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I recently diagnosed bronchiectasis in a patient, with the help of a pulmonologist, so I was especially interested in this condition and this study. Bronchiectasis is a chronic lung disease that is described as permanent dilation of the bronchi and bronchioles and enlargement of mucus-secreting glands. Patients experience chronic excessive mucus secretions into the airway that results in a chronic cough and constant desire to expel the mucus. Inflammation, injury and changes to the shape of the bronchi, mucus collection and respiratory infections are the four major aspects that underlie bronchiectasis. The treatment of bronchiectasis is focused on managing the symptoms and reducing the number of respiratory infections. Mucoactive agents such as hypertonic saline, mannitol and erdosteine can bring about some improvements in some patients. Studies on inhaling dry powder of mannitol for 12 weeks reduced sputum in these patients, and short term use of erdosteine plus chest physical therapy reduced mucus secretion, but sample size has been small and duration is too short to conclude anything definitive. Long term antibiotic regimens are also used to reduce the frequency of exacerbations, although this approach can increase the risk of bacterial resistance and adverse events.

N-acetylcysteine (NAC) is a dietary supplement used to thin the mucus, amongst many other uses, and reduces the viscosity and elasticity of sputum as well as having anti-inflammatory and antioxidant activity. This action of thinning the mucus and reducing inflammation, plus a clinical trial using NAC 1200 mg/day that reduced the rate of exacerbations and improved quality of life in chronic obstructive pulmonary disease patients suggests that it could be helpful for those with bronchiectasis as well.

The purpose of the current study was to assess whether NAC 600 mg twice daily might reduce the number of exacerbations and improve quality of life. An exacerbation is defined as the increase in three or more key symptoms: cough, sputum volume and/or consistency, sputum purulence, breathlessness and/or exercise intolerance, fatigue, and coughing up blood for at least 48 hours.

A total of 161 patients were randomized with 81 receiving oral NAC 600 mg twice daily and 80 in the control group. Due to drop outs and deaths in both the treatment and control groups, there were in the end, 69 patients taking NAC and 70 in the control group. To emphasize the potential seriousness of bronchiectasis, one patient died of an acute exacerbation of bronchiectasis in the NAC group and 2 died of the same cause, in the control group.

The incidence of exacerbations in the NAC group was significantly lower than in the control group (1.31 vs 1.98 exacerbations per patient-year. The average number of exacerbations in the NAC group was 1, compared with 2 in the control group. A total of 24.7% in the NAC group and 11.3% in the control group remained free of any exacerbation during the 12 month period. In addition, while the time to the first exacerbation did not differ between the NAC group and the control group, the time to the second exacerbation was longer in the NAC group.

Commentary: This study is very encouraging in light of a disease with no known cure. Not only did it reduce the number of exacerbations, it also reduced the volume of sputum and improved quality of life. NAC was also very well tolerated with a low incidence of adverse reactions and long term use of a year was found to be safe. It should be noted that there are subtypes of bronchiectasis, one being a dry bronchiectasis, and it is not clear if these individuals would benefit from NAC. While this study used NAC in oral encapsulated delivery, nebulized NAC might be a more effective way to deliver the medicine. I will be curious to learn if anyone has experience with this.

Reference: Qi Q, Ailiyaer Y, Liu R, et al. Effect of N-acetylcysteine on exacerbations of bronchiectasis : a randomized controlled trial. Respiratory Research 2019: 20:73

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There are several reasons to recommend strength training to women, including postmenopausal women – weight management, prevent decline in muscle mass, bone density, and now hot flashes!!

A new clinical trial suggests that it is effective for the hot flashes of perimenopause/menopause.

When it comes to exercise, some studies suggest that exercise may help reduce hot flashes but others show no effect. The researchers of the current study randomly assigned 58 women experiencing at least four moderate-to-severe hot flashes or night sweats daily to 15 weeks of resistance training or to a control group in which the women did not change their physical activity routine. None of the women in either group were regular exercisers or had used hormone therapy for the two months prior.

The strength training workout group had a regimen of 45 minutes sessions, three times per week which included six exercises on resistance machines and two using body weight. Women started with lighter weights for the first three weeks, then progressively increased their weights and loads. Prior to the workout regimen, the exercise group averaged 7.5 hot flashes or night sweats a day and after 15 weeks were having an average of 4-5 per day. There were no changes in the control group.

Commentary: I always like to see studies on hot flashes and night sweats that offer women more lifestyle options, that actually can work. If one is not already engaged in regular exercise including some kind of strength training, starting with lighter loads for the first 1-2 weeks is important in order to avoid injury. There are many non-hormonal and hormonal options to relieve hot flashes and night sweats…including dietary influences, botanicals, nutraceuticals, hormones and non-hormone prescription medications. In the case of strength training, as I said in the beginning, there are other meaningful benefits as well. Other forms of exercise are also full of benefits including a decreased incidence of heart disease, type 2 diabetes, bone loss and cancer. The “women’s movement”, can mean.. let’s get women moving!!!

Reference: Berin E, Hammr M, Lindblom M, et al. Resistance training for hot flushes in postmenopausal women: A randomised controlled trial. Maturitis. : 2019; 126:55-60

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Dr. Tori Hudson by Tori Hudson, N.d. - 2M ago

A new study holds out some hope for families who already have a child with autism spectrum disorder (ASD), and the reduction in risk of ASD in a future child. Previous population studies have demonstrated that maternal prenatal vitamin intake, particularly folic acid, appears to reduce the risk of ASD by about 40%. This is the first study to suggest that maternal use of prenatal vitamins may reduce ASD in siblings of children with ASD.

A Canadian study, the public health agency of Canada reports that about one in every 66 Canadian children and adolescents aged 5 to 17 has ASD. Previous research has shown that younger siblings of children with ASD are up to 13 times more likely to be diagnosed with ASD than those in the general population. Another way of looking at it is that the rate of ASD in families who have a child with ASD is about 1 in 5 siblings.

The current study prospectively enrolled mothers who had a child with diagnosed ASD and who were either pregnant or planning a pregnancy. Women were recruited from the Makers of Autism Risk in Babies: Learning Early Signs (MARBLES) cohort study. The sample included 241 younger siblings of which 58% were boys, with a mean age of 36.5 months at the final follow-up encounter.

While 96% of mothers took prenatal vitamins during pregnancy, only 36% took vitamins in the 6 months preceding pregnancy. The prevalence of ASD was 14.1% in children whose mothers took prenatal vitamins in the first month of pregnancy and 32.7% in children whose mothers did not.

In addition, among children with ASD, those whose mothers took prenatal vitamins also had significantly lower ASD symptom severity and higher cognitive scores than children whose mothers did not take vitamins in the first month. And, the intake of folic acid of 600 mcg or more and a higher total daily iron intake during the first month of pregnancy were each associated with lower estimated ASD risks.

Commentary: It has been known that folic acid is essential for brain development and several mechanisms that may influence the risk of ASD, but we have a long way to know cause and effect, and in the case of this study, how prenatal vitamins may be reducing the risk of ASD in those who are at increased risk. The positive effect seen in this study, is significant…and very encouraging, especially for families who are predisposed to having another child with ASD. This study also points out the benefit of pre-pregnancy planning, and mothers taking measures towards optimal health and supplementation at least 6 months prior to pregnancy attempts

Reference: Schmidt R, et al. Association of maternal prenatal vitamin use with risk for autism spectrum disorder recurrence in young siblings. JAMA Psychiatry 2019 Feb 27; 77:391

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Dr. Tori Hudson by Tori Hudson, N.d. - 2M ago

I’ve been thinking about hunger lately. Hunger and hungry seems to best describe oh so many things that we yearn for/are hungry for… peace, love, safety, ethics, leadership, security, food, water (safe water), healthy air to breathe, adequate shelter, livelihood, job, purpose, health, spirituality, connectedness, community, communication, faith, honesty, nature, and… I know there are more. Each are deep human needs… I would assert, even human rights. But, for oh so too many of us humans on this planet, we still hunger for these basic things. Just focusing on food hunger, the most common kind of hunger we might read about, is daunting enough, but let’s start here.

Here are some essentials:

· One in 9 people go hungry each day around the world — that’s 821 million people — despite the fact that the world produces enough food to feed all 7.5 billion people.

· The Central African Republic remains the world’s hungriest country

· Slightly good news, although insufficient, the level of hunger in the world has decreased by 27% since 2000

And, you might not realize, that the circumstances in the U.S. are tragic as well:

1. In 2017, 40 million people struggled with hunger in the United States

2. The USDA defines "food insecurity" as the lack of access, at times, to enough food for all household members. In 2017, an estimated 15 million households were food insecure.

3. In the U.S. hunger is caused by poverty and financial resources at both the national and local levels

4. 45 million Americans rely on stipends from the Supplemental Nutrition Assistance Program (SNAP) to buy food each month, according to the USDA. 2/3 of these benefits go to households with children.

5. 1 in 6 American children may not know where their next meal is coming from.

6. 22 million children in America rely on the free or reduced-price lunch they receive at school, but as many as 3 million children still aren’t getting the breakfast they need.

7. Children who experience food insecurity are at a higher risk of developing asthma, struggling with anxiety or depression, and performing poorly in school or physical activities.

8. 15% of families living in rural areas experience food insecurity, compared with 11.8% living in suburban and metropolitan areas.

9. People of color are disproportionately affected by higher risk of hunger. 22.5% of Black households and 18.5% of Latin/Hispanic households experienced food insecurity in 2018.

10. These 8 states have the highest rates of food insecurity in the United States: Mississippi (18.7%), Louisiana (18.3%), Alabama (18.1%), New Mexico (17.6%), Arkansas (17.5%), Kentucky (17.3%), Maine (16.4%), Oklahoma (15.2%).

11. In 2017, households with children had a substantially higher rate of food insecurity (15.7%) than those without children (10.1%).

(Resource: #1-#11 From www.dosomething.org)

Experts point out there are 9 main causes of hunger:

1. Poverty

Poverty and hunger exist in a painfully vicious cycle: If you live in poverty, you often cannot afford food, let alone nutritious food, and thus face hunger. In addition, when you are hungry, it is difficult to procure more money when you are harmfully undernourished. When hunger looms, individuals and families sell off resources—livestock, tools, transportation…. And then buy cheap staples such as flour and corn which is insufficient nutritionally, without the fruits and vegetables and animal products they had before.

2. Food shortages

Over the past ten years, there are numerous hot spots around the world that are repeatedly affected by food shortages and food insecurity. And, one might not have to go half way around the world to find it. In your neighborhood, or a neighborhood or town nearby, individuals and families are suffering food shortages… perhaps not due to a drought or a war, but poverty, a lost job, other natural disaster, or illness that took away the income for food, and more. Climate variability and climate change are wreaking particular havoc on stable harvests due to droughts and floods and lost farmlands.

3. War & conflict

War and violent conflicts are amongst the most vicious causes of food insecurity. People are displaced from homes, livestock, gardens and farms. Due to abandoned agricultural fields and people, there are no crops, resulting in wild inflation and food that is available is not affordable to thousands to millions. South Sudan, Yemen, Somalia and more can lead to over 65% of the population facing hunger.

4. Climate change

Some countries, while they may not be wracked by war, are frequently plagued by hunger due to droughts or floods. Too much or too little rainfall can destroy harvests or substantially reduce the amount of animal pasture available. According to the World Bank, it is estimated that climate change may push more than 100 million people into poverty over the next 10 years. Hurricanes, tornadoes, insufficient snowfall, rising temperatures, all affect farmland and harvests.

5. Poor nutrition

We’re not just talking about enough food, we are talking about food with adequate nutrition essential for health and life. Too often, poverty means you can gain access to just corn or wheat, which is missing critical amounts of protein, let alone good oils, vitamins and minerals. Poor nutrition means too little energy to procure other needed resources. And if you are a young child, or a pregnant woman, the consequences are even more dire.

6. Governmental Policy

Poor infrastructure, greed, corruption and lack of investment in local agriculture, are directly connected to hunger of a population. Political solutions can often prevent hunger, destruction of agricultural land and forced migration.

7. Economy

Economic stability—of an individual, a family and a country, prevents poverty and promotes nutritional and health resilience. On a large scale think about the Ebola outbreak in Liberia in 2014. It destabilized an already fragile economic situation, and now more than 15% of the country’s people do not know where their next meal is coming from. But you don’t have to go that far to understand the connection between economic stability and having enough money to buy food. Look at the family or woman or man living in a tent next to the freeway. While they all don’t get there via the same path, some are definitely there due to economics and either losing a decent paying job or not having enough money to stay sheltered and fed. It’s true, that some are there due to mental health and addiction issues – but where are our economic policies such that we can’t take better care of people with these life altering issues.

8. Food waste

It’s shocking, but 1/3 of all food produced is never consumed. And, that’s not even counting the natural resources utilized to waste all that food. Think, wasted water, greenhouse gases produced…. All wasted with the wasted food. And then there is just the aggravation and sadness of all this wasted food in one place, with another even right nearby, maybe even out the back door going hungry.

9. Gender inequality

There is a report from the UN that reveals that “if women farmers had the same access to resources as men, the number of hungry in the world could be reduced by up to 150 million.” Female farmers are responsible for growing, harvesting, preparing, and selling the majority of food in poor countries, yet they are underrepresented in developing policies and strategies to utilize resources well, and distribute resources fairly.

(Resource: Top 9 causes of hunger from www.concernusa.org )

Commentary: I and most of my patients have access to too much food and too much unhealthy food. We overeat sweets, we overeat starchy carbs, we overeat unhealthy fatty foods, well, we plain just overeat. And it doesn’t get easier—more grocery stores, more restaurants, more online ordering, more temptations…… We are suffering from another kind of hunger other than enough food, hoping for, or at least acting out, that we can satisfy that hunger with food. Better to figure out the hunger and make steps towards solving that hunger.

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Health care providers, governments and private organizations are supportive of the benefits of exclusive breastfeeding to promote health and optimal development of newborns. The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life. Not all women around the world are able to accomplish this due to education, confidence, nutrition, nipple problems, pain, milk storage and adequate milk volume. Many breastfeeding mothers do try to increase their milk volume and use traditional foods and medicines and herbal preparations. In Thailand, where the current study was conducted, fenugreek, ginger and turmeric are traditional galactagogues.

The study was a randomized double-blind placebo controlled trial, conducted at the Mahidol University in Thailand. Fifty breastfeeding women, ages 20-40, who were 1 month postpartum and exclusively breast feeding were enrolled in this study. Women were randomly assigned to the herbal supplement or placebo, with 25 in each group. The herbal formula contained 200 mg fenugreek seed, 120 mg ginger and 100 mg turmeric per capsule. Three capsules three times per day of herbal combination or placebo were given for 4 weeks.

Breastfeeding mothers receiving the herbal supplement had a 49% increase in milk volume at week 2 and a 103% increase at week 4. The increases in the placebo group were 11% at week 2 and 24% at week 4. The energy and nutrient composition of the human milk before and after the intervention was similar between the treatment and placebo groups, although the percent change in vitamin A tended to increase in the herbal group.

Commentary: Fenugreek is used in many parts of the world, including the U.S. as a galactagogue and has been proven to be safe and effective. The major compounds in fenugreek are flavonoids, terpenoids and saponin (diosgenin). These compounds stimulate the anterior pituitary gland to increase prolactin. The increase in milk production often seen with fenugreek occurs within 24-72 hours. Ginger also can increase milk flow, possibly by improving blood circulation. Turmeric is used as a galactagogue in India but may also be able to decrease pain, tension and inflammation in the breast. Ginger and turmeric may also stimulate the anterior pituitary to produce more prolactin resulting in increased quantity of milk.

Reference: Bumrungpert A, Somboonpanyakul P, Pavadhgul P, Thaninthranon S. Effects of fenugreek, ginger and turmeric supplementation on human milk volume and nutrient content in breastfeeding mothers: A randomized double-blind controlled trial. Breastfeedg\ing Medicine 2018;13(10)

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This study was done looking at 200 Swedish women aged 38-60 who underwent cycling testing that measured cardiovascular fitness. They were followed for an average of 29 years. Using objective assessments and repeat neuropsycychiatric evaluations, 23% were diagnosed with dementia at a mean age of 80. Researchers compared women who had medium cardiovascular fitness at baseline to those who had a high fitness levels, and found that those with a higher fitness level had an 88% lower risk for dementia over the course of the follow-up years. Of those that were in the high fitness category who were diagnosed with dementia, it developed about 11 years later compared to those with medium fitness.

Commentary: While fitness level cannot be asserted to be a causal effect, it is worth emphasizing the possibility that improved cardiovascular fitness in midlife could modify a woman’s risk and delay or prevent dementia. There are several herbs and nutrients that have shown some suggestive influence in providing neurocognitive protection, but all research should be multifactorial in this area, given the growing numbers of individuals affected. Causation, prevention and treatments, all deserve assertive research and across the spectrum of issues related to causation: environmental exposures, stressors, diet, brief and long term medication exposures and genetics. Prevention: stress, nutrition, regular aerobic exercise, optimal sleep habits, herbal/nutrient supplements and medications. Treatments: natural and pharmaceutical interventions.

Reference: Horder H, et al. Midlife cardiovascular fitness and dementia: A 44 y.r. longitudinal population study in women. Neurology 2018; March 14; e-pub

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Bladder infections in otherwise healthy pre-menopausal and non-pregnant women tend to be uncomplicated and are classified as lower urinary tract infections (UTIs). UTIs are amongst the most common infections in women and Escherichia coli (E.coli) is the organism that is the most common, responsible for about 75-95% of uncomplicated UTIs.

Trimethoprim/sulfamethoxazole (TMP/SMX), aka co-trimoxazole, and brand names, Bactrim or Septra, is an inexpensive antibiotic and generally well tolerated and effective. However, due to its common use, resistance to E. coli strains with this antibiotic has increased significantly, and as many as 20% of cases will be resistant, which is why other first line antibiotics are often chosen.

The genesis of this current study is that there are laboratory studies that have shown antimicrobial effects of green tea catechins against E. coli as well as synergistic effects between the catechins and antibiotics such as the co-trimoxazole against E. coli.

This randomized, blinded, placebo-controlled trial was conducted in Iran. Healthy premenopausal, non-pregnant women ages 18-50 with acute uncomplicated cystitis were included in the study. After urine collection, women were given four 500 mg capsules of green tea extract or placebo before bed, daily for 3 days. All of the patients also received the TMP/SMX at two 480 mg tablets twice daily for 3 days. Each gram of the green tea contained approximately a total phenol content of 283 mg and 65 mg of epigallocatechin (EGC). The urine was then tested again in each group, on the fourth day.

Results: Among the 107 eligible women patients, 70 completed the trial. Women in the green tea group showed a statistically significant decrease in the prevalence of cystitis symptoms at each time point (recorded daily). The presence of symptoms was as follows:

Baseline: Green tea 68%; placebo 75%

After 1 day Green tea 61%; placebo 74%

After 2 days Green tea 34%; placebo 67%

After 3 days Green tea 2%; placebo 63%

In addition, the addition of the green tea resulted in a statistically significant improvement in the urinalysis in terms of color, bacteria, and white blood cells. No patients, in either group, had a recurrence of their UTI after 2 weeks. After 4 weeks, 1 in the green tea group had a recurrence and after 6 weeks, 2 in the TMP/AMX only group had a recurrence.

Commentary: One of the unique things in the study design was that the green tea extract was given in a bolus, all four capsules at once, and in the evening. The rationale of the researchers was that the EGC was better retained in the bladder all night, noting that more than 90% of the urinary EGC is excreted in the first 8 hours of administration, therefore all at once and in the evening before bed would theoretically enhance its effectiveness, if they did not urinate until morning.

In my experience, 49 out of 50 premenopausal non-pregnant women with uncomplicated UTIs can be successfully treated with a combination of herbal ingredients if dosed aggressively (formulas typically would contain cranberry extract, buchu leaf, Oregon grape root, pipsissewa, uva ursi and marshmallow root); occasionally I might add mannose powder, along with robust water. On the atypical occasion that I prescribe an antibiotic, I will consider adding the dosing of green tea extract for 3 days used in the current study, whether the antibiotic is TMX/SMP or another.

Reference: Kheirabadi K, Mehrabani M, Sarafzadeh F, et al. Green tea as an adjunctive therapy for treatment of acute uncomplicated cystitis in women: A randomized clinical trial. Complementary Therapies in Clinical Practice 2019;34:13-16

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Postmenopausal women with anxiety with an average age of 45-60 were included in this Iranian study. The 156 women had anxiety scores ranging from 20 to 35 using the State-Trait Anxiety Inventory (STAI). All women were naturally menopausal and were within 6 years of their last menstrual period. Women were excluded if they were taking anti-anxiety medications or natural therapies, had a history of severe physical illness that led to anxiety or had a recent traumatic life event.

Whole dried lavender flowers and bitter orange flowers were filled into capsules with 500 mg of lavender, 500 mg of bitter orange or placebo in a capsule. Women received one of those products, one capsule twice daily for 8 weeks. A total of 52 women were in each group and completed the study. All demographic characteristics and STAI scores were similar for each group except the placebo group had a significantly lower current age and age at menopause compared to the two herbal groups.

After 8 weeks, state-anxiety scores (indicating current feelings of anxiety) were significantly lower in the lavender and bitter orange group compared to the placebo group. Trait anxiety scores (indicating anxiety as a personal characteristic) were significantly lower in the lavender and bitter orange group compared to the placebo group after 8 weeks as well. There were no significant differences between the lavender and bitter orange group in either state or trait anxiety scores after 8 weeks. The beneficial response was rated as very good or good by 83.7% of participants in the lavender group, 83.4% in the bitter orange group and only 43.8% in the placebo group. Satisfaction with the results was reported by 73.5% in the lavender group and 79.2% in the bitter orange group while only 31.3% reported satisfaction in the placebo group.

Commentary: This study is on the tails of over half dozen positive studies on lavender and anxiety. This is the first I’ve seen using bitter orange. The results of this study show a significant effect in reducing anxiety in postmenopausal women. I have no reason to think that it would only work in postmenopausal women. It is true, perimenopausal women have an increased incidence of new onset general anxiety, recurrence of general anxiety or worsening of current anxiety. Prescription medications for the treatment of general anxiety in general, work well, but are unappealing due to side effects, some of which are addictive in nature.

Reference: Farshbaf-Khalili A, Kamalifard M, Namadian M. Comparison of the effect of lavender with bitter orange on anxiety in postmenopausal women: a triple-blind, randomized, controlled clinical trial. Complement Ther Clin Pract. May 2018; 31: 32-138.

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Rheumatoid arthritis (RA) is three times more likely to develop in women than in men… that is what makes it a women’s health problem.  It is an autoimmune disorder that is progressive, and typically is characterized by inflammation, pain, swelling, and stiffness of joints.
In RA, as in other autoimmune disorders, the immune system attacks the body, in this case, healthy joint tissue, and the release of proinflammatory chemicals such as tumor necrosis factor-alpha (TNF-α). The TNF-α then stimulates production of C-reactive protein (CRP), a marker for inflammation.
Conventional treatments of RA cover a wide range of options, and can indeed reduce the symptoms and slow the progression.  When progression is unchecked, permanent joint damage occurs.  That is why it is important to not completely dismiss the time and place and specific benefits and risks of conventional pharmaceuticals RA treatment. 
Safer and effective therapies will always be welcomed for RA.  Cinnamon holds some modest interest.  Cinnamon bark is a familiar spice and herbal remedy and there is some suggestion that it has anti-inflammatory activity and may be immune regulating.  The current randomized, double-blind, placebo-controlled trial evaluated the effect of cinnamon on disease activity, serum inflammation markers, and cardiovascular risk factors in women with RA.   Forty women, both pre and postmenopausal with a diagnosis of RA were recruited in Iran.  Women had to have had RA for ≥ 2 years, have active disease, currently taking medications called disease-modifying antirheumatic drugs (DMARDs), for 3 or more months, but not taking other prescription RA medications. 
Women were randomly assigned to receive either or 2000 mg/day (two, 500 mg capsules twice daily) encapsulated ground cinnamon bark for eight weeks.  The women were evaluated at baseline and eight weeks after starting the study.  The cinnamon group had significantly more premenopausal women than the placebo group and fewer postmenopausal women than the placebo group.  A rheumatologist evaluated tenders/swelling/pain, and then scored them using the Disease Activity Score of 28 joints (DAS-28), and the Visual Analogue Scale (VAS). Several blood tests were drawn, but of note were the erythrocyte sedimentation rate (ESR), serum TNF-α, and serum C-reactive protein (CRP).  
Results:  Mean serum TNF-α in the cinnamon group decreased from 167.27 pg/mL at baseline to 130.77 pg/mL at eight weeks;  TNF-α increased from 146.11 pg/mL to 162.25 pg/mL in the placebo group, although this was not considered significant.   The difference in the final values between the two groups was not statistically significant, but the mean change from the baseline was significantly better in the cinnamon group.  Serum CRP significantly decreased over time in the cinnamon group, and increased in the placebo group.  After treatment, the DAS-28 and VAS pain scores were significantly lower in the cinnamon group than the placebo group.  Mean tender joint counts decreased from 11.44 to 2.77 in the cinnamon group and swollen joints went from 8.44 to 1.38.  There was no decline in the placebo group. 
The ESR declined significantly from baseline only in the cinnamon group. One woman in the cinnamon group reported mild stomach discomfort.

Commentary:  I’m pleased to consider that cinnamon in this dose of 1,000 mg twice daily improved disease activity and inflammatory markers seen in RA patients.  This is the first study I’ve seen on cinnamon bark and RA, so I will be eager to see if these findings can be duplicated, although I will definitely incorporate this study into my clinical management of women with RA.  It would be important to study cinnamon in patients with RA who were not taking DMARDS to see if there was clinical benefit without the benefits and stability that the drug had imparted already. 
Reference:  Shishehbor F, Rezaeyan Safar M, Rajaei E, Haghighizadeh MH. Small Controlled Trial Reports Cinnamon May Benefit Rheumatoid Arthritis Cinnamon consumption improves clinical symptoms and inflammatory markers in women with rheumatoid arthritis. [published online May 3, 2018] J Am Coll Nutr.

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It’s not surprising to me that the age of puberty in girls has been declining the last 15-20 years. Environmental causes have been a suspect, but the reasons have not been clearly understood. The problem with early puberty is this is associated with higher rates of obesity, cardiovascular disease, polycystic ovarian syndrome and even breast cancer later in life. The normal range for the start of puberty in girls is between 8 and 13 years. There are several factors that are influencing the declining age ranges. Obesity has something to do with it… because we know that overweight girls enter puberty at younger ages. High levels of psychosocial stress can also influence the onset of puberty. And… exposures to certain endocrine-disruption chemicals in our environment may also be a factor. Here are some things we know:

· Daughters of mothers with high levels of diethyl phthalate, triclosan, phenols and parabens in their system during pregnancy, entered puberty earlier than others. These chemicals are common in all kinds of cosmetics, toothpaste, soaps and several other personal care products.

Phthalates are found in perfumes, deodorants, shampoos, cosmetics and other scented products. Parabens are added as a preservative; toothpaste, soaps, lipstick and skin lotions often contain phenols.

· Resent research looked at 179 girls and 159 boys in California who were born to mothers who were pregnant between 1999 and 2000. The study looked at how prenatal exposure to endocrine-disrupting chemicals influences the age of puberty onset. The study was looking at exposure in the womb, knowing that these hormone disrupting chemicals have windows of susceptibility and this prenatal period is a very specific window. Mothers were interviewed twice during pregnancy and when their children were 9. Children were assessed every 9 months between ages 9 and 13. Levels of various chemicals were measured in the urine of the pregnant moms and in the 9 y.o. children. By 9 years of age, 55% of the children were overweight or obese and 69% were living below the federal poverty threshold. The majority were Latino.

Associations between higher prenatal chemical exposure and early onset of puberty were seen in girls. High prenatal monoethyl phthalate concentrations were associated with earlier development of pubic hair; high levels of prenatal triclosan, propyl paraben, and 2,4-dichlorophenol were associated with earlier onset of menarche in the children. Methyl paraben and 2,5-dichlorophenol in urine were associated with earlier breast and pubic hair development. The daughters of women with the highest amounts of these substances in their urine started their periods an average of 4 months earlier. There was no evidence that boys were affected by prenatal chemical exposure in the same way.

Commentary:

The endocrine-disrupting chemicals detected in this study are known to have estrogenic activity, and this is known to affect sexual development. Previous laboratory research demonstrates that these chemicals mimic the estrogen that we produce in our own bodies. Animal studies also demonstrate that these endocrine disrupting chemicals may significantly impact reproductive development and the timing of puberty. We can minimize exposure to these chemicals—especially for pregnant women, BUT FOR ALL OF US!! Over 90% of women in the U.S. have detectable concentrations of phthalate, phenol, and parabens metabolites in their urine.

Read labels for one, especially in the arena of personal care products- shampoos, lotions, toothpaste, cosmetics. There are many brands and options available that do not contain these chemicals. Eat organic food, especially fruits and vegetables. If you cannot or do not have access…

You can wash fruits and vegetables to remove potential chemicals. Limit the use of plastics and synthetic materials for food preparation and storage. I now have cloth bags to store my vegetables in. The next step I’m going to take is remove the yoghurt and cottage cheese, etc… from their plastic and put into glass containers in my fridge.

Get active—with friends, family, neighbors, stores, farmers, legislators— there are some communities that have been successful about limiting new pesticide sprays in their areas. It would be transforming if we could diminish these harmful chemicals— not only for the health of our children, but for all beings and life on this planet.

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