Eating nuts may help lower cholesterol levels, US research suggests. CLICK & SEE THE PICTURES
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%.
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”...SAYS Lead researcher Joan Sabate
The people involved ate 67g of nuts a day on average, over a period of three to eight weeks.
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.
If people would just do four things — engage in regular physical activity, eat a healthy diet, not smoke and avoid becoming obese — they could slash their risk of diabetes, heart attack, stroke or cancer by 80%, a new report has found. But less than 10% of the 23,153 people in the multiyear study — published in Monday’s Archives of Internal Medicine — actually lived their lives this way.
“The study has such a simple straightforward focus on making the point that prevention works in preventing serious disease,” said Dr. J. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society.
“What really has been difficult is trying to figure out how to get people to take notice of the message and engage in healthy behaviors.”
Researchers at the U.S. Centers for Disease Control and Prevention and in Germany examined the habits of German men and women ages 35 to 65 from 1994 and 1998. At the start of the study, the scientists measured participants’ heights and weights and asked them about their diseases, lifestyle habits and diets.
Healthy factors included never smoking; engaging in physical activity for at least 3 1/2 hours each week; eating a diet low in red meat and high in fruits and vegetables; and having a body mass index lower than 30. (A person with a BMI of 30 or above is classed as obese.)
About 9% of participants practiced all four healthy lifestyle choices.
Four percent practiced none.
Roughly 35% followed two of the healthy practices.
Researchers reviewed participants’ medical records about eight years later, on average, looking for diabetes, heart attacks, strokes or cancer. People who followed all four healthy practices were at far lower risk compared with people who followed none: 93% lower risk for diabetes, 81% for a heart attack, 50% for a stroke and 36% for cancer.
For people who had never smoked and who maintained a BMI under 30, the risk of chronic disease was reduced 72% — the most dramatic reduction of any dual combination of healthy factors.
The scientists also found that each healthy factor reduced chronic disease risk.
A BMI under 30 lowered overall disease risk most — particularly for diabetes.
Never smoking reduced heart attack risk the most of all four factors.
“All of them are important, and trying to pick one is like asking someone to pick their favorite child,” said study coauthor Dr. Earl S. Ford, a senior scientist in the CDC’s Division of Nutrition, Physical Activity and Obesity.
Dr. Vyshali S. Rao, chairwoman of cardiology at Huntington Hospital in Pasadena and an American Heart Assn. spokeswoman, said the study underscores that shifting to a healthier diet helps the heart even if a person remains overweight.
However, she said, people who alter their diets often find they lose weight as a side benefit.
“Cardiologists try to stress to their patients more and more [that] cardiovascular disease is in hands of each individual patient to change,” Rao added.
The study’s findings, which are consistent with investigations that started in the late 1990s, are likely to apply to people living in the United States as well as those in Germany.
“The strongest reductions in risk for diabetes and [heart attack] are not surprising,” said Dr. Rachel Ballard-Barbash, associate director of the National Cancer Institute’s Applied Research program. “Even within a few years’ time, we can see changes in these diseases associated with these health behaviors,” such as lowered levels of LDL cholesterol and blood pressure.
“For stroke and cancer,” she added, “most studies would suggest it would take longer to see changes.”
Heart disease, cancer and strokes are the top three causes of death in the United States, killing an estimated 1,328,643 people every year, according to the CDC. Diabetes is the sixth cause of death, killing 72,449 annually. Many additional people live constrained lives in poor health because of these illnesses.
At the same time, about one out of four slim people in the study actually had at least two cardiovascular risk factors typically associated with obesity.
Being overweight or obese is definitely linked with numerous health problems. Nonetheless, researchers found the proportion of overweight and obese people who are metabolically healthy surprising.
Several studies have shown that fitness, as determined by how a person performs on a treadmill, is a far better indicator of health than body mass index. Some research has indicated that people who are fat but can still keep up on treadmill tests have much lower heart risk than people who are slim and unfit.
Glucosamine (C6H13NO5) is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids. A type of glucosamine forms chitin, which composes the exoskeletons of crustaceans and other arthropods, cell walls in fungi and many higher organisms. Glucosamine is one of the most abundant monosaccharides. It is produced commercially by the hydrolysis of crustacean exoskeletons or, less commonly and more expensive to the consumer, by fermentation of a grain such as corn or wheat. Glucosamine is commonly used as a treatment for osteoarthritis, although its acceptance as a medical therapy varies.
Glucosamine is a compound found naturally in the body, made from glucose and the amino acid glutamine. Glucosamine is needed to produce glycosaminoglycan, a molecule used in the formation and repair of cartilage and other body tissues. Production of glucosamine slows with age.
Glucosamine is available as a nutritional supplement in health food stores and many drug stores. Glucosamine supplements are manufactured in a laboratory from chitin, a substance found in the shells of shrimp, crab, lobster, and other sea creatures. In additional to nutritional supplements, glucosamine is also used in sports drinks and in cosmetics.
Glucosamine is often combined with chondroitin sulfate, a molecule naturally present in cartilage. Chondroitin gives cartilage elasticity and is believed to prevent the destruction of cartilage by enzymes. Glucosamine is sometimes combined with methylsulfonylmethane, or MSM, in nutritional supplements.
Glucosamine was first identified in 1876 by Dr. Georg Ledderhose, but the stereochemistry was not fully defined until 1939 by the work of Walter Haworth. D-Glucosamine is made naturally in the form of glucosamine-6-phosphate, and is the biochemical precursor of all nitrogen-containing sugars. Specifically, glucosamine-6-phosphate is synthesized from fructose-6-phosphate and glutamine as the first step of the hexosamine biosynthesis pathway. The end-product of this pathway is UDP-N-acetylglucosamine (UDP-GlcNAc), which is then used for making glycosaminoglycans, proteoglycans, and glycolipids.
As the formation of glucosamine-6-phosphate is the first step for the synthesis of these products, glucosamine may be important in regulating their production. However, the way that the hexosamine biosynthesis pathway is actually regulated, and whether this could be involved in contributing to human disease, remains unclear.
Oral glucosamine is commonly used for the treatment of osteoarthritis. Since glucosamine is a precursor for glycosaminoglycans, and glycosaminoglycans are a major component of joint cartilage, supplemental glucosamine may help to rebuild cartilage and treat arthritis. Its use as a therapy for osteoarthritis appears safe, but there is conflicting evidence as to its effectiveness. A randomized, double-blind, placebo-controlled trial found glucosamine sulfate is no better than placebo in reducing the symptoms or progression of hip osteoarthritis.
There is promising evidence that glucosamine may reduce pain symptoms of knee osteoarthritis and possibly slow the progression of osteoarthritis. For example, a study published in the journal Archives of Internal Medicine examined people with osteoarthritis over three years. Researchers assessed pain and structural improvements seen on x-ray. They gave 202 people with mild to moderate osteoarthritis 1,500 mg of glucosamine sulfate a day or a placebo.
At the end of the study, researchers found that glucosamine slowed the progression of knee osteoarthritis compared to the placebo. People in the glucosamine group had a significant reduction in pain and stiffness. On x-ray, there was no average change or narrowing of joint spaces in the knees (a sign of deterioration) of the glucosamine group. In contrast, joint spaces of participants taking the placebo narrowed over the three years.
One of the largest studies on glucosamine for osteoarthritis was a 6-month study sponsored by the National Institutes of Health. Called GAIT, the study compared the effectiveness of glucosamine hydrochloride (HCL), chondroitin sulfate, a combination of glucosamine and chondroitin sulfate, the drug celecoxib (Celebrex), or a placebo in people with knee osteoarthritis.
Glucosamine or chondroitin alone or in combination didn’t reduce pain in the overall group, although people in the study with moderate-to-severe knee pain were more likely to respond to glucosamine.
One major drawback of the GAIT Trial was that glucosamine hydrochloride was used rather than the more widely used and researched glucosamine sulfate. A recent analysis of previous studies, including the GAIT Trial, concluded that glucosamine hydrochloride was not effective. The analysis also found that studies on glucosamine sulfate were too different from one another and were not as well-designed as they should be, so they could not properly draw a conclusion. More research is needed.
Still, health care providers often suggest a three month trial of glucosamine and discontinuing it if there is no improvement after three months. A typical dose for osteoarthritis is 1,500 mg of glucosamine sulfate each day.
Other conditions for which glucosamine is used include rheumatoid arthritis, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), chronic venous insufficiency, and skin conditions, although further evidence is needed.
A typical dosage of glucosamine salt is 1,500 mg per day. Glucosamine contains an amino group that is positively charged at physiological pH. The anion included in the salt may vary. Commonly sold forms of glucosamine are glucosamine sulphate and glucosamine hydrochloride. The amount of glucosamine present in 1500 mg of glucosamine salt will depend on which anion is present and whether additional salts are included in the manufacturer’s calculation. Glucosamine is often sold in combination with other supplements such as chondroitin sulfate and methylsulfonylmethane.
Glucosamine is a popular alternative medicine used by consumers for the treatment of osteoarthritis. Glucosamine is also extensively used in veterinary medicine as an unregulated but widely accepted supplement.
Bioavailability and pharmacokinetics:
Two recent studies confirm that glucosamine is bioavailable both systemically and at the site of action (the joint) after oral administration of crystalline glucosamine sulfate in osteoarthritis patients. Steady state glucosamine concentrations in plasma and synovial fluid were correlated and in line with those effective in selected in vitro studies
There have been multiple clinical trials of glucosamine as a medical therapy for osteoarthritis, but results have been conflicting. The evidence both for and against glucosamine’s efficacy has led to debate among physicians about whether to recommend glucosamine treatment to their patients.
Multiple clinical trials in the 1980s and 1990s, all sponsored by the European patent-holder, Rottapharm, demonstrated a benefit for glucosamine. However, these studies were of poor quality due to shortcomings in their methods, including small size, short duration, poor analysis of drop-outs, and unclear procedures for blinding. Rottapharm then sponsored two large (at least 100 patients per group), three-year-long, placebo-controlled clinical trials of the Rottapharm brand of glucosamine sulfate. These studies both demonstrated a clear benefit for glucosamine treatment. There was not only an improvement in symptoms but also an improvement in joint space narrowing on radiographs. This suggested that glucosamine, unlike pain relievers such as NSAIDs, can actually help prevent the destruction of cartilage that is the hallmark of osteoarthritis. On the other hand, several subsequent studies, independent of Rottapharm, but smaller and shorter, did not detect any benefit of glucosamine.
Due to these controversial results, some reviews and meta-analyses have evaluated the efficacy of glucosamine. Richy et al. performed a meta-analysis of randomized clinical trials in 2003 and found efficacy for glucosamine on VAS and WOMAC pain, Lequesne index and VAS mobility and good tolerability.
Recently, a review by Bruyere et al. about glucosamine and chondroitin sulfate for the treatment of knee and hip osteoarthritis concludes that both products act as valuable symptomatic therapies for osteoarthritis disease with some potential structure-modifying effects.
This situation led the National Institutes of Health to fund a large, multicenter clinical trial (the GAIT trial) studying reported pain in osteoarthritis of the knee, comparing groups treated with chondroitin sulfate, glucosamine, and the combination, as well as both placebo and celecoxib. The results of this 6-month trial found that patients taking glucosamine HCl, chondroitin sulfate, or a combination of the two had no statistically significant improvement in their symptoms compared to patients taking a placebo. The group of patients who took celecoxib did have a statistically significant improvement in their symptoms. These results suggest that glucosamine and chondroitin did not effectively relieve pain in the overall group of osteoarthritis patients, but it should be interpreted with caution because most patients presented only mild pain (thus a narrow margin to appraise pain improvement) and because of an unusual response to placebo in the trial (60%). However, exploratory analysis of a subgroup of patients suggested that the supplements taken together (glucosamine and chondroitin sulfate) may be significantly more effective than placebo (79.2% versus 54%; p = 0.002) and a 10% higher than the positive control, in patients with pain classified as moderate to severe (see testing hypotheses suggested by the data).
In an accompanying editorial, Dr. Marc Hochberg also noted that “It is disappointing that the GAIT investigators did not use glucosamine sulfate … since the results would then have provided important information that might have explained in part the heterogeneity in the studies reviewed by Towheed and colleagues” But this concern is not shared by pharmacologists at the PDR who state, “The counter anion of the glucosamine salt (i.e. chloride or sulfate) is unlikely to play any role in the action or pharmacokinetics of glucosamine”. Thus the question of glucosamine’s efficacy will not be resolved without further updates or trials.
In this respect, a 6-month double-blind, multicenter trial has been recently performed to assess the efficacy of glucosamine sulfate 1500 mg once daily compared to placebo and acetaminophen in patients with osteoarthritis of the knee (GUIDE study). The results showed that glucosamine sulfate improved the Lequesne algofunctional index significantly compared to placebo and the positive control. Secondary analyses, including the OARSI responder indices, were also significantly favorable for glucosamine sulfate.
A subsequent meta-analysis of randomized controlled trials, including the NIH trial by Clegg, concluded that hydrochloride is not effective and that there was too much heterogeneity among trials of glucosamine sulfate to draw a conclusion. In response to these conclusions, Dr. J-Y Reginster in an accompanying editorial suggests that the authors failed to apply the principles of a sound systematic review to the meta-analysis, but instead put together different efficacy outcomes and trial designs by mixing 4-week studies with 3-year trials, intramuscular/intraarticular administrations with oral ones, and low-quality small studies reported in the early 1980s with high-quality studies reported in 2007.
However, currently OARSI (OsteoArthritis Research Society International) is recommending glucosamine as the second most effective treatment for moderate cases of osteoarthritis. Likewise, recent European League Against Rheumatism practice guidelines for knee osteoarthritis grants to glucosamine sulfate the highest level of evidence, 1A, and strength of the recommendation, A.
Clinical studies have consistently reported that glucosamine appears safe. Since glucosamine is usually derived from shellfish, those allergic to shellfish may wish to avoid it. However, since glucosamine is derived from the shells of these animals while the allergen is within the flesh of the animals, it is probably safe even for those with shellfish allergy. Alternative sources using fungal fermentation of corn are available. Another concern has been that the extra glucosamine could contribute to diabetes by interfering with the normal regulation of the hexosamine biosynthesis pathway, but several investigations have found no evidence that this occurs. A review conducted by Anderson et al in 2005 summarizes the effects of glucosamine on glucose metabolism in in vitro studies, the effects of oral administration of large doses of glucosamine in animals and the effects of glucosamine supplementation with normal recommended dosages in humans, concluding that glucosamine does not cause glucose intolerance and has no documented effects on glucose metabolism. Other studies conducted in lean or obese subjects concluded that oral glucosamine at standard doses does not cause or significantly worsen insulin resistance or endothelial dysfunction.
The U.S. National Institutes of Health is currently conducting a study of supplemental glucosamine in obese patients, since this population may be particularly sensitive to any effects of glucosamine on insulin resistance.
In the United States, glucosamine is not approved by the Food and Drug Administration for medical use in humans. Since glucosamine is classified as a dietary supplement in the US, safety and formulation are solely the responsibility of the manufacturer; evidence of safety and efficacy is not required as long as it is not advertised as a treatment for a medical condition.
In Europe, glucosamine is approved as a medical drug and is sold in the form of glucosamine sulfate. In this case, evidence of safety and efficacy is required for the medical use of glucosamine and several guidelines have recommended its use as an effective and safe therapy for osteoarthritis. Actually, the Task Force of the European League Against Rheumatism (EULAR) committee recently granted glucosamine sulfate a level of toxicity of 5 in a 0-100 scale, and recent OARSI (OsteoArthritis Research Society International) guidelines for hip and knee osteoarthritis also confirm its excellent safety profile.
Most studies involving humans have found that short-term use of glucosamine is well-tolerated. Side effects may include drowsiness, headache, insomnia, and mild and temporary digestive complaints such as abdominal pain, poor appetite, nausea, heartburn, constipation, diarrhea, and vomiting. In rare human cases, the combination of glucosamine and chondroitin has been linked with temporarily elevated blood pressure and heart rate and palpitations.
Since glucosamine supplements may be made from shellfish, people with allergies to shellfish should avoid glucosamine unless it has been confirmed that it is from a non-shellfish source. The source of glucosamine is not required to be printed on the label, so it may require a phone call to the manufacturer.
There is some evidence suggesting that glucosamine, in doses used to treat osteoarthritis, may worsen blood sugar, insulin, and/or hemoglobin A1c (a test that measures how well blood sugar has been controlled during the previous three months) levels in people with diabetes or insulin resistance.
Theoretically, glucosamine may increase the risk of bleeding. People with bleeding disorders, those taking anti-clotting or anti-platelet medication, such as warfarin, clopidogrel, and Ticlid, or people taking supplements that may increase the risk of bleeding, such as garlic, ginkgo, vitamin E, or red clover, should not take glucosamine unless under the supervision of a healthcare provider.
The safety of glucosamine in pregnant or nursing women isn’t known.
Every person who takes up running has been confronted by a “helpful” critic who is more than happy to reel off the reasons running will ruin your life. Here’s a look at three questionable claims about running and health:
1. Running will give you a heart attack or other heart problems. It is true that exercise temporarily raises the odds of a heart attack while you’re mid-workout, but doing it consistently reduces that risk over the long haul, leading to a net benefit. Going for a run most days of the week is doing far more good than bad for your heart.
2. Running will ruin your bones and joints. A study in the American Journal of Preventive Medicine found no evidence of accelerated rates of osteoarthritis among long-distance runners. Weight-bearing exercise like running helps stave off osteoporosis by maintaining bone mineral density.
3. Running will kill you before your time. According to a study in the Archives of Internal Medicine, running and other vigorous exercise in middle age is associated with a longer life. Not only that, it will make your later years more pleasant by reducing disability.