine use and the fact that evidence remains mixed as to whether the drugs may raise the risk for dementia, health care providers "are still advised to avoid benzodiazepines in older adults to prevent important adverse health outcomes, withdrawal and dependence."

The systematic review and meta-analysis is published in the journal Alimentary Pharmacology & Therapeutics.

The researchers - from the University of Southampton in the UK - pooled and analyzed data from nine long-term studies covering nearly half a million men and women from six countries.

They found that increasing coffee consumption may substantially reduce the risk of liver cirrhosis.

The analysis shows a dose-response relationship between coffee consumption and liver cirrhosis - with more cups per day linked to lower risk.

Two extra cups of coffee per day were linked to a 44% lower risk of developing liver cirrhosis and a nearly 50% lower risk of death to the disease.

Liver cirrhosis can be fatal because it raises the risk of liver failure and cancer.

The condition develops when healthy tissue in the liver is replaced by scarred tissue, often as a result of long-term and persistent injury from viruses like hepatitis C and toxins like alcohol.

Liver cirrhosis is an important public health concern and a significant cause of disease and death in the US. The prevalence is likely to be higher than official figures suggest because many cases are undiagnosed.

A recent estimate suggests around 0.27% of Americans - some 633,323 adults - have liver cirrhosis, with 69% unaware of the fact they have the disease.

Effect is 'larger than that of statins on reducing cardiovascular risk'
In their paper, where they discuss the results, the authors explain that coffee has many biologically active ingredients, in addition to caffeine. These include "oxidative and anti-inflammatory agents, such as chlorogenic acid, kahweol and cafestol," and there is evidence, they note, that these may "confer protection against liver fibrosis."

In addition to a direct biochemical effect, there could also be an indirect effect of coffee protecting against cirrhosis, suggest the researchers. For example, they cite lab studies that show various compounds found in coffee block hepatitis B and C viruses and studies that show links between increased coffee consumption and reduction in type 2 diabetes.

The paper concludes that the analysis shows the link between increased daily coffee consumption and reduction in risk of liver cirrhosis is large - larger than that of many medications used for the prevention of disease.

"For example," note the authors, "statin therapy reduces the risk of cardiovascular disease by 25%."

They also point out that "unlike many medications, coffee is generally well tolerated and has an excellent safety profile."

Lead and corresponding author Dr. O. J. Kennedy, of Southampton's Faculty of Medicine, concludes:

"Coffee appeared to protect against cirrhosis. This could be an important finding for patients at risk of cirrhosis to help to improve their health outcomes. However, we now need robust clinical trials to investigate the wider benefits and harms of coffee so that doctors can make specific recommendations to patients."

In November 2015, Medical News Today learned how chronic liver disease and cirrhosis are among the reasons death rates are increasing among middle-aged white Americans.

Our Knowledge Center article - "Coffee: health benefits, nutritional information" - looks at some of the other ways the popular beverage may benefit our health, as well as the risks associated with it.

According to many media reports, a recent study in JAMA Oncology found that omega-3 fatty acids can reduce the effectiveness of cancer treatment.

"Cancer patients who eat herring and mackerel or take omega-3 supplements may end up resistant to chemotherapy, a study has warned," writes the Daily Mail.

The same stories have reported the researchers' recommendation that people undergoing chemotherapy refrain from eating oily fish or taking fish oil or omega-3 supplements on the day of their treatment.

But the study in question found no such thing, while other studies have actually suggested that omega-3s might reduce the side effects of cancer drugs while increasing their effectiveness.

Study didn't even look at cancer patients

The researchers in the JAMA Oncology study actually did two separate experiments. In one, they asked 118 cancer patients whether they regularly took any supplements, and found that 11 percent took omega-3s. In a separate study, the researchers measured omega-3 levels in people without cancer.

Unsurprisingly, blood levels of omega-3s increased after taking a 10 mL supplement, and increased more after taking 50 mL. These levels returned to normal within eight hours. The study also found that when participants ate 100 grams of herring or mackerel - oily fish known to be high in omega-3s - their omega-3 blood levels increased more than when they ate tuna, which is lower in omega-3s. Omega-3 levels also increased after a meal of salmon, but returned to normal more quickly. The implications of this are unclear, since omega-3s may need to disappear from the blood to be taken up by the cells that need them.

Why should these findings cause alarm? The researchers said that according to some mouse studies, omega-3s might make cancer cells resistant to chemo drugs. Therefore, said researcher Emile Voest, "Our findings ... raise concern about the simultaneous use of chemotherapy and fish oil. ... We advise patients to temporarily avoid fish oil from the day before chemotherapy until the day thereafter.'

Some media outlets misreported this recommendation as one to also avoid fish oil on the day before and the day after treatment - even though the study showed blood levels returning to normal within eight hours.

Evidence suggests the opposite

Cancer and nutrition experts expressed skepticism that new recommendations should be made based on a study that didn't even look at cancer drug effectiveness.

"This work shows that in healthy human volunteers, taking various fish oil supplements unsurprisingly raises the level of a particular unsaturated fatty acid in the blood," said Keith Jones of the Institute of Cancer Research.

"This is a very preliminary study that takes a measurement in healthy human subjects, and one in a mouse model of cancer, and extrapolates both to human cancer patients," he said. "Further studies are needed before clear advice should be given to patients - and these would need to include a correlation between blood levels of the fatty acid in mice treated and the effect on the anti-cancer drug to demonstrate a clear link.

"There is no evidence that mice metabolize this fatty acid in the same way as humans, and particularly cancer patients."

Other studies have had very different findings, said dietitian Catherine Collins of St. George's Hospital NHS Trust.

"Other studies on fish oil and cancer drugs have shown different effects, so it's possible that the type of cancer and the anti-cancer treatment may be affected differently by the amount and type of fish oil consumed," she said.

For example, a 2014 study in the Journal of Clinical Oncology found that an omega-3 supplement significantly reduced the incidence of nerve disorders caused by the chemo drug paclitaxel. Other studies have suggested that omega-3s reduce chemo side effects, increase chemo effectiveness and reduce the rate of cancer growth, potentially lengthening and improving life in cancer patients.

Taking a class of drugs commonly used to reduce acid in the stomach is linked to a higher risk of developing chronic kidney disease, compared with not taking them.
Stomach and esophagus
Over 15 million Americans used prescription PPIs - drugs that reduce stomach acid - in 2013, at a cost of over $10 billion.

This was the finding of a new study led by the Johns Hopkins University in Baltimore, MD, and published in JAMA Internal Medicine.

However, the authors also point out that finding a link between use of proton pump inhibitors (PPIs) and chronic kidney disease does not prove the drugs actually cause the disease - that is for further studies to establish.

It could be, they suggest, that the participants who were prescribed PPIs may have been at higher risk of chronic kidney disease for reasons unrelated to their PPI use.

However, the researchers also note that previous studies have linked use of PPIs to a form of kidney inflammation called acute interstitial nephritis.

PPIs are among the most commonly used drugs worldwide. They are used to relieve symptoms of acid reflux and gastroesophageal reflux disease (GERD). They are also prescribed for treating peptic or stomach ulcers and damage to the lower esophagus caused by acid reflux.

PPIs work by reducing the amount of stomach acid made by cells in the lining of the stomach. They are not the same as antacids, which work by neutralizing excess acid after it has entered the stomach.

There are many types and brands of PPI; examples include omeprazole (brand name Prilosec, also available without a prescription), esomeprazole (Nexium) and lansoprazole (Prevacid). The side effects vary from drug to drug.

In an accompanying editorial article - where they summarize recent evidence on the adverse effects of taking PPIs - Drs. Adam Jacob Schoenfeld and Deborah Grad, of the University of California-San Francisco, note that:

"A large number of patients are taking PPIs for no clear reason - often remote symptoms of dyspepsia or 'heartburn' that have since resolved."
10-year risk of kidney disease higher for PPI users

For their study, the Johns Hopkins researchers and their colleagues first analyzed data on 10,482 participants followed up for a median of nearly 14 years in the Atherosclerosis Risk in Communities (ARIC) study.

Fast facts about acid reflux

    Acid reflux, or gastroesophageal reflux (GER), happens when stomach contents come back up into the esophagus
    It is felt as heartburn when stomach acid touches the lining of the esophagus
    A more serious, persistent form - gastroesophageal reflux disease (GERD) - affects about 20% of the US population.



They then replicated the results in a bigger cohort of 248,751 participants followed up for a median of 6 years - these participants were members of the Geisinger Health System in Pennsylvania.

They found that at the beginning of the monitoring period, PPI users in both groups were more likely to have a higher body mass index (BMI) and to be taking aspirin, statins or drugs to control high blood pressure.

In the ARIC group, 56 of 332 participants using PPIs developed chronic kidney disease, compared with 1,382 of 10,160 non-users. These figures translate to 14.2 and 10.7 per 1,000-person years, respectively. Participants were classed as a PPI user if they were taking the drugs at the start of the follow-up.

Further analysis of these ARIC figures revealed that the 10-year absolute risk of developing chronic kidney disease in the PPI users was 11.8%, compared with 8.5% if they had not used PPIs.

When they repeated this same analysis in the Geisinger cohort, the researchers found 1,921 of 16,900 PPI users and 28,226 of 231,851 of non-users developed chronic kidney disease, which translates to 20.1 and 18.3 per 1,000 person-years, respectively.

Again, further analysis of the larger cohort showed PPI use was associated with higher risk of disease. The 10-year absolute risk of developing chronic kidney disease among the PPI users was 15.6%, compared with 13.9% had they not used the drugs.

Commenting on their own findings, the authors emphasize the point that their study "is observational and does not provide evidence of causality," but should the link between PPI use and chronic kidney disease prove to be causal, then it could have important implications for public health, given the widespread use of the drugs.

Over 15 million Americans used prescription PPIs in 2013 at a cost of over $10 billion, they note, and conclude:

    "Study findings suggest that up to 70% of these prescriptions are without indication and that 25% of long-term PPI users could discontinue therapy without developing symptoms. Indeed, there are already calls for the reduction of unnecessary use of PPIs."

In 2010, Medical News Today reported how a study by researchers from Seoul National University Hospital in South Korea, published in the Canadian Medical Association Journal, also found that use of PPIs and another class of acid reflux drug called histamine2 receptor antagonists may be linked to higher risk of pneumonia.

itamin D supplementation could be a safe and cost-effective treatment strategy for individuals with multiple sclerosis, according to new research published in the journal Neurology.

Researchers found a high daily dose of vitamin D for 6 months reduced MS-related T cell activity in patients with the disease.

Numerous studies have associated low levels of vitamin D with increased risk of multiple sclerosis (MS). Additionally, among people who have MS, low vitamin D levels have been linked to greater disability and more severe symptoms.

Whether vitamin D supplementation may benefit patients with MS, however, has been a subject of debate.

With the aim of finding out, study coauthor Dr. Peter A. Calabresi, of Johns Hopkins University School of Medicine in Baltimore, MD, and colleagues analyzed the effects of vitamin D supplementation among 40 adults aged 18-55 with relapsing-remitting MS.

Each individual took either 10,400 IU (high dose) or 800 IU (low dose) of vitamin D3 supplements daily for 6 months. For comparison, the standard recommended daily vitamin D intake for adults aged 18-70 is 600 IU.

At study baseline and at 3 and 6 months, the vitamin D levels of each participant were measured through blood tests, and the researchers also assessed subjects' MS-related T cell responses - an indicator of disease activity.
High-dose vitamin D reduced MS-related T cell activity

The study results revealed that individuals who took the high dose of vitamin D3 demonstrated a reduction in the percentage of T cells associated with MS activity.

Specifically, the researchers found that when vitamin D levels in the blood reached greater than 18 nanograms per milliliter (ng/ml), each further 5 ng/ml rise in vitamin D levels was linked to a 1% fall in the percentage of interleukin-17 T cells in the blood; these cells are believed to play a role in MS pathogenesis.

No reduction in the percentage of interleukin-17 T cells in the blood was identified among individuals who took the low dose of vitamin D3.

There were no differences in side effects from vitamin D supplementation between the high-dose and low-dose groups, according to the researchers, and one person from each group experienced a disease relapse.

Though MS incidence and prevalence is not currently tracked in the US, it is estimated that around 400,000 Americans are living with the condition and around 200 new cases are diagnosed each week.

At present, there is no cure for MS; symptoms and the course of disease are normally managed through medications. But according to Dr. Calabresi, these latest findings indicate there may be a promising new treatment option for MS:

    "These results are exciting, as vitamin D has the potential to be an inexpensive, safe and convenient treatment for people with MS.

    More research is needed to confirm these findings with larger groups of people and to help us understand the mechanisms for these effects, but the results are promising."