E. Paul Cherniack

Polyphenols: Planting the seeds of treatment for the metabolic syndrome

Greater understanding about the pathogenesis of metabolic syndrome and potential causes suggests that plant polyphenols might be useful as a treatment. Dietary excess energy can be stored in adipocytes, leading to the release of proinflammatory cytokines and adipose-related hormones that cause vascular injury. Plant polyphenols, organic compounds found in numerous plant species and their fruits, are being actively studied as potential treatments for components of the metabolic syndrome. Individual polyphenols that have been examined include resveratrol, quercetin, epigallocathechin-3-gallate, and curcumin. Resveratrol lowers weight, blood pressure, glucose, and insulin resistance in rodents, and a human trial is currently underway. Quercetin decreases lipid and glucose levels in obese rats, and in a human investigation of subjects with the metabolic syndrome has lowered blood pressure without significant alteration of lipids. Epigallocathechin-3-gallate-induced weight loss has attenuated glucose levels and insulin resistance in rodents and improved hemoglobin A(1c) and lipid in human studies. Plant extracts also can be used. Grape seed and chokeberry extracts have decreased blood pressure and lipid levels in small human trials. Other human investigations have shown the beneficial effects of cocoa, coffee, carob, and Momordica charantia. Thus far, most studies have involved a small number of subjects and have been of short duration. Future studies should be designed to account for a disease process in which the pathogenic factors may take place for years before disease manifestations take place, the possibly limited bioavailability of polyphenols, and the potential need to provide combinations or modifications of polyphenols.

Influence of race and ethnicity on alternative medicine as a self-treatment preference for common medical conditions in a population of multi-ethnic urban elderly

The use of complementary and alternative medicine (CAM) is prevalent among elderly individuals. While race and ethnicity may influence the choice of CAM, it is uncertain how this influence affects an individuals choice of CAM or conventional medicine. Furthermore, it is unclear whether this choice of CAM or conventional medicine might vary for different medical conditions. A survey of CAM use was performed on a convenience sample of 338 multi-ethnic urban elderly subjects who attended clinic at two large university-affiliated hospitals over 2 years. The survey asked about individual CAM therapies used, and whether subjects would prefer conventional (prescription or over-the-counter) or CAM (herbal or other) treatment for three different medical conditions: colds, insomnia, and back pain. Hispanic ethnicity and female gender were the best predictors of CAM use. Blacks were more likely than whites to utilize CAM. Hispanics were more likely to choose herbal medications to self-treat colds and insomnia than whites or blacks, or low-back pain than whites. More Hispanics chose herbal medications to treat insomnia than over-the-counter or prescription medications.

The benefit of pets and animal-assisted therapy to the health of older individuals.

Many studies utilizing dogs, cats, birds, fish, and robotic simulations of animals have tried to ascertain the health benefits of pet ownership or animal-assisted therapy in the elderly. Several small unblinded investigations outlined improvements in behavior in demented persons given treatment in the presence of animals. Studies piloting the use of animals in the treatment of depression and schizophrenia have yielded mixed results. Animals may provide intangible benefits to the mental health of older persons, such as relief social isolation and boredom, but these have not been formally studied. Several investigations of the effect of pets on physical health suggest animals can lower blood pressure, and dog walkers partake in more physical activity. Dog walking, in epidemiological studies and few preliminary trials, is associated with lower complication risk among patients with cardiovascular disease. Pets may also have harms: they may be expensive to care for, and their owners are more likely to fall. Theoretically, zoonotic infections and bites can occur, but how often this occurs in the context of pet ownership or animal-assisted therapy is unknown. Despite the poor methodological quality of pet research after decades of study, pet ownership and animal-assisted therapy are likely to continue due to positive subjective feelings many people have toward animals.

Incidence of Deep-Venous Thrombosis in Nursing Home Residents Using Megestrol Acetate

OBJECTIVE To determine the incidence of deep venous thrombosis in users of megestrol acetate in population of institutionalized elderly. DESIGN Retrospective chart review. SETTING A teaching nursing home in New York City. MEASUREMENTS Number of cases of deep venous thrombosis in megesterol users. RESULTS The incidence of deep venous thrombosis in 246 users was 4.9% CONCLUSION There is a six-fold higher incidence of deep venous thrombosis among megestrol users in this population than in the general population of institutionalized elderly.

The response of elderly veterans to daily vitamin D3 supplementation of 2,000 IU: a pilot efficacy study.

OBJECTIVES: To determine the prevalence of hypovitaminosis D (serum 25‐hydroxyvitamin D<32 ng/mL; HVD) in a population of elderly veterans and conduct a preliminary assessment of the efficacy of supplementation with cholecalciferol in correcting HVD.

Use of complementary and alternative medicine to treat constipation in the elderly

Many modalities of complementary and alternative medicine, such as probiotic bacteria, traditional herbal medicines, biofeedback and massage, have been used to treat constipation in older adults. Virtually all studies in the published literature have been plagued with methodological problems, such as lack of blinding. Chinese herbal medications have been the most frequent subject of studies in controlled trials, but have suffered from methodological insufficiencies, and few have been published in publications other than Chinese language journals. Several therapies, such as yogurt containing probiotic bacteria and massage, are relatively easy to use by the patient, and are likely to cause few adverse reactions. Therefore, complementary and alternative therapies might show the greatest promise for being adopted as adjunctive therapies to conventional treatment. Geriatr Gerontol Int 2013; 13: 533–538.

Complementary medicine use is not associated with non-adherence to conventional medication in the elderly: A retrospective study

Lack of adherence to medications is a potential cause of hospitalizations, morbidity, and mortality in the elderly. Medication adherence decreases with polypharmacy. Older persons commonly use complementary medicine, therefore complementary medicine use might pose an increase risk of loss of medication adherence with conventional medications, but this has not been previously investigated. A chart review was conducted of 300 patients at least sixty-five years of age who used at least three medications each who attended a university geriatrics clinic in Florida, USA to obtain information about medication adherence and complementary medicine use. However, no association was found between use of at least one complementary medicine and adherence to conventional medications.

Would the elderly be better off if they were given more placebos

Placebos are useful in the medical care of the elderly, although the exact definition of a “placebo” or “placebo effect” is difficult to define precisely. They have an important role as control treatments in research trials, but a non‐specific “placebo effect” may also be beneficial part of many physician–patient interactions. Physicians also give them deliberately according to several studies worldwide to satisfy patient demands or because they believe in a “placebo effect” among other reasons. A significant placebo effect has been observed among older patients in clinical trials of antidepressants (12–15%), and in treatments of Parkinsons disease (16%). Placebos activate serotonergic pathways in the brain used by antidepressants. In Parkinsons disease, the administration of a placebo stimulates dopamine release in the dorsal (resulting in motor effects) and ventral striatum (which influences expectation of reward). Much of our understanding of the placebo effect comes from studies of placebo analgesia which is influenced by conditioning, expectation, meaning and context of the treatment for the patient, and patient–physician interaction. It is anatomically medicated by brain opioid pathways. Response to “sham” acupuncture in osteoarthritis may be an example of its use in the elderly. Placebos have often been considered a deception and thus unethical. On the other hand, some physicians and ethicists have suggested conditions for appropriate uses for placebos. A placebo might offer the theoretical advantage of an inexpensive treatment that would not cause adverse drug reactions or interactions with other medications, potentially avoiding complications of polypharmacy.

Ergogenic dietary aids for the elderly

Ergogenic dietary aids might be useful adjunctive therapy to enhance the effects of exercise in the elderly, who lose physical function with age. Many such aids have been tested in athletes and untrained younger persons in laboratory and athletic performance settings, with positive results, although not all studies have demonstrated benefit. Some substances have been tested in the elderly, including creatine, caffeine, β-hydroxy-β-methylbutyrate, ubiquinone, and carnitine. The published medical evidence for the use of these substances is considered in this review article. All studies have involved a few subjects for a short period. Studies of creatine alone or together with exercise in old persons have yielded mixed results. These studies have confirmed that creatine in older individuals, as in younger individuals, can increase the short-term capacity to perform quick, repeated episodes of intense activity. An investigation of caffeine has suggested that in older as in younger individuals, caffeine increases endurance but may not improve other parameters of exercise capacity. Evidence has implied β-hydroxy-β-methylbutyrate can increase the ability to perform certain short-term activities requiring strength, but not others. Carnitine has been reported to decrease fatigue and increase endurance in older persons. An investigation of ubiquinone has shown no benefit. Further testing has involved the combinations of agents, such as creatine and caffeine, and combinations of β-hydroxy-β-methylbutyrate, showing some small improvements in physical function. Future research with these and potentially other combinations over a longer duration will be needed to establish the safety and efficacy of ergogenic dietary aids.

The Potential Influence of Plant Polyphenols on the Aging Process

Cellular senescence is characterized by cellular hypertrophy: cell growth in the absence of cell division. The genes that regulate this process can be activated or inactivated by numerous plant polyphenols such as resveratrol, quercetin, butein, fistein, piceatannol, curcumin. Many of these substances have been shown to lengthen the lifespan of invertebrates. Many of these compounds have other potential beneficial effects on lifespan as antiatherogenic or antineoplastic agents. Challenges to human testing of such substances on lifespan include determination of dosage, low bioavailability, time and resources necessary to conduct tests, and understanding which formulation of substances to use.