Ice and Brain

We all want to live longer, look younger, have more energy and lead a fuller life, right? How can it be done? These are some of the mantra. Let’s discover.

Study finds two-thirds of gluten-sensitive people had no ill effects when given gluten – ScienceAlert

A new study has found that only one-third of people diagnosed with gluten sensitivity actually experience adverse side effects from gluten intake, adding further weight to the growing suspicion among scientists that gluten intolerance isn’t actually a thing. Or at the very least, isn’t as prevalent as we’ve been led to believe.

Right now, ‘gluten-free’ means big, big business. The New York Times reports that in the US, 30 percent of people say they want to eat less gluten, and the portion of households that are purchasing gluten-free products hit 11 percent last year, up from 5 percent in 2010. But not only are these products no more healthy for you than their gluten-packed counterparts, there appears to be very little science backing up many people’s claims to needing them.

The study, led by a team of gastroenterologists from the University and Spedali Civili of Brescia in Italy, involved recruiting 35 volunteers who had been diagnosed with non-celiac gluten sensitivity (NCGS). This condition is based on a small 2011 study that found gluten-containing diets can cause gastrointestinal pain in people who don’t have caeliac disease – an autoimmune disorder that flares up with gluten intake.

These volunteers had been living off a strict gluten-free diet for at least six months before the study, and were then asked to complete a series of “challenges” involving gluten-containing and gluten-free flours. Completely blind to what they were actually eating, the volunteers were given sealed sachets simply labelled “A” and “B”, each containing 10 grams of flour.

For the first stage of the experiment, the volunteers were given one type of flour and were told to sprinkle it over pasta or soup once a day for 10 consecutive days. They were then given 14 days to go back to their normal diets, and then repeated the challenge for another 10 days using the other type of flour.

During the process, they were asked to report any symptoms of pain, reflux, indigestion, diarrhoea, and constipation, using a rating scale of 1 (no adverse effects) to 7 (severe adverse affects). Once they were all done, the volunteers had to guess which of the sachets contained the gluten-containing and gluten-free flours. If they guessed correctly, because their side effects linked up with the reality of what they had been eating, they were classified as having NCGS, regardless of the prior diagnosis.

The researchers report that just 12 of the 35 volunteers could be classified as having NCGS based on these criteria. “Of the remaining subjects, 17 identified the gluten-free flour as causing symptoms and six reported no adverse symptoms during the trial whatsoever,” Ross Pomeroy reports for Real Clear Science. “Also of note, most subjects tended to experience very mild symptoms throughout the trial. On average, participants rated the majority of gastrointestinal symptoms at 3 or lower on the aforementioned scale.”

So what does this mean? While we have to take the results with a grain of salt because the sample size is so small and the symptoms were self-reported, they do agree with another recent study conducted in Australia that also suggests that for many people, gluten intolerance is all in their head.

Jennifer Walsh reported for Business Insider:

“The [37 self-identified gluten-sensitive patients] cycled through high-gluten, low-gluten, and no-gluten (placebo) diets, without knowing which diet plan they were on at any given time. In the end, all of the treatment diets – even the placebo diet – caused pain, bloating, nausea, and gas to a similar degree. It didn’t matter if the diet contained gluten.

‘In contrast to our first study… we could find absolutely no specific response to gluten,’ Gibson wrote in the paper. A third, larger study published this month has confirmed the findings.”

Both teams put their results down to the ‘nocebo effect‘ – the anxiety felt by someone who thinks they’re at risk of getting sick can sometimes actually make them feel sick – or perhaps the presence of carbohydrates called FODMAPS that some people could find hard to digest. But as far as gluten is concerned, it doesn’t appear to be the menace we’ve been making it out to be.

“Our study has shown that gluten challenge leads to a recurrence of symptoms in only a third of patients fulfilling the recognised diagnostic criteria for the clinical diagnosis of NCGS,” the Italian team concludes in the journal Alimentary Pharmacology & Therapeutics. “Consequently, NCGS is likely to be the correct diagnosis in only a minority of those who do not have celiac disease, but whom themselves choose to follow a gluten-free diet.”

Flowers Used in Chinese Herbal Medicine

Herbal therapies are an integral part of traditional Chinese medicine (TCM). While there are 5,767 substances defined in the Encyclopedia of Traditional Chinese Medicinal Substances, a typical practitioner may routinely use between 200 and 600.

Most often, the herbs (a combination of one to 13 different plants) are added to water and boiled. The liquid is then separate from the herbs and drunk as a water decoction.

The herbs may also be consumed in powdered form, spray-dried concentrates, pill form, or even “honey pills,” which are “prepared by combining powdered herbs with concentrated decoctions and honey to produce a small herbal pill.”1

It used to be customary for Chinese families to maintain a collection of herbal formulas used to treat various medical problems, life changes (pregnancy, menopause, and old age), or even use for the different seasons.

Some still do maintain such knowledge and use herbal remedies in their daily lives, while in the modern day you can find a TCM practitioner to help determine which herbs are right for you.

7 Flowers Used in Chinese Herbal Medicine

You’ve probably heard of some of the more common herbs used in TCM, such as panax ginseng, licorice, and rhubarb root. However, there are others as well, including flowers you might not expect. For instance, the Epoch Times compiled the 7 flowers that follow, which have been used as part of Chinese medicine for centuries.2

1. Lonicera Flower (Jin Yin Hua)

Also known as honeysuckle flower, this remedy is often used for colds, flu, and sore throats. It was even used in combination with three other herbs as a treatment for swine flu.

Research has shown the flower, in combination with other herbs used to treat acute bronchitis, “had potent pharmacological action” as well as showed antiviral and antibacterial effects.3 It’s also known for its anti-inflammatory actions.4

2. Viola Flower (Zi Hua Di Ding)

Also known as the purple flower earth herb or the Chinese violet, viola flower has anti-inflammatory and antipyretic (fever-reducing) effects. It is often used for clearing heat, releasing toxins, or dissolving masses, and it is an age-old remedy for snake bites (to help reduce both swelling and toxicity).

Viola is traditionally associated with the heart and the liver5 and is also sometimes used for bacterial infections.

3. Pagoda Flower (Huai Hua)

Also known as Sophorae flower, this remedy is used for bleeding disorders, including in the treatment of hemorrhoids and excessive menstrual bleeding.

4. Chrysanthemum Flower (Ju Hua)

This common herbal medicine is useful for treating dry, irritated eyes, high blood pressure, and headaches. Chrysanthemum flowers are often used in combination with honeysuckle to lower high blood pressure and treat arteriosclerosis.6

It’s also said to affect the liver and lungs, and is commonly consumed in tea form. According to the Jade Institute:7

“The benefits of long-term consumption of Chrysanthemum tea have been recognized throughout the history of Chinese medicine. It is said to prevent aging and to be a favorite of Taoists and poets, though the benefits are achieved only with drinking the tea over a long period of time.

In the Shen Nong Ben Cao Jing, it says, ‘taken over a long time it facilitates the qi and blood, lightens the body and prevents aging.’”

5. Safflower (Hong Hua)

Also known as Carthamus, this red flower is typically used to treat menstrual disorders, invigorate circulation, and dissolve clots. It’s also useful for treating heart disease, joint pain, and flat warts.

Safflower was among a group of Chinese herbs found to be potentially beneficial for people with elevated blood triglyceride levels, a risk factor for arteriosclerosis, diabetes, and high blood pressure.8

According to the American Botanical Council (ABC), safflower is among the blood-promoting herbs in Chinese medicine that aid circulation, nourish blood and increase its production, and have anti-thrombotic properties. ABC notes safflower may “support coronary blood flow and reduce myocardial oxygen use, ischemia, and arrhythmia.”9

6. Magnolia Flower (Xin Yin Hua)

If you have nasal congestion or chronic sinusitis, magnolia flower is the herbal remedy for you. An herbal tea containing magnolia flower and other Chinese herbs was found to improve chronic sinusitis when used for six weeks.10

Fermented magnolia flower petal extract has also shown promise as a natural antioxidant and anti-cancer agent.11

7. Lotus Flower (Lian Zi Xin)

The lotus flower is used for treating bleeding disorders, including bloody noses, as well as irritability and fevers. Its seeds, stem, and leaves are also used in TCM.

Elder Flower: Another Traditional Flower Remedy Worth Trying

Elder flowers, the flowers of the elder tree (which also gives us elderberries), are rich in flavonoids, minerals, phenolic compounds, volatile oils, and more. In traditional Greek medicine, elder flowers were used as a diaphoretic (to increase sweating, which is helpful for eradicating a virus from your system).

In Germany, elder flower is commonly used to treat feverish common colds, and in the US and Canada, elder flower may be combined with yarrow flower and peppermint leaf in tea form to relieve colds and flu. According to the American Botanical Council:12

Its flavonoids and phenolic acids may contribute to the diaphoretic effect. It has demonstrated anti-inflammatory, antiviral, and diuretic actions in in vitro studies. The flavonoids and triterpenes appear to be the main biologically active constituents.

The Commission E [in Germany] approved the internal use of elder flower for colds. The British Herbal Compendium lists its uses for common cold, feverish conditions, and as a diuretic. The German Standard License for elder flower tea calls it a diaphoretic medicine for the treatment of feverish common colds or catarrhal complaints.”

Elder flower has been traditionally used as a tonic to boost immunity. It is also widely known to promote lung and bronchial tract health. If you’re battling a cold or flu, try drinking elder flower tea (combined with yarrow, boneset, linden,peppermint, and ginger, if you like) hot and often to help induce sweating and flush the virus out. Further, as noted by Herb Wisdom:13

“The most common uses [of elder flower] are for colds and flu, sinus infections, and other respiratory disturbances. As a supplement, elderflower also has diuretic and laxative properties and is helpful in relieving occasional constipation.

Elderflower has antibacterial and antiviral properties and may also help alleviate some allergies and boost the functioning of the immune system. Topically, elderflower might help reduce pain and swelling in joints due to some forms of arthritis and is used to stop bleeding.

As an oral rinse, elderflower can be used for its antiseptic properties as a mouthwash and gargle. Elderflower also reduces blood sugar levels, very similar to the way insulin works.”

Lavender: Another Incredibly Useful Herb

Lavender oil is known for its calming and relaxing properties, and has been used for alleviating insomnia, anxiety, depression, restlessness, dental anxiety, and stress. It has also been proven effective for nearly all kinds of ailments, from pain to infections.

Its name actually comes from the Latin lavare, which means “to wash,” and lavender has long been used as a tonic to help cleanse the skin.14 I am particularly fascinated by lavender oil’s potential in fighting antifungal-resistant skin and nail infections.

Scientists from the University of Coimbra found that lavender oil is lethal to skin-pathogenic strains known as dermatophytes, as well as various Candida species.15 Lavender oil has a chemically complex structure with over 150 active constituents.16This oil is rich in esters, which are aromatic molecules with antispasmodic (suppressing spasms and pain), calming, and stimulating properties. The chief botanical constituents of lavender oil are linalyl acetate, linalool (a non-toxic terpene alcohol that has natural germicidal properties), terpinen-4-ol, and camphor.

Other constituents in lavender oil that are responsible for its antibacterial, antiviral, and anti-inflammatory properties include cis-ocimene, lavandulyl acetate, 1,8-cineole, limonene, and geraniol. Lavender can also be used to:17

  • Relieve pain. It can ease sore or tense muscles, joint pain and rheumatism, sprains, backache, and lumbago. Simply massage lavender oil onto the affected area. Lavender oil may also help lessen pain following needle insertion.
  • Treat various skin disorders like acne, psoriasis, eczema, and wrinkles. It also helps form scar tissues, which may be essential in healing wounds, cuts, and burns. Lavender can also help soothe insect bites and itchy skin (lavender oil can help ward off mosquitoes and moths. It is actually used as an ingredient in some mosquito repellents).
  • Keep your hair healthy. It helps kill lice, lice eggs, and nits. The Natural Medicines Comprehensive Database (NMCB) says that lavender is possibly effective for treating alopecia areata (hair loss), boosting hair growth by up to 44 percent after just seven months of treatment.
  • Improve your digestion. This oil helps stimulate the mobility of your intestine and stimulates the production of bile and gastric juices, which may help treat stomach pain, indigestion, flatulence, colic, vomiting, and diarrhea.
  • Relieve respiratory disorders. Lavender oil can help alleviate respiratory problems like colds and flu, throat infections, cough, asthma, whooping cough, sinus congestion, bronchitis, tonsillitis, and laryngitis. It can be applied on your neck, chest, or back, or inhaled via steam inhalation or through a vaporizer.
  • Stimulates urine production, which helps restore hormonal balance, prevent cystitis (inflammation of the urinary bladder), and relieve cramps and other urinary disorders.
  • Improve your blood circulation. It helps lower elevated blood pressure levels and can be used for hypertension.

Do You Want to Use More Medicinal Herbs?

Herbs can help support your health from a very basic level, just as foods do. In the late 1800s and early 1900s, you could walk into a drug store and find hundreds of herbal extracts for sale. Upwards of 90 percent of the population at that time knew how to use the medicinal plants growing in their backyards to treat common illnesses and injuries; they had too, as this was virtually the only “medicine” available.

With the rise of what is now known as conventional allopathic medicine shortly before World War I, herbalism slowly fell out of favor and became to be thought of as folk medicine. Rather than viewing nature as the source of healing, as had been done for centuries, people began to view drugs and other “modern” healing methods as superior. If you would like to start using medicinal plants more often, here are 9 tips to do so. I also recommend browsing through my “Ultimate Guide to Herbal Oils“:18

  1. Learn to identify three medicinal plants you don’t already know that grow in your region and learn their uses.
  2. Add at least one of these herbs to your garden or to pots on your windowsill.
  3. Make a tincture, tea, syrup, or salve. Or make one of each!
  4. Harvest and dry mint, lemon balm, calendula, nettles, or any other plant growing in your region.
  5. Find a plant to sit with quietly each morning for a week; draw the plant.
  6. Identify one healing skill you would like to have but don’t, and find a way to learn it — perhaps by taking an herb or aromatherapy class.
  7. Make an herbal first aid kit.
  8. Organize local healers for emergency response in your community.
  9. With medicinal plants grown in your region, learn how to treat one condition that you and/or someone in your family struggles with.

Another Perk for Drinking Coffee

Nearly 60 percent of Americans drink coffee, and for many the habit is a daily one.1 Coffee drinking has long been viewed as more of a vice or a crutch to get a quick energy boost to power through the day, but this view is now changing as the health benefits of coffee continue to be revealed.

This is good news for those of you who sip on a cup of joe in the morning, as it turns out this may be a quite healthy way to start your day.

However, please remember that coffee is one of the most heavily pesticide sprayed crops in the world. If you drink it please be sure to get organic and ideally fair traded, This is less than 3% of all coffee.

Daily Coffee Boosts Colon Cancer Survival

Among people with advanced (stage III) colon cancer, drinking four or more cups of caffeinated coffee daily lowered the risk of cancer recurrence or death during the study by 52 percent compared to those who drank no coffee.

Drinking two or three cups per day was also beneficial, lowering the risk of recurrence or death by 31 percent.

The researchers stressed that other caffeinated beverages, such as soda, did not have the same effect. No link was found between decaffeinated coffee and risk of colon cancer recurrence either.

Further, a causal link was not found. This means it could simply be that coffee drinkers tend to follow a healthier overall lifestyle that’s contributing to the lower risk. However, the antioxidants and other beneficial plant compounds in coffee have been linked to a lower chronic disease risk before.

In fact, coffee has been linked to a lower risk type 2 diabetes as well, a condition known to increase the risk of colon cancer. It’s likely that compounds in coffee may lower the risk of multiple chronic diseases via similar pathways.

As reported by the New York Times:2

The researchers’ hypothesis is that the factors that increase risk for Type 2 diabetes, such as obesity, a sedentary lifestyle, and high insulin levels, also drive colon cancer, Dr. [Charles S.] Fuchs [director of the Gastrointestinal Cancer Center at Dana-Farber Cancer Institute in Boston] said.

And many studies have shown that coffee consumption is associated with a lower risk for Type 2 diabetes, a chronic illness that may increase the risk of colon cancer.

‘We believe that activating the energy pathways that contribute to heart disease and diabetes is also relevant for the proliferation of cancer cells,’ Dr. Fuchs said, while also stressing that more research was needed.

The analysis determined the lowered risk associated with coffee was… because of the caffeine. One hypothesis is that caffeine increases the body’s sensitivity to insulin, so it requires less of the hormone. That, in turn, may reduce inflammation, which is a risk factor for diabetes and cancer.”

What Else Does the Research Say About Coffee and Cancer?

While a number of individual studies have suggested coffee consumption might increase your cancer risk, when multiple studies are analyzed, such as is the case with meta-analyses, the association disappears, and, in fact, becomes protective.

For instance, one 2007 meta-analysis found an increase in consumption of two cups of coffee per day was associated with a 43 percent reduced risk of liver cancer3 – a finding that has been confirmed by more recent research.

Not to mention, coffee appears to have additional benefits for liver health, slowing down the progression of liver disease to cirrhosis, improving responses in people with hepatitis C, and lowering the risk of death in people with cirrhosis.4

The potential benefit of coffee for liver health appears so strong that researchers have stated daily coffee consumption should be encouraged in people with chronic liver disease.5

Another meta-analysis involving 59 studies revealed an increase in consumption of one cup of coffee per day was associated with a 3 percent reduced risk of cancers.6 According to the researchers:

“[C]offee drinking was associated with a reduced risk of bladder, breast, buccal and pharyngeal, colorectal, endometrial, esophageal, hepatocellular, leukemic, pancreatic, and prostate cancers.”7

There’s even research showing coffee consumption could lower your risk of skin cancer. Drinking four cups of caffeinated coffee daily might reduce your risk of melanoma, the most dangerous form of skin cancer.8

According to researchers:

“[C]offee constituents suppress UVB-induced skin carcinogenesis, induce cell apoptosis, protect against oxidative stress and DNA damage, reduce inflammation in epidermal cells, and inhibit changes in DNA methylation.”9

Women who consumed more than three cups of coffee a day had a significantly lower risk of basal cell carcinoma (non-melanoma skin cancer) than those who consumed less than one cup per month.10

Roasted Coffee Contains More Than 1,000 Compounds, Many of Which May Help Fight Cancer

Coffee has multiple potential anti-cancer pathways. As mentioned, caffeine is one of them, as its been shown to both stimulate and suppress tumors depending on the cancer and when it’s administered.11

Polyphenols in coffee, such as lignan phytoestrogens, flavonoids, and polyphenols are also known to have anti-cancer properties, as does caffeic acid, which inactivates several pathways involved in the development of tumors – including cell cycle regulation, inflammatory and stress response, and apoptosis.

Researchers noted in the journal BMC Cancer:12

“There are two specific diterpenes in coffee, cafestol and kahweal, which produce biological effects compatible with anti-carcinogenic properties, including the induction of phase II enzymes involved in carcinogen detoxification, specific inhibition of the activity of phase I enzyme responsible for carcinogen activation, and stimulation of intracellular antioxidant defense mechanisms.

Coffee is also a major source of the chlorogenic acid that contributes to its antioxidant effect. Intake of chlorogenic acid has been shown to reduce glucose concentrations in rats and intake of quinides, degradation products of chlorogenic acid, increases insulin sensitivity.

Chronic hyperinsulinemia and insulin resistance are confirmed markers of high risk for some cancer sites.”

The Benefits of Coffee: From Your Heart to Your Brain

The benefits of coffee are becoming so well established that, for the first time, a government advisory committee included a mention of caffeine in its recommendations for the 2015 edition of Dietary Guidelines for Americans. The report said Americans could safely consume up to five cups of coffee a day, or approximately 400 milligrams (mg) of caffeine, with no detrimental effects.13

The recommendation was based on an evaluation of multiple meta-analyses and other studies evaluating the link between coffee and chronic diseases, including cancer, type 2 diabetes, heart disease, Parkinson’s, and Alzheimer’s. Here’s a sampling of what the research shows:

Heart Health

In a study of more than 25,000 people, those who drank a moderate amount of coffee – defined as three to five cups daily – were less likely to have calcium deposits in their coronary arteries than those who drank no coffee or more coffee daily.14

A large part of arterial plaque consists of calcium deposits (atherosclerosis), hence the term “hardening of the arteries.” Coronary artery calcium can be a significant predictor of future heart disease risk.

In addition, one study showed moderate coffee drinking reduces your chances of being hospitalized for heart rhythm problems. 15 Another study found it may trigger a 30 percent increase in blood flow in your small blood vessels, which might take some strain off your heart.16

Another study, a meta-analysis that included data from 11 studies and nearly 480,000 people found drinking two to six cups of coffee a day was associated with a lower risk of stroke.17

Multiple Sclerosis and Parkinson’s Disease

Drinking four to six cups of coffee a day is associated with a lower risk of multiple sclerosis, as is drinking a high amount of coffee over five to 10 years. According to researchers, Caffeine has neuroprotective properties and seems to suppress the production of pro-inflammatory cytokines.”18 Higher coffee and caffeine intake are also associated with a lower risk of Parkinson’s disease.19


Caffeine promotes production of the neurotransmitters serotonin, dopamine, and noradrenaline, and triggers the release of brain-derived neurotrophic factor (BDNF), which activates brain stem cells to convert into new neurons, thereby improving your brain health.

Among people with mild cognitive impairment (MCI), those with higher blood levels of caffeine (due to coffee consumption) were less likely to progress to full-blown dementia.20 Caffeine/coffee intake is associated with a reduced risk of dementia or delayed onset, particularly for those who already have MCI,” the researchers said.

Premature Death

Research published in the New England Journal of Medicine has even shown that coffee consumption is inversely associated with premature death. The more coffee drank, the lower the risk of death became, including deaths from heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections.21

Coffee Is the Number One Source of Antioxidants in the US

Another reason why coffee may have such dramatic effects on Americans’ health is because it is the number one source ofantioxidants in the US diet. The research, which was presented at the 230th national meeting of the American Chemical Society, showed that Americans get more antioxidants from drinking coffee than from any other dietary source, with researchers noting “nothing else even comes close.”22

Examples of the antioxidants in coffee include significant amounts of hydrocinnamic acid and polyphenols. Antioxidants are nature’s way of providing your cells with adequate defense against attack by reactive oxygen species (ROS) or free radicals.

Free radicals are a type of a highly reactive metabolite that is naturally produced by your body as a result of normal metabolism and energy production. They are your natural biological response to environmental toxins like cigarette smoke, sunlight, chemicals, cosmic, and manmade radiation, and are even a key feature of pharmaceutical drugs. Your body also produces free radicals when you exercise and when you have inflammation anywhere in your body.

As long as you have these important micronutrients, your body will be able to resist aging caused by your everyday exposure to pollutants. If you don’t have an adequate supply of antioxidants to help squelch free radicals, then you can be at risk of oxidative stress, which leads to accelerated tissue and organ damage.

While fruits, such as berries, and vegetables are ideal sources of antioxidants, many Americans don’t eat the recommended amounts each day. This is why coffee, which is consumed widely on a daily basis, represents such a large dietary share of antioxidants. If you’re not a coffee drinker, you can easily boost your antioxidant intake by eating fresh produce – and even if you do drink coffee, getting your antioxidants from a wide variety of sources is still important.

Is Decaf Coffee a Healthy Choice?

The coffee beans used to make decaffeinated, or decaf, coffee undergo a process to remove most of the caffeine. In order to be labeled decaffeinated, the coffee must have 97 percent of the original caffeine content removed.23 This may be preferable for those who are highly sensitive to caffeine (for instance experiencing jitters after one regular cup), but there are some considerations. For starters, some of the research on coffee’s health benefits have shown caffeinated coffee to be more effective than decaf (the featured colon cancer study is one such example).

In particular, caffeinated coffee has also been linked to a lower risk of liver damage, increased metabolic rate, reduced risk of depression and suicidal thoughts, and enhanced athletic performance while decaf coffee has not.24 The process used to decaffeinate the coffee is also important to be aware of.

One of the most commonly used methods is Direct Process, which uses the chemical methyl chloride to remove the caffeine from coffee beans. Starbucks, for instance, uses this process on most of its decaf brews (although it also offers a “naturally processed” decaf Sumatra blend).25

The National Cancer Institute lists methyl chloride as a possible carcinogen, so it’s something you’re better off avoiding (trace amounts are sometimes detected in decaf coffee, although typically at levels below 1 part per million). Natural Process decaffeination uses either ethyl acetate (a plant hormone) or carbon dioxide to remove caffeine, while the Swiss Water process uses only water. Only the carbon dioxide or Swiss water methods are allowed in coffee that’s certified organic. If you choose to drink decaffeinated coffee, be sure to choose one that is decaffeinated using one of these latter two methods.

Another option, if you’re simply looking for a lower-caffeine blend, is to choose Arabica beans, which naturally have about half the caffeine content of Robusta beans. 26 Also, keep in mind that even decaffeinated coffee is not caffeine free (a typical cup of decaf may contain 3 to 18 milligrams (mg) of caffeine, compared to between 140 to 300 mg in a regular cup.

This is an important distinction for pregnant women to be aware of. Public health agencies suggest pregnant women limit daily caffeine to 200 mg (or about two cups of coffee a day). However, caffeine can significantly impact the growing fetus. It is able to freely pass through the placenta, and since caffeine does not provide any benefits to your baby, only potential hazards, I strongly recommend pregnant women avoid ALL forms of caffeine.

How to Ruin a Good Cup of Coffee…

If you want to drink coffee for its health benefits, drink your coffee black, without sugar, non-dairy creamer or cream, or flavorings. If you are dousing your cup of coffee in creamer, non-dairy creamer, sugar, and other sweeteners and flavorings, you are missing out on the therapeutic benefits and potentially harming your health.

The natural blend of polyphenol antioxidants are part of what makes coffee so healthy. However, some research suggests that adding dairy to your coffee may interfere with your body’s absorption of beneficial chlorogenic acids.27 Meanwhile, if you add sugar to your coffee you’ll spike your insulin levels, which contributes to insulin resistance.

Also, coffee beans are one of the most heavily pesticides-sprayed crops. So, you should select only coffee beans that are certified organic. Remember, you will obliterate any positive effects if you consume coffee that’s been doused in pesticides or other chemicals. Whenever possible, purchase sustainable “shade-grown” coffee to help prevent the continued destruction of our tropical rain forests and the birds that inhabit them.

There are many who say shade-grown coffee tastes better as well. In addition, you’ll want to purchase whole bean coffee that smells and tastes fresh, not stale; if your coffee does not have a pleasant aroma, it is likely rancid. Grind it yourself to prevent rancidity, as pre-ground coffee may be rancid by the time you get it home. If you use a “drip” coffee maker, be sure to use non-bleached filters. The bright white ones are chlorine-bleached, and some of this chlorine will leach from the filter during the brewing process. Bleached filters are also notoriously full of dangerous disinfection byproducts, such as dioxin.

Finally, while it appears coffee in moderation is beneficial, be careful not to overdo it, as some studies have found adverse effects when about 10 cups a day or more are consumed. When referring to a “cup” of coffee, most research considers it to be five to eight ounces with about 100 mg of caffeine. In contrast, a small cup at many coffee houses starts at 12 ounces while a large cup may hold 20 to 24 ounces. Simply be aware of how much you’re actually consuming.

Asterias’s stem cell therapy shows promise in study

Asterias Biotherapeutics Inc said initial data from a small study showed that its lead stem cell therapy could improve mobility in patients paralyzed by a spinal cord injury.

The therapy, AST OPC-1, is the first product derived from human embryos to be tested on humans.

Its success is a key step toward proving that embryonic stem cell research could cure diseases such as cancer, Parkinson’s and serious health conditions such immune deficiencies, stroke and spinal injuries.

Data showed that the severity of the spinal injury was reduced in the first patient and two other patients were able to resume their rehabilitation programs soon after being injected with the stem cells.

The early study tested the benefits of a smaller dose of 2 million stem cells that are tuned to develop into nerves.

Asterias bought OPC-1 in 2013 from the erstwhile stem cell research leader Geron Corp, which decided to focus on developing cancer drugs.

Geron chose to abandon its stem cell therapy in 2011 after such research got embroiled in the abortion debate, prompting many biotech companies to stay quiet about their research.

Monday’s announcement was the first about the therapy in more than two years.

In an early-stage study conducted by Geron, the therapy showed potential in repairing spinal injury in four of the five patients tested, without any adverse events.

Asterias is looking to show recovery of mobility in four out of every 10 patients treated with OPC-1, compared with two out of 10 achieving the same level of improvement without any treatment, Chief Executive Pedro Lichtinger told Reuters in early August.

Asterias expects to release complete safety data from the first half of the study later in the year.

Lichtinger said he was confident the data would be positive but was not expecting miracles.

“It is important to know that we do not expect patients to get up and play basketball,” he said. “But we do expect the patients to have significant improvements in mobility.”

India Virtually Eliminates Tetanus as a Killer

A year after eliminating polio, India has scored another public health victory. Following a 15-year campaign, the country has virtually eliminatedtetanus as a killer of newborns and mothers.

Tetanus, caused by a bacterium common in soil and animal dung, usually infects newborns when the umbilical cord is cut with a dirty blade. Mothers often receive the infection by giving birth on dirty surfaces or being aided by midwives with unwashed hands.

The disease — also known as lockjaw, after its muscle spasms — usually sets in about a week after a birth and is invariably fatal if not promptly treated. Fifteen years ago, the World Health Organization estimated that almost 800,000 newborns died of tetanus each year; now fewer than 50,000 do.

But the effort to reduce tetanus has gone slowly. The World Health Assembly — the annual gathering of the world’s health ministers in Geneva — originally set 1995 as the target date for its global elimination as a health threat.

Unlike polio or smallpox, tetanus can never be eradicated because bacterial spores exist in soil everywhere, said Dr. Poonam Khetrapal Singh, the director of the W.H.O.’s Southeast Asia region.

India has reduced cases to less than one per 1,000 live births, which the W.H.O. considers “elimination as a public health problem.” The country succeeded through a combination of efforts.

In immunization drives, millions of mothers received tetanus shots, which also protect babies for weeks.

Mothers who insisted on giving birth at home, per local tradition, were given kits containing antibacterial soap, a clean plastic sheet, and a sterile scalpel and plastic clamp for cutting and clamping the cord.

The country also created a program under which mothers were paid up to $21 to give birth in a clinic or hospital. “Lady health workers” from their neighborhoods were paid up to $9 per mother and up to $4 for bus or taxi fare to make sure women in labor went to clinics. The workers earned the full amount only after visiting each baby at home and giving tuberculosis shots.

The program succeeded despite corruption. The Times of India recently reported that an audit had found clearly fraudulent payments — including some to a 60-year-old woman registered as having been pregnant five times in 10 months.

Proper Use of Epinephrine for Anaphylaxis

It is the second time in a week that EMS has brought a child with an allergic reaction to your pediatric emergency department (ED). The first was an 11-month-old girl who ate hummus for the first time.

She developed lip swelling and hives and had intermittent stridor and oxygen saturation in the low 90s when EMS first arrived, although her oxygenation quickly improved. The second child was a 9-year-old girl who was out with her family at the lake when she developed generalized hives and chest pain. One thing both patients had in common was that EMS gave them benadryl and transported them. No epinephrine.

These were two different EMS crews from two different counties. When asked why epinephrine was not administered they both cited oxygenation above 95% and absence of wheezing as the reason that epinephrine was not given, despite other indicators of respiratory involvement. But what was even more interesting was the way they reacted when you asked about epinephrine. Of course we would not do anything that extreme or drastic, both crews seemed to say.

Recognize Anaphylaxis and Give Epinephrine

It is widely recognized that anaphylaxis can be life threatening and requires prompt treatment. Epinephrine is the consensus first drug of choice in every guideline for the treatment of anaphylaxis. Delay in the administration of epinephrine has been associated with fatal reactions. But providers do not always recognize anaphylaxis. There is also a lack of understanding about when and how to use epinephrine among patients and providers.

Physicians don’t always recognize anaphylaxis when we see it. At least half of anaphylactic episodes are misdiagnosed in the ED when current diagnostic criteria from standard guidelines are not employed. In a recent study of the management of anaphylaxis in U.S. EDs, only 9% of ED physicians reported that they used the guideline criteria to diagnose anaphylaxis. The authors of the study mention it doesn’t help that these guidelines are published mainly in allergy and immunology journals.

Not only are physicians failing to use guidelines for diagnosing anaphylaxis, they are also failing to follow guidelines, such as the International Consensus on Anaphylaxis or theNational Institute of Allergy and Infectious Diseases criteria for anaphylaxis, for treatment. The same study of U.S. ED providers showed that only 42% of them reported giving epinephrine in the ED for most anaphylactic episodes. The majority of them also fail to comply with guideline-based recommendations to prescribe an epinephrine auto-injector, provide a written anaphylaxis treatment plan and refer patients to a allergist at the time of discharge.

There is a paucity of literature regarding provider attitudes toward epinephrine. In adults, some physicians may hesitate to use epinephrine due to concerns about coronary disease. However, allergists say that there is not much risk to giving epinephrine to otherwise healthy children. Most serious side effects have been associated with overly large doses or intravenous administration. Giving the recommended 0.01 mg/kg IM, up to a maximal dose of 0.30 mg is associated with tremor, pallor, anxiety, and palpitations that are transient and well-tolerated in kids.

You are trying to do the right thing. You use the National Institute of Allergy and Infectious Diseases criteria to make the diagnosis of anaphylaxis. You recognize that giving children IM epinephrine as early as possible is the treatment of choice and antihistamines and steroids are only adjunct therapies. You plan to treat both of these patients with IM epinephrine, observe them in the ED and give them epinephrine auto-injectors, personalized discharge plans and allergy clinic referrals at the time of discharge. How is this likely to go?

Educate your Patients

One study looked at children coming in for their first allergy clinic appointment after such a referral. 86% of the families said they carried their epinephrine auto-injector with them “at all times” but only 71% of these could produce it at the clinic visit and 10% had a device that was past its expiration date. Only 32% could demonstrate that they knew how to use it correctly. In the same study, 36% of pediatric residents showed they could use an auto-injector correctly and only 18% of attendings could do so.

To address these issues, sit with your patients/families and give them the facts:

  • Be on the watch if you have had anaphylaxis before. If you encounter the same trigger again, use your auto-injector if you develop symptoms
  • In anaphylaxis, not everyone has skin manifestations (itching, urticaria, angioedema, flushing)
  • If you have a history of asthma and are having an allergic reaction, strongly consider treating with autoinjector early when having respiratory symptoms, as there is a strong correlation with severe and fatal anaphylaxis in this group
  • If you have experienced generalized acute urticaria due to a nut allergy or an insect sting, your risk of a more serious reaction from a future exposure is higher
  • When using the auto-injector (see below) make sure to hold it firmly against the thigh to ensure it produces an intramuscular injection. Peak concentrations of epinephrine differ between by approximately 8 minutes (intramuscular) to approximately 34 minutes (subcutaneous) for injections
  • Always have an auto-injector available and on your person. Check the expiration date and train with it frequently
  • When in doubt, err on the side of using the auto-injector rather than waiting too long, because adverse effects from epinephrine use are generally not a concern for healthy children

Know Your Device

Whether you decide to prescribe the time tested and recognizable EpiPen, or the sleek, phone sized, talking Auviq as your autoinjector of choice, you must understand one thing: You probably don’t know how to teach patients how to use these devices. Multiple studies clearly show that physicians consistently teach improper technique and omit steps, even after reading the inserts in some cases. There is even a statistic as to the likelihood of a physician injecting his or her own thumb in the process of teaching or administering (16% — which I have witnessed first hand). If you’re thinking that a pharmacist can do it better, think again. In one study about one-third of patients would not have received their epinephrine dose had they followed the pharmacist’s instructions.

So How to Proceed

While it never hurts to carefully review the manufacturer’s instructions included in the package insert, there are some common themes:

  • Remove the auto-injector from its protective case
  • Remove the safety release mechanism to arm the device, making sure that the appropriate end is perpendicular to the middle of the outer thigh
  • Firmly push the auto-injector against the middle of the outer thigh until you hear a clicking sound. This can be done through clothing, if needed
  • Hold firmly against the thigh for 5-10 seconds (depending on the manufacturer) to deliver the medication
  • Remove the device from the thigh and discard it

One final word of advice

Some patients may require more than one dose. It is also possible that despite your best efforts at teaching, the patient may inject their thumb or otherwise fail to use the device correctly. For that reason, it is a good idea to prescribe two auto-injectors.

Multiple studies clearly show that when physicians prescribe an EpiPen, they consistently teach improper technique and omit steps, even after reading the inserts in some cases. Here’s what your patient needs to know.

First-in-class drug for HF approved: Time to replace ACE inhibitors?

The approval of the first angiotensin-receptor/neprilysin inhibitor (ARNI) valsartan/sacubitril by the US Food and Drug Administration (FDA) for the treatment of heart failure with reduced ejection fraction (HFrEF) offers a new hope for patients, fueling a renewed excitement among cardiologists.

Dr. Clyde Yancy, cardiologist from the Northwestern University in Chicago, Illinois, US described the approval as “a new day in heart failure.” The approval came after an expedited review – reserved by the FDA for novel drugs believed to fill an unmet medical need – on the heels of the PARADIGM-HF* trial results last year which showed that valsartan/sacubitril (formerly called LCZ696) significantly reduced the risk of cardiovascular (CV) death and hospitalization for HF compared with the ACE inhibitor enalapril. [N Engl J Med 2014;371:993-1004]

The approval was the quickest for a CV drug in a long time and some experts are optimistic valsartan/sacubitril, given in the right patients, could replace ACE inhibitors, which are the standard of care in HF therapy.

Yancy, however, said more discussions are still needed. “We aren’t ready to offer [valsartan/sacubitril] carte blanche to everyone who comes to our offices.”

PARADIGM-HF was halted early in March, after a median follow-up of 27 months, because patients taking LCZ696 achieved a statistically significant reduction in CV deaths and HF hospitalizations despite being on beta-blockers and a diuretic. Cardiologists considered this a major step forward since only a few therapies have shown mortality reduction in HF or in other CV conditions.

Given the increasing morbidity in HF, hospitalizations, and cost of care, any new therapy that has an added benefit to – or is better than – ACE inhibitors is a potential game-changer, said Professor Carolyn Lam, senior consultant, National Heart Centre, Singapore and associate professor with the Duke-NUS Cardiovascular Academic Clinical Program. However, she added clinicians should approach this development with “cautious optimism.”

“The PARADIGM-HF trial is among the best phase III trials we have in the HF world, and results appear robust. However, I do not expect doctors will now replace ACE inhibitors with LCZ696 in all their stable patients,” said Lam. “As with all new agents, ‘real world’ or phase IV data are needed to inform clinicians as to which HF patients would be most likely to achieve benefit with the least risk.”

The FDA said valsartan/sacubitril should not be used with any ACE inhibitor because of increased risk of angioedema.

Simply standing more daily could reduce cardiometabolic risk

Standing, stepping, and engaging in other non-sitting activities for 2 hours daily significantly lowered glucose levels and improved total vs high-density lipoprotein (HDL) cholesterol ratios, both important cardiometabolic risk factors, according to a recent study.

Each additional 2 hours a day spent standing was associated with about 2 percent lower fasting plasma glucose, 6 percent lower total/HDL-cholesterol ratio, 14 percent lower triglyceride levels, 3 percent lower 2-hour plasma glucose and about 0.07 mmol/L higher HDL-cholesterol levels. [Eur Heart J 2015; doi:10.1093/eurheartj/ehv308]

Every 2 hours a day spent stepping was significantly linked to about 11 percent lower BMI, 8 cm lower waist circumference, 6 percent lower total/HDL-cholesterol ratio, 20 percent lower triglyceride levels, 14 percent lower 2-hour plasma glucose and about 0.14 mmol/L higher HDL-cholesterol levels. However, neither standing nor stepping was significantly associated with changes in systolic or diastolic blood pressure or HbA1C or LDL-cholesterol levels.

These results contrast with those spent in a sedentary position (sitting), where every additional 2 hours a day spent sitting was linked to about 3 percent higher BMI, 1 percent higher fasting plasma glucose, 5 percent higher total/HDL-cholesterol ratio, 12 percent higher triglyceride levels, 4 percent higher 2-hour plasma glucose levels, and 0.07 mmol/L lower HDL-cholesterol levels.

Every 2 hours spent stepping instead of sitting led to significant reductions in BMI (about 11 percent), waist circumference (7.5 cm) and post-load glucose levels (12 percent). On the other hand, every 2 hours spent standing instead of sitting led to significant reductions in fasting plasma glucose (about 2 percent), total/HDL-cholesterol ratio (6 percent) and triglyceride levels (11 percent), as well as 0.06 mmol/L higher HDL-cholesterol levels.

The study included 782 participants aged 36 to 80 years from the Australian Diabetes, Obesity and Lifestyle Study who were monitored for 24 hours per day for 7 days with an activPAL3TM monitor strapped to the thigh. [J Sci Med Sport 2014;17:293-299]

While the impact of physical activity on cardiometabolic risk factors has been confirmed, the findings suggest simply substituting standing for sitting could exert health benefits.

Early oocyte retrieval could boost fertility in older women

Age-related changes to cells that support egg development – not changes to the eggs themselves – are the key factors that reduce the likelihood of successful conception via in vitro fertilization (IVF) among older women. Early oocyte retrieval could neutralize those changes and improve fertility.

“We used to think that ageing eggs were responsible for poor IVF success rates in older women, but here we show that it is more due to the ageing of the egg’s environment”, said Dr. Yanguang Wu, embryologist and associate scientist at the Center for Reproductive Medicine in New York, New York, US. “The chances of reversing damage to an egg are practically zero and so these findings are exciting because it’s much more hopeful to therapeutically target the egg’s supporting environment.”

A comparison of granulosa cells (GCs), which surround oocytes and help them grow, showed that among young women (n=31, 21-29 years, oocyte donors in the study), GCs more commonly expressed follicle-stimulating hormone (FSH) receptors and, as they aged, the number of these receptors fell while the number of luteinising hormone (LH) and progesterone receptors increased among the middle aged (n=64, 3037 years) and particularly the older (n=41, 43-47 years) infertile women included in the study. [J Endocrinol 2015;JOE-15-0246]

The result of these changes in receptor expression likely explain why the chance of conception from IVF declines from 23.6 percent in women aged 38-39 to 1.3 percent among women aged 44 and older, the researchers note.

Premature luteinisation, which can happen if GCs are sensitised to LH with more LH receptors, arrests egg maturation in the process of preparing the uterus for pregnancy before the egg has left the ovary, which reduces the chance of pregnancy.

FSH response, which included cell proliferation, reduced apoptosis and some inhibited luteinisation, also seemed to decline as women aged.

To prevent premature luteinisation, the researchers conducted a pilot oocyte retrieval study in women over 43 (mean age 44.8±0.3 years) to collect follicles when they reached 16 mm rather than waiting until the normal 19-21 mm.

Compared to a group of 91 women over age 43 (n=91, mean age 44.3±0.15 years) who underwent normal retrieval, early retrieval of immature eggs produced more and better quality embryos and better IVF success rates.

Subsequent trials need to be powered to prove that early retrieval results in improved clinical pregnancy and live birth rates, the researchers said. However, “this study… with considerable certainty established non-inferiority for this new treatment and, with a reasonable level of likelihood suggest that early oocyte retrieval may improve IVF outcomes.”