255 CNO Report 28 MAY 2018


CNO Report # 255

Release Date:  28 MAY 2018

Draft Report Compiled by

Ralph Turchiano




In this issue:

1.       New studies show dark chocolate consumption reduces
stress and inflammation

2.       Research explains link between exercise and appetite

3.       Common class of drugs linked to dementia even when
taken 20 years before diagnosis

4.       Consuming protein supplements with meals may work
better for weight control

5.       Drinking kefir may prompt brain-gut communication to
lower blood pressure

6.       Probiotics useful in the fight against infection

7.       Diet rich in fish and legumes may help to delay natural

8.       Hypertensive patients may benefit from folic acid

9.       New study finds ginger proven to treat vomiting in
children with acute gastroenteritis

10.   Expert consensus finds that higher protein intake
benefits adult bone health

11.   Omega-3, omega-6 in diet alters gene expression in

12.   A high-fiber diet protects mice against the flu

13.   Biotin supplements caused misleading test results,
almost led to unnecessary procedure

14.   Compound in citrus oil could reduce dry mouth in head,
neck cancer patients

15.   Daily egg consumption may reduce cardiovascular

16.   Pregnant smokers may reduce harm done to baby’s lungs
by taking vitamin C

17.   Flavonoids may slow lung function decline due to

18.   Study finds antioxidant-enriched vitamin reduces
respiratory illnesses in patients with CF

19.   Rehabilitating lactate: From poison to

20.   Whey protein supplements and exercise help women
improve body composition




Release: 24-Apr-2018

New studies show dark chocolate consumption reduces
stress and inflammation

Data represent first human trials examining the impact
of dark chocolate consumption on cognition and other brain

Loma Linda University Adventist Health Sciences

New research shows there might be health benefits to
eating certain types of dark chocolate. Findings from two studies being
presented today at the Experimental Biology 2018 annual meeting in San Diego
show that consuming dark chocolate that has a high concentration of cacao
(minimally 70% cacao, 30% organic cane sugar) has positive effects on stress
levels, inflammation, mood, memory and immunity. While it is well known that
cacao is a major source of flavonoids, this is the first time the effect has
been studied in human subjects to determine how it can support cognitive,
endocrine and cardiovascular health.

Lee S. Berk, DrPH, associate dean of research
affairs, School of Allied Health Professions and a researcher in
psychoneuroimmunology and food science from Loma Linda University, served as
principal investigator on both studies.

“For years, we have looked at the influence of dark
chocolate on neurological functions from the standpoint of sugar content – the
more sugar, the happier we are,” Berk said. “This is the first time that we have
looked at the impact of large amounts of cacao in doses as small as a
regular-sized chocolate bar in humans over short or long periods of time, and
are encouraged by the findings. These studies show us that the higher the
concentration of cacao, the more positive the impact on cognition, memory, mood,
immunity and other beneficial effects.”

The flavonoids found in cacao are extremely potent
antioxidants and anti-inflammatory agents, with known mechanisms beneficial for
brain and cardiovascular health. The following results will be presented in live
poster sessions during the Experimental Biology 2018

Dark Chocolate (70% Cacao) Effects Human Gene
Expression: Cacao Regulates Cellular Immune Response, Neural Signaling, and
Sensory Perception (Monday, April 23, 10:00 a.m. – 12:00 p.m., San Diego
Convention Center, Exhibit Halls A – D)

  • This pilot feasibility experimental trial
    examined the impact of 70 percent cacao chocolate consumption on human
    immune and dendritic cell gene expression, with focus on pro- and
    anti-inflammatory cytokines. Study findings show cacao consumption
    up-regulates multiple intracellular signaling pathways involved in T-cell
    activation, cellular immune response and genes involved in neural signaling
    and sensory perception – the latter potentially associated with the
    phenomena of brain hyperplasticity.

Dark Chocolate (70% Organic Cacao) Increases Acute
and Chronic EEG Power Spectral Density (μv2) Response of Gamma Frequency
(25-40Hz) for Brain Health: Enhancement of Neuroplasticity, Neural Synchrony,
Cognitive Processing, Learning, Memory, Recall, and Mindfulness Meditation
(Tuesday, April 24, 10:00 a.m. – 12:00 p.m., San Diego Convention Center,
Exhibit Halls A – D)

  • This study assessed the electroencephalography
    (EEG) response to consuming 48 g of dark chocolate (70% cacao) after an
    acute period of time (30 mins) and after a chronic period of time (120
    mins), on modulating brain frequencies 0-40Hz, specifically beneficial gamma
    frequency (25-40Hz). Findings show that this superfood of 70 percent cacao
    enhances neuroplasticity for behavioral and brain health

Berk said the studies require further investigation,
specifically to determine the significance of these effects for immune cells and
the brain in larger study populations. Further research is in progress to
elaborate on the mechanisms that may be involved in the cause-and-effect
brain-behavior relationship with cacao at this high concentration.

Release: 24-Apr-2018

Research explains link between exercise and appetite

Albert Einstein College of

April 24, 2018–(BRONX, NY)–Ever wonder why intense
exercise temporarily curbs your appetite? In research described in today’s issue
of PLOS Biology,
Einstein College of Medicine
researchers reveal that the answer is all in your
head–more specifically, your arcuate nucleus.

Senior author Young-Hwan
Jo, Ph.D.
, associate professor of medicine and of molecular
pharmacology at Einstein, runs on a track near his house three times a week for
30 to 45 minutes at a time. Like many exercisers, he noticed two things about
intense workouts: they raised his body temperature and reduced his appetite for
several hours afterward.

“I’m a neuroscientist who studies the
hypothalamus–the portion of the brain that plays the central role in regulating
metabolism and weight,” he says. “I wondered if certain hypothalamic neurons
sense temperature increases and respond to exercise-induced warming by releasing
a ‘stop eating!’ message.”

Anyone who’s suffered a burn or eaten a jalapeño
pepper knows that sensory neurons with “heat-detecting” receptors (called TRPV1
receptors) abound in the body. Those neurons react to physical heat and to
capsaicin, the active ingredient in jalapeños and many other spicy foods. Could
brain neurons possess similar receptors?

Dr. Jo focused on appetite-suppressing
proopiomelanocortin (POMC) neurons in the arcuate nucleus (ARC) of the
hypothalamus. Some of those neurons are not shielded by the blood-brain barrier,
so they’re able to directly detect and respond to hormones and nutrients in the
blood. He wondered whether those neurons sense changes in body temperature as

To sense and respond to heat, ARC POMC neurons would
need receptors similar to the capsaicin- and heat-sensitive TRPV1 receptors
found elsewhere in the body. Dr. Jo and colleagues took mouse hypothalamus
tissue containing POMC neurons and exposed the tissue to capsaicin or to heat,
to see if such receptors were present.

Sure enough, both capsaicin and heat caused POMC
neurons to fire by activating their receptors. About two-thirds of the ARC’s
POMC neurons possessed such receptors. Next came experiments exploring the role
of POMC neurons and their TRPV1 receptors in reducing appetite and curbing food
intake. Dr. Jo and colleagues found that:

  • Infusing capsaicin into the ARC of mice reduced
    the amount of food they ate over the next 12 hours. Researchers could
    prevent this appetite suppression by first blocking the POMC neurons’
    TRPV1-like receptors or silencing the gene that codes for those receptors.
  • When mice were put on treadmills for 40 minutes,
    their body and ARC temperatures rapidly increased, plateauing after 20
    minutes and remaining at that elevated level for more than an hour. After
    the workout, the mice reduced their food intake by about 50 percent compared
    with non-exercising mice.
  • Bouts of treadmill exercise did not affect the
    food intake of mice whose ARC POMC neurons lacked TRPV1

“Our study provides evidence that body temperature
can act as a biological signal that regulates feeding behavior, just like
hormones and nutrients do,” says Dr. Jo. He also notes that his findings could
lead to new approaches for suppressing appetite or helping people lose


The PLOS Biology paper is titled “Activation
of temperature-sensitive TRPV1-like receptors in ARC POMC neurons reduces food
intake.” The other authors, all from Einstein, were Jae Hoon Jeong, Ph.D., Dong
Kun Lee, Ph.D., Shun-Mei Liu, M.D., Streamson Chua, M.D., Ph.D., and Gary
Schwartz, Ph.D.

About Albert Einstein College of

Albert Einstein College of
part of
is one of the nation’s premier centers for research, medical education and
clinical investigation. During the 2017-2018 academic year, Einstein is home to
students, 181
students, 108 students in the
M.D./Ph.D. program
and 265 postdoctoral research fellows
research fellows
The College of Medicine has more than 1,900 full-time faculty members located on
the main campus and at its
In 2017, Einstein received more than $174 million in awards from the National
Institutes of Health (NIH). This includes the funding of major

at Einstein in aging, intellectual development disorders, diabetes, cancer,
clinical and translational research, liver disease, and AIDS. Other areas where
the College of Medicine is concentrating its efforts include developmental brain
research, neuroscience, cardiac disease, and initiatives to reduce and eliminate
ethnic and racial health disparities. Its partnership with
the University Hospital and academic medical center for Einstein, advances
clinical and translational research to accelerate the pace at which new
discoveries become the treatments and therapies that benefit patients. Einstein
runs one of the largest residency and fellowship training programs in the
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affiliation network involving hospitals and medical centers in the Bronx,
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Release: 25-Apr-2018

Common class of drugs linked to dementia even when
taken 20 years before diagnosis

Regenstrief Institute

INDIANAPOLIS – The largest and most detailed study of
the long-term impact of anticholinergic drugs, a class of drugs commonly
prescribed in the United States and United Kingdom as antidepressants and
incontinence medications, has found that their use is associated with increased
risk of dementia, even when taken 20 years before diagnosis of cognitive

An international research team from the US, UK and
Ireland analyzed more than 27 million prescriptions as recorded in the medical
records of 40,770 patients over age 65 diagnosed with dementia compared to the
records of 283,933 older adults without dementia.

The researchers found greater incidence of dementia
among patients prescribed anticholinergic antidepressants, anticholinergic
bladder medications and anticholinergic Parkinson’s disease medications than
among older adults who were not prescribed these drugs.

Dementia increased with greater exposure to
anticholinergic medications.

“Anticholinergic Medication and Risk of Dementia:
Case-control Study” is published in BMJ (formerly the British Medical
) an international peer-reviewed medical

“Anticholinergics, medications that block
acetylcholine, a nervous system neurotransmitter, have previously been
implicated as a potential cause of cognitive impairment,” said Regenstrief
Institute and Indiana University Center for Aging Research investigator Noll
Campbell, PharmD, MS, a co-author of the new BMJ study. “This study is
large enough to evaluate the long-term effect and determine that harm may be
experienced years before a diagnosis of dementia is made.” Dr. Campbell is also
an assistant professor of pharmacy practice at Purdue University College of

“These findings make it clear that clinicians need to
carefully consider the anticholinergic burden of their patients and weigh other
options,” said study co-author Malaz Boustani, M.D., MPH, a Regenstrief
Institute and IU Center for Aging Research investigator. Dr. Boustani is the
founder of the Indiana Clinical and Translational Science Institute’s IU Center
for Health Innovation and Implementation Science and the Richard M. Fairbanks
Professor of Aging Research at IU School of Medicine.

“Physicians should review all the anticholinergic
medications – including over-the-counter drugs – that patients of all ages are
taking and determine safe ways to take individuals off anticholinergic
medications in the interest of preserving brain health,” Dr. Boustani

The study, which was led by the University of East
Anglia and funded by the Alzheimer’s Society, both in the UK, utilized data from
the Clinical Practice Research Datalink which includes anonymized diagnosis,
referral and prescription records for more than 11 million patients from 674
primary care practices across the UK. The data is broadly representative of the
UK population in terms of age, sex and ethnicity.

“This research is really important because there are
an estimated 350 million people affected globally by depression. Bladder
conditions requiring treatment are estimated to affect over 13 percent of men
and 30 percent of women in the UK and US,” said study lead researcher George
Savva, PhD, visiting researcher at University of East Anglia’s School of Health

“We don’t know exactly how anticholinergics might
cause dementia,” said study co-author Chris Fox, MD, professor of clinical
psychiatry at UEA’s Norwich Medical School and a consultant psychiatrist.
“Further research is needed to understand possible reasons for this link. In the
meantime, I strongly advise patients with any concerns to continue taking their
medicines until they have consulted their doctor or pharmacist.”

Study co-author Ian Maidment, PhD, senior lecturer in
clinical pharmacy at Aston University in the UK, said: “With many medicines
having some anticholinergic activity, one key focus should be de-prescribing.
Clinical staff, patients and carers need to work together collaboratively to
limit the potential harm associated with


In addition to Regenstrief Institute, IU, Purdue,
University of East Anglia and Aston University investigators, collaborators
included researchers from the University of Aberdeen, the Royal College of
Surgeons in Ireland, Newcastle University, and the University of Cambridge.

Release: 25-Apr-2018

Consuming protein supplements with meals may work
better for weight control

Oxford University Press

A new systematic review of available evidence
appearing in Nutrition Reviews indicates that consuming protein
supplements with meals may be more effective at promoting weight control than
consuming supplements between meals in adults following a resistance training

It is well established that consuming dietary protein
proximate to resistance-type exercise sessions promotes a positive net protein
balance during post-exercise recovery. Protein supplements are available in
ready-to-drink, powdered, and solid form and are marketed for different outcomes
such as weight gain, weight loss, and weight management. However, for each
outcome, the promoted timing of protein intake varies. Protein supplements
designed to augment weight gain or support weight stability are promoted for
consumption between meals. Protein supplements either with meals or as meal
replacements are often recommended for ingestion to promote weight loss.

Consuming protein supplements between meals may
decrease compensatory eating behaviors, thereby increasing energy intakes and
body weight. Conversely, adults undergoing a resistance training program and
consuming protein supplements twice daily with meals may compensate for the
protein supplement by decreasing their self-chosen diet. Consequently, the
timing of protein supplementation may be of particular importance, depending on
the desired body weight and body composition outcome.

The impact of timing the consumption of protein
supplements relative to meals has not previously been evaluated systematically.
In the newly published review of the literature, the researchers investigated
whether the existing research studies support consuming protein supplements
between meals, vs. with meals, to differentially change body composition in
adults who initiate resistance training regimens.

Researchers here assessed 34 randomized controlled
trials with 59 intervention groups. Of the intervention groups designated as
consuming protein supplements with meals vs. between meals, 56% vs. 72%
increased their body mass, 94% vs. 90% increased their lean mass, 87% vs. 59%
reduced their fat mass, and 100% vs. 84% increased the ratio of lean to fat mass
over time, respectively.

With-meal ingestion of protein was defined as
consumption of a dietary protein-rich supplement immediately after a meal, with
a meal, or as a high-protein meal replacement. Between-meal ingestion of protein
was defined as consumption of a dietary protein supplement predominantly either
very near a workout or during another non mealtime.

The results from this systematic review provide novel
information for people who choose to consume protein supplements as part of
their dietary pattern to promote body mass gain or improve body composition
through fat mass reduction. However, consuming protein supplements with meals,
rather than between meals, may be a more effective dietary strategy to improve
resistance training-induced changes in body composition by reducing fat mass,
which may be relevant for adults looking to improve their health status.
Consuming protein supplements between meals may be more effective at increasing
overall body mass.

Release: 25-Apr-2018

Drinking kefir may prompt brain-gut communication to
lower blood pressure

Long-term probiotic use balances gut microbiota, brain
chemicals in rodent study

Experimental Biology

Drinking kefir may have a positive effect on blood
pressure by promoting communication between the gut and brain. Kefir is a
fermented probiotic milk beverage known to help maintain the balance of
beneficial bacteria in the digestive system. Researchers will present their
findings today at the American Physiological Society (APS) annual meeting at
Experimental Biology 2018 in San Diego.

Previous research has shown that an imbalance in the
gut’s colony of bacteria (microbiota) may cause high blood pressure in some
people. Similarly, probiotics–live bacteria supplements that are beneficial to
the digestive system–have been found to lower blood pressure, but the
mechanisms by which this occurs are unclear.

A research team from Auburn University in Alabama, in
collaboration with the University of Vila Velha in Brazil, studied three groups
of rats to determine how kefir reduces high blood pressure (hypertension):

  • One group had hypertension and was treated with
    kefir (“treated”).
  • One group had hypertension and was not treated
  • One group had normal blood pressure and was not
    treated (“control”).

After nine weeks of kefir supplementation, the
treated rats had lower levels of endotoxins (toxic substances associated with
disruption in the cells), lower blood pressure and improved intestinal
permeability when compared with the untreated group. Healthy intestines allow
some substances to pass through, but generally act as a barrier to keep out
harmful bacteria and other potentially dangerous substances. In addition, kefir
supplementation restored the natural balance of four different bacteria in the
gut and of an enzyme in the brain essential for normal nervous system function,
suggesting that the nervous and digestive systems work together to reduce

“Our data suggests that kefir
antihypertensive-associated mechanisms involve gut microbiota-brain axis
communication during hypertension,” the researchers

Mirian Silva-Cutini, of Auburn University, will
present “Probiotic kefir antihypertensive effects in spontaneously hypertensive
rats involve central and peripheral mechanisms” on Wednesday, April 25, in the
Sails Pavilion of the San Diego Convention Center.


NOTE TO JOURNALISTS: To schedule an interview with a
member of the research team, please contact the
Communications Office

or 301-634-7209. Find more research highlights in the
Press Room

About Experimental Biology

Experimental Biology is an annual meeting comprised
of more than 14,000 scientists and exhibitors from five sponsoring societies and
multiple guest societies. With a mission to share the newest scientific concepts
and research findings shaping clinical advances, the meeting offers an
unparalleled opportunity for exchange among scientists from across the United
States and the world who represent dozens of scientific areas, from laboratory
to translational to clinical research.

About the American Physiological Society

Physiology is the study of how molecules, cells,
tissues and organs function in health and disease. Established in 1887, the
American Physiological Society (APS) was the first U.S. society in the
biomedical sciences field. The Society represents more than 10,500 members and
publishes 15 peer-reviewed journals with a worldwide readership.

Release: 26-Apr-2018

Probiotics useful in the fight against infection

New research shows probiotics may be a prevention tool
for Clostridium difficile infections

Society for Healthcare Epidemiology of



NEW YORK (April 26, 2018) – Probiotics may be a
relatively safe, simple, and low-cost solution for preventing Clostridium
infections (CDI) in hospital settings, according to two studies
published today in Infection Control & Hospital Epidemiology, the
journal of the Society for Healthcare Epidemiology of America. Both studies show
that treating patients who received antibiotics with multi-strain probiotics,
cut down on CDI incidence rates over time.

“While it’s not a perfect solution for a bacterium
that has proven very difficult to prevent and treat, probiotics could offer
patients another line of defense,” said Bradley Johnston, PhD, associate
professor of epidemiology at Dalhousie University in Canada and lead author of
one of the studies. “We worked with clinical trialists from 12 countries that
willingly shared their data with us to conduct what is known as an individual
patient data meta-analysis and we demonstrated that we should be considering
probiotics as a viable strategy for preventing CDI in

The research led out of Dalhousie University in
Canada conducted a synthesis of randomized controlled trials to determine
whether probiotics reduced the odds of CDI in adults and children. It found that
probiotics reduced the odds of CDI by about two-thirds in both their
non-adjusted and adjusted models (adjusting for age, sex, hospitalization
status, use of multiple antibiotics, and exposure to high-risk antibiotics).
Additionally, they found that compared to no probiotics, multi-species
probiotics were more beneficial than single-species

This study analyzed 18 eligible randomized controlled
trials that included patient data for 6,851 participants comparing probiotics to
placebo or no treatment and that reported CDI as an outcome. Probiotics were
especially effective among participants taking two or more antibiotics and in
settings where the risk of CDI was greater than five percent.

A second project conducted by Cook County Health
& Hospitals System at a separate tertiary care medical center, in which a
single-center before-after quality improvement intervention was evaluated, found
that probiotics provided a delayed benefit in reducing CDI. During the
intervention period, there was a trend toward a lower incidence in CDI in the
second six months, compared to the first six months. The authors speculate that
the postponed benefit could be attributed to the time required for environmental
contamination with spores of C. difficile to be brought under control.

“There is an expanding number of options to prevent
or treat the often serious and costly infections caused by C. difficile,” said
William Trick, MD, a clinician at Cook County Health & Hospitals System and
lead author of the study. “Probiotics are one option that is low cost,
relatively safe, and likely beneficial in the

Trick and his team compared 12-month baseline and
intervention periods. Patients in the study received capsules containing a
three-strain probiotic mixture, to be taken within 12 hours of their
antibiotics. The primary outcome of the study was the incidence of
hospital-onset CDI among participants.

While this study showed the benefits of implementing
probiotics as a strategy against CDI, it also highlighted the limitations in
this approach. For instance, during a real-world quality improvement
intervention, getting a probiotic agent to the right patients at the right time
was challenging and led to incomplete use of the intervention. Also, the
beneficial results are unlikely to match those reported in randomized controlled
trials (RCTs). It is critical that interventions are tested in routine practice
settings to uncover implementation challenges and to evaluate the replicability
of results from RCTs in different settings.


Bradley C. Johnston, PhD; Lyubov Lytvyn, MSc; Calvin
Ka-Fung Lo, BHSc; Stephen J. Allen, MD; Duolao Wang, PhD; Hania Szajewska, MD;
Mark Miller, MD; Stephan Ehrhardt, MD; John Sampalis, MD; Deniz G. Duman, MD;
Pietro Pozzoni, MD; Agostino Colli, MD: Elisabet Lönnermark, MD; Christian P.
Selinger, MD; Samford Wong; Susan Plummer, MD; Mary Hickson, PhD; Ruzha
Pancheva, MD, PhD; Sandra Hirsch, MD; Bengt Klarin, MD; Joshua Z. Goldenberg,
ND; Li Wang, MD; Lawrence Mbuagbauw, PhD; Gary Foster, PhD; Anna Maw, MD; Behnam
Sadeghirad, MPH; Lehana Thabane, PhD; Dominik Mertz, MD. Microbial preparations
(probiotics) for the prevention of Clostridium difficile infection in adults and
children: an individual patient data meta-analysis of 6851 participants. Web
(April 26, 2018).

William E. Trick, MD; Stephen Sokalski, DO; Stuart
Johnson, MD; Kristen Bunnell, PharmD; Joseph Levato, PharmD; Michael Ray, MPH;
Robert A. Weinstein, MD. Effectiveness of Probiotic for Primary Prevention of
Clostridium difficile Infection: A Single Center Before-After Quality
Improvement Intervention at a Tertiary Care Medical Center. Web (April 26,

Release: 30-Apr-2018

Diet rich in fish and legumes may help to delay
natural menopause

But high dietary intake of refined carbs may help to
hasten it, suggests research


A diet rich in fish and legumes may help to delay the
natural menopause, while high dietary intake of refined carbs, such as pasta and
rice, may instead help to hasten it, suggests the first UK study of its kind,
published online in the Journal of Epidemiology & Community

Several genetic, behavioural, and environmental
factors are thought to be involved in the timing of the menopause, and some
studies have implicated diet.

To explore this further, the researchers drew on
participants from the UK Women’s Cohort Study, involving more than 35,000 women
between the ages of 35 and 69 from England, Scotland, and

The women provided information on potentially
influential factors such as weight history, physical activity levels,
reproductive history, and use of hormone replacement therapy

They also estimated the quantities of 217 foodstuffs
they ate every day by completing a food frequency questionnaire. The food items
were collated into groups according to their culinary

Further information on when the women had gone
through the menopause naturally was gathered 4 years

In all, some 14,000 women provided information at
both time points, and the final analysis included the 914 who had gone through
the menopause naturally after the age of 40 and before the age of

The average age at menopause was 51, and certain
foods seemed to be associated with its timing.

Each additional daily portion of refined
carbs–specifically pasta and rice–was associated with reaching the menopause
1.5 years earlier, after taking account of potentially influential

But each additional portion of oily fish and fresh
legumes (eg peas, beans) was associated with a delay of more than 3 years.
Higher intakes of vitamin B6 and zinc (per mg/day) were also associated with
later menopause.

Similar results emerged when the analysis looked at
particular groups. For example, eating meat was associated with menopause
arriving almost a year later than a vegetarian diet.

Among those who weren’t vegetarian, upping daily
portions of savoury snacks was associated with the arrival of the menopause
almost 2 years earlier, while higher intake of oily fish and fresh legumes was
linked to later menopause of more than 3 and nearly 1.5 years,

Similarly, among mothers, higher intake of oily fish
and fresh legumes was associated with later menopause, while additional daily
portions of pasta, rice, and savoury snacks were associated with earlier

Among childless women, eating more grapes and poultry
was significantly associated with later menopause.

Egg maturation and release are adversely affected by
reactive oxygen species, so a high intake of legumes, which contain
antioxidants, may counter this, preserving menstruation for longer, suggest the
researchers, in a bid to explain the findings. And omega 3 fatty acids, which
are abundant in oily fish, stimulate antioxidant capacity in the

On the other hand, refined carbs boost the risk of
insulin resistance, which can interfere with sex hormone activity and boost
oestrogen levels, both of which might increase the number of menstrual cycles
and deplete egg supply faster, they say.

Vegetarians consume a lot of antioxidants too, but
they are also likely to eat a lot more fibre and less animal fat than
carnivores, both of which are associated with low oestrogen levels, which may
also alter the timing of the menopause, suggest the

This is an observational study, and as such, can’t
prove causality. Food Frequency Questionnaires are subject to faulty recall, and
the study sample was also more affluent and health conscious than average, all
of which might have influenced the findings.

But women who go through the menopause early are at
increased risk of osteoporosis and heart disease, while those who go through it
late are at increased risk of breast, womb, and ovarian cancers, so timing
matters, say the researchers.

And they conclude: “Our findings confirm that diet
may be associated with the age at natural menopause. This may be relevant at a
public health level since age at natural menopause may have implications on
future health outcomes.”

Release: 7-May-2018

Hypertensive patients may benefit from folic acid

Patients with low platelet count and high homocysteine
levels reduced first stroke risk by 73 percent with the B

American College of

Hypertensive adults with low platelet count who took
a combined daily pill of both enalapril and folic acid saw a 73 percent
reduction in their risk of first stroke compared to patients who took only
enalapril daily, according to a study published in the Journal of the
American College of Cardiology

Stroke is the second leading cause of death
worldwide, and the number one cause of death in China. About 77 percent of
strokes are first events, creating a need for better primary prevention efforts.

In an earlier published report from the China Stroke
Primary Prevention Trial (CSPPT), researchers found that folic acid treatment
could reduce first stroke risk by 21 percent on average in hypertensive adults
by lowering total homocysteine levels–elevated levels are a risk factor for
vascular disease. This present study is the first and largest of its kind to
examine the association of elevated homocysteine levels and platelet count
together–both of which play a significant role in the development of
cardiovascular disease–with first stroke.

Researchers analyzed 10,789 participants from the
CSPPT–men and women aged 45 to 75 years old who had hypertension or were on
anti-hypertensive medication. The study excluded patients with a history of
stroke or other major cardiovascular diseases. Participants were randomly
assigned into two groups. In the first group, 5,408 patients received a combined
daily oral dose of 10 mg enalapril and 0.8 mg folic acid, and in the second
group, 5,381 patients received a daily dose of only the enalapril.

Among the total number of participants, 371 first
strokes took place over a median follow up of 4.2 years. A total of 210 first
strokes occurred in the enalapril-only group, and 161 first strokes in the
enalapril-folic acid group.

“Our analysis has shown that baseline low platelet
count and elevated homocysteine can jointly increase the risk of first stroke,”
said Yong Huo, MD, director of the Heart Center of Peking University First
Hospital in China, and the study’s senior author. “If the findings are further
confirmed by prospective trials, we can raise the prospect that we can identify
patients at high risk of developing first stroke by measuring both platelet and
homocysteine, and we can remarkably lower stroke risk among this subgroup of
patients with folic acid–a simple, safe and inexpensive treatment.”

Researchers found the risk of first stroke reduced
from 5.6 percent to 1.8 percent among patients with low platelet count and high
homocysteine levels, creating a 73 percent risk reduction. However, the folic
acid had no effect among those with high platelet count and low homocysteine

“If confirmed, these results have enormous public
health implications given the high incident rate of stroke in many developing
countries, in addition to China,” Huo said. “Based on our findings, we can
detect hypertensive adults at particular high risk of stroke and incorporate a
folic acid supplement tailored to individual genetic, nutritional and clinical
characteristics. We are on the right path to figuring out cost-effective primary
prevention strategies for stroke in China and

In an accompanying editorial, J. David Spence, MD,
director of the Stroke Prevention and Atherosclerosis Research Centre at Robarts
Research Institute noted that, “Patients with lower platelet counts and higher
homocysteine levels are more likely to have been at higher risk because they had
vitamin B12 deficiency. Among folate-replete subjects, the main nutritional
determinant of high homocysteine levels is B12 deficiency.”

Spence said, “The widespread belief that B vitamins
do not reduce the risk of stroke is mistaken. This study not only invited
confirmation of the benefit of B vitamins, but opens the door to wider

As a post-hoc analysis of CSPPT, limitations of the
study include that residual confounding cannot be completely ruled out. Higher
dosages of folic acid should be evaluated for any additional beneficial effects.
Further studies should examine platelet parameters during the follow-up period
and the utility of 5-methyltetrafolate, a more naturally occurring folate than
folic acid.

RELEASE: 10-MAY-2018

New study finds ginger proven to treat vomiting in
children with acute gastroenteritis


 (Geneva, 11 May, 2018) Researchers presenting at the
51st ESPGHAN Annual Meeting have today revealed the results of a new study which
proves the efficacy and effectiveness of using ginger to treat vomiting in
children with acute gastroenteritis [1] – one of the most common conditions
resulting in admission to paediatric emergency

All children are expected to suffer from acute
gastroenteritis within the first three years of life [2] and globally there are
between 3-5 billion cases each year [3]. Vomiting is reported in three quarters
of children suffering the condition [4] contributing to fluid loss and oral
rehydration failure – which can be life threatening. While mortality rates in
Europe are low, gastroenteritis is a major cause of hospital visits and has a
substantial economic impact; it accounts for over 87,000 hospital visits a year
and almost 700,000 outpatient visits [5]. Globally, acute gastroenteritis is one
of the leading causes of childhood mortality, accounting for 1.34m childhood
deaths a year – approximately 15% of all childhood deaths

Dr Roberto Berni Canani and his team of researchers
have proven that ginger is effective at reducing both the duration and the
severity of vomiting, leading to fewer lost school days and suggest that the
findings have the potential to reduce hospitalisations and missed work days by

The double-blind, randomized, placebo-controlled
trial looked at 141 children between the ages of 1 and 10 with acute
gastroenteritis and compared the effectiveness of ginger with a placebo in
treating the condition. The results showed that the number of vomiting episodes
was 20% less in the group treated with ginger and the number of children missing
school for at least one day was 28% less in the group treated with

Whilst previous studies have found ginger to be
effective in treating vomiting in pregnant women and adult patients undergoing
chemotherapy, this study is the first time the effectiveness of ginger has been
tested in children.

Commenting, Dr Berni Canani, said: “Acute
gastroenteritis is not just an unpleasant condition for children. It has a
significant burden on parents, schools and healthcare systems. We anticipate
that the results will have a great impact on future clinical practice and the
advice given to parents in the treatment of acute gastroenteritis and could
potentially save lives across Europe and the globe. Research should now focus on
whether ginger could also be effective in treating vomiting children who are not
affected by acute gastroenteritis.”

About the Expert

Prof.Dr.Roberto Berni Canani, MD, PhD
Associate Professor of Pediatrics, Department of Translational Medical Science –
Section of Pediatrics
European Laboratory for the Investigation of Food
Induced Diseases
Chief, Immunonutrition Lab – CEINGE Advanced
Task Force on Microbiome Studies,
of Naples “Federico II”, Italy


The European Society for Paediatric Gastroenterology
Hepatology and Nutrition (ESPGHAN) is a multi-professional organisation whose
aim is to promote the health of children with special attention to the
gastrointestinal tract, liver and nutritional status, through knowledge
creation, the dissemination of science based information, the promotion of best
practice in the delivery of care and the provision of high quality education for
paediatric gastroenterology, hepatology and nutrition professionals in Europe
and beyond. Find out more by visiting

Release: 15-May-2018

Expert consensus finds that higher protein intake
benefits adult bone health

In seniors with osteoporosis, dietary protein intake
above currently recommended levels may help to reduce bone loss and fracture
risk, especially at the hip, provided calcium intakes are

International Osteoporosis

A new expert consensus endorsed by the European
Society for Clinical and Economical Aspects of Osteoporosis, Osteoarthritis, and
Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation
(IOF) has reviewed the benefits and safety of dietary protein for bone health,
based on analyses of major research studies. The review, published in
, found that a protein-rich diet, provided there is
adequate calcium intake, is in fact beneficial for adult bone health. (1) It
also found no evidence that acid load due to higher dietary protein intakes,
whether of animal or vegetable origin, is damaging to bone

The key findings of the extensive literature review

  • Hip fracture risk is modestly decreased with

    higher dietary protein intakes, provided calcium intakes are adequate;

  • Bone mineral density (BMD), which is an important
    determinant of bone strength, appears to be positively associated with
    dietary protein intakes;
  • Protein and calcium combined in dairy products
    have beneficial effects on calciotropic hormones, bone turnover markers and
    BMD. The benefit of dietary proteins on bone outcomes seems to require
    adequate calcium intakes;
  • There appears to be no direct evidence of
    osteoporosis progression, fragility fractures or altered bone strength with
    the acid load originating from a balanced

Professor René Rizzoli, Professor at the Division of
Bone Diseases of the Geneva University Hospitals and Faculty of Medicine,

“Adequate intake of dietary protein, together with
calcium, is needed for optimal bone growth in children and the maintenance of
healthy bone at all ages. This message needs to be reinforced in view of
currently circulating myths suggesting that too much protein causes ‘acid load’
and is damaging to bone health. In fact, in the elderly, we find that a common
problem is not too much protein, but too little. This review of the literature
confirms that a balanced diet with sufficient protein intake, regardless whether
of animal or vegetable source, clearly benefits bone health when accompanied by
adequate calcium intake. This is particularly important for seniors with
osteoporosis, and individuals at risk of malnutrition due to acute or chronic
illness, or recovering from an injury.”

Release: 15-May-2018

Omega-3, omega-6 in diet alters gene expression in

Fatty acid supplementation regulates gene coding for
secreted proteins in muscles

American Physiological

Bethesda, Md. (May 15, 2018)–A new study reveals
that essential fats in the diet may play a role in regulating protein secretion
in the muscles by changing the way genes associated with secretion act.
is published ahead of print in Physiological

Alpha-linolenic acid (ALA) and linoleic acid (LA) are
plant-based essential fats–called polyunsaturated fatty acids (PUFA)–that
humans consume through diet. ALA is an omega-3 fatty acid; LA is an omega-6
fatty acid. Omega-3 and omega-6 fatty acids have been shown to be beneficial to
brain health and reduce the risk of inflammation and heart

Previous studies have shown that proteins secreted
from the muscles (skeletal muscle secretome) help regulate signaling of
metabolic activities such as muscle fiber formation and the function of
insulin-producing beta cells in the pancreas. This prior research suggests that
obesity and insulin resistance–an inability of the body to properly respond to
insulin–changes the skeletal muscle secretome. A research team from the
University of Guelph in Ontario, Canada, explored how regular consumption of
essential fats regulates how genes use information (gene expression) associated
with the skeletal muscle secretome.

The researchers studied glucose levels and took
samples from muscle and RNA–a molecule chain that uses genetic information from
DNA to produce proteins in the cells–from four groups of

  • a lean group ate a normal diet (“lean”),
  • an obese group ate food supplemented with ALA
  • an obese group ate food supplemented with LA
    (“LA”), and
  • an obese control group ate a normal diet (“obese

After 12 weeks on the respective diets, both the ALA
and LA groups had lower glucose levels and better glucose tolerance compared to
the obese control group. These factors improved more in the ALA group than the
LA one. In addition, the researchers found more than 135 genes that expressed
differently–based on diet–among the four groups of animals, including genes
that correspond with 15 secreted proteins. Expression in most of these proteins
differed between the lean and obese groups.

These results suggest that “LA and ALA may
differentially regulate the skeletal muscle secretome,” the researchers
explained, and that the addition of PUFA further alters gene expression. “Our
findings concerning the relationship between obesity and the skeletal muscle
secretome add valuable information to a relatively understudied area of

Release: 15-May-2018

A high-fiber diet protects mice against the flu virus

Cell Press

Dietary fiber increases survival in
influenza-infected mice by setting the immune system at a healthy level of
responsiveness, according to a preclinical study published May 15th in the
journal Immunity. A high-fiber diet blunts harmful, excessive immune
responses in the lungs while boosting antiviral immunity by activating T cells.
These dual benefits were mediated by changes in the composition of gut
bacteria, leading to an increase in the production of short-chain fatty acids
(SCFAs) through the microbial fermentation of dietary

“The beneficial effects of dietary fiber and SCFAs on
a variety of chronic inflammatory diseases, including asthma and allergies, have
received substantial attention in recent years and have supported momentum
toward their use in clinical studies,” says senior study author Benjamin
Marsland of Monash University. “But we were concerned that these treatments
might lead to a general dampening of immune responses and could increase
susceptibility to infections.”

From a public health perspective, influenza A
infection is especially relevant because it is one of the most common viral
diseases worldwide. Up to 20% of people are infected each year, resulting in
substantial morbidity and mortality. In the new study, Marsland and his team
found that mice were protected from influenza infection by a diet supplemented
with either the highly fermentable fiber inulin or

Specifically, these treatments led to both the
dampening of the innate immune response that is typically associated with tissue
damage, and also the enhancement of the adaptive immune response that is charged
with eliminating pathogens.

“We typically find that a certain treatment turns our
immune system either on or off,” Marsland says. “What surprised us was that
dietary fiber was selectively turning off part of our immune system, while
turning on another, completely unrelated part of our immune system.”

Taken together with past studies, the new findings
suggest that the modern Western diet consisting of food high in sugar and fat
and low in fiber could increase susceptibility to inflammatory diseases while
decreasing protection against infections. From a therapeutic standpoint,
additional research is needed to determine how much fiber, and what type of
fiber, would be most effective in humans.

For their own part, Marsland and his team will
further examine how dietary changes influence the immune system, and
particularly how changes in the gut can influence lung diseases. Currently, they
are planning dietary intervention studies in humans to determine how their
results could best be translated to day-to-day

“There is a need for carefully designed and
controlled dietary or SCFA intervention studies in humans to address how these
findings could be exploited to benefit people with asthma, or for preventing
viral infections,” Marsland says. “We should also look further into these
pathways as a means of supplementing other therapies or enhancing vaccine

Release: 18-May-2018

Biotin supplements caused misleading test results,
almost led to unnecessary procedure

FDA issued warning about biotin interference with lab
tests in November 2017

University of North Carolina Health


May 18, 2018 – A new case report in the Journal of
the Endocrine Society
documents how a patient’s use of a common biotin
supplement, also known as vitamin B7, caused her to have clinically misleading
test results, which prompted numerous consultations and unnecessary radiographic
and laboratory testing.

The patient in the case report took a 5000 mcg dose
of biotin daily. Biotin supplements in that dosage are commonly sold
over-the-counter, without a prescription, in many grocery and drug stores for
about $8-$20 a bottle. They are marketed as being good for healthy hair, skin
and nails, but there is no scientific evidence to support this

In this patient’s case, “The negative clinical impact
included weeks of psychological distress concerning the possibilities of
hypercortisolemia or a testosterone-producing tumor. Most significantly, these
abnormal test results nearly resulted in an unnecessary invasive procedure for a
complex patient with a hypercoagulable state,” the case report says.
Hypercortisolemia is a condition involving a prolonged excess of cortisol — a
steroid hormone — in blood.

Maya Styner, MD, associate professor of endocrinology
and metabolism in the department of medicine, is the case report’s corresponding

“The literature is lacking with regard to biotin
interference with serum cortisol and testosterone immunoassays, as in our
case-report,” Styner said. “Patients are ingesting supplements in a higher
frequency, and higher doses, and therefore this case is timely and relevant from
both a clinical and basic-science perspective.”

She added, “Our manuscript is a product of a
collaboration between endocrinology, reproductive endocrinology/gynecology and
clinical chemistry at UNC and at the Mayo Clinic. This collaboration enabled us
to ascertain the underlying diagnosis and perform relevant research-based biotin
quantification in our patient’s sample.”

Release: 21-May-2018

Daily egg consumption may reduce cardiovascular

Having an egg a day could reduce risk of stroke by 26


People who consume an egg a day could significantly
reduce their risk of cardiovascular diseases compared with eating no eggs,
suggests a study carried out in China, published in the journal

Cardiovascular disease (CVD) is the leading cause of
death and disability worldwide, including China, mostly due to ischaemic heart
disease and stroke (including both haemorrhagic and ischaemic

Unlike ischaemic heart disease, which is the leading
cause of premature death in most Western countries, stroke is the most
responsible cause in China, followed by heart

Although ischaemic stroke accounted for the majority
of strokes, the proportion of haemorrhagic stroke in China is still higher than
that in high income countries.

Eggs are a prominent source of dietary cholesterol,
but they also contain high-quality protein, many vitamins and bioactive
components such as phospholipids and carotenoids.

Previous studies looking at associations between
eating eggs and impact on health have been inconsistent, and most of them found
insignificant associations between egg consumption and coronary heart disease or

Therefore, a team of researchers from China and the
UK led by Professor Liming Li and Dr Canqing Yu from the School of Public
Health, Peking University Health Science Center, set out to examine the
associations between egg consumption and cardiovascular disease, ischaemic heart
disease, major coronary events, haemorrhagic stroke and ischaemic

They used data from the China Kadoorie Biobank (CKB)
study, an ongoing prospective study of around half a million (512,891) adults
aged 30 to 79 from 10 different geographical areas in

The participants were recruited between 2004-2008 and
were asked about the frequency of their egg consumption. They were followed up
to determine their morbidity and mortality.

For the new study, the researchers focused on 416,213
participants who were free of prior cancer, cardiovascular disease (CVD) and

From that group at a median follow-up of 8.9 years, a
total of 83,977 cases of CVD and 9,985 CVD deaths were documented, as well as
5,103 major coronary events.

At the start of the study period, 13.1% of
participants reported daily consumption (usual amount 0.76 egg/day) and 9.1%
reported never or very rare consumption

(usual amount 0.29 egg/day) of

Analysis of the results showed that compared with
people not consuming eggs, daily egg consumption was associated with a lower
risk of CVD overall.

In particular, daily egg consumers (up to one
egg/day) had a 26% lower risk of haemorrhagic stroke – the type of stroke with a
higher prevalence rate in China than in high-income countries – a 28% lower risk
of haemorrhagic stroke death and an 18% lower risk of CVD

In addition, there was a 12% reduction in risk of
ischaemic heart disease observed for people consuming eggs daily (estimated
amount 5.32 eggs/week), when compared with the ‘never/rarely’ consumption
category (2.03 eggs/week).

This was an observational study, so no firm
conclusions can be drawn about cause and effect, but the authors said their
study had a large sample size and took into account established and potential
risk factors for CVD.

The authors concluded: “The present study finds that
there is an association between moderate level of egg consumption (up to 1
egg/day) and a lower cardiac event rate.

“Our findings contribute scientific evidence to the
dietary guidelines with regard to egg consumption for the healthy Chinese

Public Release: 21-May-2018

Compound in citrus oil could reduce dry mouth in head,
neck cancer patients


Stanford Medicine

A compound found in citrus oils could help alleviate
dry mouth caused by radiation therapy in head and neck cancer patients,
according to a new study by researchers at the Stanford University School of

The compound, called d-limonene, protected cells that
produce saliva in mice exposed to radiation therapy — without diminishing the
tumor-fighting effects of the radiation. The researchers, led by graduate
student Julie Saiki, also showed that d-limonene taken orally is transported to
the salivary gland in humans.

The study will be published online May 21 in the
Proceedings of the National Academy of Sciences.

The finding was possible because of a close
collaboration between clinicians and basic scientists, said co-senior author
Daria Mochly-Rosen, PhD, professor of chemical and systems biology. “This is a
perfect example of two pieces that could not work alone.”

“Stanford is a fertile ground for collaboration,” added
Quynh-Thu Le, co-senior author and professor and chair of radiation

About 40 percent of head and neck cancer patients who
receive radiation therapy develop dry mouth, known clinically as xerostomia.
It’s more than uncomfortable: patients struggle to speak and swallow and are
more likely to develop oral pain or dental cavities, and the condition can lead
to tooth removal in some cases, Le said. And, although some recovery can occur
in the first years after the therapy, once saliva production is impaired, it is
usually gone for life.

Radiation can kill salivary cells

One drug, called amifostine, is approved for use during
radiation therapy to try to ward off dry mouth, but its side effects, including
nausea and potential low blood pressure, are common, so it is rarely used in
the clinic, Le said.

Many of the saliva-producing cells that are needed to
keep the mouth constantly moist are found in a pair of structures called the
submandibular glands, tucked under the lower jawbone on each side of the chin.
Radiation often kills these cells and, more troublingly, also salivary stem and
progenitor cells, those juvenile members of the population that are needed to
rebuild and restore the capacity to make saliva.

The key to retaining salivary function is protecting
these rare but critical stem and progenitor cells. That’s tricky because,
following radiation therapy, toxic, highly reactive compounds called aldehydes
are created in the gland, gumming up cellular function.

Le, the Katharine Dexter McCormick and Stanley
McCormick Memorial Professor, who specializes in treating head and neck cancer,
said she had spent a decade hearing from her patients about their struggles with
dry mouth. “I wanted to do something,” she said.

Her initial strategy was to try to regenerate salivary
stem cells and, while working with these cells, her lab found that they contain
high levels of an enzyme called aldehyde dehydrogenase 3A1, or ALDH3A1. The
enzyme is a member of the large aldehyde dehydrogenase family of enzymes,
proteins that initiate or speed up chemical reactions, that can defang
troublesome aldehydes. But ALDH3A1 isn’t a match for the radiation-unleashed
aldehydes on its own.

She needed to find something to amp it up.

Looking to the East

Le had met with Mochly-Rosen through SPARK, a program
founded and co-directed by Mochly-Rosen, that shepherds basic science
discoveries into the clinic. Mochly-Rosen, who is the George D. Smith Professor
in Translational Medicine, had been working on aldehyde dehydrogenases for more
than a decade and had obtained access to a library of 135 traditional Chinese
medicine extracts.

Many of those extracts have been used as treatments for
various ailments in humans for hundreds of years, boosting the likelihood they
are safe to use, Mochly-Rosen said.

Her team found that seven of these 135 extracts boosted
ALDH3A1 activity. It was up to Saiki to see if she could break apart these
complex natural extracts — from plants including tangerine, lotus and an Asian
rhizome known as zhi mu in Chinese — to find out what, exactly, was activating
the enzyme.

“She did the unthinkable, a really amazing achievement.
She found the single active ingredient that activates the enzyme, ALDH3A1,”
Mochly-Rosen said.

Admittedly, Mochly-Rosen and Saiki said, a bit of luck
and a fair amount of trial-and-error were involved. D-limonene stood out from
other compounds in the extracts because it is broken down relatively quickly in
the body and has been deemed by the Food and Drug Administration as a food
flavor “generally recognized as safe” that has been approved for use as a food
additive, Saiki said.

Saiki said she was pleasantly surprised by her finding.
“It’s a very common molecule, and sometimes as a scientist you wonder, Why
hasn’t anyone seen this before?” she said.

Next, they had to see if d-limonene would rev up
ALDH3A1 in living cells.

Testing in mice, and humans

A series of experiments with mouse cells that had been
exposed to radiation showed that d-limonene reduced aldehyde concentrations in
both adult and salivary stem and progenitor cells. Even when the cells were
treated weeks after radiation exposure, d-limonene still improved their ability
to recover, repair gland structure and produce saliva. Mice that ate d-limonene
and were exposed to radiation also produced more saliva than mice that did not
receive d-limonene and were exposed to radiation. The researchers also learned
that d-limonene wasn’t likely to boost saliva production so high that mice, or
humans, would be drooling — the compound didn’t increase saliva production in
mice that hadn’t been exposed to radiation. And they confirmed that d-limonene
did not affect tumor growth or interfere with the tumor-shrinking effects of
the radiation in mice.

A further set of experiments pulled back the curtain on
d-limonene’s work: it was stopping the expression of messages that trigger the
salivary stem and progenitor cells to self-destruct.

Buoyed by these positive results, the researchers
wanted to know if the compound had any hope of helping patients. To work, it
would have to be active inside the salivary glands. To find out, they launched a
phase-0 study, an early clinical trial in a small number of patients to see if
d-limonene, taken by mouth in a capsule, would be distributed to the salivary
gland. Four participants who were having a salivary gland tumor removed took
d-limonene for two weeks before the surgery. When the tissue was examined after
it was removed, researchers found high levels of d-limonene, showing that it
has the potential to be used therapeutically in humans — it reaches the
salivary gland tissue.

The patients did experience one quirky side effect:
Citrus-infused burps.

Next, the team plans to start the clinical trial
process, which will take several years and require a multi-institutional
collaboration, Le said. “If it works, then this type of drug would be used
safely to prevent dry mouth in patients in the long run and make it much easier
for patients to tolerate the radiation treatment with an improved quality of
life after the treatment,” she said.

The work is an example of Stanford Medicine’s focus on
precision health, the goal of which is to anticipate and prevent disease in the
healthy and precisely diagnose and treat disease in the

Release: 21-May-2018

Pregnant smokers may reduce harm done to baby’s lungs
by taking vitamin C

American Thoracic

In a previous study, the researchers reported that
daily supplemental vitamin C in pregnant women who could not quit smoking
improved their newborn’s pulmonary function as measured by passive respiratory
compliance and the time to peak tidal expiratory flow to expiratory time. At one
year, the study also found that babies whose mothers took vitamin C were less
likely to develop wheeze.

In the newest study, the researchers measured force
expiratory flows (FEFs) at 3 and 12 months of babies born to 252 mothers who
smoked. FEF measures the speed with which air can be forced out of the lung. The
mothers who smoked were randomized to either receive 500 mg of supplemental
vitamin C every day or a placebo in addition to the same prenatal vitamin. They
were encouraged throughout their pregnancies to quit smoking. On average, the
mothers in both arms of the study who could not quit smoked seven cigarettes a

“We performed FEFs in this study because they provide
a more direct measurement of actual air way function, and are more predictive of
future disease,” said lead study author Cynthia McEvoy, MD, professor of
pediatrics, Division of Neonatology, at the Oregon Health & Science
University School of Medicine and OHSU Doernbecher Children’s Hospital. “Because
infants are not cooperative at 3 and 12 months of age, we had to use
sophisticated testing techniques to get these results, but they are similar to
the results you would get when doing a spirometry

The researchers measured FEFs at three intervals
defined by the percentage of air remaining in the lung during forced exhalation:
FEF75, FEF25-75 and FEF50. At three months, there was a statistically
significant difference in lung function between the babies born to the two
groups of women at the FEF25-75 and FEF50 intervals. At 12 months, there was a
statistically significant difference in lung function between the two groups of
babies at all three intervals.

The study did not find a significant difference
between the two groups of babies in gestational age at delivery, delivery mode,
incidence of prematurity or birthweight.

The researchers said that they are not certain why
vitamin C has this protective effect on the lungs but are focusing on this
question in continuing research. Study co-investigator Eliot Spindel, MD, PhD,
professor of neuroscience, OHSU School of Medicine, speculates that it may
“block the increased collagen deposition around the airways that has been shown
in animal models of babies born after smoke/nicotine exposure during pregnancy,
which likely makes the lungs and airways stiffer” and/or “prevent some of the
epigenetic changes that contribute to the lifelong effects of in-utero tobacco

The study will follow the children until they are six
years old to see if vitamin C has a long-term effect on improving childhood
respiratory health. The researchers are particularly interested in determining
whether children born to mothers who took vitamin C supplements are less likely
to develop asthma, which is difficult to diagnose in the first year of

Despite the apparent benefits of vitamin C, Dr.
McEvoy said, “getting women to quit smoking during pregnancy has to be priority
one.” For those roughly 50 percent of pregnant smokers who will not, or cannot
quit despite all efforts, quit smoking, vitamin C supplementation may be a
simple and safe way to help their babies breathe better, she added.


Abstract 7248

Improved Forced Expiratory Flows in Infants of
Pregnant Smokers Randomized to Daily Vitamin C versus

Authors: C. T. McEvoy1, K. Milner1, D. G. Schilling1, A.
Scherman1, C. Tiller2, B. Vuylsteke1, K. Jackson1, D. Haas3, C. Bunten4, J.
Harris1, A. Vu5, R. Schuff5, D. Kraemer6, J. Mitchell7, J. Metz6, L.
Shorey-Kendrick8, E. R. Spindel8, R. S. Tepper2, C. D. Morris5;1Pediatrics,
Oregon Health & Science University, Portland, OR, United States,
2Pediatrics, Indiana University, Indianapolis, IN, United States, 3Obstetrics
and Gynecology, Indiana University, Indianapolis, IN, United States, 4Obstetrics
and Gynecology, Vancouver Clinic, Vancouver, WA, United States, 5Medical
Informatics and Clinical Epidemiology and Oregon Clinical & Translational
Research Institute, Oregon Health & Science University, Portland, OR, United
States, 6Medical Informatics and Clinical Epidemiology, Oregon Health &
Science University, Portland, OR, United States, 7Oregon Clinical &
Translational Research Institute, Oregon Health& Science University,
Portland, OR, United States, 8Oregon National Primate Research Center,
Beaverton, OR, United States.

Rationale: We previously reported a randomized controlled trial
demonstrating that daily supplemental vitamin C to pregnant smokers
significantly improved their offspring’s newborn pulmonary function tests (PFTs)
(passive respiratory compliance and the time to peak tidal expiratory flow to
expiratory time) and decreased the incidence of wheeze through 1 year of age
(JAMA 2014; 311:2074-2081). In this subsequent trial, we hypothesized that
infants of pregnant smokers randomized to vitamin C would have significantly
increased infant forced expiratory flows (FEFs) as compared to placebo.

Methods: Women< 23 weeks of gestation with a singleton
pregnancy unable to quit smoking were randomized to daily vitamin C (500 mg) or
placebo through delivery. Both groups received the same prenatal vitamin.
Smoking cessation was discussed throughout gestation. Fasting ascorbic acid and
urine cotinine levels were measured. The primary outcome was FEFs at 3 months of
age performed with the raised volume rapid thoracic compression technique
(Viasys Jaeger BabyBody). Secondary outcomes included FEFs at 12 months of age.
Analyses of the FEFs were done on intention to treat using mixed model analysis
of covariance adjusting for design factors (site, gestational age [GA] at
randomization) and covariates (length, race, age, sex).

Results: We randomized 252 pregnant smokers. Randomization
balanced relevant covariates including: cigarettes/day at randomization (7
versus 7); GA at randomization (18.3 weeks in placebo vs 18.5 weeks in treated
group). Both groups had comparable urine cotinine and ascorbic acid levels at
randomization. At mid and late gestation, the vitamin C group had higher levels
of ascorbic acid than the placebo group. Of the 243 infants at delivery, there
was no significant effect of the intervention on delivery mode, birthweight, GA
at delivery, or incidence of prematurity. We completed FEFs in 225 infants at 3
months of age and 213 FEFs at 12 months. Infants of pregnant smokers randomized
to vitamin C had higher FEFs (FEF75, FEF25-75, FEF50) at 3 and 12 months of age
compared to placebo. (Table).

Conclusion: These results expand our previous findings in
newborns to demonstrate improved FEFs through 12 months of age after vitamin C
supplementation to pregnant smokers. We speculate that vitamin C supplementation
in pregnant women who cannot quit smoking may improve the pulmonary function
trajectory of their offspring by blocking some of the effects of in- utero smoke
on lung development.

This cohort is in active follow-up through 5-6 years
of age to study their PFT trajectory and development of

Release: 21-May-2018

Flavonoids may slow lung function decline due to

American Thoracic

Previous research has shown that the plant-produced
chemicals known as flavonoids have beneficial antioxidant and anti-inflammatory
properties. Anthocyanins, the type of flavonoid investigated in the current
study, have been detected in lung tissue shortly after being ingested, and in
animals models of chronic obstructive pulmonary disease (COPD). The plant
chemicals appear to reduce mucus and inflammatory

However, “the epidemiological evidence on the
association between flavonoids and lung function is very scant,” said lead study
author Vanessa Garcia-Larsen, PhD, assistant professor in the Human Nutrition
Division of the Department of International Health at the Johns Hopkins
Bloomberg School of Public Health in Baltimore, Maryland. “So we wanted to
investigate whether dietary intake and anthocyanins are associated with lung
function decline in middle-age adults.”

The researchers analyzed data from 463 adults
(average age: 44) who participated in the second and third European Community
Respiratory Health Surveys from 2002 to 2012. Those included in the current
study completed a dietary questionnaire and underwent spirometry at enrollment
and upon follow-up. A common lung function test, spirometry measures the amount
of air that a person can forcefully exhale in one second (FEV1), the total
amount of air a person can exhale after taking a deep breath (FVC) and the ratio
of the two, FEV1/FVC. Participants were then grouped into quartiles based on the
amount of anthocyanins they consumed.

The study found individuals in the highest, compared
to the lowest, quartile of anthocyanin intake had:

  • a slower rate of annual decline in FEV1 than
    those in the lowest quartile: -9.8 milliliters per year (mL/yr) vs. -18.9
  • a slower rate of annual decline in FVC than those
    in the lowest quartile: -9.8 mL/yr vs. -22.2 mL/yr.
  • a slower rate of annual decline in FEV1/FVC:

The researchers also analyzed the association between
anthocyanin consumption and lung function in smokers, those who had never smoked
and those who quit. The association between high consumption of the flavonoids
and reduced lung function decline appeared to be stronger among both never
smokers and those who had quit than in the general study population. Among
smokers, the study did not find an association between anthocyanin intake and
lung function.

The study adjusted for a wide range of factors,
including characteristics of participants’ diets, gender, height, body mass
index and socioeconomic status. Another strength of the study was its inclusion
of participants from two countries, Norway and England. The study was limited by
its relatively small size and the fact that diets were

“Our study suggests that the general population could
benefit from consuming more fruits rich in these flavonoids like berries,
particularly those who have given up smoking or have never smoked, Dr. Larsen
said. “For smokers, quitting remains the best thing they can do to protect their

The first European Community Respiratory Health
Survey began in 1990 in response to a worldwide increase in asthma prevalence.
The scope of the surveys has expanded to include information about the
associations between behavioral and environmental factors that might also affect
the development of COPD.


Abstract 15028

Dietary Intake of Anthocyanin Flavonoids and Ten Year
Lung Function Decline in Adults from the European Community Respiratory Health
Survey (ECRHS)

Authors: V. Garcia Larsen1, R. Villegas2, E. R. Omenaas3, C.
Svanes3, J. Garcia-Aymerich4, P. G. Burney5, D. Jarvis5, ECRHS Diet Working
Group; 1Department of International Health, Johns Hopkins Bloomberg School of
Public Health, Batimore, MD, United States, 2School of Public Health, University
of Chile, Santiago, Chile, 3Haukeland University Hospital, Bergen, Norway,
4Institut de Salut Global IS, Barcelona, Spain, 5National Heart and Lung
Institute, Imperial College London, London, United

Background: Flavonoids have antioxidant and anti-inflammatory
properties which could slow down the decline of lung function and reduce risk of
chronic obstructive pulmonary disease (COPD), but epidemiological evidence is
lacking. Anthocyanins, a subclass of flavonoids, have been detected in lung
tissue, and have attenuated mucus and infiltration of inflammatory exudates in
experimental models of COPD.

Aim: To investigate the association between dietary
intake of anthocyanins and lung function decline in two representative cohorts
of adults in Europe.

Methods: Participants were 463 adults (44.5 ±6.3y at
baseline) from England and Norway taking part in the ECRHS2 and ECRHS3 surveys,
with valid spirometry and dietary data collected at both baseline (2002) and
follow-up (2012). To investigate the effect of anthocyanin intake on forced
vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and the ratio
FEV1/FVC, separate linear mixed models were used, with a random centre and
participant specific intercepts. Anthocyanin intake was categorised into
quartiles (lowest quartile of reference from baseline survey). We estimated the
adjusted difference in annual change in lung function over time associated with
anthocyanin intake via an interaction between each anthocyanin quartile (lowest
quartile as reference) and age of the participant. All models were adjusted for
age, height, sex, socio-economic status, education, body mass index, total fruit
and vitamin C intakes, total energy intake, and smoking habit in the two
surveys. Stratified analyses by smoking status were also

Results: Individuals with the lowest quartile of anthocyanin
intake had an adjusted mean annual change of – 18.9mL/yr (standard error mean
[SEM] ±2.2), and -22.2mL/yr (SEM ±2.2) for FEV1 and FVC, respectively.
Participants with the highest quartile of anthocyanin intake had slower annual
rates of decline in FEV1 (-9.8 mL/yr; (95% CI, -15.5, -4.1) and FVC (-9.8mL/yr;
95% CI -17.3, -2.3). The FEV1/FVC ratio decline was also slower (highest vs
lowest quartile of anthocyanin intake -0.02/yr; 95% CI -0.03, -0.01). The linear
trend for adjusted difference in annual change across quartiles of increasing
anthocyanin intake was also significant for FEV1/FVC (p-trend: <0.001) and
FEV1 (p-trend: 0.019), and but not for FVC (p-trend: 0.08). Stratified analyses
showed significantly slower rates of decline in the FEV1/FVC ratio associated
with increased anthocyanin intake among never smokers and those who had quit
before ECRHS2.


Dietary intake of sources of anthocyanins is
associated with significantly slower decline in lung function in the general
population, specifically in never-and ex-smokers but not among

Release: 23-May-2018

Study finds antioxidant-enriched vitamin reduces
respiratory illnesses in patients with CF

Children’s Hospital Colorado and the University of
Colorado School of Medicine lead a multicenter clinical trial that identifies
benefits of a specially formulated antioxidant

Children’s Hospital

Researchers at Children’s Hospital Colorado
(Children’s Colorado) and the University of Colorado School of Medicine have
found that taking a specially formulated antioxidant-enriched multivitamin may
decrease respiratory illnesses in people with cystic fibrosis (CF).

The study,
which was recently published online in the
Journal of Respiratory and Critical Care Medicine
, looked at the effects of a ‘cocktail’ of multiple
antioxidants on inflammation and health outcomes in patients with CF.
Inflammation is an important contributor to lung damage in CF, and contributes
to progressive lung function decline.

The 16-week study consisted of 73
pancreatic-insufficient CF patients ages 10 years and older (average age 22
years). These patients ordinarily do not adequately absorb important dietary
antioxidants including carotenoids such as beta(β)-carotene, tocopherols
(vitamin E), coenzyme Q10 (CoQ10), and selenium that help to neutralize
inflammation in the body. To address this issue, the antioxidants used in the
study were delivered in a capsule specifically designed for individuals with
difficulties absorbing fats and proteins, including those with

Antioxidant supplementation was safe and
well-tolerated. Supplemental antioxidants increased antioxidant concentrations
in the bloodstream in treated subjects and temporarily reduced inflammation in
the blood at four weeks but not 16 weeks. Importantly, antioxidant treatment
appeared to both prolong the time to the first respiratory illness requiring
antibiotics and reduce the frequency of respiratory illnesses they experienced.

Specifically, half as many of the patients taking the
supplemental antioxidants experienced a pulmonary exacerbation (or respiratory
illness) requiring antibiotics compared to the group taking the control
multivitamin without added antioxidants at 16 weeks. In addition, the
antioxidant treated group experienced a lower frequency of respiratory illnesses
compared to the control group.

“Single oral antioxidant formulations have been
previously tested in CF with mixed results. However, there had not been a
well-designed, randomized controlled trial of an antioxidant ‘cocktail’ that
included multiple antioxidants in a single formulation,” said Scott D. Sagel,
MD, PhD, pediatric pulmonologist at Children’s Colorado and professor of
pediatrics at the University of Colorado School of Medicine. “While more
research certainly needs to be done to find a treatment that delivers a
sustained anti-inflammatory effect, we believe the fact that this antioxidant
supplement prolonged the time patients had before their first illness is
meaningful. It offers a simple, relatively inexpensive means for restoring and
maintaining normal antioxidant levels in people who would otherwise have trouble
doing so.”

Release: 23-May-2018

Rehabilitating lactate: From poison to cure

Once thought to cause muscle fatigue, it’s now being
investigated as a treatment for disease

University of California –

George Brooks has been trying to reshape thinking
about lactate – in the lab, the clinic and on the training field – for more than
40 years, and finally, it seems, people are listening. Lactate, it’s becoming
clear, is not a poison, it’s the antidote.

In a recent article in the journal Cell
, Brooks, a professor of integrative biology at the University of
California, Berkeley, reviews the history of the misunderstanding of lactate –
often called lactic acid – a small molecule that plays a big role in metabolism.
Typically labeled a “waste” product produced by muscles because lactate rises to
high levels in the blood during extreme exercise, athletic trainers and
competitive athletes think of lactate as the cause of muscle fatigue, reduced
performance and pain.

Starting in the 1970s, however, Brooks, his students,
postdoctoral fellows and staff were the first to show that lactate wasn’t waste.
It was a fuel produced by muscle cells all the time and often the preferred
source of energy in the body: The brain and heart both run more efficiently and
more strongly when fueled by lactate than by glucose, another fuel that
circulates through the blood.

“It’s a historic mistake,” Brooks said. “It was
thought that lactate is made in muscles when there is not enough oxygen. It has
been thought to be a fatigue agent, a metabolic waste product, a metabolic
poison. But the classic mistake was to note that when a cell was under stress,
there was a lot of lactate, then blame it on lactate. The proper interpretation
is that lactate production is a strain response, it’s there to compensate for
metabolic stress. It is the way cells push back on deficits in

Gradually, physiologists, nutritionists, clinicians
and sports medicine practitioners are beginning to realize that high lactate
levels seen in the blood during illness or after injury, such as severe head
trauma, are not a problem to get rid of, but, in contrast, a key part of the
body’s repair process that needs to be bolstered.

“After injury, adrenaline will activate the
sympathetic nervous system and that will give rise to lactate production,”
Brooks said. “It is like gassing up the car before a race.”

Without this added fuel, the body wouldn’t have
enough energy to repair itself, and Brooks says that studies suggest that
lactate supplementation during illness or after injury could speed recovery.
Over the course of decades of research, Brooks has discovered that there are at
least three main uses of lactate in the body: It’s a major fuel source, it’s the
major material to support blood sugar level and it’s a powerful signal for
metabolic adaptation to stress.

“The reason I wrote the review is that people in all
these different disciplines are seeing different effects of lactate, and I am
pulling it all together,” said Brooks. “Lactate formulations have been used for
decades to fuel athletes during prolonged exertions; it’s been used widely for
resuscitation after injury and to treat acidosis. Now, in clinical experiments
and trials, lactate is being used to help control blood sugar after injury, to
fuel the brain after brain injury, to treat inflammation and swelling, for
resuscitation in pancreatitis, hepatitis and dengue infection, to fuel the heart
after myocardial infarction and to manage sepsis.”

Brooks’s research has already benefitted endurance
athletes. In 1989, he worked with a sports firm to create an energy drink called
Cytomax that includes a lactate polymer that can gives athletes an energy boost
before and during competition. A combination of lactate, glucose and fructose,
it takes advantage of the different ways the body uses fuel: lactate can get
into the blood twice as fast as glucose – peaking in just 15 compared to 30
minutes after drinking. Most sports drinks contain only glucose and

Lactate shuttle

Brooks is a physiologist who has focused on exercise
and nutrition since joining the UC Berkeley faculty in 1971. He discovered that
normal muscle cells produce lactate all the time, and coined the term “lactate
shuttle” to describe the feedback loops by which lactate is an intermediary
supporting the body’s cells in many tissues and

We all store energy in several forms: as glycogen,
made from carbohydrates in the diet and stored in the muscles; and as fatty
acids, in the form of triglycerides, stored in adipose tissue. When energy is
needed, the body breaks down glycogen into lactate and glucose and adipose fat
into fatty acids, all of which are distributed throughout the body through the
bloodstream as general fuel. However, Brooks said, he and his lab colleagues
have shown that lactate is the major fuel source.

Glucose and glycogen are metabolized through a
complex series of steps that culminate in lactate. For almost a century,
scientists and clinicians believed that lactate is only made when cells lack
oxygen. However, using isotope tracers, first in lab animals and then in people,
Brooks found that we make and use lactate all the time.

This is what he calls the lactate shuttle, where
“producer” cells make lactate and the lactate is used by “consumer” cells. In
muscle tissue, for example, the white, or “fast twitch,” muscle cells convert
glycogen and glucose into lactate and excrete it as fuel for neighboring red, or
“slow twitch,” muscle cells, where lactate is burned in the mitochondrial
reticulum to produce the energy molecule ATP that powers muscle fibers. Brooks
was the first to show that the mitochondria are an interconnected network of
tubes — a reticulum – like a plumbing system that reaches throughout the cell

The lactate shuttle is also at work as working
muscles release lactate that then fuels the beating heart and improves executive
function in the brain.

In discovering the lactate shuttle and mitochondrial
reticulum, Brooks and his UC Berkeley colleagues have revolutionized thinking
about metabolic regulation in the body; not just in the body under stress, but
all the time.

For decades scientists and clinicians believed that
in cells, glycogen and glucose are degraded to the lactate precursor substance
called pyruvate. That turned out to be wrong, since pyruvate is always converted
to lactate, and in most cells lactate rapidly enters the mitochondrial reticulum
and is burned. Working with lactate tracers, isolated mitochondria, cells,
tissues and intact organisms, including humans, Brooks and UC colleagues
discovered what had been missed and, consequently, misinterpreted. More
recently, others have used magnetic resonance spectroscopy (MRS) to confirm that
lactate is continuously formed in muscles and other tissues under fully aerobic
(oxygenated) conditions.

Brooks notes that lactate can be a problem if not
used. Conditioning in sports is all about getting the body to produce a larger
mitochondrial reticulum in cells to use the lactate and thus perform

Tellingly, when lactate is around, as during intense
activity, the muscle mitochondria burn it preferentially, and even shut out
glucose and fatty acid fuels. Brooks used tracers to show that both the heart
muscle and the brain prefer lactate to glucose as fuel, and run more strongly on
lactate. Lactate also signals fat tissue to stop breaking down fat for

“One of the important things about lactate is that it
gets into the circulation and participates in inter-organ communication,” said
Jen-Chywan “Wally” Wang, a UC Berkeley professor of nutritional sciences and
toxicology. “Which is why it’s very important in normal metabolism and an
integral part of whole-body homeostasis.”

Lactate is the body’s VISA

In his review, Brooks emphasizes three major roles
for lactate in the body: It’s a major source of energy; a precursor for making
more glucose in the liver, which helps support blood sugar; and a signaling
molecule, circulating in the body and blood and communicating with different
tissues, such as adipose tissue, and affecting the expression of genes
responsible for managing stress.

For example, studies have shown that lactate
increases the production of Brain-Derived Neurotropic Factor (BDNF), which in
turn, supports neuron production in the brain. And, as a fuel source, lactate
immediately improves the brain’s executive function, whether lactate is infused
or comes from exercise.

“It’s like the VISA of energetics; lactate is
accepted by consumer cells everywhere it goes,” he

The fact that lactate is an all-purpose fuel makes it
a problem in cancer, however, and some scientists are looking for ways to block
the lactate shuttles in cancer cells to cut off their energy

“Recognition that lactate shuttles among producer and
consumer cells in tumors offers the exciting possibility of reducing
carcinogenesis and tumor size by blocking producer and recipient arms of lactate
shuttles within and among tumor cells,” he wrote in his

All this presages a turnaround in the appreciation of
lactate, though Brooks admits that textbooks – except for his own, Exercise
Physiology: Human Bioenergetics and Its Applications, now in its fourth edition
– still portray lactate as a bad actor.

“Lactate is the key to what is happening with
metabolism,” Brooks said. “That is the revolution.”

Release: 23-May-2018

Whey protein supplements and exercise help women
improve body composition

Purdue University

WEST LAFAYETTE, Ind. — It’s known that men benefit
from whey protein supplements and exercise, and for what is believed to be the
first time, the same can be said for women, according to a large study review by
Purdue University nutrition experts.

“There is a public perception that whey protein
supplementation will lead to bulkiness in women, and these findings show that is
not the case,” said Wayne Campbell, professor of nutrition science and senior
author on the study. “Whey protein supplementation favors a modest increase in
lean mass of less than 1 percent, while not influencing fat

The findings are published in Nutrition
, and the research was funded by the Whey Protein Research
Consortium. Campbell also served on the National Dairy Council’s Whey Protein
Advisory Panel during the time this study was being conducted. The study is led
by Robert Bergia, a Purdue graduate research assistant. Joshua Hudson, a Purdue
postdoctoral research associate also contributed.

“Whey protein supplementation, when combined with
physical activity, is shown to be an effective strategy to achieve a leaner body
composition in men, but notably, females are underrepresented in this line of
research. Sixty-eight percent of studies in the most-cited whey protein
supplementation review included only males and we wanted to focus on what this
means for women,” Campbell said.

More than 1,800 nutrition articles were screened
across journal databases to identify 13 suitable studies with 28 intervention
groups that were related to this topic. The studies were selected based on
specific factors including the inclusion of healthy women participants,
consumption of whey protein supplements, exercising, information on changes in
lean body mass, and a minimum of six weeks’ duration for each of the

“Although more research is needed to specifically
assess the effects of varying states of energy sufficiency and exercise
training, the overall findings support that consuming whey protein supplements
may aid women seeking to modestly improve body composition, especially when they
are reducing energy intake to lose body weight,” Bergia said.



Effect of whey protein supplementation on body
composition changes in women: a systematic review and meta-analysis Robert E.
Bergia, Joshua L. Hudson, and Wayne W. Campbell

Context: A preponderance of evidence supports the beneficial
effects of whey protein (WP) supplementation on body composition in men;
however, there is currently insufficient evidence to make an equivalent claim in
women. Objective: This systematic review and meta-analysis assessed the effects
of WP supplementation with or without energy restriction (ER) and resistance
training (RT) on changes in body mass, lean mass, and fat mass in women. Data
Sources: Pubmed, Scopus, Cochrane, and CINAHL were searched using the keywords
“whey protein,” “body composition,” and “lean mass.” Data Extraction: Two
researchers independently screened 1845 abstracts and extracted 276 articles.
Thirteen randomized controlled trials with 28 groups met the inclusion
criteria. Results: Globally, WP supplementation increased lean mass (WMD,
0.37kg; 95% confidence interval [CI], 0.06 to 0.67 while not influencing changes
in fat mass (-0.20 kg; 95CI, -0.67tp 0.27) relative to non-WP control. The
beneficial effect of WP on lean mass was lost when only studies with RT were
included in the analysis (n=7 comparisons; 0.23 kg; 95%CI, -0.17 to 0.630. The
beneficial effect of WP on lean mass was more robust when only studies with an
ER component were included (n = 6 comparisons; 0.90 kg; 955CI, 0.31 to 1.49).
There was no effect of WP on lean mass in studies without ER (n = 9
comparisons; 0.22 kg; 95%CI, -0.12 to 0.57). Conclusion: Whey protein
supplementation improves body composition by modestly increasing lean mass
without influencing changes in fat mass. Body compositions improvements from WP
are more robust when combined with ER.