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Cochrane review should ‘end all the debates on chondroitin’s efficacy for osteoarthritis’
Cochrane Collaboration & Birmingham VA Medical Center, February 10, 2023
Chondroitin sulfate is safe and efficacious for improving pain and functional capacity in people with osteoarthritis, says a new review from the prestigious Cochrane Collaboration. Data from 43 clinical trials including 9,110 people receiving chondroitin sulfate supplements indicated that, not only did the supplement produce ‘small to moderate’ benefits for people with osteoarthritis, but the risk of adverse events was also lower than in the control groups. “The combination of some efficacy and low risk associated with chondroitin may explain its popularity among patients as an over-the-counter supplement,” wrote the authors, led by Jasvinder Singh from the Birmingham VA Medical Center in Alabama. “If one suffers from degenerative osteoarthritis pain, takes a joint health supplement containing chondroitin for some time, and still finds it not effective, most likely it is because the supplement ingredient is of low quality or adulterated, or because the supplement does not have adequate amount of chondroitin in it. We have lead the industry to clean up the chondroitin ingredient supply chain, investing deeply in research and education. When pure ingredients are used in the right amounts, always, chondroitin works.” Data from 43 clinical trials using chondroitin sulfate for osteoarthritis indicated that chondroitin sulfate is better than placebo in improving pain and functional capacity in osteoarthritic patients, with the added advantage of improved safety. In addition, chondroitin sulfate was associated with slightly delayed narrowing of joint space on X-rays of the affected joint compared to placebo, indicating that the ingredient may slow down progression of the disease. Combining chondroitin with glucosamine also produced a statistically significant reduction in pain, compared with placebo.
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Skipping breakfast may compromise the immune system, says study
Mount Sinai Hospital, February 23, 2023
Fasting may be detrimental to fighting off infection, and could lead to an increased risk of heart disease, according to a new study by the Icahn School of Medicine at Mount Sinai. The research, which focused on mouse models, is among the first to show that skipping meals triggers a response in the brain that negatively affects immune cells. The results that focus on breakfast were published in Immunity, and could lead to a better understanding of how chronic fasting may affect the body long term. “There is a growing awareness that fasting is healthy, and there is indeed abundant evidence for the benefits of fasting. Our study provides a word of caution as it suggests that there may also be a cost to fasting that carries a health risk,” says lead author Filip Swirski, Ph.D., Director of the Cardiovascular Research Institute at Icahn Mount Sinai. “This is a mechanistic study delving into some of the fundamental biology relevant to fasting. The study shows that there is a conversation between the nervous and immune systems.”Researchers aimed to better understand how fasting—from a relatively short fast of only a few hours to a more severe fast of 24 hours—affects the immune system. They analyzed two groups of mice. One group ate breakfast right after waking up (breakfast is their largest meal of the day), and the other group had no breakfast. Researchers collected blood samples in both groups when mice woke up (baseline), then four hours later, and eight hours later. When examining the blood work, researchers noticed a distinct difference in the fasting group. Specifically, the researchers saw a difference in the number of monocytes, which are white blood cells that are made in the bone marrow and travel through the body, where they play many critical roles, from fighting infections, to heart disease, to cancer. At baseline, all mice had the same amount of monocytes. But after four hours, monocytes in mice from the fasting group were dramatically affected. Researchers found 90% of these cells disappeared from the bloodstream, and the number further declined at eight hours. Meanwhile monocytes in the non-fasting group were unaffected. In fasting mice, researchers discovered the monocytes traveled back to the bone marrow to hibernate. Concurrently, production of new cells in the bone marrow diminished. The monocytes in the bone marrow—which typically have a short lifespan—significantly changed. They survived longer as a consequence of staying in the bone marrow, and aged differently than the monocytes that stayed in the blood. The researchers continued to fast mice for up to 24 hours, and then reintroduced food. The cells hiding in the bone marrow surged back into the bloodstream within a few hours. This surge led to heightened level of inflammation. Instead of protecting against infection, these altered monocytes were more inflammatory, making the body less resistant to fighting infection. This study is among the first to make the connection between the brain and these immune cells during fasting. Researchers found that specific regions in the brain controlled the monocyte response during fasting. This study demonstrated that fasting elicits a stress response in the brain—that’s what makes people “hangry” (feeling hungry and angry)—and this instantly triggers a large-scale migration of these white blood cells from the blood to the bone marrow, and then back to the bloodstream shortly after food is reintroduced. “The study shows that, on the one hand, fasting reduces the number of circulating monocytes, which one might think is a good thing, as these cells are important components of inflammation. On the other hand, reintroduction of food creates a surge of monocytes flooding back to the blood, which can be problematic. “Fasting, therefore regulates this pool in ways that are not always beneficial to the body’s capacity to respond to a challenge such as an infection,” explains Dr. Swirski. “Because these cells are so important to other diseases like heart disease or cancer, understanding how their function is controlled is critical.”
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L-Glutamine Changes Gut Bacteria Leading To Weight Loss
Washington University in St. Louis, February 2, 2023
L-Glutamine is the most common amino acid found in your muscles and it plays a key role in protein metabolism, and the ability to secrete human growth hormone, which helps metabolize body fat and support new muscle growth. Researchers have now found that a daily L-glutamine dose of 30 grams per day was associated with a significant reduction in the ratio of specific biomarkers for obesity. L-Glutamine supplementation promotes a positive nitrogen balance and prevents the loss of muscle. Recent studies have shown that taking just 2 grams of L-Glutamine can increase growth hormone levels by 400%. The 30g dose studied was associated with a significant reduction in the ratio of Firmicutes to Bacteroidetes in obese and overweight people. “The finding that L-glutamine promotes changes in the gut microbiota composition provides support for the importance of some nutrients in modulating the intestinal bacterial profile,” wrote the researchers in Nutrition. “These changes resembled the weight loss programs established in the literature.”The study adds to emerging body of science supporting the effects of gut microflora on metabolic factors and obesity. The connection between gut microbiota and energy homeostasis and inflammation and its role in the pathogenesis of obesity-related disorders are increasingly recognized. The new study, albeit small scale and of limited duration, suggested that the amino acid L-glutamine may also have weight management potential by changing the bacterial composition in the gut. The researchers recruited 33 overweight and obese adults, aged between 23 and 59 and randomly assigned them receive supplements of L-glutamine or L-alanine for two weeks. Results showed that the L-glutamine group exhibited statistically significant differences in the Firmicutes and Actinobacteria phyla compared with the ALA group. A reduction of 0.3 was observed in the ratio of Firmicutes to Bacteroidetes ratio in the L-glutamine group, they added (from 0.85 to 0.57), while L-alanince was associated with an increased from 0.91 to 1.12. “Thus, these findings suggest that oral supplementation of L-glutamine have similar effects on gut microbiota as weight loss,” said the researchers. “We would like to highlight that although the age range of the volunteers was large (23-59 y) and aging may have an effect on intestinal microbiota, the results obtained in this study were statistically significant.” Commenting on a potential mechanism, they noted that L-Glutamine supplementation may reduce pro-inflammatory cytokines. “Some bacteria genera are associated with gut inflammation,” they wrote. “For example, increased levels of Veillonella are associated with higher levels of gut inflammation and the development of colitis and Crohn’s disease. In our study, the number of bacteria from the Veillonella genus reduced after L-glutamine supplementation, suggesting that L-glutamine may have an anti-inflammatory effect, at least in part, due to the decrease of this genus. “In addition, increased abundance of the Prevotella genus has been described as a shield against inflammation and non-infectious diseases of the colon. After L-glutamine supplementation, but not after alanine, we observed an increase in Prevotella, suggesting that L-glutamine may have a protective effect on the gut via modulation of bacteria.”
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Study of intravenous mistletoe extract to treat advanced cancer
Johns Hopkins University School of Medicine, February 22, 2023
Mistletoe extract has been widely used to support cancer therapy and improve quality of life, but there has been a lack of clinical trials and data to support its use. Researchers at the Johns Hopkins Kimmel Cancer Center completed what is believed to be the first phase I trial of intravenous Helixor M in the U.S. aimed at determining dosing for subsequent clinical trials and to evaluate safety. The findings from the small study were reported in Cancer Research Communications. The trial’s purpose was to evaluate the drug’s safety, but the researchers, led by Channing Paller, M.D., associate professor of oncology, also documented improved quality of life and some disease control. Mistletoe extract (ME), known as Helixor M, was studied in 21 patients with advanced and treatment-resistant cancers of various types. The phase I trial used dose escalation to determine the maximum dose that could be safely tolerated by patients. ME was delivered intravenously three times per week until disease progression or until toxicity. The study concluded that dose to be 600 milligrams of ME. The median follow-up duration on mistletoe was 15.3 weeks. Stable disease was observed in five patients and lasted, on average, for 15 weeks. Tumors in three participants decreased in size, and remained stable for two to five months, however, this did not meet official criteria for partial response. Patients also reported overall improved quality of life via a questionnaire. The most common side effects reported were fatigue, nausea, and chills and they were noted as manageable. “Intravenous mistletoe demonstrated manageable toxicities with disease control and improved quality of life in this group of patients, who had already received multiple cancer therapies,” says Paller, adding that additional phase II studies in combination with chemotherapy are the next step, pending additional funding. In addition, Paller says, laboratory research to better decipher ME’s mechanisms are needed, as the cytokines (cell-signaling proteins) measured in this study are preliminary and hypothesis generating. Mistletoe extract is a semi-parasitic plant with several active ingredients that, in preclinical studies, appear to directly cause the death of tumor cells and stimulate an immune response. It has been used in Europe for several decades as a complementary medicine approach to cancer treatment alone or in combination with chemotherapy and radiation therapy, but it has not been evaluated in clinical trials. ME is not currently FDA approved for cancer treatment in the U.S. but is listed in the Homeopathic Pharmacopoeia and is offered in integrative care clinics.
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Hypnosis, meditation, and prayer: which is most helpful for pain management?
Instituto Universitário (Portugal), University of Washington, et al, February 23, 2023
Researchers compared the immediate effects of hypnosis, mindfulness meditation, and Christian prayer on pain intensity and tolerance. The results suggested that a single session of hypnosis and mindfulness meditation, but not prayer, may be useful for managing acute pain, with hypnosis being slightly more useful. There are several approaches that focus on the biopsychosocial factors that influence pain, including psychosocial, complementary, and integrative approaches. Previous studies confirm the usefulness of hypnosis, mindfulness meditation, and prayer as useful practices in the self-management of chronic pain in adults. However, their effects on acute pain have been less investigated and there has not yet been any study that has compared the immediate effects of these three approaches on the experience of acute pain. It was in this context that the research team led by Alexandra Ferreira-Valente resorted to the heart rate variability and other measures to compare the immediate effects of hypnosis, mindfulness meditation, and Christian prayer on pain intensity, pain tolerance, and stress. The results of the study are published in the Journal of Pain Research. The study took place at the facilities of the Psychology Laboratory of the William James Center for Research at Ispa – Instituto Universitário in Lisbon, involving the participation of 232 healthy adults. Pain was induced in the participants by wrapping the forearm and hand in a cold compress (Cold Pressor Arm Wrap – CPAW) for up to 5 minutes at the most and assessing their pain tolerance, the intensity of pain, as well as heart rate variability, as a physiological marker of stress. After a rest period, participants listened to a 20-minute recording of guided hypnosis, or mindfulness meditation, or suggesting a Christian prayer, or reading a natural history book (control condition) depending on the group they were randomly assigned to. After this session, the participants underwent a second session of CPAW, during which they listened to up to 5 minutes of the recording and their cardiac function was monitored. The results obtained by researchers from the William James Center for Research – Ispa (Portugal), Universidade Católica Portuguesa (Portugal), University of Washington (USA), and University of Queensland (Australia) suggest that single brief session of hypnosis and mindfulness meditation, but not Ignatian Christian prayer based on biblical meditation, may be useful for acute pain self-management, with hypnosis being the slightly superior option. According to Alexandra Ferreira-Valente, team coordinator, “in the future, researchers should compare the effects of different types of prayer and examine the predictors and moderators of the effects of hypnosis and mindfulness on the experience of acute pain”.
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Blue collar benefits: Lifting heavy objects linked to better male fertility
Brigham and Women’s Hospital, February 23, 2023
Plenty of studies warn of the dangers associated with office jobs and sitting all day long. Now, researchers from Brigham and Women’s Hospital are espousing the reproductive benefits of more physically demanding jobs for men — especially those that require them to lift heavy objects. Scientists say their findings show that men who habitually lift heavy objects at work have higher sperm counts. This study is part of the greater Environment and Reproductive Health (EARTH) cohort, a clinical project focused on exploring how exposure to environmental chemicals and lifestyle choices impact reproductive health. “What these new findings suggest is that physical activity during work may also be associated with significant improvement in men’s reproductive potential.” Infertility continues to be a growing issue across the entire world. While infertility can be the result of a wide array of factors, roughly 40 percent of infertility cases have to do with elements of male fertility — including sperm count, semen quality, and sexual function. “Further, there is increasing evidence that male infertility is associated with common chronic diseases such as cardiovascular disease and autoimmune disease, highlighting the broader importance of male reproductive health,” adds Mínguez-Alarcón. The EARTH study collected samples and survey data from more than 1,500 men and women. This current study used a subset of those participants, including 377 male partners in couples seeking treatment at a fertility center. Ultimately, the research team found that men who reported often lifting or moving heavy objects at work had 46 percent higher sperm concentration and 44 percent higher total sperm count in comparison to other men with less physical jobs. It’s worth noting that men working more physically demanding jobs also had higher levels of the male sex hormone testosterone and the female hormone estrogen. “Further, there is increasing evidence that male infertility is associated with common chronic diseases such as cardiovascular disease and autoimmune disease, highlighting the broader importance of male reproductive health,” adds Mínguez-Alarcón. The study is published in the journal Human Reproduction.