Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers” 

SOY ISOFLAVONES & RECURRENT PROSTATE CANCER

The interest level in natural and complementary treatments for cancer has never been higher in the medical and scientific communities than it is now.  For decades, now, this area of research was often relegated to the fringes of the clinical research community, while most mainstream academic research centers and Big Pharma companies focused on the design and testing of new biochemical therapies with improved therapeutic and safety profiles.  With the 5-year overall survival rate among all patients with cancer approaching a record 65 percent, we have, unquestionably, made enormous improvement in our ability to cure many of the cancers that, not too long ago, were associated with a very high risk of death.  Cancer physicians also have far more effective medications available now to control the noxious side effects of many of our “front-line” cancer therapies, which have had the beneficial effect of further reducing suffering and morbidity among thousands of cancer patients as they undergo their daily treatments. 

Despite the  admirable (and ongoing) progress that has been achieved over the past four decades in cancer care, however, nearly 600,000 cancer patients will still succumb to their disease this year in the United States, alone.  Thus, more effective cancer prevention strategies are necessary to reduce the number of new cases of cancer, and more effective (and less toxic) cancer therapies must be identified.  Moreover, with the annual cost of many new cancer therapies now running into the hundreds-of-thousands of dollars per patient, per year, our already unsustainable (and still rising) health care costs demand that the cancer care community rigorously evaluate less costly approaches to cancer prevention and treatment.

Because so-called “natural products” are relatively inexpensive, widely available, and generally non-toxic, there is a growing interest in studying these agents using the same high-level prospective, randomized clinical trials that are routinely used by pharmaceutical companies and academic medical centers to evaluate promising new drug therapies.  Because of their great complexity and high cost, however, randomized clinical trials are best reserved for studying novel therapies for which there is at least some laboratory (“preclinical”) or early-phase clinical data available that suggests some potential benefit to humans.  Until recently, however, and most likely due to inherent biases against natural products by the mainstream clinical research community in the past, very little high-level clinical research has been performed to definitively evaluate natural products as disease prevention and treatment agents.  Fortunately, and despite shrinking research funding over the past decade, there has been a recent surge in the number of large randomized, prospective, controlled clinical research trials reporting their findings of the effects of natural products on disease prevention and treatment.

As the vast majority of natural products and lifestyle-related research in the past has been based upon low-powered research methods, it should come as no surprise that recent high-level prospective clinical research studies have, more often than not, found little or no benefit associated with the use of many of these supplements and products.  (Moreover, in some cases, several very popular and highly recommended vitamins and dietary supplements have actually been found to be potentially harmful.)   However, a great deal of promising high-level clinical research has yet to be done in order to fully and accurately assess the, literally, hundreds of natural products for which there is at least some preclinical data supporting potentially beneficial health effects.  (In my forthcoming book, “A Cancer Prevention Guide for the Human Race,” I will be comprehensively reviewing and analyzing the available laboratory and clinical research data on natural products and lifestyle strategies as an integral approach to a cancer prevention lifestyle.  The publication of this groundbreaking and authoritative evidence-based cancer prevention guide is tentatively scheduled for May of this year.)

In many respects, prostate cancer is the male counterpart of breast cancer in women.  Analogous to breast cancer in women, prostate cancer is the most common cancer that occurs in men (excluding minor skin cancers), and the second most common cause of cancer death.  In 2009, an estimated 192,000 new cases of prostate cancer were diagnosed in the United States alone, and approximately 27,000 American men died of this disease in the same year.  In most industrialized nations, prostate cancer accounts for approximately 25 percent of all cancer diagnoses in men (similar to the percentage of breast cancer cases among all cancer cases diagnosed in women).

A newly published prospective, early-phase, clinical pilot study from Canada evaluated the effects of a soy beverage (“soy milk”) on the progression of recurrent prostate cancer in 29 men following radiation therapy for their cancers.  This study, which has just been published in the journal Nutrition and Cancer, was not a placebo-controlled randomized study, however, this small phase II clinical study prospectively followed these patient volunteers for 6 months, during which time serial measurements of the level of prostate-specific antigen (PSA) in their blood was performed (PSA is the primary prostate tumor marker that is measured both to detect early prostate cancer and to identify recurrences of this type of cancer.)

The time interval during which the level of PSA in the blood doubles is an important indicator of the rate of progression of recurrent prostate cancer.  In this small prospective clinical pilot study, the consumption of approximately 500 ml of soy beverage per day, for 6 months, was associated with an actual decline in PSA levels in 4 (14 percent) of these patient volunteers, while another 8 (28 percent) of these recurrent prostate cancer patients experienced a greater than 100 percent increase in their PSA doubling times.  However, another 5 patients (17 percent) experienced a 50 percent or greater decrease in their PSA doubling times during the 6 month duration of this study, which was an unfavorable development.  Thus, during the brief duration of this intriguing small pilot study, 42 percent of men with early recurrence of their prostate cancer experienced either a decrease in the biochemical extent of their recurrent cancers or a significant biochemical slowing of the progression of their recurrent disease.

Whether or not longer durations of soy intake will be able to sustain the impressive results of this study is not clear at this time.  More importantly, whether or not these observed favorable effects of daily soy intake on PSA levels and PSA doubling times will actually translate into prolonged survival (or not) is also unknown at this time.  It will require several larger and longer-term randomized, placebo-controlled, blinded, prospective clinical trials of soy foods and soy isoflavone supplements to answer these critical questions (several of which are already underway).  Meanwhile, the overall safety profile for moderate amounts of soy intake in men appears to be quite favorable, and so many prostate cancer experts are cautiously recommending soy-derived foods for men with prostate cancer, and for men who are at an increased risk of developing prostate cancer, pending the completion of these larger prostate cancer research studies.

For a much more detailed and comprehensive evaluation of the role of soy foods, and other dietary supplements and lifestyle modifications, in the prevention of prostate cancer (and other cancers), look for the publication of “A Cancer Prevention Guide for the Human Race” in the spring of this year.

I and the staff of Weekly Health Update would like to take this opportunity to thank the more than 100,000 new and returning readers who have visited our premier global health information website this month, alone.  As always, we enjoy receiving your feedback and questions, and I continue to try to personally answer as many of your inquiries as I possibly can.

In view of the extreme devastation and human misery brought about in Haiti and Chile by the recent earthquakes, Weekly Health Update asks our tens of thousands of caring readers to give generously to established charities that are currently working in that country to assist the injured, the ill, and the homeless there.  There are many such legitimate charities, including the following two:

http://www.redcross.org/

http://www.imcworldwide.org/haiti

For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg

Welcome to Weekly Health Update

  “A critical weekly review of important new research findings for health-conscious readers” 

TESTOSTERONE SUPPLEMENTS IN FRAIL ELDERLY MEN

As we age, we tend to lose both muscle mass and bone density.  These adverse effects of aging often lead to an increased risk of generalized weakness, early fatigue, imbalance and falls, bone fractures, long-term disability, and hospitalization or other forms of chronic institutionalization.  In turn, these complications of frailty in the elderly are significantly associated with an increased risk of death.

While an elixir of eternal youth has not yet been discovered (despite many claims to the contrary over the centuries), some of the causes of aging-related frailty can be treated.  Sex hormone replacement therapy in the elderly has been a major focus of clinical intervention, in both men and women, in an effort to reverse many of the debilitating effects of aging, including declines in muscle mass, bone density, and sexual function.  However, the true risks and benefits of sex hormone replacement therapy have not always been well understood.  Indeed, within the past decade, old assumptions about the safety of hormone replacement therapy have been called into question by high-level prospective, randomized, placebo-controlled, blinded clinical research trials, including the recent and disturbing (but not altogether surprising) findings that long-term combination hormone replacement therapy in postmenopausal women is associated with a significant increase in the risk of both breast cancer and cardiovascular disease.

Although aging men do not experience an abrupt and total loss of testicular function, unlike the complete loss of ovarian function that occurs in women following menopause, testicular function does dramatically and progressively decline with advancing age.  Significant decreases in the levels of testosterone (and other “androgens”) in the blood often leads to decreased muscle mass and bone density which, in turn, can result in reduced strength and balance, and an increased risk of falls and serious injuries. 

Testosterone replacement therapy has been shown to be effective in improving muscle mass and bone density (and sexual function) in older men with very low testosterone levels (hypogonadism).  However, the role of testosterone replacement therapy in men with borderline-low circulating levels of androgen hormones has been much less clear.   As with sex hormone replacement therapy in postmenopausal women, there are known side effects associated with male sex hormone replacement therapy.  These include enlargement of the prostate gland (benign prostatic hypertrophy, or BPH), liver disease (especially with oral testosterone supplements), fluid retention, decreased fertility, breast enlargement and pain (gynecomastia), and a potential increase in the risk of prostate cancer, among others.

A newly published research study, in the Journal of Clinical Endocrinology & Metabolism, evaluated 274 men who were 65 years of age or older, and who were determined, by validated clinical criteria, to be either “intermediate-frail” or “frail.”  All of these men were also confirmed to have “borderline-low” levels of testosterone in their blood. 

In this randomized, prospective, placebo-controlled, double-blind study (which is the “gold standard” method of performing clinical research), these older men were randomly assigned to receive either transdermal testosterone therapy (50 mg per day) or a placebo gel that appeared identical to the testosterone gel.  These treatments were continued for 6 months.  The researchers then assessed both groups of men in terms of their muscle strength, muscle mass, body fat, overall level of physical function, and self-reported quality-of-life.

At the end of 6 months, the men who had been secretly randomized to the testosterone gel group were found to have experienced significant improvements in both muscle mass and muscle strength, as well as a decrease in total body fat.  Overall physical function in the “intermediate-frail” and “frail” older men also significantly improved.  Finally, and not surprisingly, self-reported physical health and sexual health satisfaction scores were substantially improved among the men who, unknown to them at the time, had received the testosterone gel.

Thus, the findings of this prospective, randomized, controlled clinical research trial certainly suggest a potential role for transdermal testosterone supplementation in frail older men with borderline-low testosterone levels.  At the same time, continued follow-up of the men in this study who elected to continue receiving testosterone supplementation is indicated, as the rather short duration of this study (6 months) is not long enough to identify the long-term benefits and risks of androgen replacement therapy.

If you are an older man who is experiencing significant frailty and disability due to progressive muscle mass and bone density loss, and you have borderline-low or low testosterone levels, then you might wish to discuss the potential benefits of a monitored testosterone supplementation regimen with your physician, or with an Endocrinologist who specialize in male endocrinology (Andrology).

On a related topic, please also see my recent column on the use of Vitamin D to decrease the risk of falls and fractures in the elderly:

http://doctorwascher.com/Archives/10-11-09.htm 

In view of the extreme devastation and human misery brought about in Haiti and Chile by the recent earthquakes, Weekly Health Update asks our tens of thousands of caring readers to give generously to established charities that are currently working in that country to assist the injured, the ill, and the homeless there.  There are many such legitimate charities, including the following two:

http://www.redcross.org/

http://www.imcworldwide.org/haiti

For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers” 

PANCREATIC CANCER RISK, SODAS & JUICE 

Pancreatic cancer is one of the deadliest of all types of cancer.  Nearly 45,000 new cases of pancreatic cancer were diagnosed in 2009 in the United States, and more than 35,000 deaths due to this disease occurred during the same year.  At the time of diagnosis, the vast majority of patients with this terrible disease are already incurable, and overall, 5-year survival rates remain a dismal 5 percent at this time.  Even among the small minority of patients who are diagnosed with pancreas cancer at a relatively early stage, when the tumor is still confined to the pancreas, the 5-year survival rate is only in the 15 to 20 percent range.

The only possible hope for pancreatic cancer cure is very radical surgery, which is often followed by chemotherapy and radiation therapy.  For most patients with pancreatic cancer, however, surgery is not even an option due to the advanced stage of their cancer at the time of diagnosis.  Therefore, efforts to prevent pancreas cancer are critically important in decreasing the death rate from this aggressive and treatment-resistant type of cancer.

There are several known risk factors for pancreatic cancer.  These include smoking, obesity, diabetes, chronic pancreatitis (inflammation of the pancreas), and chronic liver disease.  Because of the known links between pancreatic cancer, diabetes and obesity, there is concern that regularly consuming foods that significantly elevate the level of glucose (sugar) in the blood may also increase the risk of developing pancreatic cancer.

A new large-scale prospective public health study, just published in the journal Cancer Epidemiology, Biomarkers & Prevention, adds further evidence that the regular consumption of sugar-rich foods may indeed increase the risk of developing this deadly type of cancer.  In this study, nearly 61,000 patient volunteers within the Singapore Chinese Health Study were followed for up to 14 years by researchers.  All of these volunteers were extensively surveyed regarding their consumption of juices, sugary sodas (“soft drinks”), and other dietary items.  Additionally, other lifestyle factors and environmental exposures linked to various types of cancer were assessed within this very large group of patients. 

Within 14 years of the beginning of this very large epidemiological study, 140 new cases of pancreatic cancer were diagnosed within this cohort of patient volunteers.  When the researchers analyzed all of their data, they discovered that the consumption of 2 or more sodas per week was associated with nearly twice the risk of developing pancreatic cancer when compared to not drinking any sodas at all (fortunately, there appeared to be no link between juice intake and pancreatic cancer risk). 

The findings of this study add further evidence to previous similar studies regarding the intake of so-called “high glycemic index” foods and pancreatic cancer risk.  As these same sugar-rich foods also directly contribute to the development of both diabetes and obesity, it is not surprising that scientists have begun to identify common biochemical pathways that link excessive calorie intake from sugar-rich foods with all three of these life-threatening diseases. 

I will be discussing the known risk factors (and evidence-based prevention strategies) for pancreatic cancer, and for many other cancers, in much greater detail in my new book, “A Cancer Prevention Guide for the Human Race,” which is due to be published in the spring of this year.  Meanwhile, if you currently drink sodas containing sucrose or fructose on a regular basis, you might want to seriously consider eliminating these soft drinks from your diet altogether. 

In view of the extreme devastation and human misery brought about in Haiti by the recent earthquake, Weekly Health Update asks our tens of thousands of caring readers to give generously to established charities that are currently working in that country to assist the injured, the ill, and the homeless there.  There are many such legitimate charities, including the following two:

http://www.redcross.org/

http://www.imcworldwide.org/haiti

For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg

Welcome to Weekly Health Update

VITAMIN D, CARDIOVASCULAR DISEASE & DEATH

There is mounting evidence that Vitamin D plays a much more complex role in maintaining health beyond its primary function in regulating calcium absorption.  Increasingly, research data suggests that this hormone-like vitamin may also play important roles in the prevention of cardiovascular disease and cancer, as well.  (A comprehensive update on Vitamin D’s cancer prevention properties will appear in my forthcoming book, “A Cancer Prevention Guide for the Human Race.”)

The vast majority of published research studies in disease prevention have relied upon low-level research methods, including surveys of patient volunteers and retrospective medical chart reviews.  More recently, however, high-quality prospective, randomized cardiovascular disease prevention and cancer prevention clinical research trials have been performed.  These high-level studies have the potential to significantly improve lifestyle-based approaches to preventing the diseases that, together, cause the majority of all premature deaths.   

A newly published prospective clinical research study, from the Chianti region of Italy, enrolled more than 1,000 adults, aged 65 years and older.  All patient volunteers were tested for the level of Vitamin D in their blood when they joined this study, and all of these older adults were then carefully followed for an average of nearly 7 years.  During the course of this study, 228 study participants died.  The researchers then compared the levels of Vitamin D in the blood of the participants who died during the study with those of the volunteers who survived.  (This study is published in the current issue of the European Journal of Clinical Nutrition.)

The findings of this prospective clinical study were striking.  The patient volunteers with the lowest levels of Vitamin D in their blood were more than 2 times as likely to die, from any cause, when compared with the patients who had the highest levels of Vitamin D in their blood.  The patients with the lowest Vitamin D levels were also nearly 3 times as likely to die from heart attacks, and other complications related to cardiovascular disease, when compared to the patients with high levels of Vitamin D in their blood.  These dramatic findings held up even after the researchers made statistical adjustments for differences in the age, gender, education level, exercise habits, and other health-related factors among these two groups of study participants. 

As we age, our bodies become less efficient in converting sunlight into Vitamin D, and multiple research studies have shown that the majority of older adults are deficient in Vitamin D.  A growing number of high-level clinical research studies, such as this Italian study, continue to suggest that Vitamin D deficiency is associated with an increased risk of cardiovascular disease, cancer, osteoporosis, bone fractures, and decreased muscle strength in older men and women.  Therefore, the importance of this vitamin-hormone in maintaining optimal health is becoming increasingly apparent.

For additional Weekly Health Update articles on Vitamin D, please click the following links:

http://doctorwascher.com/Archives/2-3-08

http://doctorwascher.com/Archives/10-11-09.htm

http://doctorwascher.com/Archives/11-8-09.html

http://doctorwascher.com/Archives/9-20-09.htm

http://doctorwascher.com/Archives/8-9-09.htm

http://doctorwascher.com/Archives/12-28-08.htm

http://doctorwascher.com/Archives/10-5-08.htm

http://doctorwascher.com/Archives/6-29-08.htm  

In view of the extreme devastation and human misery brought about in Haiti by the recent earthquake, Weekly Health Update asks our tens of thousands of caring readers to give generously to established charities that are currently working in that country to assist the injured, the ill, and the homeless there.  There are many such legitimate charities, including the following two:

http://www.redcross.org/

http://www.imcworldwide.org/haiti

For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

CONCORD GRAPE JUICE IMPROVES MEMORY

Polyphenols are plant-based dietary compounds with known antioxidant and anti-inflammatory properties.  These biological properties of polyphenols reduce the ongoing damage to the DNA in our cells that results from the toxic byproducts of metabolism, including free radicals.  Polyphenols have, therefore, been the subject of intense research as potential prevention agents for a variety of human ailments, including cardiovascular disease, dementia, and cancer.  (The evidence-based role of dietary polyphenols in cancer prevention is discussed in great detail in my soon-to-be-published book, “A Cancer Prevention Guide for the Human Race.”)

Foods that are naturally rich in polyphenols include most blue and red berries, grapes (including red wine), pomegranates, walnuts, peanuts, olive oil, green tea, dark chocolate and cocoa, coffee, and beer (as well as other fruits and vegetables). 

Recent animal research has suggested that polyphenols derived from grape seeds can reduce the development of plaques in the brain (at least in mice) that are associated with the development of Alzheimer’s disease.  Now, a newly published prospective, randomized, double-blind clinical research study suggests that Concord grape juice, which is rich in polyphenols, may be able to improve early memory decline in older adults.

In this small study, which has been published in the British Journal of Nutrition, 12 elderly adults with declining memory were divided into two groups.  The “experimental group” received daily Concord grape juice supplements for a period of 12 weeks.  The second group, the “control group,” received placebo supplements that were identical in appearance to Concord grape juice, but which contained no juice.  Neither the 12 patient volunteers nor the research assistants were aware of which patients received grape juice and which patients received the placebo while the study was being conducted.

Standardized, validated tests of memory, and other aspects of cognitive function, were administered to all 12 patient volunteers participating in this study.  These cognitive function tests revealed statistically significant improvements in verbal learning skills among the patients who received 12 weeks of Concord grape juice (when compared to the placebo group).  Although not statistically significant, improvements were also noted in both verbal and spatial recall among the patient volunteers who received the grape juice supplements in this small clinical study with a brief duration of patient follow-up.

While larger studies, with a longer duration of follow-up, will be required to confirm the findings of this small pilot study, the prospective, randomized, placebo-controlled, double-blind nature of this small study does give it considerably more predictive power than the much larger dietary survey-based epidemiological studies that are more commonly used in disease prevention research. 

In view of the extreme devastation and human misery brought about in Haiti by the recent earthquake, Weekly Health Update asks our tens of thousands of caring readers to give generously to established charities that are currently working in that country to assist the injured, the ill, and the homeless there.  There are many such legitimate charities, including the following two:

http://www.redcross.org/

http://www.imcworldwide.org/haiti

For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

MOZART, MUSIC, BABIES & HEALTH

Wolfgang Amadeus Mozart, born in Salzburg on January 27, 1756, was a prolific and gifted composer, and is credited with over 600 original compositions prior to his death in 1791 at the age of 35.  A child prodigy, Mozart is said to have written his first composition by the age of 5.  Although Mozart composed music in a wide variety of styles, music scholars have noted that Mozart’s compositions tend to reflect a high degree of “periodicity,” involving extensive repetition of major melodic themes, when compared to the other enduring master classical music composers of Mozart’s era.  This aspect of Mozart’s music may be clinically important as, for example, clinical research studies in adults with epilepsy have compared Mozart’s music with that of Beethoven, Wagner, Bach, Chopin, Hayden, and Liszt, among others, and found that Mozart’s music was more effective in reducing seizure activity than that of the other titans of Classical music.  Thus, some experts in brain physiology have concluded that Mozart’s compositions may particularly resonate with the human brain’s circuitry, and may potentially affect brain function in clinically significant ways.

An entire commercial industry has emerged from a phenomenon that is often referred to as the “Mozart Effect.”  Clinical research in the early 1990s with infants suggested that listening to music by Mozart could at least temporarily improve spatial reasoning, or “spatial-temporal intelligence” in babies.  The rather narrowly focused findings of these studies have subsequently been grossly over-generalized, primarily by companies marketing Mozart recordings to hopeful new parents, as evidence that regularly listening to Mozart can enhance the IQ of infants and toddlers. 

Putting aside the debate over the potential impact of Mozart on the IQ of babies and toddlers, other recent research data has suggested that exposure to Mozart’s music might be associated with improved weight gain in underweight babies and children.  A newly published prospective clinical research study, which appears in the current issue of the journal Pediatrics, suggests a mechanism whereby underweight premature infants may be stimulated to gain weight following exposure to the music of Mozart. 

In this prospective, randomized study, 20 hospitalized premature infants receiving liquid nutrition through feeding tubes were randomly assigned to two different groups.  In the experimental group, the pre-term babies were exposed to a 30-minute period of Mozart’s music each day, for two consecutive days.   The control group of infants, however, was not exposed to any music on these two consecutive days.  This study included a crossover design, wherein all of these infants were then “crossed-over” into the opposite group, such that each baby participated in both the experimental group and the control group.  Measurements of these babies’ rate of energy metabolism were then performed during each 30-minute period of Mozart music exposure in the experimental group, and for equal 30-minute periods in the babies that were randomized to the control group.

Interestingly, the metabolic rates of the babies exposed to Mozart’s music decreased by 10 to 13 percent within 10 minutes of starting the Great Composer’s music (compared to the infants in the control group).  This innovative little study’s finding that the rate of energy metabolism in premature infants decreases following exposure to Mozart’s music is interesting, and may explain, at least in part, the findings of previous studies that underweight children gain weight after being exposed to recordings of Mozart’s music. 

Research studies such as this one raise the question of whether or not Mozart’s music, or that of other Classical composers, should be routinely used in hospital nurseries and neonatal intensive care units.  Meanwhile, if your baby or toddler is underweight, but otherwise healthy, a trial of “Mozart therapy” might just be in order.

In view of the extreme devastation and human misery brought about in Haiti by the recent earthquake, Weekly Health Update asks our tens of thousands of caring readers to give generously to established charities that are currently working in that country to assist the injured, the ill, and the homeless there.  There are many such legitimate charities, including the following two:

http://www.redcross.org/

http://www.imcworldwide.org/haiti

For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg

Welcome to Weekly Health Update

  “A critical weekly review of important new research findings for health-conscious readers” 

WALNUTS, CHOLESTEROL, LDL & TRIGLYCERIDES

Walnuts are rich in anti-inflammatory nutrients, including omega-3 fatty acids and ellagic acid.   Previous research has shown that the regular consumption of walnuts appears to improve cardiovascular function following high-fat meals.  In diabetics, who face an increased risk of cardiovascular disease, walnuts also appear to improve cardiovascular function.

A newly published prospective, randomized clinical research trial, which appears in the European Journal of Clinical Nutrition, evaluated the effects of a walnut-supplemented diet on 87 adults with normal-to-high cholesterol levels in their blood.  This study used a “crossover” approach, in which all of the patient volunteers received walnut supplements for 6 months, and were then switched to a walnut-free diet for another 6 months.  During this 12-month study, blood tests were performed at the beginning of the study, and then at 4, 6, 10 and 12 months into the study.  Because of the crossover design of this study, the researchers were able to directly compare the effects of walnut supplementation on body weight, total cholesterol, LDL cholesterol (the “bad cholesterol”), HDL cholesterol (the “good cholesterol”), and fatty acids (triglycerides).  (Together, these compounds are referred to as “lipids.”)

As has been observed in previous clinical studies of shorter duration, this study found that a 6-month period of walnut supplementation resulted in significant reductions in total cholesterol and triglyceride levels.  LDL levels were also reduced, although this finding just barely failed to reach statistical significance.  Importantly, these favorable changes in blood lipid levels were found to be more pronounced in patients with elevated total cholesterol and LDL cholesterol levels.  (I should note that significant reductions in LDL blood levels have been observed in response to adding walnuts to the diet of patients with elevated LDL levels, in other studies.)

While statins, and other lipid-lowering drugs, have revolutionized the management of elevated cholesterol and triglycerides, and have been shown to significantly reduce the risk of cardiovascular disease (and death due to cardiovascular disease), not all patients with hyperlipidemia can tolerate these drugs.  Moreover, as with all medications, these lipid-lowering drugs are not equally effective in all patients, and many patients with hyperlipidemia will continue to have elevated LDL cholesterol and/or triglyceride levels despite taking lipid-lowering drugs.

Studies such as this one suggest that the addition of walnuts to one’s diet may be a useful adjunct in lowering elevated LDL cholesterol and triglyceride levels.  (As always, I encourage everyone to check with their doctor before making any significant alterations in their diet, especially if you have one or more chronic illnesses.)

http://www.redcross.org/

http://www.imcworldwide.org/haiti

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg

I and the staff of Weekly Health Update would like to take this opportunity to thank the more than 110,000 new and returning readers who visit our premier global health information website each and every month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can. 

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

BREAST CANCER, PHYSICAL THERAPY &

LYMPHEDEMA

Arm lymphedema, or chronic swelling of the arm, occurs in 10 to 30 percent of women following treatment for breast cancer.  When the lymphatic drainage network in the arm and hand has been disrupted by the surgical removal of axillary (armpit) lymph nodes, or by radiation therapy to the axilla (or, sometimes, following both types of treatment), the delicate network of lymphatic vessels that return excess tissue fluid back to the heart can become obstructed. This lymphatic obstruction can then result in chronic swelling of the hand and arm.  Patients with significant lymphedema of the arm following breast cancer treatment may experience considerable swelling (edema), heaviness, stiffness and discomfort of the affected hand and arm.

Unfortunately, there are no known effective methods available to prevent lymphedema, and once significant lymphedema does develop, compression sleeves and soft tissue massage are the primary treatment modalities currently available.  Unfortunately, currently available lymphedema treatments are often not highly effective for many patients, and there is no known cure for lymphedema once it develops.

Now, a newly published research study, in the British Medical Journal, suggests that physical therapy, when initiated early after breast cancer surgery, can significantly decrease the risk of arm and hand lymphedema.  In this prospective randomized clinical research study, 120 women who underwent removal of their axillary lymph nodes for breast cancer were randomized to one of two groups.  Women assigned to the experimental group underwent physical therapy 3 times per week, for a total of 3 weeks.  Physical therapy techniques used in this group included manual lymph drainage and soft tissue massage techniques, as well as progressive shoulder exercises.  Both groups of women also underwent the same lymphedema management educational course, but the control group of women did not receive any physical therapy interventions.

Among the 116 women who completed at least one year of follow-up, 18 women (16 percent) went on to develop lymphedema.  Fourteen of the women who developed lymphedema were in the control group, while the remaining 4 women were in the experimental group.  Thus, in this clinical study, early physical therapy following axillary lymph node dissection (ALND) was associated with a very significant 72 percent reduction in the risk of developing lymphedema, at least within the first year following breast cancer surgery.

Whether or not the use of early postoperative physical therapy can reduce the incidence of arm lymphedema over periods longer than one year is unknown at this time, and additional follow-up of the patients who participated in this clinical research study will be required to answer this very important question.  However, this is one of the very few studies available that suggests a role for physical therapy in the actual prevention of arm and hand lymphedema following ALND for breast cancer.  If additional, mature follow-up of these patients confirms a long-term benefit from early postoperative physical therapy in preventing arm lymphedema, then a strong case could be made for the routine use of early physical therapy in women who undergo ALND, and perhaps, as well, women who undergo sentinel lymph node biopsy with subsequent radiation therapy to the breast and armpit (axilla) area.

For additional information and resources related to cancer-associated lymphedema, please click on the links below:

http://www.cancersupportivecare.com/Abstracts/asbdpbtps.html

http://meeting.ascopubs.org/cgi/content/abstract/23/16_suppl/8185

http://www.annalssurgicaloncology.org/cgi/content/abstract/15/7/1996

http://www.cancerlynx.com/sln.html

http://doctorwascher.com/Archives/11-23-08.htm

http://doctorwascher.com/Archives/8-16-09.htm

For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

PREVENTION OF SURGICAL SITE INFECTIONS

(SSIs) AFTER SURGERY

Infections following surgery in the United States occur in approximately 3 to 5 percent of all cases, and in more than 10 percent of certain types of operations.  In view of these statistics, surgical site infections (SSIs) are a major public health problem throughout the world.  On average, patients in the United States who develop an SSI will remain in the hospital for an additional week, resulting in an average of more than $25,000 in additional healthcare costs per affected patient.  Patients who develop SSIs are also 60 percent more likely to be admitted to the ICU, and are twice as likely to die, when compared to patients who do not develop SSIs following surgery.   Moreover, at a time when profound changes in the United State’s health care system are being proposed to control skyrocketing health care costs, SSIs are estimated to add an additional $10 billion in national health care costs, annually.   In addition to the economic costs associated with SSIs, serious infections following surgery often cause considerable suffering among affected patients; and in severe cases, SSIs can also result in permanent disability or death.

The known causes of SSIs are complex and multiple and, therefore, no single or simple solution is capable of eliminating all cases of SSIs.  However, there is ample research data available suggesting that a number of opportunities exist whereby the risk of SSIs can be further reduced.  For example, one major (and preventable) cause of potentially life-threatening SSIs is the increasing prevalence of antibiotic-resistant strains of bacteria that have developed following decades of excessive and inappropriate antibiotic use.  Among these resistant bacteria, few have raised more concern than methicillin-resistant Staphylococcus aureus (more commonly known by its acronym, MRSA).  MRSA is capable of causing limb- and life-threatening infections, particularly in very ill patients, and in the very young and very old.  When I began my medical career, more than 20 years ago, MRSA was an exceedingly rare cause of bacterial infections.  When MRSA first began to appear, this bacterium primarily caused infections among seriously ill hospitalized patients, and was rarely a source of infection among generally healthy nonhospitalized patients.

In a landmark study by the Centers for Disease Control, and published in the Journal of the American Medical Association in 2007, a remarkable 58 percent of invasive infections caused by MRSA in 2004 and 2005 occurred in nonhospitalized patients, while 27 percent of MRSA infections arose among hospitalized patients.  This tectonic shift in the epidemiology of MRSA (and other emerging strains of antibiotic-resistant bacteria and fungi, as well) has grave implications for preventing SSIs, as the majority of SSIs are known to arise from the surgical patient’s own native bacteria.

Two important new studies related to SSI prevention, and just published in The New England Journal of Medicine, offer important new ammunition in the ongoing fight against potentially deadly SSIs.

In the first study, from the Netherlands, patients being admitted to the hospital for elective surgery were tested for the presence of Staphylococcus aureus bacteria in their nasal passages.  In this prospective, randomized, placebo-controlled, double-blind, multi-center clinical research trial, 6,771 patients were screened for the presence of nasal Staphylococcus aureus, and 1,251 of these patients were confirmed to be nasal carriers of this bacterium.  A total of 917 of these patients were subsequently enrolled into this clinical research trial. These 917 patients were then divided into an “experimental” group and a “control” group, although neither the patients nor the research assistants in this double-blind study were permitted to know which group any patient was assigned to until after the study had been completed.  Patients randomized to the “experimental” group were treated, before surgery, with antibacterial ointment (mupirocin) applied to their nasal passages, and with showers using antibacterial soap (chlorhexidine), in an effort to eradicate surface bacteria (including Staphylococcus aureus) from their noses and skin.  The “control group” of patients received identical-appearing nasal ointment and skin soap, but without mupirocin or chlorhexidine.

All study patients were tracked following surgery, and the incidence of SSIs was then analyzed.  In this highly-powered randomized, controlled clinical research trial, there was a 58 percent overall reduction in the relative risk of SSIs among the “experimental group” of patients when compared to the patients who received only placebo ointment and placebo soap.  The benefit of preoperative treatment with mupirocin ointment and chlorhexidine soap was even more pronounced for SSIs involving deep body spaces, in this study: the relative risk of deep body space SSIs was reduced by 79 percent in the “experimental group” of patients.  Therefore, the results of this powerful prospective clinical trial suggest that SSIs following elective surgery can be significantly reduced by, first, testing patients for evidence of colonization with Staphylococcus aureus bacteria and, secondly, by “decolonizing” the nasal passages and skin of already-colonized patients with antibacterial ointment and soap, respectively.  Many hospitals already selectively apply nasal cavity testing for MRSA (either before or following surgery), and recommend a shower with chlorhexidine soap prior to surgery.  The results of this important public health study suggest that the incidence of SSIs can probably be further lowered by more rigorous and more universal preoperative screening programs for nasal Staphylococcus aureus (including both MRSA and non-MRSA Staphylococcus aureus) directed at all patients who are undergoing elective surgery.

The second, and related, study evaluated the impact of two different preoperative skin prep solutions on the incidence of SSIs.

For decades, now, iodine-based skin cleansing solutions have been applied to skin surfaces just prior to the start of surgery, in an effort to kill skin-surface bacteria that can lead to SSIs.  While these traditional iodine-based antibacterial skin prep solutions are active against many bacteria and fungi that are known to cause SSIs, their antibacterial and antifungal activity rapidly dissipates after being applied.  Newer surgical skin prep agents that contain alcohol and chlorhexidine have been shown by recent research studies to not only have a wider spectrum of activity against skin bacteria and fungi than traditional iodine-based prep solutions, but these newer surgical prep solutions also sustain their antibacterial and antifungal activity over a much longer duration than their iodine-based counterparts.  In this new prospective, randomized clinical research study, 849 patients undergoing elective surgery were randomized to one of two groups.  One group of patient volunteers underwent preoperative skin preparation with a commercially available chlorhexidine-alcohol solution, while the second group was randomized to undergo skin preparation with the traditional povidone-iodine solution.

Following surgery, 16 percent of the patients who had their skin prepped with povidone-iodine solution developed SSIs within 30 days of surgery, while just under 10 percent of the patients who received the chlorhexidine-alcohol skin prep solution subsequently developed SSIs.  (This 41 percent reduction in the relative risk of SSIs was found to be highly statistically significant.)    Although use of the chlorhexidine-alcohol skin prep, alone, did not appear to protect against deep organ-space infections (when compared with the use of povidone-iodine skin prep solutions) in this study, both superficial and deep SSIs of the surgical incision were significantly reduced following use of the chlorhexidine-alcohol skin prep solution.  In this study, the use of a chlorhexidine-alcohol prep solution cut the risk of superficial incisional infection by one-half, while deep incisional infections were reduced threefold.  Thus, the use of chlorhexidine-alcohol skin prep solutions, just prior to making the incision, was associated with a highly significant reduction in the incidence of both superficial and deep infections of surgical incisions when compared to traditional iodine-based prep solutions.

Taken together, these two very important prospective randomized clinical research trials offer clinically valuable lessons for patients, physicians, and hospitals in our crucial quest to drive down the incidence of SSIs to the lowest achievable level.  In view of the recent and ongoing emergence of highly virulent strains of bacteria and fungi that have become resistant to many of our most powerful antibiotic and antifungal drugs, respectively, it is imperative that we find new ways to reduce the risk of SSIs, and particularly new methods that do not involve the continued inappropriate or excessive utilization of broad spectrum antibiotic drugs.

If you are scheduled to undergo elective surgery in the near future, I would advocate that you share the findings of these two clinically important research studies with your surgeon (if they are not already aware of them).

For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg