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The Gary Null Show – 11.16.20

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Vitamin C’s effectiveness against COVID may hinge on vitamin’s natural transporter levels

Medical College of Georgia Center for Healthy Aging, November 12, 2020

High doses of vitamin C under study for treating COVID-19 may benefit some populations, but investigators exploring its potential in aging say key factors in effectiveness include levels of the natural transporter needed to get the vitamin inside cells.

Age, race, gender, as well as expression levels and genetic variations of those vitamin C transporters that make them less efficient, all may be factors in the effectiveness of vitamin C therapy against COVID-19 and other maladies, investigators at the Medical College of Georgia Center for Healthy Aging report in a commentary in the journal Aging and Disease

The investigators recommend that those factors be considered in the design and execution of clinical trials, and when trial results are analyzed, for COVID-19 as well as other conditions, says Dr. Sadanand Fulzele, aging researcher and the article’s corresponding author.

The novel nature and lack of immunity against the coronavirus has prompted a worldwide pursuit of effective treatments for COVID-19, they write. That includes repurposing drugs with known safety profiles, including Vitamin C, an established immune system booster and antioxidant, which made it a logical choice to explore in COVID-19. Both strategies are needed in response to infection with the novel coronavirus to ensure a strong immune response to stop the virus from replicating in the body, and to avoid the over-the-top, destructive immune response the virus itself can generate if it does. 

There are at least 30 clinical trials underway in which vitamin C, alone or in combination with other treatments, is being evaluated against COVID-19, some with doses up to 10 times the recommended 65 to 90 milligrams daily of vitamin C.

Factors like whether or not vitamin C can get inside the cell, likely are an issue in the effectiveness the therapies ultimately show, says Dr. Carlos M. Isales, co-director of the MCG Center for Healthy Aging and chief of the MCG Division of Endocrinology, Diabetes and Metabolism. 

In fact, without adequate transporters on a cell’s surface to get the water-soluble vitamin past the lipid layer of cell membranes, particularly large doses may enable the vitamin to cluster around the outside of cells where it actually starts producing oxidants, like damaging reactive oxygen species, rather than helping eliminate them, says Isales, a study coauthor. 

“We think it’s important to look at transporter expression,” Fulzele says.

They suspect low transporter expression is a factor in the mixed results from vitamin C’s use in a variety of other conditions. Clinical trials in osteoarthritis, for example, an autoimmune disease where a misdirected immune system is attacking the joints, has gotten mixed results, Fulzele says. However its usage in other viral-induced problems, like potentially deadly sepsis, has shown benefit in reducing organ failure and improving lung function in acute respiratory distress syndrome, which is also a major cause of sickness and death with COVID-19. 

At the time their Aging and Disease paper was published, there were not yet published studies of the efficacies of high-dose, intravenous vitamin studies underway for COVID-19.

Fulzele, who works on vitamin C in aging, and others have shown that some conditions, like osteoarthritis and even normal aging, are associated with significant downregulation of at least one subtype of vitamin C transporter. 

In fact, part of the paradox and concern with COVID-19 is that those most at risk mostly have both lower levels of vitamin C before they get sick and fewer transporters to enable the vitamin to be of benefit if they get more, Fulzele says.

Many of those most at risk from COVID-19, including individuals who are older, Black, male and with chronic medical conditions like osteoarthritis, hypertension and diabetes, tend to have lower levels of vitamin C, another reason vitamin C therapy would be considered a reasonable treatment, Isales says. The investigators also note that patients may develop a vitamin C deficiency over the course of their COVID-19 illness since, during an active infection, vitamin C is consumed at a more rapid rate. Insufficient levels can augment the damage done by an overzealous immune response.

While not routinely done, transporter expression can be measured today using PCR technology, a method also used for novel coronavirus as well as influenza testing. While increasing transporter expression is not yet doable in humans, one of Fulzele’s many research goals is to find a drug or other method to directly increase expression, which should improve the health of older individuals as well as those with other medical conditions that compromise those levels.

He notes that reduced transporter levels that occur naturally with age are a factor in the reduced immune function that also typically accompanies aging. That means that even when a 60-year-old and 20-year-old both have a healthy diet in which they consume similar, sufficient amounts of vitamin C, the vitamin is not as effective at boosting the older individual’s immune response. Reduced immune function in older individuals is known to put them at increased risk for problems like cancer and COVID-19. 

Low vitamin C levels also have been correlated with higher mortality in older individuals from causes like cardiovascular disease. High oxidative stress, a major factor in conditions like cardiovascular disease as well as aging and now COVID-19, also is associated with significantly reduced expression of the vitamin C transporter. 

Isales and Fulzele doubt that taking a lot of vitamin C is a good preventive strategy against COVID-19, except in those individuals with a known deficiency.

Vitamin C is an essential vitamin, which means people have to consume it in their food or supplements. Foods naturally high in vitamin C include oranges, potatoes, tomatoes, broccoli and Brussels sprouts. The vitamin’s diverse roles in the body also include formation of blood vessels, collagen and cartilage.

Emerging role of vitamin C in prevention and treatment of novel respiratory virus

University of Otago (New Zealand), November 11, 2020

According to news reporting out of Christchurch, New Zealand, research stated, “Investigation into the role of vitamin C in the prevention and treatment of pneumonia and sepsis has been underway for many decades. This research has laid a strong foundation for translation of these findings into patients with severe coronavirus disease (COVID-19).”

Our news correspondents obtained a quote from the research from University of Otago: “Research has indicated that patients with pneumonia and sepsis have low vitamin C status and elevated oxidative stress. Administration of vitamin C to patients with pneumonia can decrease the severity and duration of the disease. Critically ill patients with sepsis require intravenous administration of gram amounts of the vitamin to normalize plasma levels, an intervention that some studies suggest reduces mortality. The vitamin has pleiotropic physiological functions, many of which are relevant to COVID-19. These include its antioxidant, anti-inflammatory, antithrombotic and immuno-modulatory functions. Preliminary observational studies indicate low vitamin C status in critically ill patients with COVID-19. There are currently a number of randomized controlled trials (RCTs) registered globally that are assessing intravenous vitamin C monotherapy in patients with COVID-19. Since hypovitaminosis C and deficiency are common in low-middle-income settings, and many of the risk factors for vitamin C deficiency overlap with COVID-19 risk factors, it is possible that trials carried out in populations with chronic hypovitaminosis C may show greater efficacy. This is particularly relevant for the global research effort since COVID-19 is disproportionately affecting low-middle-income countries and low-income groups globally. One small trial from China has finished early and the findings are currently under peer review. There was significantly decreased mortality in the more severely ill patients who received vitamin C intervention. The upcoming findings from the larger RCTs currently underway will provide more definitive evidence.”

According to the news reporters, the research concluded: “Optimization of the intervention protocols in future trials, e.g., earlier and sustained administration, is warranted to potentially improve its efficacy. Due to the excellent safety profile, low cost, and potential for rapid upscaling of production, administration of vitamin C to patients with hypovitaminosis C and severe respiratory infections, e.g., COVID-19, appears warranted.”

 

Beneficial effects of intermittent fasting: an update on mechanism, and the role of circadian rhythm and gut microbiota

Sun Yat-sen University (China), November 11, 2020

According to news originating from Guangzhou, People’s Republic of China, research stated, “Importance: There is accumulating evidence that intermittent fasting (IF) is connected to improved health condition and longevity time-restricted feeding (TRF) is the most recognized and extensively studied model of IF. To investigate the underlying mechanism of pleiotropic benefits of IF and hint the most advantageous feeding pattern for humans.”

Our news journalists obtained a quote from the research from Sun Yat-sen University, “Evidence review: We searched MEDLINE, EMBASE, Cochrane Library and Google Scholar by 2020 April for publications on IF or TRF and their mechanisms. Studies include animal models and human cohorts. One important mechanism is that IF allows certain period of fasting time, in which our bodies activate pathways of repair and rejuvenation. Moreover, the advantages of IF, especially TRF over total caloric restriction (CR) provided bases for various animal and human studies which suggested that the feeding-fasting rhythm stimulates the fluctuation of our gut microbiota and a series of subsequent molecular alterations, which in turn restored a healthier circadian clock that resembled our inherent clock formed throughout millions of years of homo sapiens history.”

According to the news editors, the research concluded: “Conclusions and Relevance for Reviews: Complete understanding of the mechanism leading to the beneficial effects of IF paves the way for tailored dietary regimen to combat a wide range of diseases and ill health conditions.”

This research has been peer-reviewed.

 
 

Valerian Quality, Storage Issues May Affect Sleep Outcomes

Chiba and Nagasaki universities (Japan), November 1, 2020

Valerian (Valeriana officinalis L.) may be a safe and effective herbal sleep aid; however quality control issues may affect outcomes, according to the findings of a recently published systematic review and meta-analysis.

While valerian is considered a popular herbal supplement for managing sleep disorders, study outcomes related to its effectiveness have been inconsistent. This review, which included a total of 60 studies (n=6894), aimed to determine the reason for this inconsistency as well as to provide an overview of the role of valerian for other disorders associated with sleep problems.

Meta-analyses were performed to assess the efficacy of valerian on improving subjective sleep quality (10 studies, n=1065), as well as to evaluate its role in reducing anxiety (8 studies, n=535). “Repeated treatments with the whole root/rhizome consistently promoted sleep quality at 450-1410mg per day for 4-8 weeks, whereas valerian extracts 300-600mg per day for 5 days-4 weeks resulted in inconsistent outcomes,” the study authors reported.

In their review, the authors found that the variability in the quality of valerian extracts was dependent on the extraction solvents utilized during the study. Additionally, findings revealed limited information on storage conditions, such as temperature and storage duration, used during each study.  “The absence of such information limits the discussion as to why some extracts were ineffective while others exhibited effectiveness in those clinical trials,” the authors noted.

As for safety, findings revealed no severe adverse events with valerian intake in patients 7 to 80 years old. Valerian was also not observed to have a significant impact on cytochrome (CYP) P1A2, 2D6, 2E1, or 3A4/5.

Based on their findings, the authors concluded that revisions to quality control processes for valerian were needed; however, for the time being, “the usage of whole herbal substances (root/rhizome), rather than extracts, may be the way to obtain optimal efficacy.”

Oh my aching back: Do yoga, tai chi or qigong help?

Florida Atlantic University, November 6, 2020

It’s a pain. About 80 percent of adults in the United States will experience lower back pain at some point. Treating back pain typically involves medication, including opioids, surgery, therapy and self-care options. Efforts to reduce opioid use and increase physically based therapies to reduce pain and increase physical function and safety are crucial.

Patients are often advised to use non-pharmacological treatments to manage lower back pain such as exercise and mind-body interventions. But, do they really help? In a review published in the journal Holistic Nursing Practice, researchers from Florida Atlantic University’s College for Design and Social Inquiry and Christine E. Lynn College of Nursing evaluated the evidence of effects of three movement-based mind-body interventions on chronic low back pain. They examined yoga, tai chi, which combines gentle physical exercise and stretching with mindfulness, and qigong, a traditional Chinese meditative movement therapy focused on body awareness and attention during slow, relaxed, and fluid repetitive body movements. Little is known about the effects of movement-based mind-body intervention, in particular qigong and tai chi.

Researchers compared and contrasted yoga, tai chi and qigong by examining frequency and duration of these interventions; primary and secondary outcomes; attrition rates and possible adverse events; and results. Findings from their review provide empirical evidence regarding the benefits of yoga, tai chi, and qigong, which have been recommended by health care providers for patients with lower back pain.

“Back pain is a major public health issue often contributing to emotional distress such as depression and anxiety, as well as sleep issues and even social isolation,” said Juyoung Park, Ph.D., corresponding author and an associate professor in the Phyllis and Harvey Sandler School of Social Work within FAU’s College for Design and Social Inquiry. “We reviewed data to determine the effects of movement-based mind-body interventions on chronic back pain, psychological factors, coping strategies, and quality of life in people suffering with back pain. Our goal was to provide a comprehensive assessment of the effects of these interventions to be able to offer information across disciplines to implement evidence-based interventions to reduce such pain.”

Of the 625 peer-reviewed articles the researchers identified, 32 met inclusion criteria and were included in the review. Results found that the majority of these articles showed movement-based mind-body interventions to be effective for treatment of low back pain, reporting positive outcomes such as reduction in pain or psychological distress such as depression and anxiety, reduction in pain-related disability, and improved functional ability. Among the key findings, researchers discovered that longer duration and high-dose yoga intervention showed reductions in back pain while tai chi reduced acute lower back pain in males in their 20s. Tai chi also was more effective than stretching for lower back pain in young males. In the general community, tai chi showed greater reductions in pain intensity, bothersomeness of pain symptoms, and pain-related disability than the control intervention. Because there are only three qigong studies to date, it was unclear to the researchers whether this intervention is useful in treating chronic lower back pain. Existing research suggests positive benefits of yoga, however, tai chi and qigong for lower back pain are still under-investigated.

“Two of the studies we examined in our review were focused on the effects of movement modality, specifically yoga, in veterans. Many military veterans and active duty military personnel experience chronic low back pain and are affected by this pain more than the general population,” said Cheryl Krause-Parello, Ph.D., co-author, a professor and director of Canines Providing Assistance to Wounded Warriors (C-P.A.W.W.) within FAU’s Christine E. Lynn College of Nursing, and a faculty fellow of FAU’s Institute for Human Health and Disease Intervention (I-HEALTH). “Our review provides emerging evidence that movement-based mind-body interventions could benefit veterans and others experiencing chronic low back pain.”

The review included both randomized and nonrandomized studies with a total of 3,484 subjects ages 33 to 73 years old. Study sample sizes ranged from 25 to 320 subjects. The majority of articles reported on yoga (25), followed by tai chi (four), and qigong (three). Most of the yoga studies were conducted in India, followed by the U.S., while other studies were conducted in Australia (tai chi) and Germany (qigong).

People with chronic low back pain are at increased risk of functional limitations, job-related disability, and potential long-term disability. Moreover, the economic burden of chronic low back pain is high due to the cost of medications such as opioids, procedures, hospitalization, surgical treatment, and absence from work.

“Yoga, tai chi and qigong could be used as effective treatment alternatives to pain medications, surgery, or injection-based treatments such as nerve blocks, which are associated with high incidence of adverse effects in treating lower back pain,” said Park. “We need more clinical trials and empirical evidence so that clinicians can prescribe these types of interventions with more confidence for managing lower back pain in their patients.”

Go (over) easy on the eggs: ‘Egg-cess’ consumption linked to diabetes

University of South Australia, China Medical University, Qatar University, November 15, 2020

Scrambled, poached or boiled, eggs are a popular breakfast food the world over. Yet the health benefits of the humble egg might not be all they’re cracked up to be as new research from the University of South Australia shows that excess egg consumption can increase your risk of diabetes.

Conducted in partnership with the China Medical University, and Qatar University, the longitudinal study (1991 to 2009) is the first to assess egg consumption in a large sample of Chinese adults. 

It found that people who regularly consumed one or more eggs per day (equivalent to 50 grams) increased their risk of diabetes by 60 per cent.

With the prevalence of diabetes in China now exceeding 11 per cent – above that of the global average of 8.5 per cent – diabetes has become a serious public health concern.

The economic impact of diabetes is also significant, accounting for 10 per cent of global health expenditure (USD $760 billion). In China, diabetes-related costs have exceeded USD $109 billion.

Epidemiologist and public health expert, UniSA’s Dr Ming Li, says the rise of diabetes is a growing concern, especially in China where changes to the traditional Chinese diet are impacting health.

“Diet is a known and modifiable factor that contributes to the onset Type 2 diabetes, so understanding the range of dietary factors that might impact the growing prevalence of the disease is important,” Dr Li says.

“Over the past few decades China has undergone a substantial nutritional transition that’s seen many people move away from a traditional diet comprising grains and vegetables, to a more processed diet that includes greater amounts of meat, snacks and energy-dense food.

“At the same time, egg consumption has also been steadily increasing; from 1991 to 2009, the number of people eating eggs in China nearly doubled*. 

“While the association between eating eggs and diabetes is often debated, this study has aimed to assess people’s long-term egg consumption of eggs and their risk of developing diabetes, as determined by fasting blood glucose.

“What we discovered was that higher long-term egg consumption (greater than 38 grams per day) increased the risk of diabetes among Chinese adults by approximately 25 per cent. 

“Furthermore, adults who regularly ate a lot of eggs (over 50 grams, or equivalent to one egg, per day) had an increased risk of diabetes by 60 per cent.”

The effect was also more pronounced in women than in men. 

Dr Li says that while these results suggest that higher egg consumption is positively associated with the risk of diabetes in Chinese adults, more research is needed to explore causal relationships.

“To beat diabetes, a multi-faceted approach is needed that not only encompasses research, but also a clear set of guidelines to help inform and guide the public. This study is one step towards that long-term goal.”

Veganism: Vitamin B12 is well supplemented, iodine is a matter of concern

A study shows differences between vegan and mixed diets

German Federal Institute for Risk Assessment, November 9, 2020

There was no significant difference with regard to vitamin B12, which was present in approximately the same amount in the blood of both groups. Since vitamin B12 is taken up almost exclusively by animal food, the supply of participants following a vegan diet could be due to the intake via dietary supplements. “This study makes it possible to compare a vegan diet with a mixed diet with regard to a variety vitamins and trace elements,” says BfR President Professor Dr. Dr. Andreas Hensel. “Both diets investigated revealed a lack of iodine. However, the shortage is clearly more distinct in the vegan variant.”

n the RBVD study, the BfR research team analysed blood and urine samples and evaluated lifestyle questionnaires and dietary protocols. Of those participating (18 women and men respectively per group aged 30-60 years), almost all those following a vegan diet and one third following a mixed diet took different food supplements.

The study results were particularly noteworthy with regard to the trace element iodine. Iodine excretion measured in urine samples provides information on how well the body is supplied with the trace element. The majority of the participants had a deficiency. The deficiency was significantly more pronounced among vegans – in one third of them, the level was below 20 micrograms per litre (μg/L), the limit defined by the World Health Organization (WHO); anything below this represents a serious shortage. A vegan diet has, however, also shown health benefits, such as a higher fibre intake and lower cholesterol levels. For both diets, about 10% of participants had an iron deficiency.

One-third of people with cancer use complementary and alternative medicines

University of Texas, October 31, 2020
 

A stunning one-third of people with a cancer diagnosis use complementary and alternative medicines such as meditation, yoga, acupuncture, herbal medicine, and supplements.

UT Southwestern Medical Center’s Dr. Nina Sanford made the discovery that’s now drawing renewed attention to habits she said cancer patients must disclose during treatment. Dr. Sanford is an Assistant Professor of Radiation Oncology who specializes in and treats cancers of the gastrointestinal tract.

Herbal supplements were the most common alternative medicine and chiropractic, or osteopathic manipulation, was the second most common, according to Dr. Sanford’s analysis of data from the Centers for Disease Control and Prevention’s National Health Interview Survey. Her findings were published in the journal JAMA Oncology.

“Younger patients are more likely to use complementary and alternative medicines and women were more likely to, but I would have thought more people would tell their doctors,” Dr. Sanford said, referring to the finding that 29 percent of people who use complementary and alternative medicine did not tell their physicians. Many survey respondents said they did not say anything because their doctors did not ask, or they did not think their doctors needed to know.

Dr. Sanford and other cancer specialists agree this is concerning, especially in the case of herbal supplements.

“You don’t know what’s in them,” Dr. Sanford said. “Some of these supplements are kind of a mishmash of different things. Unless we know what’s in them, I would recommend patients avoid using them during radiation because there’s likely not data on certain supplements, which could interfere with treatment. With radiation specifically, there is concern that very high levels of antioxidants could make radiation less effective.”

Dr. David Gerber, a lung cancer specialist and a Professor of Internal Medicine and Population and Data Sciences at UTSW, said physicians need to know if their patients use herbal supplements because they can completely throw off traditional cancer treatments.

“They may interact with the medicines we’re giving them, and through that interaction it could alter the level of the medicine in the patient,” he said. “If the levels get too high, then toxicities increase, and if the levels get too low, the efficacy would drop.”

Nancy Myers wanted to use supplements during her 2015-2017 cancer treatments, but she ran it by her doctors first.

“I would ask the physician, ‘Could I?’ and everyone said, ‘No, we don’t know how that interacts with your conventional medicine,’ so I respected that,” the 47-year-old mother of four said. Only after treatment did she start taking turmeric, omega-3, vitamin D, and vitamin B6.

“I have plenty of friends in this cancer journey who I’ve met who take supplements. A lady I met recently takes 75 supplements a day. It takes her two hours to package her supplements every week,” she said.

Ms. Myers said every person in her cancer support group uses some kind of alternative medicine. In addition to supplements, she practices meditation and yoga with guidance from a smartphone app.

“It’s what we can control. We can’t control the whole cancer,” she said. “It helps because it takes your mind off just thinking about it.”

She said she knows of some people with cancer who use only alternative medicine – and no traditional medical treatments. Dr. Sanford said this is a dangerous approach that could be fatal. The most famous case of this was Apple founder Steve Jobs, who reportedly used special diets, acupuncture, and other alternatives after receiving a diagnosis of pancreatic cancer. He turned to traditional medicine late in his battle with cancer and died in 2011.

While doctors are highly cautious about the use of herbs and other supplements during treatment, they are much more open to meditation and yoga as practices that can help patients cope with the shock of a cancer diagnosis and the stress of chemotherapy, radiation, and surgery.

“We strongly advise patients to stay active and engage in exercise during treatment,” Dr. Sanford said. “A common side effect of radiation is fatigue. I let the patients know that the patients who feel the most fatigue are the ones who are the most sedentary and that those who are doing exercise are the ones who frequently have the most energy.”

Belindy Sarembock, 53, of Dallas, said she practiced yoga during her treatments for breast cancer. She started the classes with skepticism and quickly became convinced of the benefits.

“I was one who would have laughed at yoga before breast cancer, but now it just helps me so much,” she said. “It’s just so relaxing, I just feel so good after I leave. It’s just so peaceful. For your body, I can’t think of anything better than that.”

She said she had neuropathy or nerve damage from chemotherapy, and yoga almost immediately took the pain away.

“I couldn’t get onto my toes. After the second time of going to yoga, I was able to go onto my toes,” she said. “I wish I would have known about the yoga earlier. It was just such a benefit and helped me so much. I highly recommend it to anyone.”