Facial skin aging and vitamin D

Posted on October 12, 2010 by Dr. Jonathan

A study just published in the journal Cancer Causes & Control throws light on the link between skin aging and vitamin D levels. The authors set out to investigate…

“…whether individuals with less facial aging due to photoprotection are more likely to have low vitamin D as measured by 25(OH) vitamin D levels.”

They examined 45 females over age 40 taking into consideration menopausal and smoking status, history of skin cancer, use of supplements, and when the blood draws were done according to season. Then…

“A single-blinded, dermatologist evaluated standardized digital facial images for overall photodamage, erythema/telangiectasias, hyperpigmentation, number of lentigines, and wrinkling.”

The data painted a striking picture:

“…women with lower photodamage scores were associated with a 5-fold increased odds of being vitamin D insufficient. Low scores for specific photodamage parameters including erythema/telangiectasias, hyperpigmentation, and wrinkling were also significantly associated with vitamin D insufficiency.”

What does this mean in practical terms? As previous studies have reported, it is usually not possible to optimize vitamin D levels by sun exposure only without an undesirable price to pay in skin damage. As other investigators have asserted, supplementation of vitamin D according to your specific needs as determined by the 25(OH)D (25-hydroxy vitamin D) blood test is best evidence-based method.

Is moderate wine consumption good for women?

Posted on October 11, 2010 by Dr. Jonathan

More data on the effect of alcohol on health is offered by a study recently published in the journal Acta Neurologica Scandinavica in which the authors specifically investigate its influence on the risk of dementia.

“The impact of moderate alcohol consumption on cognitive function and dementia is unclear. We examined the relationship between consumption of different alcoholic beverages and cognitive function in a large population-based study.”

Their study subjects were 5033 Norwegian men and women whose alcohol consumption was correlated with cardiovascular risk factors and cognitive function at baseline and after 7 years. What did the data show?

“Moderate wine consumption was independently associated with better performance on all cognitive tests in both men and women.“

Moreover…

“There was no consistent association between consumption of beer and spirits and cognitive test results. Alcohol abstention was associated with lower cognitive performance in women[!].“

There are a lot of good reasons to not drink alcohol; but for those whom it is not contraindicated, their conclusion is interesting:

“Light-to-moderate wine consumption was associated with better performance on cognitive tests after 7 years follow up.”

Carbohydrates and death from inflammatory disease

Posted on September 22, 2010 by Dr. Jonathan

As the authors of research just published in the American Journal of Clinical Nutrition state:

“Several studies suggest that carbohydrate nutrition is related to oxidative stress and inflammatory markers.”

The proceeded to examine whether dietary glycemic index (GI), dietary fiber, and carbohydrate-containing food groups were associated with death due to non-cardiovascular, non-cancer inflammatory disease in 1490 postmenopausal women and 1245 men. What did their data show?

“Over a 13-y period, 84 women and 86 men died of inflammatory diseases. Women in the highest GI tertile had a 2.9-fold increased risk of inflammatory death…Increasing intakes of foods high in refined sugars or refined starches and decreasing intakes of bread and cereals or vegetables other than potatoes also independently predicted a greater risk. In men, only an increased consumption of fruit fiber and fruit conferred an independent decrease in risk of inflammatory death.”

In other words, for postmenopausal women the high glycemic index diet almost tripled the risk of death from inflammatory disease.

Breast cancer risk decreased with higher vitamin D

Posted on September 21, 2010 by Dr. Jonathan

A study just published in the journal Cancer Epidemiology, Biomarkers & Prevention increases the weight of evidence for the importance of vitamin D in breast cancer prevention. The authors state:

“High 25-hydroxyvitamin D [25(OH)D] serum concentrations have been found to be associated with reduced breast cancer risk. However, few studies have further investigated this relationship according to menopausal status, nor have they taken into account factors known to influence vitamin D status, such as dietary and serum calcium, parathyroid hormone, and estradiol serum levels.”

The authors investigated the connection in 636 French women diagnosed with breast cancer compared with 1,272 controls with considerations for age, menopausal status, and other variables. What did the data show?

“We found a decreased risk of breast cancer with increasing 25(OH) vitamin D3 serum concentrations among women in the highest tertile. We also observed a significant inverse association restricted to women under 53 years of age at blood sampling.”

They concluded from their evidence:

“Our findings support a decreased risk of breast cancer associated with high 25(OH) vitamin D3 serum concentrations, especially in younger women, although we were unable to confirm a direct influence of age or menopausal status… the maintenance of adequate vitamin D levels should be encouraged by public health policy.”

In other words, vitamin D concentrations were found to be a significant influence regardless of age or menopausal status. How do you find out how you’re doing with vitamin D? Ask your doctor for a 25-hydroxyvitamin D [25(OH)D] blood test.

Oral contraceptives and breast cancer

Posted on September 6, 2010 by Dr. Jonathan

A study recently published in the journal Cancer Epidemiology, Biomarkers & Prevention alerts us to a serious risk of breast cancer for young women taking even the newer oral contraceptives, especially levonorgestrol. The authors note:

“Previous studies convincingly showed an increase in risk of breast cancer associated with current or recent use of oral contraceptives in the 1960′s to 1980′s. The relation of contemporary oral contraceptive formulations to breast cancer risk is less clear.”

The authors assessed specific formulations of contraceptive use by 116,608 female nurses aged 25 to 42 years for 12 years. What did the data show?

“During 1,246,967 person-years of follow-up, 1,344 cases of invasive breast cancer were diagnosed…Current use of any oral contraceptive was related to a marginally significant higher risk. One specific formulation substantially accounted for the excess risk: the relative risk for current use of triphasic preparations with levonorgestrel as the progestin was 3.05.”

That’s a 300% increase in the risk of breast cancer. The authors conclude:

“Current use of oral contraceptives carries an excess risk of breast cancer. Levonorgestrel used in triphasic preparations may account for much of this elevation in risk. Impact: Different oral contraceptive formulations may convey different risks of breast cancer; ongoing monitoring of these associations is necessary as oral contraceptive formulations change.”

Omega-3 fatty acids work differently for men and women

Posted on August 23, 2010 by Dr. Jonathan

There are fascinating and profound biological differences between men and women, so it’s not surprising that a study just published in Nutrition, Metabolism and Cardiovascular Diseases proves that there is a gender difference in the blood ‘anti-stickiness’ benefit from omega-3 fatty acids. The authors begin by stating:

“Increased platelet aggregation is a major risk factor for heart attacks, stroke and thrombosis. Long chain omega-3 polyunsaturated fatty acids (LCn-3PUFA; eicosapentaenoic acid, EPA; docosahexaenoic acid, DHA) reduce platelet aggregation…Recent in vitro studies have demonstrated that inhibition of platelet aggregation by LCn-3PUFA is gender specific. We examined the acute effects of dietary supplementation with EPA or DHA rich oils on platelet aggregation in healthy male and females.“

Platelet aggregation is the ‘sticking together’ or clotting of the sub-cellular blood platelets. Blood that is too ‘sticky’ or clots too easily is a risk factor for heart attacks and strokes and a hindrance to the blood perfusion of tissues. The authors dosed males and females with EPA or DHA rich oil and measured the post-supplementation platelet aggregation. What did the data show?

“EPA was significantly the most effective in reducing platelet aggregation in males…whereas DHA was not effective relative to placebo. In contrast, in females, DHA significantly reduced platelet aggregation at 24 h (while EPA was not effective. An inverse relationship between testosterone levels and platelet aggregation following EPA supplementation was observed.”

This paper follows another recent study reporting that cholesterol levels vary with the menstrual cycle. Practitioners must bear in mind these and other gender differences. The authors conclude:

“Interactions between sex hormones and omega-3 fatty acids exist to differentially reduce platelet aggregation. For healthy individuals, males may benefit more from EPA supplementation while females are more responsive to DHA.“

DNA methylation—a key factor in breast cancer prognosis and treatment

Posted on August 16, 2010 by Dr. Jonathan

Landmark research just published in PLoS Genetics (Public Library of Science) brings to light two important points in breast cancer diagnosis and treatment. First, the authors prove that defects in methylation (addition of a methyl group) a critical process for maintaining DNA health, is a powerful prognostic indicator for breast cancer outcome. The authors first observe:

“Although tumor size and lymph node involvement are the current cornerstones of breast cancer prognosis, they have not been extensively explored in relation to tumor methylation attributes in conjunction with other tumor and patient dietary and hormonal characteristics…We investigated DNA methylation profiles in over 160 well annotated breast tumor samples and found significant relationships with standard and other known predictors of prognosis, as well as established risk factors for disease: alcohol intake and dietary folate.”

They measured the methylation patterns of critical genes primary breast tumors from 162 women. Their findings are compelling:

“Tumor grade, size, estrogen and progesterone receptor status, and triple negative status were significantly associated with altered methylation…”

The second valuable point confirms the role of alcohol intake and folate status, both known to impact methylation capability.

“Using multinomial logistic regression to adjust for potential confounders, patient age and tumor size, as well as known disease risk factors of alcohol intake and total dietary folate, were all significantly associated with methylation class membership.”

The authors’ conclusion indicates the profound importance of assessing and protecting methylation capacity:

“Breast cancer prognostic characteristics and risk-related exposures [alcohol and folate status] appear to be associated with gene-specific tumor methylation, as well as overall methylation patterns.”

I use measurements of urinary methylmalonate and formiminoglutamate, objective indicators of important methylation cofactors. One or both of these is typically abnormal in patients with breast cancer. In my opinion, measuring this and treating methylation abnormalities with physiological interventions should be part of the standard of care for breast cancer.

Menstrual pain changes the brain, meditation helps

Posted on August 14, 2010 by Dr. Jonathan

The authors of a paper just published in the journal Pain report that pain from primary dysmenorrhea (PDM) can produce structural changes in the brain that make the subsequent experience of pain worse. The authors note:

“Prolonged nociceptive [painful] input to the central nervous system can induce functional and structural alterations throughout the nervous system. In PDM, a chronic viscero-nociceptive drive of cyclic nature, indications of central sensitization and altered brain metabolism suggest a substantial central reorganization.”

The authors tested their earlier hypothesis that loss of inhibition [calming] of orbitofrontal networks [neural circuits in the frontal areas in the region of the eyes] could result in increased pain and negative feelings with menstrual pain. They used a type of brain MRI called voxel-based morphometry to measure differences in the amount of gray matter (GM) in subjects with and without PDM. What did their data show?

“Abnormal decreases were found in regions involved in pain transmission, higher level sensory processing, and affected regulation while increases were found in regions involved in pain modulation and in regulation of endocrine function. Moreover, GM changes in regions involved in top-down pain modulation and in generation of negative affect were related to the severity of the experienced PDM pain.”

The most striking and important finding was articulated in their conclusion:

“Our results demonstrate that abnormal GM volume changes are present in PDM patients even in the absence of pain. These changes may underpin a combination of impaired pain inhibition, increased pain facilitation and increased affect. Our findings highlight that longer lasting central changes may occur not only in sustained chronic pain conditions but also in cyclic occurring pain conditions.”

Interestingly, another paper in the same issue of the same journal offers EEG evidence that meditation reduces the negative experience of pain.

“In this study we compared a group of individuals with meditation experience to a control group to test whether any differences in the affective appraisal of pain could be explained by lower anticipatory neural processing.”

The authors used anticipatory and pain-evoked ERP (event related potentials measured by electroencephalography) data and pain unpleasantness reported by test subjects to determine whether experience with meditation made a difference. What did the data show?

“More experienced meditators perceived the pain as less unpleasant relative to controls, with meditation experience correlating inversely with unpleasantness ratings. ERP source data for anticipation showed that in meditators, lower activity in midcingulate cortex relative to controls was related to the lower unpleasantness ratings, and was predicted by lifetime meditation experience.”

Meditators also had less medial prefrontal cortical activity engaged in anticipating pain unpleasantness. The authors concluded:

“Our data is consistent with the hypothesis that meditation reduces the anticipation and negative appraisal of pain…”

Cholesterol levels vary with the menstrual cycle

Posted on August 13, 2010 by Dr. Jonathan

A study recently published in The Journal of Clinical Endocrinology & Metabolism proves that we must take the menstrual cycle into consideration when testing cholesterol in cycling women.

“The objective of the study was to evaluate the association between endogenous [internally produced] estrogen and serum lipoproteins across the menstrual cycle.”

The authors found that total and LDL cholesterol were lower during the luteal phase (second half, when progesterone is higher) than the follicular phase:

“More women were classified above the desirable range (LDL ≥130 mg/dl or total cholesterol ≥200 mg/dl) when measured during the follicular phase [first half].”

HDL was higher when estradiol had peaked, corresponding also to lower LDL and triglycerides.

“Because lipoprotein cholesterol levels vary across the menstrual cycle, cyclic variations in lipoprotein levels may need to be considered in the design and interpretation of studies in reproductive-age women and in the clinical management of women’s cholesterol.“

Bicycle riding and erectile dysfunction

Posted on July 24, 2010 by Dr. Jonathan

The standard bicycle seat can deliver a significant insult to the nerve and blood vessel supply to the male genitalia. There have been numerous studies investigating the relationship between bicycle riding and erectile dysfunction. The authors of a paper published a while back in The Journal of Sexual Medicine that reviewed the science set out to:

“…summarize accumulating data on the safety of bicycle riding based on medical evidence categorized by levels of evidence, including case reports, observational studies, case control studies, mechanistic studies, and population-based epidemiologic investigations. The secondary aim was to address the concerns of bicyclists and propose measures to minimize the risk of ED associated with bicycle riding.”

The mass of data revealed a clear picture and yielded specific recommendations:

“Bicycle riding more than 3 hours per week was an independent relative risk for moderate to severe ED. Therefore, bicycle riders should take precautionary measures to minimize the risk of ED associated with bicycle riding: change the bicycle saddle with a protruding nose to a noseless seat, change the posture to a more upright/reclining position, change the material of the saddle (GEL), and tilt the saddle/seat downwards.”

The authors note in their conclusion:

“Straddling bicycle saddles with a nose extension is associated with suprasystolic perineal compression pressures, temporarily occluding penile perfusion and potentially inducing endothelial injury and vasculogenic ED.”

In a subsequent paper published in the same journal this year the authors revisit the problem and begin by noting:

“For many years, reports in the literature have implicated bicycle riding as causing increased risk of erectile dysfunction (ED). Perineal compression during cycling has been associated with the development of sexual complications.”

They conducted a comprehensive review of the scientific literature and found that further studies had firmly established the risk of cycling-related sexual dysfunction and extended it to females:

“There is a significant relationship between cycling-induced perineal compression leading to vascular, endothelial, and neurogenic dysfunction in men and the development of ED. Research on female bicyclists is very limited but indicates the same impairment as in male bicyclists.”

The authors of a review published earlier in European Urology caution practitioners to be aware of this widespread phenomenon. They report that a range of problems have been documented:

“The most common bicycling associated urogenital problems are nerve entrapment syndromes presenting as genitalia numbness, which is reported in 50–91% of the cyclists, followed by erectile dysfunction reported in 13–24%. Other less common symptoms include priapism, penile thrombosis, infertility, hematuria, torsion of spermatic cord, prostatitis, perineal nodular induration and elevated serum PSA, which are reported only sporadically.”

They conclude by exhorting practitioners to be alert:

“Urologists should be aware that bicycling is a potential and not an infrequent cause of a variety of urological and andrological disorders caused by overuse injuries affecting the genitourinary system.”

Perhaps this could contribute, at least to some degree, occurrences of ‘cyclist road rage’. Are there any remedies or recommendations for cyclists to follow? Another study in The Journal of Sexual Medicine investigated the condition in police officers:

“The average bicycle police officer spends 24 hours a week on his bicycle and previous studies have shown riding a bicycle with a traditional (nosed) saddle has been associated with urogenital paresthesia and sexual dysfunction.”

The officers manifested the typical problems, but also demonstrated some improvement when using a ‘no-nose saddle’:

“(i) With few exceptions, bicycle police officers were able to effectively use no-nose saddles in their police work. (ii) Use of no-nose saddles reduced most perineal pressure. (iii) Penile health improved after 6 month using no-nose saddles as measured by biothesiometry and IIEF. There was no improvement in Rigiscan® [nocturnal erection] measure after 6 months of using no nose saddles, suggesting that a longer recovery time may be needed.”

It only makes anatomical sense that insult to the nerves and blood vessels that supply the genitalia could cause sexual dysfunction in both males and females.