Supplements for osteoarthritis 'do not work'

Two popular supplements taken to combat joint pain do not work, a study says.

The review of 10 previous trials by Bern University in Switzerland found glucosamine and chondroitin did not have any beneficial effect on osteoarthritis of the hip or knee.

But the researchers said they did no harm so if people wanted to continue taking them they could.
This is because of the so-called placebo effect, where symptoms improve because a patients feels better psychologically for taking a substance.

Researchers analyzed the results of tests on 3,800 patients, assessing changes in levels of pain after patients took glucosamine, chondroitin or both together.  They then compared the effects with patients who took a placebo, the British Medical Journal reported.

Lead researcher Professor Peter Juni said: "Compared with placebo, glucosamine, chondroitin and their combination do not reduce joint pain or have an impact on narrowing of joint space.
"Health authorities and health insurers should be discouraged from funding glucosamine and chondroitin treatment."

But the researchers argued that given these supplements were not dangerous there was no reason for patients not to keep taking them if "they perceive a benefit and cover the cost of treatment themselves".
Global sales of glucosamine supplements reached nearly £1.3bn in 2008, although very few are funded by the NHS as they are not recommended by NICE, the official advisory body for the health service.

New cartilage Glucosamine and chondroitin are natural body chemicals which go to make up cartilage, the natural shock absorber in our joints which prevents bones rubbing together.  Some glucosamine and chondroitin is made by the body, but taking them as supplements is thought to boost the production of new cartilage.


However, Dr James Kennedy, of the Royal College of GPs, said he had never prescribed them to a patient.
"If a patient is eating a balanced diet then do they really need supplements?" he asks.
Jane Tadman, from Arthritis Research UK, said they were two of the most popular health supplements for osteoarthritis - and two of the most commonly investigated.
"NICE makes it clear in their guidelines on osteoarthritis that while they don't feel there's enough evidence to warrant the NHS paying for the supplements, some people may want to consider an over-the-counter trial as part of a wider self-management plan which includes exercise and keeping to an ideal weight, and we would support that view," she said.

The researchers' conclusion also supports the view taken by the Scottish Medicines Consortium

Eating nuts can lower cholesterol, say experts

Eating nuts may help lower cholesterol levels, US research suggests.

The review of 25 studies, involving nearly 600 people, showed eating on average 67g of nuts - a small bag - a day reduced cholesterol levels by 7.4%.

The US Loma Linda University team believes nuts may help prevent the absorption of cholesterol.

UK experts said the research showed nuts were an important part of a healthy diet, but warned against eating nuts covered in sugar or salt.

Previous work has indicated eating nuts regularly is beneficial, but the Archives of Internal Medicine study set out to put an accurate figure on the effect.

The effects of nut consumption were dose related, and different types of nuts had similar effects  Lead researcher Joan Sabate

The people involved ate 67g of nuts a day on average, over a period of three to eight weeks.

As well as improving cholesterol levels, it also reduced the amount of triglyceride, a type of blood fat that has been linked to heart disease.

However, the impact was least pronounced among the overweight.

It is not yet clear why nuts have this effect, although one suggestion is that it is down to the plant sterols they contain, which are thought to interfere with cholesterol absorption.

Lead researcher Joan Sabate said increasing nut consumption as part of a healthy diet should be recommended.

He added: "The effects of nut consumption were dose related, and different types of nuts had similar effects."

Ellen Mason, senior cardiac nurse at the British Heart Foundation, agreed, but she urged people to go for unsalted nuts.

"Apart from salted peanuts at the pub, nuts in sugary cereals or the traditional Christmas selection, nuts have been largely lacking in our diets in the UK," she added.

The study was carried out by independent researchers, although it was partly funded by the International Tree Nut Council Nutrition Research and Education Foundation

High GI' carbohydrates increase women's heart risk

Women who eat diets heavy in certain carbohydrates may be at greater risk of coronary heart disease, according to researchers.

A study of over 47,000 Italian adults found that women alone whose diets contained a lot of bread, pizza and rice doubled their heart disease risk.

These foods have a high glycaemic index (GI), meaning they release energy and raise blood sugar quickly.

The findings are published in Archives of Internal Medicine.

The experts say much more research is needed to understand why these high GI foods, rather than carbohydrates per se, appear to pose a risk - and why the risk applies to women and not men.

Low GI carbohydrates, such as pasta, which release energy and raise blood sugar far slower, showed no such link with heart disease.

Glycaemic index

The doctors who produced the report studied 15,171 men and 32,578 women who completed dietary questionnaires over many years.

This allowed the researchers to calculate overall carbohydrate intakes as well as the average glycaemic index of the foods eaten and the glycaemic loads of the diets.

They could try broadening the types of bread and cereals they eat to include granary, rye or oat; including more beans, pulses; and accompanying meals with a good helping of fruit and vegetables  Victoria Taylor of the British Heart Foundation

The glycaemic index (GI) is a measure of how much a food raises blood glucose levels compared with the same amount of glucose or white bread.

The glycaemic load is calculated based on the glycaemic index of a given food and also on the total amount of carbohydrates it contains.

After seven years, 463 participants had developed coronary heart disease.

The researchers found that the women whose diet had the highest glycaemic load had more than double the risk of heart disease compared with those women with the lowest glycaemic load.

The authors concluded: "Thus, a high consumption of carbohydrates from high-glycaemic index foods, rather than the overall quantity of carbohydrates consumed, appears to influence the risk of developing coronary heart disease."

The researchers believe that a high-glycaemic diet may dampen 'good' cholesterol levels in women more than in men.

But further research is needed to verify the absence of a link between high-glucose foods and cardiovascular disease in men, says the study.

Victoria Taylor, senior heart health dietician at the The British Heart Foundation, said that for women, choosing lower GI foods could be useful in helping them to reduce their risk of coronary heart disease.

She said: "They could try broadening the types of bread and cereals they eat to include granary, rye or oat; including more beans, pulses; and accompanying meals with a good helping of fruit and vegetables."

Five-a-day has little impact on cancer, study finds

Eating more fruit and vegetables has only a modest effect on protecting against cancer, a study into the link between diet and disease has found.

The study of 500,000 Europeans joins a growing body of evidence undermining the high hopes that pushing "five-a-day" might slash Western cancer rates.

The international team of researchers estimates only around 2.5% of cancers could be averted by increasing intake.

But experts stress eating fruit and vegetables is still key to good health.

In 1990, the World Health Organization recommended that everyone consume at least five portions of fruit and vegetables a day to prevent cancer and other chronic diseases.

The advice has formed a central plank of public health campaigns in many developed countries. It has been promoted in the UK since 2003 and in the US for nearly two decades.

But research has failed to substantiate the suggestion that as many as 50% of cancers could be prevented by boosting the public's consumption of fruit and vegetables.

It's still a good idea to eat your five-a-day but remember that fruits and vegetables are pieces in a much larger lifestyle jigsaw  Yinka Ebo Cancer Research UK

This latest study, which analysed recruits from 10 countries to the highly-regarded European Prospective Investigation into Cancer and Nutrition, confirms that the association between fruit and vegetable intake and reduced cancer risk is indeed weak.

The team, led by researchers from the Mount Sinai School of Medicine, in New York, took into account lifestyle factors such as smoking and exercise when drawing their conclusions.

But writing in the Journal of the National Cancer Institute, they said they could not rule out that even the small reduction in cancer risk seen was down to the fact that the kind of people who ate more fruit and vegetables lived healthier lives in many other respects too.

Broccoli not biscuits

In the best case scenario, an extra two portions of fruit and vegetables each day could prevent 2.6% of cancers in men and 2.3% of cases in women, the study concluded.

Research should focus more sharply on specific fruits and vegetables and their constitutents  Walter Willett Harvard School of Public Health

Vegetables, which tend to be richer in nutrients, appeared to be more beneficial than fruits, while heavy drinkers seemed to gain the most from a higher intake of both when it came to protection from cancers caused by alcohol and smoking.

In an accompanying editorial, Professor Walter Willet of Harvard University said the research strongly confirmed the findings of other studies, showing "that any association of intake and fruits and vegetables with risk of cancer is weak at best".

But he stressed specific substances contained in certain fruit and vegetables, if harnessed, could still have an important, protective effect.

Substantial evidence suggests lycopene from tomatoes, for instance, may reduce the risk of prostate cancer, while chemicals in broccoli are thought to stimulate a gene which protects against bowel cancer.

And data still suggests fruit and vegetables may provide protection against cardiovascular disease, one of the major killers in the developed world - although this too has yet to be proven categorically.

Keeping lean

But while the links between diet and cancer remain unclear, obesity is now seen as an established risk factor.

Eating five-a-day still has health benefits

Fruit and vegetables could therefore be beneficial just by virtue of taking the place of more calorific fare, health experts say.

In any event, a reduced risk of 2.5% should not be dismissed out of hand, the World Cancer Research Fund argues.

"For the UK, this works out as about 7,000 cases a year, which is a significant number," says Dr Rachel Thompson from the charity, which in a major 1997 report said there was "convincing evidence" of the protective effect of fruit and vegetables.

Yinka Ebo of Cancer Research UK said: "It's still a good idea to eat your five-a-day but remember that fruits and vegetables are pieces in a much larger lifestyle jigsaw.

"There are many things we can do to lower our chances of developing cancer such as not smoking, keeping a healthy weight, cutting down on alcohol, eating a healthy balanced diet, being physically active and staying safe in the sun."

Canada's doctors told to stop using swine flu vaccine

GlaxoSmithKline has advised doctors in Canada to stop using a batch of its swine flu vaccine, amid reports of severe side-effects in some patients.

The batch of some 170,000 doses was put on hold because of the reported higher than usual number of patients having anaphylactic reactions.

This may include breathing problems, raised heart rate and skin rashes.

The pharmaceutical company said it was investigating the reports, which could lead to the withdrawal of the batch.

The reports say one in 20,000 people suffered adverse reactions to the batch of GlaxoSmithKline's Aperanix vaccine.

Aspirin 'only for heart patients'

Low dose aspirin is widely given to people who have had heart problems
The use of aspirin to ward off heart attacks and strokes in those who do not have obvious cardiovascular disease should be abandoned, researchers say.

The Drugs and Therapeutics Bulletin (DTB) study says aspirin can cause serious internal bleeding and does not prevent cardiovascular disease deaths.

It says doctors should review all patients currently taking the drug for prevention of heart disease.
The Royal College of GPs says it supports the DTB's recommendations.
Low-dose aspirin is widely used to prevent further episodes of cardiovascular disease in people who have already had problems such as a heart attack or stroke.

Given the evidence, the DTB's statement on aspirin prescription is a sensible one
Prof Steve Field, Royal College of GPs

This approach - known as secondary prevention - is well-established and has confirmed benefits.
But many thousands of people in the UK are believed to be taking aspirin as a protective measure before they have any heart symptoms.

Controlled trials
Between 2005 and 2008, the DTB said four sets of guidelines were published recommending aspirin for the "primary prevention" of cardiovascular disease - in patients who had shown no sign of the disease.

These included people aged 50 and older with type 2 diabetes and those with high blood pressure.
But the DTB said a recent analysis of six controlled trials involving a total of 95,000 patients published in the journal the Lancet does not back up the routine use of aspirin in these patients because of the risk of serious gastrointestinal bleeds and the negligible impact it has on curbing death rates.

Dr Ike Ikeanacho, editor of the DTB, said: "Current evidence for primary prevention suggests the benefits and harms of aspirin in this setting may be more finely balanced than previously thought, even in individuals estimated to be at high risk of experiencing cardiovascular events, including those with diabetes or elevated blood pressure."

'Sensible statement'
Professor Steve Field, chairman of the Royal College of General Practitioners, said the DTB was an excellent source of independent advice for medical professionals.
He said: "Given the evidence, the DTB's statement on aspirin prescription is a sensible one.
"The Royal College of General Practitioners would support their call for existing guidelines on aspirin prescription to be amended, and for a review of patients currently taking aspirin for prevention."

June Davison, senior cardiac nurse at the British Heart Foundation said: "It is well established that aspirin can help prevent heart attacks and strokes among people with heart and circulatory disease - so this group of people should continue to take aspirin as prescribed by their doctor.

"However, for those who do not have heart and circulatory disease the risk of serious bleeding outweighs the potential preventative benefits of taking aspirin.
"We advise people not to take aspirin daily, unless they check with their doctor.
"The best way to reduce your risk of developing this disease is to avoid smoking, eat a diet low in saturated fat and rich in fruit and vegetables and take regular physical activity."

Schoolgirl dies after cancer jab

The vaccine works by making girls immune to strains of a STI
A 14-year-old girl has died after being given a cervical cancer jab as part of a national immunisation programme, but the exact cause of death is unknown.
The pupil was taken ill at Blue Coat CofE School in Coventry shortly after she received the Cervarix vaccine. She died in the town's University Hospital.
The batch of the vaccine used has been quarantined by the local NHS.
The injection offers protection against a sexually transmitted disease, which is linked to most cervical cancers.
A routine programme of vaccinating 12- and 13-year-old girls started in September 2008 across the UK using the Cervarix vaccine made by GlaxoSmithKline. A catch-up campaign is now under way for older girls.
The injection offers protection against the human papilloma virus (HPV), the most common cause of cervical cancer.
'Urgent investigation'
The girl, who has not yet been named, died at lunchtime on Monday.

We are conducting an urgent and full investigation into the events surrounding this tragedy
Dr Caron Grainger
Dr Caron Grainger, joint director of public health for NHS Coventry and Coventry City Council, said their sympathies are with the girl's family and friends.
She said: "The incident happened shortly after the girl had received her HPV vaccine in the school. No link can be made between the death and the vaccine until all the facts are known and a post-mortem takes place.
"We are conducting an urgent and full investigation into the events surrounding this tragedy."
A small number of girls at the school had also reported mild symptoms such as dizziness and nausea but they were not admitted to hospital.
In a statement posted on the school's website, headteacher Dr Julie Roberts said during the immunisation, "one of the girls suffered a rare, but extreme reaction to the vaccine".
"A number of other girls also reported being unwell and some were sent home," she said.
"If your daughter has received a vaccine today we ask that you are extra vigilant regarding any signs or symptoms."
She listed possible reactions as mild to moderate short-lasting pain at the injection site, headache, muscle pain, fatigue and a low-grade fever.
'Tragic death'
It is thought about a million girls have already safely received the vaccine.
When the national immunisation project was announced, there was some controversy about the selection of Cervarix over Gardasil, which is used by the majority of vaccination programmes worldwide.

It is important we have the results of further investigations as soon as possible to establish the cause of this sad event
Department of Health

Q&A: The cervical cancer vaccine
Dr Pim Kon, medical director at GlaxoSmithKline UK, which makes Cervarix, said: "Our deepest sympathies are with the family and friends of the young girl.
"We are working with the Department of Health and MHRA (Medicines and Healthcare products Regulatory Agency) to better understand this case, as at this stage the exact cause of this tragic death is unknown."
The global pharmaceutical company added that the vast majority of suspected adverse reactions have related either to the symptoms of recognised side effects or were due to the injection process and not the vaccine itself.
Different vaccine
Public health minister Gillian Merron said: "Our deepest sympathies are with the family. It is important we have the results of further investigations as soon as possible to establish the cause of this sad event."
In the UK, about 3,000 women are diagnosed with cervical cancer every year and about 1,000 die from it.
The department said Cervarix had a strong safety record.
Shadow Health Secretary Andrew Lansley said the tragedy needed to be investigated "as a matter of urgency".
He said: "This again raises the question which we have asked for some time, as to why the government won't publish the assessments it made of the relative merits of the two HPV vaccines and why we therefore use a different vaccine to most other comparable countries."
There are more than 100 types of HPV but only 13 of them are known to cause cancer.
Cervarix protects against two strains of HPV that cause more than 70% of cases of cervical cancer in women.
Vaccination is not compulsory and consent is required before it is administered to the under-16s.

Could a fat jab ease chronic knee pain?

By PAT HAGAN

Tiny globules of fat that are injected into painful joints could be a radical new treatment for osteoarthritis.
Thousands of the fat particles - each one no bigger than a speck of dust - are injected to protect the cartilage inside the joint from further damage.

Cartilage is the spongy material in the hips, knees, spine, wrists and shoulders that acts as the body's shock absorber, stopping the bones rubbing together.

'Holy grail': Chronic knee pain could be eased by injecting tiny globules of fat into the joint
But injury, illness or wear and tear can cause the cartilage to start breaking down. As bones come into contact, the friction makes the joints swollen and painful.

Around eight million Britons suffer from osteoarthritis. Many rely on anti-inflammatory painkillers though these carry the risk of damage to the stomach if used long term.
Every year, thousands of patients end up having joint replacement surgery.
The scientists who have developed the fat jab hope it will prevent the need for this surgery, or at least postpone it for several years.

The fat molecules, which are manufactured in a laboratory, are soft enough to help cushion the impact from everyday activities, but strong enough not to be destroyed under the strain of a working joint.
The treatment was developed in Israel by scientists at the Hebrew University of Jerusalem and the Technion Institute of Technology.

In tests, the scientists injected the fat particles into hip joints.
The results, published in the arthritis journal Wear, showed the fat jabs reduced the rate of cartilage destruction by 40 per cent compared with 10 per cent with an existing therapy, hyaluronic acid.
(Hyaluronic acid is sometimes injected into damaged joints to help keep cartilage lubricated and spongy.)

The fat jabs are a form of nanotechnology - a technique using moleculesso small they can't be seen with the naked eye, yet which are capable of delivering powerful medicines or treatments deep inside the body. This stops healthy tissue being exposed to the potential side-effects.

The size of the molecules also means they can't be detected by the body's defence systems so they won't be cleared away.
The molecules developed for the new arthritis treatment are no more than one millionth of a millimetre in diameter and are engineered to pass into the cells within the joint, something previously not possible.

Professor Philip Conaghan, from the Arthritis Research Campaign, said a treatment that stopped cartilage breakdown was the 'holy grail' for osteoarthritis researchers.
But he said there was no guarantee this would actually reduce pain.
'One of the complexities is that we're not sure whether the pain comes from the bone underlying the cartilage or inflammation in the tissue lining the joints.
'So we should be careful about thinking that a treatment that reduces cartilage loss will necessarily improve pain. But we all hope it will.'

Heart Surgeon Admits Huge Mistake!

by Dwight Lundell MD 02/03/2009
We physicians with all our training, knowledge and authority often acquire a rather large ego that tends to make it difficult to admit we are wrong. So, here it is. I freely admit to being wrong. As a heart surgeon with 25 years experience, having performed over 5,000 open-heart surgeries, today is my day to right the wrong with medical and scientific fact.

I trained for many years with other prominent physicians labeled “opinion makers.” Bombarded with scientific literature, continually attending education seminars, we opinion makers insisted heart disease resulted from the simple fact of elevated blood cholesterol.

The only accepted therapy was prescribing medications to lower cholesterol and a diet that severely restricted fat intake. The latter of course we insisted would lower cholesterol and heart disease. Deviations from these recommendations were considered heresy and could quite possibly result in malpractice.

It Is Not Working!

These recommendations are no longer scientifically or morally defensible. The discovery a few years ago that inflammation in the artery wall is the real cause of heart disease is slowly leading to a paradigm shift in how heart disease and other chronic ailments will be treated.

The long-established dietary recommendations have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and dire economic consequences.

Despite the fact that 25% of the population takes expensive statin medications and despite the fact we have reduced the fat content of our diets, more Americans will die this year of heart disease than ever before.

Statistics from the American Heart Association show that 75 million Americans currently suffer from heart disease, 20 million have diabetes and 57 million have pre-diabetes. These disorders are affecting younger and younger people in greater numbers every year.

Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped.

Inflammation is not complicated — it is quite simply your body’s natural defense to a foreign invader such as a bacteria, toxin or virus. The cycle of inflammation is perfect in how it protects your body from these bacterial and viral invaders. However, if we chronically expose the body to injury by toxins or foods the human body was never designed to process, a condition occurs called chronic inflammation. Chronic inflammation is just as harmful as acute inflammation is beneficial.

What thoughtful person would willfully expose himself repeatedly to foods or other substances that are known to cause injury to the body? Well, smokers perhaps, but at least they made that choice willfully.

The rest of us have simply followed the recommended mainstream diet that is low in fat and high in polyunsaturated fats and carbohydrates, not knowing we were causing repeated injury to our blood vessels. This repeated injury creates chronic inflammation leading to heart disease, stroke, diabetes and obesity. Let me repeat that. The injury and inflammation in our blood vessels is caused by the low fat diet that has been recommended for years by mainstream medicine.

What are the biggest culprits of chronic inflammation? Quite simply, they are the overload of simple, highly processed carbohydrates (sugar, flour and all the products made from them) and the excess consumption of omega-6 vegetable oils like soybean, corn and sunflower that are found in many processed foods.

Coffee 'may reverse Alzheimer's'

A possible treatment for dementia?
Drinking five cups of coffee a day could reverse memory problems seen in Alzheimer's disease, US scientists say.
The Florida research, carried out on mice, also suggested caffeine hampered the production of the protein plaques which are the hallmark of the disease.
Previous research has also suggested a protective effect from caffeine.
But British experts said the Journal of Alzheimer's disease study did not mean that dementia patients should start using caffeine supplements.

The results are particularly exciting in that a reversal of pre-existing memory impairment is more difficult to achieve
Dr Gary Arendash
University of South Florida
The 55 mice used in the University of South Florida study had been bred to develop symptoms of Alzheimer's disease.
First the researchers used behavioural tests to confirm the mice were exhibiting signs of memory impairment when they were aged 18 to 19 months, the equivalent to humans being about 70.
Then they gave half the mice caffeine in their drinking water. The rest were given plain water.
The mice were given the equivalent of five 8 oz (227 grams) cups of coffee a day - about 500 milligrams of caffeine.
The researchers say this is the same as is found in two cups of "specialty" coffees such as lattes or cappuccinos from coffee shops, 14 cups of tea, or 20 soft drinks.
When the mice were tested again after two months, those who were given the caffeine performed much better on tests measuring their memory and thinking skills and performed as well as mice of the same age without dementia.
Those drinking plain water continued to do poorly on the tests.
In addition, the brains of the mice given caffeine showed nearly a 50% reduction in levels of the beta amyloid protein, which forms destructive clumps in the brains of dementia patients.
Further tests suggested caffeine affects the production of both the enzymes needed to produce beta amyloid.
The researchers also suggest that caffeine suppresses inflammatory changes in the brain that lead to an overabundance of the protein.
Earlier research by the same team had shown younger mice, who had also been bred to develop Alzheimer's but who were given caffeine in their early adulthood, were protected against the onset of memory problems.
'Safe drug'
Dr Gary Arendash, who led the latest study, told the BBC: "The results are particularly exciting in that a reversal of pre-existing memory impairment is more difficult to achieve.
"They provide evidence that caffeine could be a viable 'treatment' for established Alzheimer's disease and not simply a protective strategy.
"That's important because caffeine is a safe drug for most people, it easily enters the brain, and it appears to directly affect the disease process."
The team now hope to begin human trials of caffeine to see if the mouse findings are replicated in people.
They do not know if a lower amount of caffeine would be as effective, but said most people could safely consume the 500 milligrams per day.
However they said people with high blood pressure, and pregnant women, should limit their daily caffeine intake.
Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: "In this study on mice with symptoms of Alzheimer's, researchers found that caffeine boosted their memory. We need to do more research to find out whether this effect will be seen in people.
"It is too early to say whether drinking coffee or taking caffeine supplements will help people with Alzheimer's.
Neil Hunt, chief executive of the Alzheimer's Society, said previous research into caffeine had suggested it could delay Alzheimer's disease and even protect against vascular dementia.
"This research in mice suggests that coffee may actually reverse some element of memory impairment.
"However much more research is needed to determine whether drinking coffee has the same impact in people.
"It is too soon to say whether a cup of coffee is anything more than a pleasant pick me up."