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Healthnotes Newswire (August 21, 2008)—Vitiligo is a difficult-to-treat skin disorder in which a loss of pigment-producing cells creates white patches on various parts of the body. A review of natural treatments for vitiligo published in BMC Dermatology found that an extract of the herb Ginkgo biloba may help return the natural pigment to the skin in some people.About 2% of people have vitiligo; half of these develop it before age 20. The most commonly affected areas are the face, arms, legs, and genitalia. Vitiligo is more obvious in dark skinned people and in lighter skinned people when sun exposure causes non-affected areas to tan. The disfigurement caused by vitiligo can lead to emotional difficulties such as depression, sleep disturbances, and anxiety.

Current therapies for vitiligo

It is rare for areas affected by vitiligo to repigment on their own, and available treatments are fraught with side effects. Corticosteroid creams are sometimes used to help the pigment return to small areas, but these can cause skin to thin. Medications that increase the skin’s sensitivity to ultraviolet (UV) light may be used in conjunction with controlled UV light exposure (phototherapy). However, this treatment raises the risk of skin cancer, and people with vitiligo are already at increased risk.

Natural products review

Alternative treatments have been sought after to help ease the emotional discomfort of vitiligo by aiding in skin repigmentation. The new study reviewed 15 trials of natural health products used to treat vitiligo, including the amino acid L-phenylalanine, various herbs, vitamins, and traditional Chinese medicine.

Three studies using L-phenylalanine combined with phototherapy showed “moderate evidence” of effectiveness in treating vitiligo. Three studies of Chinese medicinal herbs provided only weak evidence of usefulness, as did four trials using phototherapy in conjunction with plant extracts that increase the skin’s sensitivity to UV light. One trial using vitamin B12 and folic acid with phototherapy was not effective and another using vitamin E plus phototherapy was only mildly effective.

One study used 40 mg of Ginkgo biloba (containing 9.6 mg ginkgo flavone) three times per day for six months. Of the people treated with ginkgo, the progression of the disorder was halted in 80%, and 40% experienced complete repigmentation, compared with only 8% in the placebo group. “Ginkgo’s apparent efficacy without the need for phototherapy—thus eliminating the adverse events inherent with phototherapy—makes it a therapeutic option worth investigating,” said the review’s authors.

Common sense precautions

Because people with vitiligo are more sensitive to the harmful effects of the sun, wearing sunscreen with an SPF of 30+ is advisable.

While ginkgo appears to be effective and was associated with only minor gastrointestinal complaints, more studies are needed before it can be recommended to everyone with vitiligo.

(BMJ Dermatol 2008;doi:10.1186/1471-5945-8-2)

Healthnotes Newswire (August 21, 2008)—Antioxidants, especially from the diet, may help prevent age-related cataracts, according to a new study published in the American Journal of Clinical Nutrition.

A cataract is a clouding up of the lens of the eye that eventually interferes with vision, and requires surgical removal for vision to be restored. Age, genetics, and the environment, as well as injury, trauma, and medications such as corticosteroids, are all factors that may contribute to cataract development, a common condition in people over age 65. Oxidative stress may also play a role, so the authors of this study investigated whether long-term use of antioxidants can help prevent cataracts.

The Blue Mountains Eye Study included 3,654 people over 48 years old. At the initial assessment, each participant had an eye exam and filled out a food frequency questionnaire, which noted antioxidant use including beta carotene, zinc, and vitamins A, C, and E. More than 66% of the people then attended a follow-up examination five and/or ten years later.

People who had the highest vitamin C intake from diet and supplements had a significantly reduced risk of cataracts after ten years compared with those who consumed less vitamin C. Those with above-average intakes of combined antioxidants, including vitamins C and E, beta carotene, and zinc, also had a reduced cataract risk compared with those who consumed fewer antioxidants.

The authors pointed out that the study participants overall ate lots of fruits and vegetables and had “fairly healthy diet habits.” Said Ava Grace Tan and her colleagues from the Department of Ophthalmology at the University of Sydney, Sydney, Australia, “Around one-third of the population was taking vitamin supplements at the baseline examination, with a median vitamin C intake of 500 mg among supplement consumers.”

Eating for eye health

The main dietary sources of vitamin C among people in the study were:

• Brassica vegetables, such as broccoli, spinach, and cabbage

• Potatoes

• Citrus fruits, such as oranges

• Fruit juice

Eating plenty of fruits and vegetables (five or more servings a day) in your daily diet is good for maintaining health and preventing a wide variety of diseases. Talk with your doctor about the right mix of dietary supplements for you based on your health.

(Am J Clin Nutr 2008;87:1899–905)

Healthnotes Newswire (August 21, 2008)—A new study shows the cost of heart disease prevention treatments—including medications to control related health issues and programs to stop smoking and lose weight—could be high. Circulation reports that while these prevention strategies could reduce heart attacks by 63% and stroke by 31%, the current price tag of delivering these strategies will increase overall healthcare costs.

Fortunately, the impact of these findings is mitigated by the many diet and lifestyle steps that are well-known to decrease disease risk, but were not factored into the results as they were difficult to measure in the study design.

Calculating the cost of prevention

About 78% of all people ages 20 to 80 are candidates for heart disease prevention strategies, such as medications to lower cholesterol, blood pressure, and blood sugar; aspirin therapy; and smoking cessation and weight loss programs. The new study used a mathematical model to simulate these prevention activities and to answer questions about how they may reduce heart disease risk, improve quality of life, and add years to life. The cost of implementing these changes was estimated and compared with current healthcare expenditures.

By fully utilizing all the heart disease prevention strategies, researchers estimated that more than 27 million heart attacks and 10 million strokes could be prevented over the next 30 years, reducing the cost of caring for cardiovascular disease and related illnesses by almost 10%. Implementing the strategies would also improve quality of life and extend lifespan by an average of 1.3 years.

“The greatest benefits to the population come from providing aspirin to high-risk individuals, controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure in people with diabetes, and lowering LDL (“bad”) cholesterol in people with existing coronary heart disease,” said the study’s authors. Most of these strategies are pricey, though, and total healthcare costs would increase by 162%. Smoking cessation was the only prevention activity projected to save money.

Looking at lifestyle factors

Fortunately for the everyday person, the model did not consider behavioral changes like exercise and dietary modification, which can have a profound effect on cardiovascular disease risk, often without taxing the pocketbook. “It wasn’t possible to quantify the effects of certain dietary changes or exercise on heart disease risk using this model,” said Dr. Kahn.

Lifestyle changes such as the following can make a big difference when it comes to preventing heart disease:

• Regular aerobic exercise can improve heart health by aiding in weight loss, lowering blood pressure, and decreasing the risk of diabetes by improving insulin sensitivity.

• Diets low in saturated fat that include fish such as salmon and rainbow trout, plenty of vegetables, legumes, nuts, seeds, and whole grains may help lower cholesterol and support healthy function of blood vessels.

“There is enormous benefit to be had by employing the interventions we studied, and several of them are cost effective,” said Dr. Richard Kahn, the study’s lead author. “Now we need to look for ways to make the costlier interventions more affordable.”

(Circulation 2008;118:epub ahead of print)

Healthnotes Newswire (July 31, 2008)—Premature babies are at risk for complications in their mental development, but new evidence shows that their brains may get a boost from fatty acids: A study in Pediatrics reports that breast milk supplemented with omega-3 DHA (docosahexaenoic acid) and omega-6 AA (arachidonic acid) may improve brain development in premature infants.DHA and AA are two types of fatty acids essential for many bodily functions including brain, eye, and nervous system development. The optimal amounts of these fatty acids for premature infants has not been determined, but researchers suggest that increasing the amounts in early infancy may reduce the risk of developmental problems later in life.

Learning disabilities and school-related problems are more common among premature infants than full-term infants. Prior studies, however, have shown that premature infants who are breast-fed have higher IQs than babies receiving formula milk. This finding was attributed to higher concentrations of DHA found in human milk compared with formula milk. The authors of the new study considered the possibility that increasing the DHA content of human milk and adding AA could further improve preemies’ brain development.

Study results encouraging

In the study, 141 premature infants weighing less than 1,500 grams (about 3 pounds) were randomly assigned to receive human breast milk supplemented with either 32 mg of DHA and 31 mg of AA per 100 ml of milk, or breast milk supplemented with soy oil and medium-chain triglyceride oil. Infants received more than 100 ml of human milk per kilogram of body weight per day beginning on the first or second day of birth and continuing until discharge from the hospital (an average of nine weeks).

At six months of age, infants who received the human milk supplemented with DHA and AA were better at problem-solving and were better able to discriminate between familiar and unfamiliar objects compared with infants in the control group.

“There is growing evidence that DHA and AA have specific functions related to memory and problem-solving,” said Christine Henriksen, PhD, lead author of the study from the Department of Nutrition at the University of Oslo, Norway. Dr. Henriksen and her colleagues point out that these functions are critical for being able to focus, be attentive, learn, and process information. Further research is needed to understand the long-term impact of supplementing with fatty acids on school performance and attention capacity later in life.

Ensure you eat your EFAs

Babies are dependent on breast milk and/or fortified formula milk for DHA and AA, but there are other important sources of essential fatty acids (EFAs) to consider as the child grows older. In addition, recent research has shown that it is important for pregnant women to eat plenty of fatty acids in order to help optimize their baby’s brain function. You can find them in these sources:

• Fatty fish such as salmon, halibut, and tuna are good sources of DHA, which is also found in smaller amounts in eggs. Pregnant women should balance the need for fatty acids from fish with reducing exposure to mercury by limiting the amount of fish they eat and avoiding fish high in mercury content.

• AA is found in meat, chicken, and eggs.

• Some people may benefit from supplements that contain fatty acids. Check with your doctor about the appropriateness of using supplements to further enrich your diet.

(Pediatrics 2008;121:1137–45)

Healthnotes Newswire (July 31, 2008)—Low levels of vitamin D in the blood may increase risk of cardiovascular events such as a heart attack, according to two recent studies published in the Archives of Internal Medicine.

In addition to its critical role in bone development and maintenance, recent research has shown that vitamin D may be far more important for other aspects of health and disease prevention than was previously realized. In fact, research has linked low levels of vitamin D with chronic diseases such as cancer and multiple sclerosis. Now, new research suggests that inadequate vitamin D may increase the risk of heart attacks and death due to cardiovascular disease and other causes.

Investigating diet’s impact on heart health

In the Health Professionals Follow-up study, a study evaluating the associations between diet and the incidence of chronic disease, 18,225 men ages 40 to 75 were evaluated for their blood levels of vitamin D (measured as 25-hydroxyvitamin D [25(OH)D]) and subsequent risk of heart attack. After ten years of follow-up, 454 men had a heart attack or died from coronary artery disease. Men who had less than 15 nanograms per milliliter of the vitamin D measure had a 50% increased risk of having a heart attack compared with men whose blood levels were 30 nanograms per milliliter or higher.

In another study, 3,258 men and women (average age 62) who were scheduled for angiography because of suspected coronary artery disease were followed for subsequent cardiovascular death or death by another cause. People in the study had blood levels of vitamin D drawn at the time of angiography. After 7.7 years of follow-up, 737 people died and 463 of those people died from cardiovascular disease. People with the lowest levels of vitamin D—less than 13.3 nanograms per milliliter—had a higher risk of death from any cause, and a higher risk of death from cardiovascular disease compared with those people whose levels were greater than 28.3 nanograms per milliliter.

Vitamin D may help prevent heart disease by lowering blood pressure, decreasing calcification in the heart vessels, or by other mechanisms. However, the optimal daily level of vitamin D to prevent chronic disease and maintain health is still not known.

“Vitamin D deficiency has been related to an increasing number of conditions and to total mortality,” said Edward Giovannucci, MD, ScD, and his colleagues from the Harvard School of Public Health, Boston, Massachusetts. Dr. Giovannucci comments that the amount of vitamin D required for optimal health may be much higher than the current daily recommendation of 200 to 600 IU per day. This would be especially true for those with minimal sun exposure, added Dr. Giovannucci.

Getting enough vitamin D

Sources of vitamin D include the sun, food, and dietary supplements. People who live in sunny climates who wear less clothing and therefore allow more daily exposure of their arms and legs usually have higher levels of vitamin D compared with people who live in more northern or more cloudy climates.

Food sources of vitamin D are limited but include some fish such as salmon, mackerel, and tuna; cod liver oil; fortified milk; and fortified cereal products. Eggs, fortified margarine, some cheese, and other foods have small amounts of vitamin D.

Ask your doctor about how to get enough vitamin D from appropriate dietary changes or supplements based on your current health.

(Arch Intern Med 2008;168:1174–80; Arch Intern Med 2008;168:1340–9)

Healthnotes Newswire (July 31, 2008)—Women over 50 are usually reminded to have their bone density evaluated every couple of years, but many healthcare providers don’t know when to recommend this screening to men. To help pinpoint the right time for testing men’s bone density, a new review has identified the major factors that put men at risk for fracture from osteoporosis. The review, published in the Annals of Internal Medicine, analyzed the findings from 177 studies performed between 1990 and 2007 that assessed risk factors for osteoporosis-related fracture in men, and 20 studies that evaluated various screening tests for osteoporosis. The findings from a previous review were also included in the analysis.

What puts men at risk

It comes as little surprise that the two most important risk factors identified for men were the same as those for women: being over 70 years old and being thin (having a low body mass index). Other risk factors included sedentary lifestyle, having taken prolonged courses of steroid medications, weight loss, and having had a previous fracture due to osteoporosis. Androgen deprivation therapy, a prostate cancer therapy that reduces testosterone levels, was also found to significantly increase fracture risk.

Smoking was found to slightly increase fracture risk, while low dietary calcium from milk was not consistently associated with fracture risk. Drinking alcohol had no apparent effect on fracture risk or bone mineral density.

Although some studies identified rheumatoid arthritis, respiratory diseases such as asthma, and gastrointestinal disorders such as celiac disease as risk factors for low bone density and fracture, the evidence was not strong.

Are you a good candidate for screening?

Dual-energy x-ray absorptiometry (DEXA) is the current gold standard for diagnosing low bone density and osteoporosis in men and women. It is regularly recommended for women but less commonly for men, despite the fact that 25% of men over age 60 will have a fracture due to osteoporosis sometime in their lifetime.

A simple osteoporosis screening questionnaire involving age and weight as the only variables was found to be an accurate predictor of osteoporosis in men, and one study found that the strongest predictor for hip fracture risk was weight under about 150 pounds (70 kilograms).

“Osteoporosis in men is substantially underdiagnosed and undertreated in the United States and worldwide,” said lead study author Dr. Hau Liu of the Santa Clara Valley Medical Center in San Jose, California. “We determined that men of advanced age and low body weight are the best candidates for osteoporosis screening. Identifying other important risk factors, particularly weight loss, physical inactivity, corticosteroid use, previous osteoporotic fracture, and androgen deprivation therapy, can help healthcare providers select other men who are good candidates for screening.”

(Ann Intern Med 2008;148:685–701)