Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Turmeric, curcumin in ulcerative colitis

Curcumin is a biologically active phytochemical component in turmeric or yellow curry powder and has been found to be effective in numerous diseases including cancer. Ulcerative colitis (one form of inflammatory bowel disease) may be one of those conditions with poven benefit.

The study below was discussed at one of the sessions at the annual Digestive Diseases week (2008) which is the largest gathering of the gastroenterologists in the world. The two panelists (Dr. Koratz from UCLA and Dr. Mullen from Johns Hopkins) gave two thumbs up to this study of turmeric and endorsed its used in ulcerative colitis.

Hanai and colleagues studied the effect of turmeric (curcumin) as a maintenance therapy for ulcerative colitis in a randomized controlled fashion. They reported their findings in the journal Clinical Gastroenterology & Hepatology (2006) in a study titled, "Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial."89 with ulcerative colitis in remisssion participated in the study. Patients received curcumin (1g twice a day) or placebo in addition to the standard treatment (sulfasalazine or mesalamine) for 6 months.Of the patients receiving curcumin, 5% relapsed as compared to 21% in the placebo group.

The investigators concluded that curcumin seems to be a promising and safe medication for maintaining remission in ulcerative colitis.

What are your thoughts on the above study and the action of a "natural remedy" being endorsed at a prominent medical scientific meeting? Please share your thoughts.

Probiotics and prebiotics

Pasteur made the prophetic statement that life sans microbes would be impossible. It was Metchnikoff who in 1907 came up with idea of positive role of some bacteria. Lilly & Stillwell coined term probiotic in1965. A 2001 FAO/WHO report defines probiotic as live microorganisms when given in adequate amounts confer benefit to the host.

The intestinal bacteria participate in normal functioning of gut:

• Structure and function e.g gut transit is delayed in germ-free animals.
• Biochemical interactions
• Immunology
• Maturation of blood vessels
• Gene expression
• Maintaining body weight

Potentially helpful actions of gut bacteria

• Reduce or eliminate pathogens
• Reduce/eliminate toxins/carcinogens
• Release nutrients/antioxidants, growth factors
• Impact on immune function
• Synthesize vitamins (K, FA, B group)

Prebiotics

As mentioned in the book Natural Stomach Care, these are the substances that provide substrate for fermentation by the intestinal bacteria. They are usually undigested food, mostly plant food. They are also known as colonic foods. They involved in the following functions in the intestines.

• Maintain mucosal growth
• Water electrolyte balance
• Provide Energy/nutrients for host/bacteria
• Stimulate growth of flora

Clinical studies

Probiotics, prebiotics as well as combined probiotics and prebiotics have been studied in many digestive illnesses like infantile colic, infectious diarrhea, travelers diarrhea, inflammatory bowel disease, antibiotic induced diarrhea, recurrent C. difficile colitis and irritable bowel syndrome.

Studies have also examined the impact of probiotics in non-digestive illnesses like atopic dermatitis, dental caries, gingivitis, postoperative infections, infections in liver transplant patients, preventing colds and sickness-related absenteism, baby growth etc.

Many of these studies have been very positive leading to introduction of multiple commercial products into the market. However, each product is different with respect to the type, number of strains and bacterial count. Just like antibiotics, some antibiotics may work in certain situations and not the others.

Properties of an ideal probiotic

• Ability to survive through gut
• Able to proliferate and colonize gut
• Safe and effective
• Maintain potency for the shelf-life

Myths about probiotics

• Alters the composition
• Permanent homeliness
• Impact on bowel ecosystem

Bacteria for your infant's colic?

Infantile colic is a difficult problem, vexing both to parents and physicians. The cause is thought to be excess intestinal gas. On the lines of irritable bowel syndrome or IBS, new research indicates that probiotic bacteria help in kids with colic.

Probiotics or "good bacteria" that tend to maintain a healthy balance of good versus bad bacteria in the gut. They are being increasingly have been found to be useful for treatment of various illnesses, both gut and non-gut related.

Dr. Savino and colleagues from the University of Turin in Italy conducted a randomized placebo controlled trial to study the effect of Lactobacillus reuteri. Their findings were published in the journal Pediatrics (January 2007).

The study cohort consisted of 90 breast fed babies who were administered either the probiotic or the common over the counter anti-gas medication known as simethicone for 28 days. Mothers refrained from ingesting cow's milk in their diet. Baby crying times were assessed.

The daily median crying time at day 28 was 145 minutes/day in placebo group as compared to only 51 minutes/day in the probiotic group. 95% babies were termed as responders among the probiotic group in contrast to only 7% in the placebo group.

The mechanism of action of the probiotic in such conditions remains to be established. Possible mechanisms include immune-modulation and enhanced peristalsis thus affecting the balance of the gut flora and reduced triggers for abdominal pain.

Do you or someone close to have kids? Do any of them have colicky problems? What remedies have you tried for such episodes?

Swedish massage for osteoarthritis

First my confession. I have no idea whether Swedish massage is different and more exotic than regular massage Swedish Massage.

Dr. Perlman and colleagues from the University of Medicine and Dentistry of New Jersey, Newark and Yale Prevention Research Center, Yale University School of Medicine recently published their findings suggesting that Swedish massage relieves pain in osteoarthritis. The article was published in the December 2006 issue of Archives of Internal Medicine.

These investigators conducted a randomized, controlled trial involving 68 subjects over a period of 8 weeks. Subjects were divided into Swedish massage group or delayed intervention.

The massage therapy group showed significant improvements in pain, stiffness, range of motion and time to walk 50 feet.

The authors concluded that massage therapy is effective in the treatment of osteoarthritis.

Massage therapy may be a valuable adjunct for treatment in such patients especially since many of the drug treatments carry significant side effects.

Do you or someone you know has arthritis? Have you had massage for stress relaxation or any other reason? What are your thoughts on the results of the above study?

DHEA: is it good against aging?

DHEA is a popular over the counter product that has been used for its benefits against aging processes. There have been many studies that support that thesis. However, a recent study put cold water on the enthusiasm for this popular remedy and brought its efficacy into question.

The study was performed by researchers at Mayo Clinic in Rochester, MN. Dr. Nair and colleagues conducted a double blind, randomized, placebo-controlled trial to study the effect of DHEA. It involved 87 elderly men with low levels of the DHEA and testosterone plus 57 elderly women with low levels of DHEA.

They studied the effect of intervention on physical performance, body composition, bone mineral density and quality of life over a period of two years.

These researchers found that DHEA or low-dose testosterone replacement in elderly people did not have any clinically relevant beneficial impact on the outcome measures studied.

These results are in contrast to some previous studies. However, the validity of many of those has been questioned because of the inadequate number of subjects and short duration. However it does not answer whether use of high doses of testosterone may be helpful.

Do you use DHEA or testosterone as a supplement or any other over the counter supplements? What are your thoughts on their marketing and beneficial effects?

Is homeopathy safe or effective?

While many people in eastern cultures and even Europe swear by the effectiveness of homeopathy, it is generally looked own upon by many involved in Western medicine.

A recent report from Germany led by Dr. Bernhoft and colleagues provides an overview of evidence for effectiveness of homeopathy based on published literature. The authors systematically searched all the medical literature and found many high-quality pre-clinical and clinical studies proving positive effects of homeopathy.

They report that 20 of 22 systematic reviews demonstrated at least a trend in favor of homeopathy with five of the studies demonstrating definitive evidence for effectiveness of homeopathic treatment.

They concluded that homeopathy is clearly effective, safe and essentially devoid of side effects based on scientific evidence.

What do you think about alternative and complimentary medicine therapies? Have you used any one of them or would you consider using them under certain circumstances? What are your thoughts about homeopathy?

Drink tea for better heart!

Some of us drink coffee whereas others are fans of tea. While green tea has a lot of proponents, black tea is not far behind in health benefits. Tea is known to help heart we don't know how.

Dr. Steptoe and colleagues from the University College in London (UK) indirectly examined the effect of drinking black tea on coronary artery disease and recently published their findings in the journal Atherosclerosis (September 2006). White blood cell with platelet aggregates and C-reactive protein levels were used as markers for increased risk for coronary artery disease.

Seventy-five healthy non-smoking men participated in study. They were randomized to drinking black tea or placebo for a period of six weeks.

The authors found that at the end of six-week period, tea drinkers had much less platelet aggregation and lower C-reactive protein levels than the subjects drinking placebo.

Just imagine, next time you are sipping a cup of tea, you are also doing your heart some good!

What beverage do you prefer? Do you drink it more for taste or the perceived health benefits? I drink both coffee ad teas although my favorite is tea.

Black tea soothes rattled nerves

Stressed out? Don't go for the alcoholic drink. Instead enjoy a cup of black tea.

Numerous benefits have been ascribed to black and green tea over the recent years and he recent study by Dr. Steptoe and colleagues (Psychopharmacology Sept 2006) further support for evidence for beneficial effects of black tea.

These investigators examined the effect of 6-week ingestion of black tea versus placebo on bodily responses to stress. This included stress induced effect on cardiovascular system, cortisol and platelets. These were measured before and after two challenging behavioral tasks.

The authors found the cardiovascular responses (blood pressure, heart rate and subjective stress ratings) were not affected by black tea suggesting that black tea does not affect the actual stress experienced. On the other hand, black tea consumption resulted in lower post-stress cortisol and greater subjective relaxation accompanied by lesser platelet activation.

The obvious conclusion from the above study is that black tea mediated health benefits may be due to faster recovery of the body to baseline after a stressful experience.

Do you like tea and/or drink it regularly? Are you a fan of green or black tea? Do you drink it for health benefits or just the taste and smell of it?

Chronic low back pain? Acupuncture needles to the rescue

Chronic low back pain is a major source of health problem and gets more common as we grow older. The treatment has in many cases been frustrating despite intake of medications that themselves have significant side effects. Now comes a report that the ancient remedy of acupuncture may be superior to the current regimes (drugs, physiotherapy, manipulation, massage, transcutaneous electrical nerve stimulation or TENS, and back exercises).

Dr. Thomas and colleagues from the School of Health and Related Research, University of Sheffield (UK) conducted a randomized controlled trial to compare a short course of 10 acupuncture treatments spread over a three-month course with the standard treatment. 241 patients with chronic low back pain greater than 1 year were studied.

At the end of two years, these investigators found that the acupuncture treatment was superior in improving the bodily pain of the patients although functional disability was not improved.

Take home message: Over long term, "new" and "advanced" may not necessarily be better as compared to ancient treatments.

Acupuncture and depression

Acupuncture has been advocated for management of many chronic disorders. Multiple trials have studied its efficacy in depression, which affects 2.3 to 3.2 percent of men and 4.5 to 9 percent of women.

Dr. Leo and colleagues from State University of New York at Buffalo conducted a systematic review of the existing randomized controlled trials on this topic and published their findings in the Journal of Affective Disorders (August 2006).

These investigators found that comparison of acupuncture with control conditions suggests evidence for the efficacy of acupuncture in depression. They also found that acupuncture might be as effective as antidepressants. Data from studies comparing acupuncture with sham acupuncture however was not supportive.

What are your thoughts on alternative and complimentary therapies (CAM)? Have you or someone close to you has used them? Given a choice between a CAM therapy versus traditional therapy, which one would you use?