Many articles have been written about endocrine disrupting chemicals and the numerous health problems they're linked to (see posts on them). It's been known for decades that endocrine-disrupting chemicals pose a danger to human health because the compounds can interfere with natural hormone function. Chemical exposure occurs through routine contact with plastic bottles, vinyl items, toys, food cans, cosmetics, flame retardants, and other consumer products containing "endocrine-disrupting chemicals". We ingest, breathe them in (inhalation), or absorb them through the skin as consumer products are used and also as consumer products break down (the dust).

Finally a study examines the financial cost of these chemicals - an estimate of more than $340 billion annually due to health care costs and lost wages (the authors say this is a conservative estimate). What can ordinary people do to lower their exposure to these chemicals? Avoid the use of pesticides in the home, lawns, and gardens. Eat as much organic foods as possible. Avoid buying food in cans, including soda. Store food in glass and stainless steel containers. Avoid microwaving in plastic containers (use glass instead). Avoid plastic bottles with the numbers 3, 6, and 7 on the bottom. Avoid vinyl items such as vinyl shower curtains and vinyl toys. Avoid fragrances (get unscented products). Read labels on lotions, shampoos, soaps, make-up - avoid phthalates and parabens. Avoid flame retardants (check the labels on new upholstered furniture). Avoid non-stick pots, avoid stain-repellant items, avoid air fresheners and dryer sheets. And that's just a partial list....From Environmental Health News:

Toxic economy: Common chemicals cost US billions every year

Exposure to chemicals in pesticides, toys, makeup, food packaging and detergents costs the U.S. more than $340 billion annually due to health care costs and lost wages, according to a new analysis. The chemicals, known as endocrine disruptors, impact how human hormones function and have been linked to a variety of health problems such as impaired brain development, lower IQs, behavior problems, infertility, birth defects, obesity and diabetes. The findings, researchers say, "document the urgent public threat posed by endocrine disrupting chemicals.” 

The researchers estimated costs by looking at exposures, then projecting 15 medical conditions linked to the chemicals and the associated health costs and lost wages. The findings are built upon calculations made by the Endocrine Society, the World Health Organization and the United Nations Environment Program. A similar study conducted in Europe found about $217 billion in annual costs due to exposure to these compounds. 

The U.S. public has greater exposure to flame retardant chemicals, due in part to stringent fire-safety rules. These compounds are added to furniture foam and electronics to slow the spread of flames. In Europe, pesticides were the main cost driver. Both flame retardants and certain pesticides can impact brain development when unborn babies are exposed..... Conversely, Europe has been much more proactive in tackling a particularly concerning groups of flame retardant chemicals called polybrominated diphenyl ethers (PBDEs).

PBDEs were the worst offenders in the U.S., accounting for nearly two thirds of the estimated health problems. PBDEs were estimated to annually cause about 11 million lost IQ points and 43,000 additional cases of intellectual disability to the tune of $268 billion. Pesticide exposure—the second most costly chemical group in the U.S.—causes an estimated 1.8 million lost IQ points and another 7,500 intellectual disability cases annually, with an estimated cost of $44.7 billion. The researchers also looked at common chemicals such as bisphenol-A (BPA), used in polycarbonate plastics, food tin cans and receipts; and phthalates, found in food containers and cosmetics.

Trasande countered that estimates are on the conservative side. Researchers calculated the health-related costs from just a fraction—less than 5 percent—of known endocrine disrupting chemicals, he said. “We also didn’t focus on chemicals already banned, such as persistent organic pollutants,” he said. Those compounds, which include DDT and PCBs, remain common in the environment and in human blood despite being off the market for years, even decades.

Trasande said the study highlights the need to address endocrine disruptor exposure in the United States, especially as the country updates the federal Toxic Substances Control Act. The 2016 updates to the act, which regulates both existing and new chemicals, contained no mention of endocrine disruption, Trasande said. Chemicals should be screened for any potential impacts to human hormones before they hit the marketplace, he added. 

While many of these toxics linger in the body for a long time, people can take steps to avoid exposure. “We can ask questions about flame retardants and perfluorinated compounds when we buy rugs and furniture, and choose products without these substances,” Grandjean said. “We can choose to avoid tuna and other large predatory species of fish, and we can choose organic fruits and leafy vegetables.”  (Original study)

Image result for dark chocolate Great news for chocolate lovers! A review of 19 good studies (studies with people randomly assigned to different conditions) found that chocolate (whether from cocoa products, chocolate, or cocoa beverages), overall had beneficial effects on cardiometabolic health, and that it may improve lipid metabolism, and reduce inflammation and insulin resistance. This held for both men and women. The main assumption is that it is the flavanols in chocolate that has the beneficial effects on health. From Medical Xpress:

Cocoa compound linked to some cardiovascular biomarker improvements

To the tantalizing delight of chocolate lovers everywhere, a number of recent studies employing various methods have suggested that compounds in cocoa called flavanols could benefit cardiovascular health. Now a systematic review and meta-analysis of 19 randomized controlled trials (RCTs) of cocoa consumption reveals some further pieces of supporting evidence..... "We found that cocoa flavanol intake may reduce dyslipidemia (elevated triglycerides), insulin resistance and systemic inflammation, which are all major subclinical risk factors for cardiometabolic diseases."

Liu noted some limitations in the trials. All studies were small and of short duration, not all of the biomarkers tracked in these studies changed for the better, and none of the studies were designed to test directly whether cocoa flavanol consumption leads to reduced cases of heart attacks or type 2 diabetes. But taking into account some of these heterogeneities across studies, the team's meta-analysis summarizing data from 19 trials found potential beneficial effects of flavanol-rich cocoa on cardiometabolic health. There were small-to-modest but statistically significant improvements among those who ate flavanol-rich cocoa product vs. those who did not.

The greatest effects were seen among trial volunteers who ate between 200 and 600 milligrams of flavanols a day (based on their cocoa consumption). They saw significant declines in blood glucose and insulin, as well as another indicator of insulin resistance called HOMA-IR. They also saw an increase in HDL, or "good," cholesterol. Those consuming higher doses saw some of the insulin resistance benefits and a drop in triglycerides, but not a significant increase in HDL. Those with lower doses of flavanols only saw a significant HDL benefit. 

In general, Lin said, where there were benefits they were evident for both women and men and didn't depend on what physical form the flavanol-rich cocoa product was consumed in —dark chocolate vs. a beverage, for example.

Mediterranean Diet is Healthy Eating – A Good Option for Seniors One of the dreaded afflictions of getting older is age-related macular degeneration (AMD), which is a leading cause of vision loss in Americans 60 years and older. It has no cure. Thus this study finding that eating a Mediterranean diet, and especially lots of fruit, was associated with a lower risk of macular degeneration was welcome news. They also found a protective effect from drinking caffeinated beverages - about 78 mg of caffeine per day (about one cup of coffee or one shot of espresso). A Mediterranean diet stresses eating fruits, vegetables, nuts, whole grains, legumes, fish, seeds, and olive oil. From Science Daily:

Fruit-rich Mediterranean diet with antioxidants may cut age-related macular degeneration risk by more than a third

People who closely follow the Mediterranean diet -- especially by eating fruit -- may be more than a third less likely to develop age-related macular degeneration, a leading cause of blindness, according to a study presented at AAO 2016, the 120th annual meeting of the American Academy of Ophthalmology. The study is the first to identify that caffeine may be especially protective against AMD.

Many studies have confirmed the health benefits of the Mediterranean diet, which emphasizes eating fruits, vegetables, whole grains, legumes, nuts, healthy fats and fish, and limiting red meat and butter. The diet has been shown to improve heart health and reduced risk of cancer, but there has been little research on whether its benefits can extend to eye disease. To determine this, researchers studied a Portuguese population to see whether adherence to the diet impacted people's risk of AMD. Their findings revealed a significant reduction in risk in those who ate a Mediterranean diet most frequently, and particularly among those who consumed more fruit and caffeine.

Researchers at the University of Coimbra in Portugal studied 883 people age 55 or older in the central region of the country between 2013 and 2015. Of those, 449 had AMD in its early stages before vision loss, and 434 did not have AMD. Researchers assessed their diets based on a questionnaire asking how often they ate foods associated with the Mediterranean diet. The more they ate foods associated with the diet, the higher the score, from 0-9. Those who closely followed the diet scored a 6 or greater. Their findings were as follows:

Higher diet adherence scores meant lower AMD risk Of those who did not closely follow the diet (scored below a 6), 50 percent had AMD. Of those who did closely follow the diet (scored 6 or above), only 39 percent had AMD. This represents a 35 percent lower risk compared to those who did not adhere to the diet.

Fruits were especially beneficial Researchers analyzed consumption of foods and found that people who consumed higher levels of fruit were significantly less likely to have AMD. Of those who consumed 150 grams (about five ounces) or more of fruit a day: 54.5 percent did not have AMD and 45.5 percent had AMD. Overall, people who ate that much fruit or more each day were almost 15 percent less likely to have AMD, based on an odds ratio calculation.

Caffeine and antioxidants also were protective Researchers used a computer program to analyze the participants' consumption of micronutrients, according to their answers on the questionnaire. They found higher consumption of antioxidants such as caffeine, beta-carotene and vitamins C and E was protective against AMD. Of those who consumed high levels of caffeine (about 78 mg a day, or the equivalent of one shot of espresso): 54.4 percent did not have AMD and 45.1 percent had AMD....The researchers opted to look at caffeine because it is a powerful antioxidant that is known to be protective against other conditions, such as Alzheimer's disease.

Image result for lawns with weeds, wikipedia Conserving native bees for their vital pollination services is of national interest. It turns out that an excellent way to save bees is to not treat lawns with herbicides (weed-killers) or any other pesticides. It turns out that lawns with "flowering weeds" (think wildflowers or flowering plant species such as dandelions and clover) are valuable nectar and pollen sources for all sorts of species of bees (and also for butterflies). And as much research shows, pesticides (insecticides, herbicides, fungicides) have all sorts of negative health effects - on humans, pets, and wildlife (here, herehere, and here).

Chemically treated lawns are "dead zones" with an absence of normally occurring plant species. In contrast, this study found 63 different flowering plant species in 17 suburban lawns that were NOT treated with any herbicides or pesticides over the 2 year study period. The bee species they found tend to travel only short distances and so lived within close proximity of the lawns with the flowering weeds. So do your bit for both human health and to protect bees, and don't treat lawns with chemicals. View what we now call lawn weeds as "spontaneous flowering plants" and that they are wildlife habitats. Of course using an organic fertilizer is OK, but just "mowing and leaving grass clippings" is also an excellent way to fertilize the lawn. From The University of Massachusetts at Amherst (press release):

To Help Bees, Skip Herbicides and Pesticides, Keep Lawns Naturally Diverse

Declining populations of pollinators is a major concern to ecologists because bees, butterflies and other insects play a critical role in supporting healthy ecosystems. Now a new study from urban ecologists at the University of Massachusetts Amherst suggests that when urban and suburban lawns are left untreated with herbicides, they provide a diversity of “spontaneous” flowers such as dandelions and clover that offer nectar and pollen to bees and other pollinators. 

Private lawns make up a significant part of urban lands in the United States, an estimated 50 percent of city and suburbs, say Susannah Lerman and co-author Joan Milam, an adjunct research fellow in environmental conservation. They write, “Practices that support nesting and foraging opportunities for bees could have important implications for bee conservation in suburban areas.” Lerman, an adjunct UMass Amherst faculty member who is also with the U.S. Forest Service, says, “We are still surprised at how many bees we found on these untreated lawns.” In this study of lawns in suburban Springfield, Mass., she and Milam found that “spontaneous lawn flowers could be viewed as supplemental floral resources and support pollinators, thereby enhancing the value of urban green spaces.”

For this study, supported by the National Science Foundation, the researchers enlisted owners of 17 lawns in suburban Springfield. Between May 2013 and September 2014, the homeowners did not apply chemical pesticides or herbicides to lawns. “We documented 63 plant species in the lawns, the majority of which were not intentionally planted,” the authors report. Lerman and Milam visited each yard six times per year for two years, collecting a total of 5,331 individual bees representing 111 species, of which 97 percent were native to North America.

Conserving native bees for their vital pollination services is of national interest, Lerman and Milam point out.....Overall, one of their main findings, say Lerman and Milam, is that “when lawns are not intensively managed, lawn flowers can serve as wildlife habitat and contribute to networks of urban green spaces.” Further, “developing outreach to homeowners and lawn care companies to encourage, rather than eliminate, lawn flowers such as dandelions and clover and thin grass cover or bare spots could be a key strategy for urban bee conservation programs targeting private yards.”

Original study from the Annals of the Entomological Society of America: Bee Fauna and Floral Abundance Within Lawn-Dominated Suburban Yards in Springfield, MA

Private yards comprise a significant component of urban lands, with managed lawns representing the dominant land cover. Lawns blanket > 163,000 km2 of the United States, and 50% of urban and suburban areas. When not treated with herbicides, lawns have the capacity to support a diversity of spontaneous (e.g., not planted) flowers, with the potential to provide nectar and pollen resources for pollinators such as native bees.....We collected 5,331 individual bees, representing 111 species, and 29% of bee species reported for the state. The majority of species were native to North America (94.6%), nested in soil (73%), and solitary (48.6%).

We recorded 63 different flowering plant species in 17 lawns during 2013 and 2014. Dandelion (Taraxacum officinale) was the most widespread flower, found in all lawns in both years (Table 4). White clover (Trifolium repens), purple violet (Viola sororia), yellow wood-sorrel (Oxalis stricta), Canadian horseweed (Conyza canadensis), annual fleabane (Erigeron annuus), dwarf cinquefoil (Potentilla canadensis), and Pennsylvania smartweed (Polygonum pensylvanicum) were recorded in at least 60% of all sites for the two years (Table 4). In 2013, horseweed, hairy rock cress (Arabis hirsute), and white clover represented more than 67% of all flowers, whereas in 2014, white clover, yellow wood-sorrel, purple smartweed and purple violet were the most abundant species.

  More bad news about BPA (bisphenol A) - an endocrine disrupter linked to a number of health problems, including reproductive disorders (here, here, and here). A new study has lent support for a  link between bisphenol A (BPA) exposure during pregnancy and later breast cancer. BPA can cross the placenta in the womb, and so expose the fetus, it has been found in placental tissue, and newborns can be exposed through breastfeeding. BPA is found in the urine of about 95% of the U.S. population.

It's hard to avoid BPA because it's found in so many products, but a person can lower exposure to it by avoiding canned products (it's in the can linings), as well as plastic bottles and containers, microwaving or heating food in plastic containers, and fast food (it's in the packaging and leaches into the food) . Glass and stainless steel is OK for storing food. By the way, BPA substitutes such as BPS  and BPSIP have the same negative health effects (because they're chemically similar) - so also avoid "BPA-free" products. From Endocrine News;

A Pervasive Threat: The Danger of in utero BPA Exposure

A new study presented at ENDO [Endocrine Society] 2016 revealed a possible link between bisphenol A exposure in utero to breast cancer later in life. In the process, the researchers created a new bioassay that can test chemicals much faster than typical animal studies. Almost every single person alive today has detectable amounts of endocrine-disrupting chemicals (EDCs) in his or her body, according to the 2015 joint Endocrine Society/IPEN publication Introduction to Endocrine Disrupting Chemicals (EDCs): A Guide for Public Interest Organizations and Policy-Makers.

These EDCs — phthalates (plasticizers), bisphenol A (BPA), polychlorinated biphenyls (PCBs), and others, in their bodies — are hormone-like industrial chemicals that did not even exist 100 or so years ago. Studies on human populations consistently demonstrate associations between the presence of certain chemicals and higher risks of endocrine disorders such as impaired fertility, diabetes, obesity, cardiovascular disorders, and cancer.

The xenoestrogen BPA is especially prevalent as a component used in rigid plastic products such as compact discs, food and beverage containers, food and formula can linings, and glossy paper receipts. In the case of food containers, when they are heated or scratched, the BPA can seep out into the food and then be ingested. BPA also escapes from water pipes, dental materials, cosmetics, and household products among others and is released into the environment or directly consumed. According to research, such exposures help account for why BPA has been found in the urine of a representative sample of 95% of the U.S. population.

Notably, BPA can cross the placenta in the womb, indirectly exposing the fetus — it has been found in both maternal and fetal serum as well as neonatal placental tissue. Newborns can also be directly exposed through breastfeeding.

The results of a study presented at ENDO 2016 provide compelling support for the idea that fetal exposure to BPA might increase risk for development of breast cancer in adulthood; in fact, it may explain why overall incidence increased in the 20th century. Lucia Speroni, PhD, a research associate and member of the Soto-Sonnenschein lab at Tufts University School of Medicine in Boston and the study’s lead investigator, reports, “We found that BPA acts directly on the mammary gland and that this effect is dose dependent: A low dose significantly increased ductal growth, whereas a high dose decreased it.”

“Because these effects are similar to those found when exposing the fetus through its mother, our experiment suggests that BPA acts directly on the fetal mammary gland, causing changes to the tissue that have been associated with a higher predisposition to breast cancer later in life,” Speroni explains. In replicating the process of mammary gland development in vitro, this method additionally allows for live observation throughout the whole process.....The lab team had previously shown that the most harmful time for exposure to BPA is during fetal development by causing alterations in the developing mammary gland.

Image result for calcium rich foods, wikipedia Once again, research shows that a supplement is not beneficial and may have some health harms, while eating foods rich in the mineral or vitamin being measured has health benefits. A ten year study found that calcium supplements are not beneficial and linked to health harm - they raised the risk of atherosclerosis, as measured by "coronary artery calcification" or plaque buildup in arteries, while a diet high in calcium rich foods was linked with health benefits (a protective effect). Other studies have found a higher risk for other health problems with calcium supplements (heart attacks, kidney stones, death),

Currently an estimated 43 percent of American adults take a supplement that includes calcium. Instead, for health benefits, focus on eating calcium rich foods. Some calcium rich foods are: dairy products (milk, cheese, yogurt, kefir), sardines, salmon, broccoli, collard greens, kale, edamame, figs, oranges, white beans, okra, tofu, and almonds. From Science Daily:

Calcium supplements may damage the heart

After analyzing 10 years of medical tests on more than 2,700 people in a federally funded heart disease study, researchers at Johns Hopkins Medicine and elsewhere conclude that taking calcium in the form of supplements may raise the risk of plaque buildup in arteries and heart damage, although a diet high in calcium-rich foods appears be protective.

In a report on the research....the researchers caution that their work only documents an association between calcium supplements and atherosclerosis, and does not prove cause and effect. But they say the results add to growing scientific concerns about the potential harms of supplements....But our study adds to the body of evidence that excess calcium in the form of supplements may harm the heart and vascular system.

"The researchers were motivated to look at the effects of calcium on the heart and vascular system because studies already showed that "ingested calcium supplements -- particularly in older people -- don't make it to the skeleton or get completely excreted in the urine, so they must be accumulating in the body's soft tissues," says nutritionist John Anderson, Ph.D., professor emeritus of nutrition at the University of North Carolina at Chapel Hill's Gillings School of Global Public Health and a co-author of the report. Scientists also knew that as a person ages, calcium-based plaque builds up in the body's main blood vessel, the aorta and other arteries, impeding blood flow and increasing the risk of heart attack.

Their study focused on 2,742 of these participants who completed dietary questionnaires and two CT scans spanning 10 years apart. The participants chosen for this study ranged in age from 45 to 84, and 51 percent were female. Forty-one percent were white, 26 percent were African-American, 22 percent were Hispanic and 12 percent were Chinese. At the study's onset in 2000, all participants answered a 120-part questionnaire about their dietary habits to determine how much calcium they took in by eating dairy products; leafy greens; calcium-enriched foods, like cereals; and other calcium-rich foods....The coronary artery calcium tests were repeated 10 years later to assess newly developing or worsening coronary heart disease.

Next, the investigators focused on the differences among those taking in only dietary calcium and those using calcium supplements. Forty-six percent of their study population used calcium supplements. The researchers.....found that supplement users showed a 22 percent increased likelihood of having their coronary artery calcium scores rise higher than zero over the decade, indicating development of heart disease....Among participants with highest dietary intake of calcium -- over 1,022 milligrams per day -- there was no increase in relative risk of developing heart disease over the 10-year study period.

Excerpts from the original study (Please note:  CVD = cardiovascular disease, CAC = coronary artery calcification) in the  Journal of the American Heart Association:  Calcium Intake From Diet and Supplements and the Risk of Coronary Artery Calcification and its Progression Among Older Adults: 10‐Year Follow‐up of the Multi‐Ethnic Study of Atherosclerosis (MESA)

Recent evidence derived from randomized, controlled trials, including the Women's Health Initiative, have raised a concern for an association between calcium supplement use and increased risk for CVD events.12, 13, 14 Among calcium supplement users, a high intake of calcium greater than 1400 mg/day has been reported to be associated with higher death rates from all causes, including from CVD.15

The purported CVD risk associated with total calcium intake may depend on the source of calcium intake.3 Intake of calcium from food sources has not been shown to increase CVD risk, whereas a signal for increased risk of myocardial infarction (MI) among calcium supplement users has been reported.7 In a similar fashion, dietary calcium intake may decrease risk of kidney stones, whereas calcium supplementation may increase risk.16 One explanation for this apparent paradox may be that large boluses of calcium intake through supplements may transiently elevate serum calcium concentrations,17, 18 which, in turn, may lead to vascular calcification and other adverse health effects.

In summary, results from this long‐term study of 10 years showed a protective relationship between total calcium intake and incident coronary atherosclerosis, particularly among nonsupplement users. Even though mean total calcium intake in quintile 5 was greater than the upper limits of current recommendations, no increased risk of CAC progression was found, and the highest quintile of calcium intake actually had decreased risk of incident CAC among those without prevalent CAC at baseline. However, we found evidence that calcium supplement use was independently associated with incident CAC, whether or not we adjusted for total calcium intake.

Image result My last post discussed Lactobacillus crispatus as an important bacteria for womens' vaginal health and as a possible treatment for bacterial vaginosis (BV) - a condition where the vaginal microbes are out of whack (dysbiosis). It appears that Lactobacillus crispatus may also be a possible treatment for women with urinary tract infactions (UTIs), a condition where again microbes are out of whack. The bacteria Lactobacillus crispatus is part of the vaginal microbiome of many healthy women and thought to be protective. It is unknown whether L. crispatus would also work for men with UTIs.

In the US, the vaginal suppository product Lactin-V (containing the freeze dried human vaginal strain of L. crispatus CTV-050) is currently being tested for both bacterial vaginosis and recurring urinary tract infections (UTIs). So far there are positive results for this product (manufactured by Osel, Inc.) in phase 2 clinical trials, but it may be years away from FDA approval. The following article excerpts are from April 2011, but these are still the most recent published research results for this probiotic (beneficial bacteria). The results are pretty convincing that beneficial bacteria might some day replace standard medical treatment (antibiotics) for UTIs.  The Lactin-V treatment in women with recurrent UTIs resulted in "robust and prolonged colonization with Lcrispatus" in the vagina, which resulted in reducing the incidence of UTIs by about 50%. But...the results also showed that which strain of L. crispatus the women had was important - some women had lots of one strain of "endogenous" L. crispatus - naturally occurring in them - that was not protective. could be that other microbes that are not being looked at are also important.

Of course researchers are also looking at other beneficial bacteria and there has been more recent research. D-Mannose and cranberry supplements have also been found to be effective in treating UTIs of many women (see herehere, and here), as well as changing the urine's acidity through diet. While studies typically focus on women, these other products also work for UTIs in men (D-Mannose and cranberry supplements seem to be especially effective). Looks like probiotics and alternative treatments (D-mannose, cranberry supplements, etc.) are the future in treating UTIs!

From Medscape: Probiotic May Help Prevent Recurrent Urinary Tract Infection

In a randomized, double-blind phase 2 study, an intravaginal probiotic composed of Lactobacillus crispatus CTV-05 (Lactin-V, Osel Inc) reduced the rate of recurrent urinary tract infection (rUTI) in UTI-prone women by roughly one half, which compares favorably with historical data on antimicrobial prophylaxis, the researchers say. They add that larger trials are warranted to see whether use of vaginal Lactobacillus could replace long-term antimicrobial preventive treatments in women susceptible to rUTI.

UTIs are common in women and frequently recur, Ann Stapleton, MD, from the University of Washington in Seattle, and colleagues note in their report. It has been shown, they add, that women with rUTIs [recurrent UTIs] often have alterations in vaginal microbiota, including depletion of lactobacilli.

A phase 1 study of Lactobacillus crispatus CTV-05 showed that the probiotic can be given as a vaginal suppository with minimal adverse effects to healthy women with a history of rUTI. In the phase 2 study, 100 premenopausal women (median age, 21 years) with a history of rUTI received antimicrobials for acute UTI and then were randomly assigned to receive either Lactobacillus crispatus CTV-05 or placebo vaginal suppository gelatin capsules administered once daily for 5 days, followed by once weekly for 10 weeks.

"We found that Lactin-V reduced the risk of rUTI approximately as effectively as antimicrobial prophylaxis, achieved high-level vaginal colonization in most women, and was well tolerated," Dr. Stapleton and colleagues report. According to the investigators, culture-confirmed rUTI occurred in 7 (15%) of 48 of women who received Lactobacillus crispatus CTV-05 compared with 13 (27%) of 48 women who received placebo.

A high level of vaginal colonization with L crispatus throughout follow-up was associated with a significant reduction in rUTI only among women receiving Lactobacillus crispatus CTV-05. What was "striking," the investigators add, was that placebo-treated women often had high concentrations of vaginal L crispatus during follow-up, yet this failed to protect them from rUTI. In contrast, women who received Lactobacillus crispatus CTV-05 and achieved high colonization were protected from rUTI. "Lactin-V after treatment for acute UTI," they conclude, "confers a significant advantage over repopulation of the vaginal microbiota with endogenous L. crispatus." [The original study.]

Image result Lactobacillus crispatus  Credit:MicrobeWiki

Image result Today I read an interesting article about bacterial vaginosis and research on bacteria that could finally treat it effectively. Bacterial vaginosis (BV) appears to be a problem with the microbial community of a woman's vagina being out of whack (dysbiosis). Common symptoms include increased white or gray vaginal discharge that often smells like fish, there may be burning with urination and sometimes itching, and the discharge has higher than normal vaginal pH (alkaline). One bacteria that seems to be very important and beneficial for vaginal health is Lactobacillus crispatus. Research suggests that L. crispatus may be a treatment for both bacterial vaginosis and urinary tract infections. Currently the treatment for BV is a course of antibiotics, but the problem recurs frequently.

In the US, the vaginal product Lactin-V (containing the freeze dried human vaginal strain of L. crispatus CTV-05, and used as an vaginal suppository) is currently being tested (with so far positive results in phase 2 clinical trials) for both bacterial vaginosis and recurrent urinary tract infections (UTIs). But it may be years away from FDA approval. The biopharmaceutical company Osel Inc. is currently conducting research on this product, and as of May 2016 is recruiting women for a phase 2b clinical study of this product in the US.

Other sources that I know of for the bacteria L. crispatus are: the probiotic Ordesa DonnaPlus+Intimate Flora (manufactured in Spain) and NaturaMedicatrix LactoGyn Crispatus Bio (made in Luxembourg). However, these are different strains of L. crispatus than what has been successfully tested using Lactin-V. (It is unknown whether this makes a difference.) Both are meant to be taken orally (swallowed daily) - which may or may not be an effective way to get L. crispatus in the vagina (it is unknown which way works best).

Other probiotics, especially Lactobacillus species, may also benefit vaginal health. One way to get an idea of products women find helpful is to look at user comments after products listed on Amazon. (By the way - douches, sprays, wipes, deodorizers, and special soaps will not help bacterial vaginosis.... Not at all.).

The following article was written by science journalist Kendall Powell. Do click on the link and read the entire article to get an idea of the complexity of the problem, the role of various bacteria in vaginal health, other health problems that occur with BV, ethnic differences, and how certain bacteria can alter vaginal mucus (leaving women vulnerable to infection). It is clear that much is unknown, but it looks like vaginal health depends on a "healthy microbial community". Excerpts from Mosaic:

The superhero in your vagina

The aisle is marked with a little red sign that says “Feminine Treatments”. Squeezed between the urinary incontinence pads and treatments for yeast infections, there is a wall of bottles and packages in every pastel shade imaginable. Feminine deodorant sprays, freshening wipes, washes for your “intimate area”.

Vaginal odor might be the last taboo for the modern woman.....The companies behind these products know that many women are looking for ways to counter embarrassing and debilitating symptoms such as vaginal odor and discharge. The culprit is often bacterial vaginosis, the most common vaginal infection you’ve probably never heard of. Nearly one-third of US women of reproductive age have it at any given time. The sad truth is that these sprays, soaps and wipes will not fix the problem. They will – in many cases – actually make it worse.

But while women try to mask embarrassing smells, a more sinister truth also remains under cover: the bacteria responsible are putting millions of women, and their unborn babies, at risk from serious health problems. All of which is making researchers look anew at the most private part of a woman’s body, to understand what it means to have a healthy – some prefer “optimal” – vagina and why that is so important for wider health.

Compared with those of other mammals, the human vagina is unique. As warm, moist canals exposed to all sorts of things including penises, babies and dirt, most mammalian vaginas harbour a diverse mix of bacteria. However, for many women, one or another species of Lactobacillus has become the dominant bacterial resident. Lactobacillus bacteria pump out lactic acid, which keeps the vaginal environment at a low, acidic pH that kills or discourages other bacteria, yeast and viruses from thriving. There are even hints that certain Lactobacillus species reinforce the mucus in the vagina that acts as a natural barrier to invaders.

For the most part, we’ve been happily cohabitating ever since, but it’s a delicate balancing act. Normal intrusions to the vaginal environment, such as semen (which causes vaginal pH to rise) or menstruation, can reduce numbers of Lactobacillus and allow other microbes, including those associated with bacterial vaginosis (BV), to flourish.

Her doctor explained that BV is a disturbance of the natural balance of bacteria that live inside the vagina. Sex with someone new, having multiple partners, and douching – rinsing out the vagina with a bag or bottle of liquid – can all contribute to getting BV, but it is not classified as a sexually transmitted disease. Mostly, how a woman develops BV is still a big mystery.

And if the embarrassment and discomfort weren’t enough, BV has a far more menacing side. Women affected have a higher risk of contracting sexually transmitted infections (STIs) like gonorrhoea and chlamydia, acquiring and transmitting HIV, and having pelvic inflammatory disease (which can lead to infertility) and other vaginal and uterine infections. During pregnancy, BV gives a woman a greater chance of having a preterm birth or passing infections to her baby, both of which can lead to lifelong problems for the baby.

Holmes felt the syndrome should be renamed bacterial vaginosis, which loosely translates to “too much bacteria”. And fulfilling three of the four Amsel criteria – thin vaginal discharge, vaginal pH greater than 4.5, positive whiff test and clue cells – is still used by many doctors today to diagnose BV.

They are realising that all Lactobacillus bacteria – long thought to keep vaginas healthy – are not created equal. For some researchers, L. crispatus is emerging as the vagina’s superhero. It not only pumps out the best mix of two different types of lactic acid to keep the vagina inhospitable to other bugs, but it also fortifies a woman’s vaginal mucus to trap and keep at bay HIV and other pathogens.

In 2011, Larry Forney, an evolutionary ecologist at University of Idaho in Moscow, and Jacques Ravel, a microbial genomicist from the University of Maryland School of Medicine in Baltimore, sequenced the bacterial species found in the vaginas of nearly 400 North American women who didn’t have the symptoms of BV. They found five different types of bacterial community. Four of these were dominated by different Lactobacillus species, but the fifth contained a diverse mix of microbes (including Gardnerella, Sneathia, Eggerthella and Mobiluncus species), many of which have been associated with BV. 

The African studies leave researchers clamouring for better solutions for these women. Like others, van de Wijgert believes that the solution lies in getting the right bacteria to set up house in women’s vaginas. In 2014, she found that Rwandan sex workers with L. crispatus dominant in their vaginas were less likely to have HIV and other STIs. This bacterium may have even protected the clients of HIV-positive sex workers somewhat, because these women were also less likely to shed HIV in the vagina.

Image result Lactobacillus crispatus Credit: MicrobeWiki

Image result for yoga wikipedia A recent study found that yoga is as good as physical therapy in reducing chronic back pain in a diverse group of low-income patients. In those sticking with the program and attending the most yoga classes, yoga was better in the long-term than physical therapy and much better than just receiving educational advice about back pain. Both physical therapy and yoga reduced pain medication use by 20% at 12 weeks. These findings are supported by other research finding that yoga improves pain, function, reduces medication use, and practicing yoga long-term results in positive brain changes (such as more gray matter in the brain). From Medscape:

Yoga as Good as Physical Therapy for Back Pain

Yoga is as good as physical therapy (PT) in reducing chronic low back pain, the most common pain problem in the United States, new research shows. "Our study showed that yoga was noninferior to physical therapy for a diverse group of low-income patients," said Robert B. Saper, MD, director of integrative medicine, Boston Medical Center, Massachusetts. "Its effectiveness was most obvious in the most adherent patients." Dr Saper presented his study at the American Academy of Pain Management (AAPM) 2016 Annual Meeting. 

Previous research has shown that yoga improves pain and function and reduces medication use. For example, a 2013 meta-analysis demonstrated small to medium effect sizes for yoga in short-term and long-term back pain–related disability. Research also shows that PT is effective in treating patients with back pain. PT is considered a conventional therapy and is the most common nonpharmacologic referral by physicians for chronic low back pain, Dr Saper said. 

For this new study, researchers enrolled 320 adult patients from Boston-area community health centers who had chronic back pain with no obvious anatomic cause, such as spinal stenosis. The patients were predominantly nonwhite and low income, with a relatively low education level. The patients had "quite high" pain scores (average of 7 out of 10 on a pain scale) and were "quite disabled" in terms of their back pain, said Dr Saper. Almost three quarters were using pain medication, with about 20% taking opioids....Patients were randomly assigned to one of three groups: yoga, PT, or education.

To develop the structured yoga protocol, Dr Saper and his colleagues organized an expert panel, which reviewed the literature on the topic. The final product was a 75-minute weekly class with a very low student-to-teacher ratio. The classes began with short segment on yoga philosophy (nonviolence, moderation, self-acceptance). Participants were then given mats on which to do the simple yoga poses. They received a DVD to practice these at home. The PT group had 15 one-on-one 60-minute sessions that included aerobic exercise. PT personnel were trained to help coach patients on fear avoidance. The education group got a comprehensive book on back pain.

Both the PT and yoga sessions continued for 12 weeks, after which patients were followed to 52 weeks. During this postintervention period, patients in both the yoga and PT groups were randomly assigned to maintenance (drop in yoga classes or more PT sessions) or just at-home practice. Overall adherence was not great. The mean number of yoga classes and PT sessions attended during the initial phase was 7.

The primary question being addressed was whether yoga is not inferior to PT at 12 weeks. The study showed that for function (score on the Roland-Morris Disability Questionnaire), yoga and PT "are exactly the same, ie noninferior," said Dr Saper, adding that, "they are not terribly different from education at 12 weeks...."What that means is that for every two patients who go to yoga, about 50% of them are going to have a clinical response."....comparing the various interventions, "yoga is actually superior" to PT and is "quite a bit" superior to education, said Dr Saper. At baseline, about 70% of participants were using medication. At 12 weeks, such use was down by about 20% in both the yoga and PT groups, and hadn't changed in the education group. A similar number of yoga and PT subjects reported being "very improved" and "very satisfied," said Dr Saper.

Yoga proved to be safe, with only mild, usually transient exacerbations of back pain.....Larger studies are needed to develop better strategies to enhance adherence, he said. The new study "adds to our knowledge in suggesting that a) yoga is as good as the standard of care, non pharmacologic therapy, and b) it can be done in a diverse population, including a low income, non-English speaking population in Boston. So it takes away some of those barriers to recommending it."

There's also evidence that yoga has a positive impact on the brain. According to M. Catherine Bushnell, PhD, National Center for Complementary and Integrative Health, National Institutes of Health, long-time yoga practitioners have more gray matter than matched physically active controls. "Gray matter goes down with age, but yoga practitioners have a flat line; you don't see this age-related decrease in gray matter that you see in other healthy people,".... And there seems to be "quite a robust" relationship between how long a person has done yoga and positive brain changes, she said. "The number of years a person has practiced yoga, the more gray matter at multiple sites in the brain." Yoga influences areas of the brain that are important for pain modulation, said Dr Bushnell. It is a "complex activity" that involves not only exercise but also breath control and meditation.

Image result for yoga wikipedia  Ustrasana  Yoga position photos  Credit:Wikipedia

 More great news about drinking coffee daily - for women. Older women (between ages of 65 to 80 at the start of the study) reporting drinking higher amounts of caffeinated beverages (about 261 mg which is about 2 to 3 cups of coffee per day) had a lower incidence of dementia and cognitive impairment over a 10 year period (as compared to the low caffeine group). The low caffeine group averaged 64 mg of caffeine per day.  Other studies also found a reduction in "cognitive decline" in older people with coffee consumption. This study, among others, is more evidence of caffeine being "neuroprotective". NOTE: an 8-ounce cup of brewed coffee contains about 95 mg of caffeine, 8-ounces of brewed black tea contains about 47 mg, a 12-ounce can of carbonated cola contains 33 mg, and 8-ounces of decaffeinated coffee has about 5 mg of caffeine. Science Daily:

For women, caffeine could be ally in warding off dementia

Among a group of older women, self-reported caffeine consumption of more than 261 mg per day was associated with a 36 percent reduction in the risk of incident dementia over 10 years of follow-up. This level is equivalent to two to three 8-oz cups of coffee per day, five to six 8-oz cups of black tea, or seven to eight 12-ounce cans of cola.

"The mounting evidence of caffeine consumption as a potentially protective factor against cognitive impairment is exciting given that caffeine is also an easily modifiable dietary factor with very few contraindications," said Ira Driscoll, PhD, the study's lead author and a professor of psychology at the University of Wisconsin-Milwaukee. "What is unique about this study is that we had an unprecedented opportunity to examine the relationships between caffeine intake and dementia incidence in a large and well-defined, prospectively-studied cohort of women."

The findings come from participants in the Women's Health Initiative Memory Study, which is funded by the National Heart, Lung, and Blood Institute. Driscoll and her research colleagues used data from 6,467 community-dwelling, postmenopausal women aged 65 and older who reported some level of caffeine consumption. Intake was estimated from questions about coffee, tea, and cola beverage intake, including frequency and serving size.

In 10 years or less of follow-up with annual assessments of cognitive function, 388 of these women received a diagnosis of probable dementia or some form of global cognitive impairment. Those who consumed above the median amount of caffeine for this group (with an average intake of 261 mg per day) were diagnosed at a lower rate than those who fell below the median (with an average intake of 64 mg per day). The researchers adjusted for risk factors such as hormone therapy, age, race, education, body mass index, sleep quality, depression, hypertension, prior cardiovascular disease, diabetes, smoking, and alcohol consumption. (The original study in the Journal of Gerontology.)