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This new research suggests possible future treatments in treating urinary tract infections (UTIs) by manipulating the person's diet and so influencing gut microbes and urinary pH (how acidic is the urine). These possible future treatments are different than what others are looking for, which are bacteria (probiotics) that one can take to prevent or treat UTIs. (Earlier posts on treating UTIs are here and here,)

The researchers found that during UTIs, humans secrete siderocalin which helps the body fight infection by depriving bacteria of iron (a mineral necessary for bacterial growth), and that samples that were less acidic, and closer to the neutral pH of pure water, showed higher activity of the protein siderocalin and were better at restricting bacterial growth than the more acidic samples.

The researchers found that the presence of small metabolites called aromatics, which vary depending on a person's diet, also contributed to variations in bacterial growth. Samples that restricted bacterial growth had more aromatic compounds, and urine that permitted bacterial growth had fewer. Stay tuned for follow-up research. 

One of the researchers, Dr. Jeffrey P. Henderson, pointed out that physicians already know how to raise urinary pH with things like calcium supplements, and alkalizing agents are already used in the U.K. as over-the-counter UTI treatments. But knowing how to encourage the metabolites is trickier, but will involve dietary changes. Some good food sources include those rich in antioxidants: coffee, tea, colorful berries, cranberries, and red wine.

From Science Daily: A person's diet, acidity of urine may affect susceptibility to UTIs

The acidity of urine -- as well as the presence of small molecules related to diet -- may influence how well bacteria can grow in the urinary tract, a new study shows. The research may have implications for treating urinary tract infections, which are among the most common bacterial infections worldwide. Urinary tract infections (UTIs) often are caused by a strain of bacteria called Escherichia coli (E. coli), and doctors long have relied on antibiotics to kill the microbes. But increasing bacterial resistance to these drugs is leading researchers to look for alternative treatment strategies.

"Many physicians can tell you that they see patients who are particularly susceptible to urinary tract infections," said senior author Jeffrey P. Henderson​, MD, PhD,...With this in mind, Henderson and his team, including first author Robin R. Shields-Cutler, a graduate student in Henderson's lab, were interested in studying how the body naturally fights bacterial infections. They cultured E. coli in urine samples from healthy volunteers and noted major differences in how well individual urine samples could harness a key immune protein to limit bacterial growth. "We could divide these urine samples into two groups based on whether they permitted or restricted bacterial growth," Henderson said. "Then we asked, what is special about the urine samples that restricted growth?"

The urine samples that prevented bacterial growth supported more activity of this key protein, which the body makes naturally in response to infection, than the samples that permitted bacteria to grow easily. The protein is called siderocalin, and past research has suggested that it helps the body fight infection by depriving bacteria of iron, a mineral necessary for bacterial growth. Their data led the researchers to ask if any characteristics of their healthy volunteers were associated with the effectiveness of siderocalin.

"Age and sex did not turn out to be major players," Shields-Cutler said. "Of all the factors we measured, the only one that was really different between the two groups was pH -- how acidic or basic the urine was."Henderson said that conventional wisdom in medicine favors the idea that acidic urine is better for restricting bacterial growth. But their results were surprising because samples that were less acidic, closer to the neutral pH of pure water, showed higher activity of the protein siderocalin and were better at restricting bacterial growth than the more acidic samples.

Importantly, the researchers also showed that they could encourage or discourage bacterial growth in urine simply by adjusting the pH, a finding that could have implications for how patients with UTIs are treated.

"Physicians are very good at manipulating urinary pH," said Henderson, who treats patients with UTIs. "If you take Tums, for example, it makes the urine less acidic. But pH is not the whole story here. Urine is a destination for much of the body's waste in the form of small molecules. It's an incredibly complex medium that is changed by diet, individual genetics and many other factors."

After analyzing thousands of compounds in the samples, the researchers determined that the presence of small metabolites called aromatics, which vary depending on a person's diet, also contributed to variations in bacterial growth. Samples that restricted bacterial growth had more aromatic compounds, and urine that permitted bacterial growth had fewer.

Henderson and his colleagues suspect that at least some of these aromatics are good iron binders, helping deprive the bacteria of iron. And perhaps surprisingly, these molecules are not produced by human cells, but by a person's gut microbes as they process food in the diet."Our study suggests that the body's immune system harnesses dietary plant compounds to prevent bacterial growth," Henderson said. "We identified a list of compounds of interest, and many of these are associated with specific dietary components and with gut microbes."

Indeed, their results implicate cranberries among other possible dietary interventions. Shield-Cutler noted that many studies already have investigated extracts or juices from cranberries as UTI treatments but the results of such investigations have not been consistent.

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The study results of 218 overweight, postmenopausal women who had insufficient levels of vitamin D (like most people) at the beginning of the study found that weight loss (including exercise), in combination with vitamin D supplementation, had a greater effect on reducing chronic inflammation than weight loss alone.

Current thinking is that chronic inflammation is linked to various chronic diseases as well as cancers. So reducing chronic inflammation is good. From Medical Xpress:

Weight loss plus vitamin D reduces inflammation linked to cancer, chronic disease

For the first time, researchers at Fred Hutchinson Cancer Research Center have found that weight loss, in combination with vitamin D supplementation, has a greater effect on reducing chronic inflammation than weight loss alone. Chronic inflammation is known to contribute to the development and progression of several diseases, including some cancers.

"We know from our previous studies that by losing weight, people can reduce their overall levels of inflammation, and there is some evidence suggesting that taking vitamin D supplements can have a similar effect if one has insufficient levels of the nutrient," said lead and corresponding author Catherine Duggan, Ph.D., a principal staff scientist in the Public Health Sciences Division at Fred Hutch. 

To explore this question, Duggan and colleagues recruited 218 healthy, overweight older women who had lower-than-recommended levels of vitamin D (less than 32 ng/mL). The women then took part in a 12-month diet and exercise program (including 45 minutes of moderate-to-vigorous exercise five days a week). Half of the study participants were randomly selected to receive 2,000 IU of vitamin D daily for the duration of the year-long trial, and the other half received an identical-appearing placebo, or dummy vitamin. 

At the end of the study, all of the participants had reduced levels of inflammation, regardless of whether they took vitamin D, "which highlights the importance of weight loss in reducing inflammation," Duggan said. However, those who saw the most significant decline in markers of inflammation were those who took vitamin D and lost 5 to 10 percent of their baseline weight. These study participants had a 37 percent reduction in a pro-inflammatory cytokine called interleukin-6, or IL-6, as compared to those in the placebo group, who saw a 17.2 percent reduction in IL-6. The researchers found similar results among women in the vitamin D group who lost more than 10 percent of their starting weight. While IL-6 has normal functions in the body, elevated levels are associated with an increased risk of developing certain cancers and diabetes and may be implicated as a cause of depression, Duggan said.

Inflammation occurs when the body is exposed to pathogens, such as bacteria or viruses, which puts the immune system in overdrive until the "attack" ceases and the inflammatory response abates. Overweight or obese people, however, exist in a state of chronic inflammation. This sustained upregulation of the inflammatory response occurs because fat tissue continually produces cytokines, molecules that are usually only present for a short time, while the body is fighting infection, for example.

"It is thought that this state of chronic inflammation is pro-tumorigenic, that is, it encourages the growth of cancer cells," she said. There is also some evidence that increased body mass "dilutes" vitamin D, possibly by sequestering it in fat tissue."Weight loss reduces inflammation, and thus represents another mechanism for reducing cancer risk," Duggan said. "If ensuring that vitamin D levels are replete, or at an optimum level, can decrease inflammation over and above that of weight loss alone, that can be an important addition to the tools people can use to reduce their cancer risk."

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Foods with trans fats. Credit: Wikipedia.

Finally the FDA is phasing out the use of artificial trans fats in foods (found in partially hydrogenated vegetable oils) within 3 years. It turns out that even though for many years scientists and the medical community pushed foods such as margarine (which have trans fats) as healthier than saturated fats such as butter, they were wrong. Instead the trans fats are linked to cardiovascular problems.

We can thank 100 year old Frank Kummerow for the ban, and for warning about trans fats for six decades! He is still drinking whole milk, eating eggs and butter, but he does avoid "fried foods, margarine, and anything associated with partially-hydrogenated oils". Other foods that are currently viewed as healthy by the medical community are extra virgin olive oil and coconut oil. However, please note that canola oil, currently viewed as a healthy and safe alternative to partially hydrogenated oils, also contains trans fats (due to the manufacturing process) and should be avoided. Also keep in mind that companies are allowed to say they have zero trans fat of they contain less than 0.5 grams per serving (which means the trans fats can add up over the course of a day). From The Washington Post:

The 100-year-old scientist who pushed the FDA to ban artificial trans fat

No one was more pleased by the Food and Drug Administration's decision Tuesday to eliminate artificial trans fats from the U.S. food supply than Fred Kummerow, a 100-year-old University of Illinois professor who has warned about the dangers of the artery-clogging substance for nearly six decades."Science won out," Kummerow, who sued the FDA in 2013 for not acting sooner, said in an interview from his home in Illinois. "It's very important that we don't have this in our diet."

In the 1950s, as a young university researcher, Kummerow convinced a local hospital to let him examine the arteries of people who had died from heart disease. He made a jarring discovery. The tissue contained high levels of artificial trans fat, a substance that had been discovered decades earlier but had become ubiquitous in processed foods throughout the country.

Later, he conducted a study showing that rats developed atherosclerosis after being fed artificial trans fats. When he removed the substance from their diets, the atherosclerosis disappeared from their arteries.

Kummerow first published his research warning about the dangers of artery-clogging trans fats in 1957. More than a decade later, while serving on a subcommittee of the American Heart Association, he detailed the massive amounts of trans fat in the shortening and margarines lining grocery shelves, and helped convince the food industry to lower the content in certain products.

Despite Kummerow's research and warnings over the years, artificial trans fats remained a staple of processed food for decades. Well into the 1980s, many scientists and public health advocates believed that partially hydrogenated oils were preferable to more natural saturated fats. And the food industry was reluctant to do away with artificial trans fats, which were cheaper than their natural counterparts, extended shelf life and gave foods desirable taste and texture.

Frustrated by the lack of action, Kummerow filed a 3,000-word citizen petition with the FDA in 2009, citing the mounting body of evidence against trans fat. The first line read: "I request to ban partially hydrogenated fat from the American diet."

In the 1990s, more and more studies had shown that trans fats were a key culprit in the rising rates of heart disease. The advocacy group Center for Science in the Public Interest also petitioned the FDA in 1994 to require that the substance be listed on nutrition labels -- a move that the agency put into place in 2006. In 2002, the Institute of Medicine found that there was “no safe level of trans fatty acids and people should eat as little of them as possible.” As the dangers of trans fat became clearer, public opinion also shifted, and food companies increasingly removed the substance from products, though it remained in a broad range of foods, from cake frostings to baked goods.

Four years after filing his petition and hearing nothing, Kummerow sued the FDA and the Department of Health and Human Services in 2013, with the help of a California law firm. The suit asked a judge to compel the agency to respond to Kummerow's petition and "to ban partially hydrogenated oils unless a complete administrative review finds new evidence for their safety."

Three months later, the FDA announced its plans to effectively eliminate trans fats by saying that the substance no longer would be assumed safe for use in human foods. Tuesday's action finalizes that initial proposal, and manufacturers will have three years to reformulate products or to petition the agency for an exception.

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New research finding health benefits to humans from a four day low calorie diet - the Fasting Mimic Diet (FMD). Cutting calories to 34 to 54% of normal for a few days is obviously much easier to do than actual fastiing, so these results look very promising. In summary: the researchers found that in a small human trial, three cycles of this diet given to 19 subjects once a month for five days decreased risk factors and biomarkers for aging, diabetes, cardiovascular disease and cancer (and with no major adverse side effects). Three earlier posts on various types of minifasting health benefits: Minifasting May Benefit Health, Health Benefits of Feast and Famine Diet, Fasting and the Immune System. From Science Daily:

Diet that mimics fasting appears to slow aging

Want to lose abdominal fat, get smarter and live longer? New research led by USC's Valter Longo shows that periodically adopting a diet that mimics the effects of fasting may yield a wide range of health benefits. In a new study, Longo and his colleagues show that cycles of a four-day low-calorie diet that mimics fasting (FMD cut visceral belly fat and elevated the number of progenitor and stem cells in several organs of old mice -- including the brain, where it boosted neural regeneration and improved learning and memory.

The mouse tests were part of a three-tiered study on periodic fasting's effects -- testing yeast, mice and humans...Mice, which have relatively short life spans, provided details about fasting's lifelong effects. Yeast, which are simpler organisms, allowed Longo to uncover the biological mechanisms that fasting triggers at a cellular level. And a pilot study in humans found evidence that the mouse and yeast studies were applicable to humans.

In a pilot human trial, three cycles of a similar diet given to 19 subjects once a month for five days decreased risk factors and biomarkers for aging, diabetes, cardiovascular disease and cancer with no major adverse side effects, according to Longo.

The diet slashed the individual's caloric intake down to 34 to 54 percent of normal, with a specific composition of proteins, carbohydrates, fats and micronutrients. It decreased amounts of the hormone IGF-I, which is required during development to grow, but it is a promoter of aging and has been linked to cancer susceptibility. It also increased the amount of the hormone IGFBP-, and reduced biomarkers/risk factors linked to diabetes and cardiovascular disease, including glucose, trunk fat and C-reactive protein without negatively affecting muscle and bone mass.

Longo has previously shown how fasting can help starve out cancer cells while protecting immune and other cells from chemotherapy toxicity. 'It's about reprogramming the body so it enters a slower aging mode, but also rejuvenating it through stem cell-based regeneration,' Longo said. 'It's not a typical diet because it isn't something you need to stay on.'

For 25 days a month, study participants went back to their regular eating habits -- good or bad -- once they finished the treatment. They were not asked to change their diet and still saw positive changes. Longo believes that for most normal people, the FMD can be done every three to six months, depending on the abdominal circumference and health status. For obese subjects or those with elevated disease risk factors, the FMD could be recommended by the physician as often as once every two weeks. His group is testing its effect in a randomized clinical trial, which will be completed soon, with more than 70 subjects.

Despite its positive effects, Longo cautioned against water-only fasting and warned even about attempting the fasting mimicking diet without first consulting a doctor and seeking their supervision throughout the process....Longo also cautioned that diabetic subjects should not undergo either fasting or fasting mimicking diets while receiving insulin, metformin or similar drugs. He also said that subjects with body mass index less than 18 should not undergo the FMD diet.

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Elderly people (average age was 77 years) who have been married a long time (average length of marriage was 44 years, but one couple was married 76 years!) give advice on marriage and love. The gerontologist  Karl Pillemer details the finding of the Cornell Marriage Advice Project in his book, "30 Lessons for Loving: Advice from the Wisest Americans on Love, Relationships, and Marriage."  From Science Daily:

Love, factually: Gerontologist finds the formula to a happy marriage

A gerontologist has uncovered common advice for couples walking down the aisle or decades into marriage. To capture the voice of lived experience, the study included a random national survey of nearly 400 Americans age 65 and older, asking how to find a compatible partner and other advice on love and relationships. In subsequent in-person interviews with more than 300 long-wedded individuals -- those in unions of 30, 40, 50, or more years -- the study captured more insights for overcoming common marriage troubles. The team of researchers interviewed divorced individuals, too, asking how others might avoid marital breakups.

Pillemer uncovered common advice for couples walking down the aisle or decades into marriage. The top five lessons from the elders..:

Learn to communicate: "For a good marriage, the elders overwhelmingly tell us to 'talk, talk, talk.' They believe most marital problems can be solved through open communication, and conversely many whose marriages dissolved blamed lack of communication."

Get to know your partner very well before marrying: "Many of the elders I surveyed married very young; despite that fact, they recommend the opposite.

Treat marriage as an unbreakable, lifelong commitment

Learn to work as a team: ...Concretely, this viewpoint involves seeing problems as collective to the couple, rather than the domain of one partner. Any difficulty, illness, or setback experienced by one member of the couple is the other partner's responsibility."

Chose a partner who is very similar to you: "Marriage is difficult at times for everyone, the elders assert, but it's much easier with someone who shares your interests, background and orientation. The most critical need for similarity is in core values regarding potentially contentious issues like child-rearing, how money should be spent and religion."

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This latest study finding health benefits of eating nuts was a review of 36 observational studies, involving a total of 30,000 people. Nut consumption was associated with a lower risk of cancer in general, and a decreased risk of some types of cancer (colorectal, endometrial, pancreatic), but not with type 2 diabetes. So go ahead - eat a small handful of nuts for your health at least several times a week.From Medpage Today:

A Nutty Way to Prevent Cancer?

Nut consumption was associated with a decreased risk of some types of cancer but not with type 2 diabetes in a large review.When patients eating the most nuts were compared with those eating the least, those in the first group had a lower risk of colorectal cancer in three studies (RR 0.76, 95% CI 0.61-0.96; I2=51.3%), of endometrial cancer in two studies (RR 0.58, 95% CI 0.43-0.79; I2=0%), and pancreatic cancer in one study (RR 0.68, 95% CI 0.48-0.96; I2 not available). Those results were reported in the meta-analysis of 36 observational studies, with a total population of more than 30,000 patients.

Nut consumption was also associated with a lower risk of cancer in general (RR 0.85, 95% CI 0.76-0.95;I2=66.5%), according to the authors. But it was not associated with other types of cancer or with type 2 diabetes (RR 0.98, 95% CI 0.84-1.14; I2=74.2%), found the researchers, who were led by Lang Wu, a PhD candidate at the Mayo Clinic. They published their results on June 16 in Nutrition Reviews.

"Overall, nut intake was associated with a decreased risk of cancer," wrote Wu and colleagues. "Given the scarcity of currently available data, however, evidence from additional studies is required to more precisely determine the relationship between nut consumption and risk of individual cancer types." Evidence for the association between nuts and cancer has been mixed, according to the authors. Follow-up time in the studies ranged from 4.6 years to 30 years, found the review.

The amount of nuts eaten ranged from none for some of the patients to eating nuts more than seven times a week....No associations were found between nut consumption and acute myeloid leukemia, breast cancer, gastric cancer, glioma, hepatocellular carcinoma, leukemia, lymphoma, ovarian cancer, prostate cancer, or stomach cancer.

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Drawing of colon seen from front (the appendix is colored red). Credit: Wikipedia.

For more than 100 years, the standard treatment for appendicitis has been surgery. Now a large Finnish study provides the best evidence to date that most patients can be treated with antibiotics alone.

How did the usual treatment of doing an appendectomy (appendix removal) arise? In 1886 Dr. Reginald Fitz, while investigating pelvic infections (which resulted in many deaths in those days), decided that an inflamed appendix progresses from a mild inflammation, to gangrene, then perforation, which would result in pelvic abscess.

This reason for an appendectomy (that it would prevent serious infection) became established in medical thought and still guides appendicitis management today. But nowadays we have antibiotics! And the researchers noted that some cases resolved on their own without any treatment.

And instead of the prevailing view for many years that the appendix is a "vestigial organ with no purpose",  it turns out that the appendix has a great reason for existence. It seems to provide a safe haven for good bacteria when gastrointestinal illness flushes those bacteria from the rest of the intestines. This reservoir of gut microbes then repopulates the digestive system following the illness.

It makes me wonder why some people get appendicitis and others don't - do they have inflammation for some reason so that their bacterial communities are out of whack (dysbiosis)? Would dietary changes help prevent recurrences?

From the NY Times: Antibiotics Are Effective in Appendicitis, Study Says

For more than 100 years, the standard treatment for appendicitis has been surgery. Now a large Finnish study provides the best evidence to date that most patients can be treated with antibiotics alone. The study, published Tuesday in JAMA, involved 530 patients aged 18 to 60 who agreed to have their treatment — antibiotics or surgery — decided at random. Three out of four who took antibiotics recovered easily, the researchers found. And none who had surgery after taking antibiotics were worse off for having waited.

The new study comes amid growing questions about the routine use of surgery to treat appendicitis, which strikes about 300,000 Americans a year, afflicting one out of 10 adults at some point in their lives.

The results only apply to uncomplicated appendicitis, stressed Dr. Paulina Salminen, a surgeon at Turku University Hospital in Finland and lead author of the new study. She and her colleagues excluded from their trial the 20 percent of patients with complicated cases — people with perforated appendices or abdominal abscesses, and those with a little, rock like blockage of the appendix called an appendicolith.

In the 1950s, soon after antibiotics were discovered, some doctors reported success using them to treat patients with appendicitis. But, Dr. Livingston wrote in his editorial, “So powerful is the perceived benefit of appendectomy for appendicitis that surgical treatment for appendicitis remains unquestioned, with seemingly little interest in studying the problem.”

Dr. Livingston also found that most appendices that perforate have already done so by the time the patient shows up at an emergency room. Those that have not perforated when the patient seeks medical help almost never do so. People with so-called uncomplicated appendicitis, he concluded, seem to have a different disease — one that can be treated with antibiotics.

“The reason we take the appendix out and do it as an emergency is the belief, dating back to 1886, that the appendix will eventually become gangrenous and cause a pelvic abscess,” Dr. Livingston said.

Even with the results of the Finnish study, many questions remain. A person who has had one episode of appendicitis is at higher than usual risk for another....Accumulating data has led other experts to raise an even more controversial idea: Perhaps antibiotics aren’t always necessary, either. It is possible, some researchers say, that most people with appendicitis would get better on their own if doctors did nothing. The Finnish team is now planning a clinical trial to test that theory.

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There is growing evidence that women around a lot of endocrine disrupting chemicals at home or in jobs such as cleaners, hairdressers and laboratory workers during pregnancy are more likely to have baby boys with a genital defect called hypospadias (a condition where the opening of the urethra is on the underside of the penis rather than at the tip). From Environmental Health News:

Genital defect in baby boys linked to moms’ chemical exposure

Mothers around a lot of endocrine disrupting chemicals at home or in jobs such as cleaners, hairdressers and laboratory workers during pregnancy are more likely to have baby boys with a genital defect, according to a new study in the south of France.The study adds to mounting evidence that fetal exposure to chemicals that mimic people’s natural hormones may cause hypospadias, a condition where the opening of the urethra is on the underside of the penis rather than at the tip.

French researchers examined more than 600 children in the south of France and found that babies exposed to endocrine disrupting chemicals while their genitals were developing were more likely to suffer from hypospadias. Half the boys had hypospadias and half did not. The risk for those exposed was 68 percent higher than the unexposed boys. The researchers ruled out baby boys with known genetic risks for such defects.

The defect, which can be minor or quite severe depending on how far the opening is from the tip, can lead to problems with urination and, later in life, sexual difficulty....It is one of the most common genital defects in baby boys, and most cases require surgery, often done before they reach two years old. In the United States, an estimated five out of 1,000 boys are born annually with hypospadias, while Europe’s rate is slightly less than two out of 1,000.

The researchers estimated the unborn babies’ exposure by looking at their parents’ jobs and where they lived. Working with hormone disrupting chemicals and living in homes near heavy polluters were both linked to more baby boys having the defect. However, the researchers did say a limit of the study was attempting to estimate fetal exposure to such chemicals.Mothers were most likely to have boys with hypospadias if they worked as a cleaner, hairdresser or beautician.  

Some of the endocrine disrupting chemicals linked to the professions involved in the study were bisphenol-A (BPA), phthalates, polychlorinated compounds, alkylphenolic compounds and organic solvents. Most exposures—78 percent—occurred in the window of development when babies’ genitals are forming.... but detergents, pesticides, and cosmetics accounted for 75 percent of the cases,” the authors wrote in the study published in the European Urology journal this month.

Other possible causes of the birth defect include older, obese mothers, and fertility or hormone treatments during pregnancy, according to the U.S. Centers for Disease Control and Prevention.

This wasn’t the first time scientists have found a link between certain chemicals and hypospadias. Mothers in southeast England who were heavily exposed to endocrine disrupting phthalates on the job were about three times as likely to have a baby boy with hypospadias. Phthalates are used in some cosmetics, fragrances, food packaging and PVC plastics.

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Looks like another procedure is found not to be beneficial and possibly harmful - this time arthroscopic surgery as a treatment for the middle aged or older person with a painful arthritic knee or torn meniscus (the shock absorbing cartilage between the knee bones). The researchers also found that "exercise therapy" had more benefits. From Medical Xpress:

Benefit of knee surgery for middle aged or older patients 'inconsequential', say experts

The benefit of surgery for middle aged or older patients with persistent knee pain is inconsequential and such surgery is potentially harmful, say researchers in a study published in The BMJ this week.Their findings do not support arthroscopic surgery as a treatment for the middle aged or older person with a painful arthritic knee or torn meniscus (the shock absorbing cartilage between the knee bones).

The article is part of The BMJ's Too Much Medicine campaign - to highlight the threat to human health and the waste of resources caused by unnecessary care. Over 700,000 knee arthroscopies (a type of keyhole surgery) are carried out in the USA and 150,000 in the UK each year on middle aged and older adults with persistent knee pain. Yet the evidence for arthroscopic surgery is known to be weak, with all but one published trials showing no added benefit for surgery over control treatment.Despite this, many specialists are convinced of the benefits of surgery.

So researchers based in Denmark and Sweden reviewed the results of 18 studies on the benefits and harms of arthroscopic surgery compared with a variety of control treatments (ranging from placebo surgery to exercise) for middle aged and older people with persistent knee pain.s.

Overall, surgery was associated with a small but significant effect on pain at three and six months (but no longer) compared with control treatments. No significant benefit on physical function was found. A further nine studies reporting on harms found that, although rare, deep vein thrombosis (DVT) was the most frequently reported adverse event, followed by infection, pulmonary embolism (a blockage of the main artery of the lung), and death.

"Interventions that include arthroscopy are associated with a small benefit and with harms," say the authors, and the benefit is "markedly smaller than that seen from exercise therapy." These findings "do not support the practice of arthroscopic surgery as treatment for middle aged or older patients with knee pain with or without signs of osteoarthritis," they conclude.

"It is difficult to support or justify a procedure with the potential for serious harm, even if it is rare, when that procedure offers patients no more benefit than placebo," argues Professor Andy Carr from Oxford University in an accompanying editorial.

 

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Image result for dark chocolate My kind of study! Eating up to 100 grams of chocolate every day is linked to lowered heart disease and stroke risk. Not just dark chocolate, but milk chocolate also. Note that 100 grams of chocolate is equal to about 3.5 ounces chocolate.From Science Daily:

Chocolate for your heart

Eating up to 100 g of chocolate every day is linked to lowered heart disease and stroke risk. The calculations showed that compared with those who ate no chocolate higher intake was linked to an 11% lower risk of cardiovascular disease and a 25% lower risk of associated death.

They base their findings on almost 21,000 adults taking part in the EPIC-Norfolk study, which is tracking the impact of diet on the long term health of 25,000 men and women in Norfolk, England, using food frequency and lifestyle questionnaires.... were monitored for an average of almost 12 years, during which time 3013 (14%) people experienced either an episode of fatal or non-fatal coronary heart disease or stroke. Around one in five (20%) participants said they did not eat any chocolate, but among the others, daily consumption averaged 7 g, with some eating up to 100 g.

Higher levels of consumption were associated with younger age and lower weight (BMI), waist: hip ratio, systolic blood pressure, inflammatory proteins, diabetes and more regular physical activity --all of which add up to a favourable cardiovascular disease risk profile.Eating more chocolate was also associated with higher energy intake and a diet containing more fat and carbs and less protein and alcohol.

And among the 16,000 people whose inflammatory protein (CRP) level had been measured, those eating the most chocolate seemed to have an 18% lower risk than those who ate the least.The highest chocolate intake was similarly associated with a 23% lower risk of stroke, even after taking account of other potential risk factors.

Of nine relevant studies included in the systematic review, five studies each assessed coronary heart disease and stroke outcome, and they found a significantly lower risk of both conditions associated with regular chocolate consumption. And it was linked to a 25% lower risk of any episode of cardiovascular disease and a 45% lower risk of associated death.

This is an observational study so no definitive conclusions about cause and effect can be drawn. ...Nevertheless, they add: "Cumulative evidence suggests that higher chocolate intake is associated with a lower risk of future cardiovascular events."And they point out that as milk chocolate, which is considered to be less 'healthy' than dark chocolate, was more frequently eaten by the EPIC-Norfolk participants, the beneficial health effects may extend to this type of chocolate too.