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Herbal medicine, also called botanical medicine or phytomedicine, refers to using a plant's seeds, berries, roots, leaves, bark, or flowers for medicinal purposes. Herbalism has a long tradition of use outside conventional medicine. It is becoming more mainstream as improvements in analysis and quality control, along with advances in clinical research, show the value of herbal medicine in treating and preventing disease.

What is the history of herbal medicine?

Plants have been used for medicinal purposes long before recorded history. Ancient Chinese and Egyptian papyrus writings describe medicinal uses for plants as early as 3,000 BC. Indigenous cultures (such as African and Native American) used herbs in their healing rituals, while others developed traditional medical systems (such as Ayurveda and Traditional Chinese Medicine) in which herbal therapies were used. Researchers found that people in different parts of the world tended to use the same or similar plants for the same purposes.

In the early 19th century, when chemical analysis first became available, scientists began to extract and modify the active ingredients from plants. Later, chemists began making their own version of plant compounds and, over time, the use of herbal medicines declined in favor of drugs. Almost one fourth of pharmaceutical drugs are derived from botanicals.

Recently, the World Health Organization estimated that 80% of people worldwide rely on herbal medicines for some part of their primary health care. In Germany, about 600 to 700 plant based medicines are available and are prescribed by some 70% of German physicians. In the past 20 years in the United States, public dissatisfaction with the cost of prescription medications, combined with an interest in returning to natural or organic remedies, has led to an increase in herbal medicine use.

How do herbs work?

In many cases, scientists are not sure what specific ingredient in a particular herb works to treat a condition or illness. Whole herbs contain many ingredients, and they may work together to produce a beneficial effect. Many factors determine how effective an herb will be. For example, the type of environment (climate, bugs, and soil quality) in which a plant grew will affect it, as will how and when it was harvested and processed.

How are herbs used?

The use of herbal supplements has increased dramatically over the past 30 years. Herbal supplements are classified as dietary supplements by the U.S. Dietary Supplement Health and Education Act (DSHEA) of 1994. That means herbal supplements, unlike prescription drugs, can be sold without being tested to prove they are safe and effective. However, herbal supplements must be made according to good manufacturing practices.

The most commonly used herbal supplements in the U.S. include:

Echinacea (Echinacea purpurea and related species)

St. John's wort (Hypericum perforatum)

Ginkgo (Ginkgo biloba)

Garlic (Allium sativum)

Saw palmetto (Serenoa repens)

Ginseng (Panax ginseng or Asian ginseng) and Panax quinquefolius or American ginseng)

Goldenseal (Hydrastis canadensis)

Valerian (Valeriana officinalis)

Chamomile (Matricaria recutita)

Feverfew (Tanacetum parthenium)

Ginger (Zingiber officinale)

Evening primrose (Oenothera biennis)

Milk thistle (Silybum marianum)

Practitioners often use herbs together because the combination is more effective. Health care providers must take many factors into account when recommending herbs, including the species and variety of the plant, the plant's habitat, how it was stored and processed, and whether or not there are contaminants (including heavy metals and pesticides).

What is herbal medicine good for?

Herbal medicine is used to treat many conditions, such as allergies, asthma, eczema, premenstrual syndrome, rheumatoid arthritis, fibromyalgia, migraine, menopausal symptoms, chronic fatigue, irritable bowel syndrome, and cancer, among others. It is best to take herbal supplements under the guidance of a trained provider. For example, one study found that 90% of people with arthritic use alternative therapies, such as herbal medicine. Since herbal medicines can potentially interact with prescription medications, and may worsen certain medical conditions, be sure to consult with your doctor or pharmacist before taking any herbs. Some common herbs and their uses are discussed below.

Ginkgo (Ginkgo biloba) has been used in traditional medicine to treat circulatory disorders and enhance memory. Although not all studies agree, ginkgo may be especially effective in treating dementia (including Alzheimer disease) and intermittent claudication (poor circulation in the legs). It also shows promise for enhancing memory in older adults. Laboratory studies have shown that ginkgo improves blood circulation by dilating blood vessels and reducing the stickiness of blood platelets. By the same token, this means ginkgo may also increase the effect of some blood-thinning medications, including aspirin. People taking blood-thinning medications should ask their doctor before using ginkgo. People with a history of seizures and people with fertility issues should also use concern; Speak with your physician.

Kava kava (Piper methysticum) is said to elevate mood, enhance wellbeing and contentment, and produce a feeling of relaxation. Several studies show that kava may help treat anxiety, insomnia, and related nervous disorders. However, there is serious concern that kava may cause liver damage. It is not clear whether the kava itself caused liver damage in a few people, or whether it was taking kava in combination with other drugs or herbs. It is also not clear whether kava is dangerous at previously recommended doses, or only at higher doses. Some countries have taken kava off the market. It remains available in the United States, but the Food and Drug Administration (FDA) issued a consumer advisory in March of 2002 regarding the "rare" but potential risk of liver failure associated with kava-containing products.

Saw palmetto (Serenoa repens) is used by more than 2 million men in the United States for the treatment of benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate gland. Several studies suggest that the herb is effective for treating symptoms, including frequent urination, having trouble starting or maintaining urination, and needing to urinate during the night. But not all studies agree. At least one well-conducted study found that saw palmetto was no better than placebo in relieving the signs and symptoms of BPH.

St. John's wort (Hypericum perforatum) is well known for its antidepressant effects. In general, most studies have shown that St. John's wort may be an effective treatment for mild-to-moderate depression, and has fewer side effects than most other prescription antidepressants. But the herb interacts with a wide variety of medications, including birth control pills, and can potentially cause unwanted side effects, so it is important to take it only under the guidance of a health care provider.

Valerian (Valeriana officinalis) is a popular alternative to commonly prescribed medications for sleep problems because it is considered to be both safe and gentle. Some studies bear this out, although not all have found valerian to be effective. Unlike many prescription sleeping pills, valerian may have fewer side effects, such as morning drowsiness. However, Valerian does interact with some medications, particularly psychiatric medications, so you should speak to your doctor to see if Valerian is right for you.

Echinacea preparations (from Echinacea purpurea and other Echinacea species) may improve the body's natural immunity. Echinacea is one of the most commonly used herbal products, but studies are mixed as to whether it can help prevent or treat colds. A review of 14 clinical studies examining the effect of echinacea on the incidence and duration of the common cold found that echinacea supplements decreased the odds of getting a cold by 58%. It also shortened the duration of a cold by 1.4 days. Echinacea can interact with certain medications and may not be right for people with certain conditions, for example people with autoimmune disorders or certain allergies. Speak with your physician.

Buying standardized herbal supplements helps ensure you will get the right dose and the effects similar to human clinical trials. Ask your doctor or pharmacist about which herbal supplements are best for your health concerns.

Is there anything I should watch out for?

Used correctly, herbs can help treat a variety of conditions, and in some cases, may have fewer side effects than some conventional medications. Never assume that because herbs are "natural," they are safe. Some herbs may be inappropriate for people with certain medical conditions. Because they are unregulated, herbal products are often mislabeled and may contain additives and contaminants that are not listed on the label. Some herbs may cause allergic reactions or interact with conventional drugs, and some are toxic if used improperly or at high doses. Taking herbs on your own increases your risk, so it is important to consult with your doctor or pharmacist before taking herbal medicines. Some examples of adverse reactions from certain popular herbs are described below.

St. John's wort can cause your skin to be more sensitive to the sun's ultraviolet rays, and may cause an allergic reaction, stomach upset, fatigue, and restlessness. Clinical studies have found that St. John's wort also interferes with the effectiveness of many drugs, including the blood thinner warfarin (Couamdin), protease inhibitors for HIV, birth control pills, certain asthma drugs, and many other medications. In addition, St. John's wort should not be taken with prescribed antidepressant medication. The FDA has issued a public health advisory concerning many of these interactions.

Kava kava has been linked to liver toxicity. Kava has been taken off the market in several countries because of liver toxicity.

Valerian may cause sleepiness, and in some people it may even have the unexpected effect of overstimulating instead of sedating.

Garlic, ginkgo, feverfew, and ginger, among other herbs, may increase the risk of bleeding.

Evening primrose (Oenothera biennis) may increase the risk of seizures in people who have seizure disorders and bleeding in people with bleeding disorders or who take blood-thinning medications, such as warfarin (Coumadin).

Some herbal supplements, especially those imported from Asian countries, may contain high levels of heavy metals, including lead, mercury, and cadmium. It is important to purchase herbal supplements from reputable manufacturers to ensure quality. Many herbs can interact with prescription medications and cause unwanted or dangerous reactions. For example, there is a high degree of herb/drug interaction among patients who are under treatment for cancer. Be sure to consult your doctor before trying any herbal products.

Who is using herbal medicine?

Nearly one-third of Americans use herbs. Unfortunately, a study in the New England Journal of Medicine found that nearly 70% of people taking herbal medicines (most of whom were well educated and had a higher-than-average income) were reluctant tell their doctors that they used complementary and alternative medicine (CAM).

How is herbal medicine sold in stores?

The herbs available in most stores come in several different forms: teas, syrups, oils, liquid extracts, tinctures, and dry extracts (pills or capsules). You can make teas from dried herbs left to soak for a few minutes in hot water, or by boiling herbs in water and then straining the liquid. Syrups, made from concentrated extracts and added to sweet-tasting preparations, are often used for sore throats and coughs. Oils are extracted from plants and often used as rubs for massage, either by themselves or as part of an ointment or cream. Tinctures and liquid extracts are made of active herbal ingredients dissolved in a liquid (usually water, alcohol, or glycerol). Tinctures are typically a 1:5 or 1:10 concentration, meaning that one part of the herb is prepared with 5 to 10 parts (by weight) of the liquid. Liquid extracts are more concentrated than tinctures and are typically a 1:1 concentration. A dry extract form is the most concentrated form of an herbal product (typically 2:1 to 8:1) and is sold as a tablet, capsule, or lozenge.

No organization or agency regulates the manufacture or certifies the labeling of herbal preparations. This means you cannot be sure that the amount of the herb contained in the bottle, or even from dose to dose, is the same as what is stated on the label. Some herbal preparations are standardized, meaning that the preparation is guaranteed to contain a specific amount of the active ingredients of the herb. However, it is still important to ask companies making standardized herbal products about their product's guarantee. It is important to talk to your doctor or an expert in herbal medicine about the recommended doses of any herbal products.

Are there experts in herbal medicine?

Herbalists, chiropractors, naturopathic physicians, pharmacists, medical doctors, and practitioners of Traditional Chinese Medicine all may use herbs to treat illness. Naturopathic physicians believe that the body is continually striving for balance and that natural therapies can support this process. They are trained in 4-year, postgraduate institutions that combine courses in conventional medical science (such as pathology, microbiology, pharmacology, and surgery) with clinical training in herbal medicine, homeopathy, nutrition, and lifestyle counseling.

How can I find a qualified herbalist in my area?

For additional information, or to locate an experienced herbalist in your area, contact the American Herbalists Guild (AHG) site at

www.americanherbalistguild.com

www.naturopathic.org

. To located a licensed naturopath in your area, call the American Association of Naturopathic Physicians (AANP) at .

What is the future of herbal medicine?

In some countries in Europe, unlike the U.S., herbs are classified as drugs and are regulated. The German Commission E, an expert medical panel, actively researches their safety and effectiveness.

While still not widely accepted, herbal medicine is being taught more in medical schools and pharmacy schools. More health care providers are learning about the positive and potentially negative effects of using herbal medicines to help treat health conditions. Some health care providers, including doctors and pharmacists, are trained in herbal medicine. They can help people create treatment plans that use herbs, conventional medications, and lifestyle

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.

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norexia nervosa is a serious eating disorder, affecting over 3 million Americans. New research published in Psychosomatic Medicine suggests that people with this debilitating disease may have very different gut microbial communities than those found in healthy individuals.

Moreover, researchers at the University of North Carolina (UNC) School of Medicine speculate that this bacterial imbalance could be linked to some of the psychological symptoms related to the disorder, which has the highest mortality rate of any mental health issue.

The research, led by Ian Carroll, PhD, senior author of the paper and assistant professor of medicine in the UNC Center for Gastrointestinal Biology and Disease, suggests that gut bacteria, the trillions of bacteria that affect digestive health and immunity, could play a prominent role in the symptoms of anorexia nervosa.

It is known that microbial diversity is a sign of better overall health. Previous studies have also suggested that the abundance and diversity of gut microbiota could also affect the so-called "gut-brain axis."

In previous research, scientists took gut microbial communities from an obese person and put them into germ-free mice, which are maintained in sterile conditions and lack intestinal microbiota. The result was a greater weight gain in mice with these bacteria than in germ-free mice that had been colonized with gut microbiota from a lean person. This suggests that gut microbes could mediate weight gain or loss.

In other experiments where gut bacteria were added to germ-free mice, altered behavior resulted, especially in relation to anxiety and stress.
Less diverse microbial communities in those with very low weight

The UNC team wanted to study this relationship further to find out if altering gut microbiota could help patients with anorexia nervosa to maintain weight and stabilize mood over time.

They collected fecal samples from 16 women with anorexia nervosa after they were first admitted into the UNC Center of Excellence for Eating Disorders, and then again on discharge from the center after their weight was restored. The samples were analyzed for composition and diversity of gut microbiota.

They also collected gut microbiota from 12 healthy individuals for comparison.

Susan Kleiman, a graduate student in Carroll's lab and first author of the paper, found significant changes in the gut bacteria populations between admission and discharge.

The samples taken at admission had fewer different types of bacteria, making the intestinal communities much less diverse. On discharge, the microbial diversity had increased but was still significantly less diverse than that of the healthy individuals.

As the microbial communities in patients with anorexia improved during clinical care and weight gain, the moods of patients also improved, suggesting a link between the two.


Learn more about anorexia nervosa

The next question is whether improving microbial abundance and diversity could help relieve symptoms related to the eating disorder.

To help them find out, Carroll and a team of researchers have received a 5-year, $2.5-million grant from the National Institutes of Mental Health (NIMH) to further study the relationship between gut microbiota and anorexia nervosa.

The team will characterize the microbiotas of a large number of people with anorexia nervosa as they enter UNC's clinic and when they are discharged, normally when they reach about 85% of their ideal body weight.

Then they will put those gut bacteria in germ-free mice, to investigate how the microbiota from anorexia nervosa patients affects the biology and behavior of the mice.

If the bacteria have a detrimental effect on the mice, it is possible that cultivating a healthy microbiota could be used in therapy for people with anorexia nervosa.

Carroll says:

    "We're not able to say a gut bacterial imbalance causes the symptoms of anorexia nervosa, including associated symptoms, such as anxiety and depression. But the severe limitation of nutritional intake at the center of anorexia nervosa could change the composition of the gut microbial community.

    These changes could contribute to the anxiety, depression, and further weight loss of people with the disorder. It's a vicious cycle, and we want to see if we can help patients avoid or reverse that phenomenon."

Treatments for anorexia nervosa need improvement. The process of weight gain and renourishment can be extremely uncomfortable, so that after leaving the hospital, patients often begin to lose weight again and face readmission.

If specific alterations in the microbiota can help decrease the discomfort of renourishment, enable better weight regulation and positively affect behavior, this could lead to better outcomes for patients.

Carroll points out that this will not be "the magic bullet for people with anorexia nervosa," because other important factors are involved. But he believes that if the gut microbiota is associated with a variety of health and brain-related issues, it could make a difference for people with anorexia nervosa.

While anorexia nervosa mostly starts during adolescence, a Spotlight from Medical News Today has previously investigated how eating disorders can affect people of any age.

 

 

 

 

 

 

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."

 

 

 

 

 

 


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.

 

 

 

 

 

 

offee and diabetes are two of the most commonly covered topics in current medical news. The latest research looks in detail at some of coffee's ingredients and their potential effects on diabetes.

The prevalence of coffee and diabetes in modern media makes a great deal of sense: almost 1 in 10 Americans are diabetic, and more than half of American adults drink coffee daily.

The US spends roughly $40 billion on coffee per year, and in 2012, the total estimated cost of diagnosed diabetes in America was $245 billion.

Any links between these two unlikely bedfellows are likely to be chased down with vigor.

Recent research published in the American Chemical Society's Journal of Natural Products gives us a glimpse into the potential benefits of some of coffee's natural compounds in the management of type 2 diabetes.
Type 2 diabetes

Individuals with type 2 diabetes have a resistance to insulin. Insulin normally helps control the amount of glucose in the blood. If levels are high, it instructs the liver and muscles to absorb more.

Diabetes causes the body to stop reacting to insulin as it should. Insulin is released, but the liver and muscle cells no longer absorb the excess glucose. In the early phases of the disease, an increased amount of insulin is produced in an effort to convince the body to take on more glucose.

As the disease progresses, insulin-producing cells in the pancreas slowly die off through overuse.

The health implications of diabetes can be dire: damage to large blood vessels in the heart, brain and legs. Also, damage to smaller blood vessels can cause problems in the kidneys, eyes, feet and nerves.
The chemistry of coffee

All in all, there are more than 1,000 distinct chemical compounds in coffee. This impressive recipe includes quinic acid, 3,5-dicaffeoylquinic acid, acetylmethylcarbinol, dimethyl disulfide, putrescine, niacin, trigonelline, theophylline and our old friend and foe, caffeine.

Each of coffee's ingredients has the potential to affect human biology. More than likely, the majority of compounds, in the tiny amounts they are present in coffee, will not have a great effect on the body.

Having said that, there is no reason not to study each of these molecules in an effort to get to grips with the myriad of effects that coffee appears to exert on us.
Coffee and diabetes

Research into coffee and its ability to prevent or slow the onset of type 2 diabetes has garnered a fair amount of attention. A recent review of the literature concluded that habitual coffee drinking does seem to lower the risk of type 2 diabetes.

The next challenge is to tease apart the many components of coffee to pinpoint the active ingredients. As the bewildering list of chemicals above infers, this may be a gargantuan task.

Recent research conducted by Søren Gregersen and colleagues at the Department of Endocrinology and Internal Medicine at Aarhus University Hospital in Denmark may have narrowed the search.

Gregersen and his team looked at the effect of a number of coffee's constituents on rat cells in vitro. Most of the compounds did not have significant effects, but cafestol and caffeic acid threw out some intriguing results.

 

 

 

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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.

 

 

 

 

 

 

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."

 

 

 

 

 

 

When surgeon Alan Bauman started his hair restoration practice in Boca Raton, Fla., in the late 1990s, about 10% of his patients were women. Now, he says, half are. Joseph Greco, a hair loss specialist in Sarasota, Fla., says his share of female patients has gone from 25% to 60% in the last decade alone.

There's no reason to think more women these days are losing hair. Almost all women lose some hair as they age and some women – just like some men – are genetically predisposed to lose a lot. Women rarely go bald, but what starts with a widening part, noticeable shedding or a shrinking pony tail can become significant, scalp-exposing hair thinning for about one third of women, studies show.

How women feel about that may be changing, says Melissa Piliang, a dermatologist specializing in hair loss at the Cleveland Clinic.

"I think there is an increased awareness and an increased interest in treatment," Piliang says. "For our grandmothers' generation, women over 50 were considered old. Now women that age are considered pretty young. Many also have jobs in which appearance is important."

And, it's fair to say, many also are seeing marketing for an increasing array of hair restoration products and procedures aimed at women – including a pricey but unproven treatment that both Bauman and Greco specialize in. It involves scalp injections with something called platelet-rich plasma (PRP).

Bauman, Greco and other practitioners – some of whom market PRP as a "vampire hair treatment," akin to the bloody "vampire facials" made famous by Kim Kardashian – say that substances in concentrated plasma, taken from a patient's own blood, can stimulate hair regrowth. They say the procedure is safe and produces noticeable results in most, but not all, male and female patients. A 20% to 25% increase in hair mass is typical, Bauman says.

But studies so far have been small and most have lacked the comparison groups that would show how PRP stacks up against other treatments or no treatment at all. "The early findings show promise, but more studies are needed to know whether this is a safe and effective treatment," the American Academy of Dermatology says.

Also, a lack of standardization – with each clinic using its own methods – "means it's buyer beware out there," Bauman says.

Those buyers are spending big bucks: Bauman charges $2,500 for a PRP treatment that he says needs to be repeated once a year on average. Greco says he repeats his version three times over the first 18 months for typical "female pattern hair loss" patients, charging $1,600 for the first treatment, $1,400 for the second and $1,000 for the third. Patients have an incentive to return because any new hair will fall out when treatment stops – just as it does with any treatment except for hair transplants.

But no one considers PRP the first-line treatment for women with hair loss.

That distinction goes to minoxidil, a liquid or foam applied to the scalp, available over the counter for years. The Food and Drug Administration approved a full-strength foam (a 5% solution) for women in 2014 and it is now sold as Women's Rogaine. The big advantage over older 2% versions is that it can be used once a day, instead of twice. It costs about $35 for a four-month supply.

Pililang says about 80% of women using minoxidil will stop losing hair and about half will regrow some. "It's not going to take someone who's 50 or 60 back to the hair they had at 20," she says.

"It doesn't work for everybody, but I tell my patients to use it diligently for six months and then look in the mirror and see how they feel," says Paradi Mirmirani, a dermatologist specializing in hair loss at Kaiser Permanente in Vallejo, Calif. Because hair loss caused by aging and genes gets worse over time, even maintaining hair "is a win," she says. "But patients have to decide whether it's worth the time and money."

The main side effects associated with minoxidil are scalp irritation and itching. And some women report unwanted facial hair growth – something that package instructions say might be prevented with careful application.

Another treatment that might work for some women: laser therapy with comb devices that sell for about $200 to $500 or caps that cost even more. These are FDA-approved for safety and recent studies suggest "a modest benefit," Mirmirani says.

Some women are candidates for hair transplant. But because women tend to lose hair all over their heads, not in the distinct bald spots common in men, finding lusher sections that can be moved to cover sparser areas is "more challenging," Piliang says.

Supplements such as biotin, marketed for hair health, are unproven, Piliang and Mirmirani say. But eating a healthy diet, protecting hair from the sun and not smoking can help, they say.

Also important to know: not all women's hair loss is the result of aging and genes. And some causes are treatable or temporary. Among them:

• Pregnancy. Many women see temporary hair loss after pregnancy.

• Stress. Hair also can shed after stressful or traumatic events.

• Iron deficiency, thyroid, hormone and immune disorders. Treating them can often stop any associated hair loss.

• Medications. Cancer drugs but also drugs used to treat acne, depression, blood clotting and other conditions can cause hair loss.

 

 

 


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