Khara Lucius, ND

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  • Early Time-Restricted Eating: A Pair of Analyses

    Early Time-Restricted Eating: A Pair of Analyses

    In this pair of analyses, the effects of an early-time restricted eating (TRE) pattern were assessed.

    People with obesity (N=59) were randomized to one of the following for 14 weeks:

    • Early time-restricted eating plus overall energy restriction (allowing an 8-hour eating window from 7:00 a.m. to 3:00 p.m.)
    • Control eating schedule plus overall energy restriction (allowing intake over ≥12-hour window)

    Overall energy restriction was performed by asking participants to reduce their energy intake by 500 kcal/d below the requirements for their RMR. Food intake was assessed via remote food photography.

    Compared to the control schedule, early TRE did not affect diet quality, meal frequency, emotional eating, or other eating behaviors. Rather, normal eating patterns were simply condensed into a shorter time frame.

    In a secondary analysis, the authors then examined the effects of these two eating patterns on cardiometabolic indicators and weight loss.

    Relative to adherent participants in the control group, those who adhered to the early TRE ≥5 days per week had greater improvements in body weight (-3.7 ± 1.2 kg; p = 0.003), body fat (-2.8 ± 1.3 kg; p = 0.04), heart rate (-7 ± 3 beats/min; p = 0.02), insulin resistance as assessed via HOMA-IR (-2.80 ± 1.36; p = 0.047), and blood sugar (-9 ± 5 mg/dL; p = 0.047). They also had significantly greater improvements in mood (−2.4 ± 0.9; p = 0.009) as assessed by POMS-SF and PHQ-9, including measures of fatigue (−0.6 ± 0.3; p = 0.045). TRE participants did report  greater sleep onset latency (by 7 +/- 3 minutes, p = 0.04), and sleeping less (by 30 ± 13 minutes, p = 0.03), but sleep quality did not differ between groups (0.2 ± 0.7; p = 0.79), and as noted above, fatigue was actually improved in spite of this.

    This trial demonstrated that adopting a TRE approach during dietary energy restriction may offer additional benefits for the appropriate individual, compared to just dieting alone.

    Citations:

    Steger FL, Jamshed H, Martin CK, Richman JS, Bryan DR, Hanick CJ, Salvy SJ, Warriner AH, Peterson CM. Impact of early time-restricted eating on diet quality, meal frequency, appetite, and eating behaviors: A randomized trial. Obesity (Silver Spring). 2023 Feb;31 Suppl 1:127-138.

    Steger FL, Jamshed H, Bryan DR, Richman JS, Warriner AH, Hanick CJ, Martin CK, Salvy SJ, Peterson CM. Early time-restricted eating affects weight, metabolic health, mood, and sleep in adherent completers: A secondary analysis. Obesity (Silver Spring). 2023 Feb;31 Suppl 1(Suppl 1):96-107.

    Links:

    https://onlinelibrary.wiley.com/doi/10.1002/oby.23642

    https://onlinelibrary.wiley.com/doi/10.1002/oby.23614

  • Boswellia and Curcumin for Bloating in SIBO

    Boswellia and Curcumin for Bloating in SIBO

    This randomized controlled study assessed for the effects of a combination of Boswellia and Curcumin with low-FODMAP diet, compared to low-FODMAP diet alone, on abdominal bloating in IBS subjects with small bowel dysbiosis.

    Subjects were men or women ages 18 to 70 who had a diagnosis of moderate IBS according to Rome III criteria, and who reported bloating as their main symptom. SIBO was confirmed via urinary indican testing. Sixty-seven people enrolled, with 34 randomized to the control group, and 33 to the botanical medicine group.

    Curcumin was supplemented as a lecithin-based formulation along with a standardized extract of Boswellia serrata, at a dose of 500mg twice daily for 30 days. All subjects received dietary instruction on the low-FODMAP diet from the same dietician.

    At the conclusion of the trial, there was a statistically significant difference between the two groups both for bloating and abdominal pain (p < 0.0001 for both). Additionally, 94% of subjects in the botanical medicine group achieved a grade 3 or grade 4 improvement in a global assessment of efficacy, while only 15% of people in the control group achieved this improvement.

    Citation:

    Giacosa, A.; Riva, A.; Petrangolini, G.; Allegrini, P.; Fazia, T.; Bernardinelli, L.; Peroni, G.; Rondanelli, M. Beneficial Effects on Abdominal Bloating with an Innovative Food-Grade Formulation of Curcuma longa and Boswellia serrata Extracts in Subjects with Irritable Bowel Syndrome and Small Bowel Dysbiosis. Nutrients 2022, 14, 416.

    Link:

    https://www.mdpi.com/2072-6643/14/3/416

  • Pre-Diagnosis Selenium Level, Survival, and Tumor Characteristics in Women with Breast Cancer

    Pre-Diagnosis Selenium Level, Survival, and Tumor Characteristics in Women with Breast Cancer

    This study utilized data from the Malmö Diet and Cancer Study, a population‐based cohort, including 17,035 women recruited from 1991 to 1996. Women with incident breast cancer (N=1066) were included (those with DCIS or bilateral breast cancer were excluded) and compared to controls without breast cancer from both matching (N=694) as well as randomization (N=492). Prediagnostic serum selenium levels were then compared, and risk of specific tumor characteristics or subtypes was determined. Breast cancer subjects were also followed for overall mortality and breast cancer-specific mortality.

    While there was no association between serum selenium quartiles and tumor characteristics or subtypes, women in the highest compared to lowest selenium quartiles had lower overall mortality (HR 0.63, 95% CI: 0.44‐0.89) as well as breast cancer-specific mortality (HR 0.60, 95% CI: 0.37‐0.98).

    This study adds to our knowledge about how selenium levels might affect breast cancer. Previous data (including a Cochrane systematic review) indicate that it is unlikely that serum selenium levels impact the overall risk of breast cancer, but that breast cancer mortality may be impacted by serum levels or by selenium intake. The protective effects of selenium may be limited to clinical outcomes in women with existing breast cancers, rather than to overall incidence. The benefit of baseline selenium level in this trial does not seem tied to specific subtypes or tumor characteristics.

    Citation:

    Sandsveden M, Nilsson E, Borgquist S, Rosendahl AH, Manjer J. Prediagnostic serum selenium levels in relation to breast cancer survival and tumor characteristics. Int J Cancer. 2020;147(9):2424-2436. doi:10.1002/ijc.33031

    Link:

    https://onlinelibrary.wiley.com/doi/10.1002/ijc.33031

  • 48-Hour Water Fasting During Chemotherapy for Gynecologic Cancer

    48-Hour Water Fasting During Chemotherapy for Gynecologic Cancer

    In this small randomized controlled trial (N= 20), women with gynecologic cancer (11 with ovarian, 8 with uterine, and 1 with cervical cancer) receiving at least 6 cycles of chemotherapy were randomized to either a fasting or non-fasting group. The fasting group maintained a water-only fast for 24 hours before through 24 hours after each chemotherapy cycle. Most participants (90%) were receiving platinum-taxane doublet, and most (80%) had stage 3 or 4 disease.

    Analysis included data from 120 cycles of chemo. Hospitalization rates and weight loss were no different between the two groups. Mean QOL scores were not significantly different between the two groups. There were fewer dose reductions and treatment delays among women in the fasting group (8.3% among fasters compared to 13.3% in the control group).

    Additionally, mean serum glucose (at cycle day 1) was significantly lower among fasters, and mean platelet counts remained significantly higher (p<0.0001 and p=0.009).

    It was concluded that fasting was well tolerated, did not increase weight loss or hospitalizations, and resulted in fewer treatment modifications.

    Citation:

    Riedinger CJ, Kimball KJ, Kilgore LC, Bell CW, Heidel RE, Boone JD. Water only fasting and its effect on chemotherapy administration in gynecologic malignancies. Gynecol Oncol. 2020;159(3):799-803. doi:10.1016/j.ygyno.2020.09.008

    Link:

    https://www.gynecologiconcology-online.net/article/S0090-8258(20)33901-9/fulltext

  • Light at Night and Postmenopausal Breast Cancer Risk

    Light at Night and Postmenopausal Breast Cancer Risk

    This analysis examined an estimation of outdoor light at night (LAN) exposure from satellite imagery in association with postmenopausal breast cancer, utilizing data from the NIH-AARP Diet and Health Study. LAN was estimated at baseline from 1996, in 186,981 postmenopausal women. Over a 16 year follow up period, 12,318 cases of breast cancer were detected.

    Comparing women in the lowest to highest quintile of baseline LAN, there was a 10% increase in the risk of postmenopausal breast cancer among women in the highest quintile of exposure (HR 1.10, p-trend=0.002). This association was stronger for ER+ breast cancer compared to ER(-) breast cancer (HR 1.12, p-trend=0.007).

    The authors also found that important lifestyle factors, such as BMI, physical activity habits, hormone replacement therapy, smoking status, and alcohol consumption, along with environmental and social factors such as poverty rate, may interact with LAN to affect risk. For example, there were somewhat stronger associations for women who were current smokers, and also stronger associations for women consuming ≥ 1 alcohol drink daily. LAN may influence postmenopausal breast cancer risk via synergistic interactions with these factors, potentially via alteration of melatonin or estrogen pathways.

    Citation:

    Xiao Q, James P, Breheny P, et al. Outdoor light at night and postmenopausal breast cancer risk in the NIH-AARP diet and health study. Int J Cancer. 2020; 147(9):2363-2372. doi:10.1002/ijc.33016

    Link:

    https://onlinelibrary.wiley.com/doi/10.1002/ijc.33016

  • Melatonin reduces fatigue during adjuvant treatment in women with early stage or locally advanced breast cancer

    Melatonin reduces fatigue during adjuvant treatment in women with early stage or locally advanced breast cancer

    In this double-blind randomized prospective trial, women with stage I-III breast cancer (n=74) were randomized to receive either melatonin at a dose of 18mg nightly, or a placebo, starting 1 week before and continuing through 4 weeks after adjuvant therapy (adjuvant treatment consisted of 16 weeks of dose dense AC-T and 5 weeks of radiation). Thirty-seven women were included in each group. Menopausal status was not given.

    At the completion of the trial, fatigue was significantly lower in women who received melatonin (p<0.001) and the incidence of severe fatigue was also significantly lower, 42% in the melatonin group compared to 83% in the placebo group (p<0.001).

    This study did not assess impact on sleep (or on other treatment-related side effects), so it is unclear if these effects may have been related to sleep quality itself or if they occur independent of that. Nonetheless, these results agree with previous studies (Palmer et al 2020, Semiglazova et al 2019) finding an impact of melatonin supplements on energy levels in women undergoing adjuvant or neoadjuvant breast cancer treatment.

    Citation:

    Sedighi Pashaki, A., Mohammadian, K., Afshar, S., Gholami, M. H., Moradi, A., Javadinia, S. A., & Keshtpour Amlashi, Z. (2021). A Randomized, Controlled, Parallel-Group, Trial on the Effects of Melatonin on Fatigue Associated with Breast Cancer and Its Adjuvant Treatments. Integrative cancer therapies, 20, 1534735420988343.

    Link:

    https://journals.sagepub.com/doi/10.1177/1534735420988343

  • Curcumin reduces serum uremic toxins in people with CKD on dialysis

    Curcumin reduces serum uremic toxins in people with CKD on dialysis

    Curcumin in combination with other natural anti-inflammatory or antioxidant substances (such as Boswellia or resveratrol) has been previously shown to have positive effects in people with CKD receiving dialysis. These include increasing bone and muscle mass, and decreasing markers of inflammation.

    In this pilot-scale double-blind trial, 28 people were randomized to receive either turmeric 2500mg, standardized to 95% curcumin (mixed into an orange juice with added carrot), or control (same juice with no added curcumin) 3 times weekly, following their dialysis sessions, for 3 months.

    After 3 months, there was a significant reduction in the uremic toxin p-cresyl sulfate in people in the curcumin group compared to those who received the control (p = 0.009).  The authors speculate that this effect may be a result of improved gut barrier function or modulation of the microbiome as a result of curcumin supplementation, changes which could decrease p-cresyl sulfate permeability and absorption.

    Citation:

    Salarolli, R.T., Alvarenga, L., Cardozo, L.F.M.F. et al. Can curcumin supplementation reduce plasma levels of gut-derived uremic toxins in hemodialysis patients? A pilot randomized, double-blind, controlled study. Int Urol Nephrol (2021).

    Link:

    https://doi.org/10.1007/s11255-020-02760-z

  • Walnut Consumption Leads to Favorable Alterations in Tumor Gene Expression in Women with Breast Cancer

    Walnut Consumption Leads to Favorable Alterations in Tumor Gene Expression in Women with Breast Cancer

    In this small trial, postmenopausal women with biopsy-confirmed breast cancers (most participants had IDC, with either + or – hormone receptor and Her2 status) were randomized to either a control group (following their usual diet, N=5), or the walnut group (usual diet with addition of 2oz walnuts daily, N=5) while awaiting surgery (which was performed 2 to 3 weeks later). Tumor gene expression from the biopsy was compared to that from the surgical sample.

    The expression of 456 identified genes was significantly altered in the tumors of women who consumed walnuts compared to controls. This included favorable alterations in the expression of PI3K/Akt, the estrogen receptor, p38/ERK ratio, bradykinin receptor B1 (BDKRB1), JNK mRNA, caspase, and VEGF.

    No information on the usual diet followed by participants was provided, and the authors admit that “consumption of a different background diet might result is a different degree of benefit” with walnut consumption. Nonetheless, this is an easy intervention with intriguing results.

    Citation:

    Hardman WE, Primerano DA, Legenza MT, Morgan J, Fan J, Denvir J. Dietary walnut altered gene expressions related to tumor growth, survival, and metastasis in breast cancer patients: a pilot clinical trial. Nutr Res. 2019; 66:82-94.

    Link:

    doi:10.1016/j.nutres.2019.03.004

  • Green Tea Supplement Does Not Impact Tamoxifen Pharmacokinetics

    Green Tea Supplement Does Not Impact Tamoxifen Pharmacokinetics in Women with Breast Cancer

    In this small open-label crossover trial, 14 breast cancer patients who had been on Tamoxifen at 20 or 40mg QD for at least 3 months were randomized to either Tamoxifen alone for 28 days, or Tamoxifen plus Green tea Extract for 14 days, followed by crossover. Green Tea Extract was dosed at 1000mg (with 150mg EGCG) BID, a dose roughly equivalent to 5 to 6 cups of green tea daily. Patients with genetic variations in CYP2D6 were excluded.

    Endoxifen AUC during GTE supplementation was no different from that during tamoxifen monotherapy (p=0.92). There was also no difference in endoxifen Cmax or Ctrough during the combination or monotherapy periods (p=0.77). Likewise, the AUC, Cmax and Ctrough for Tamoxifen were no different during GTE supplementation compared to drug monotherapy (p=0.44, p=0.64, and p=0.34 respectively).

    This small trial may give a measure of reassurance to people with breast cancer who wish to combine Green tea supplements and Tamoxifen.

    Citation:

    Braal CL, Hussaarts KGAM, Seuren L, et al. Influence of green tea consumption on endoxifen steady-state concentration in breast cancer patients treated with tamoxifen [published online ahead of print, 2020 Aug 16]. Breast Cancer Res Treat. 2020; 10.1007/s10549-020-05829-6.

    Link:

    https://doi.org/10.1007/s10549-020-05829-6

  • Mediterranean Diet and Risk of Cancer

    Mediterranean Diet and Risk of Cancer

    The authors of a 2014 meta-analysis and systematic review revisited the association between adherence to the Mediterranean Diet (MD) and risk of cancer, incorporating new data. A total of 117 studies with 3.2 million participants (predominately European and US cohorts) were included in the meta-analysis. Highest adherence to MD was inversely associated with a number of findings, including:

    • cancer mortality (RR 0.87)
    • all-cause mortality among cancer survivors (RR 0.75)
    • breast cancer (RR 0.94)
    • colorectal cancer (RR 0.83)
    • head and neck cancer (RR 0.56)
    • lung cancer (RR 0.84)
    • gastric cancer (RR 0.70)
    • bladder cancer(RR 0.87)
    • hepatocellular cancer (RR 0.64)

    MD adherence was not associated with the risk of hematologic, esophageal, pancreatic or prostate cancer.

    Utilizing the NutriGrade scoring system, the evidence was ranked as “moderate” for cancer mortality and colorectal cancer risk, whereas as the evidence for other findings was ranked as “low”. One challenge affecting MD studies (including this review) is variability in the definition of the MD eating pattern.  Most of the included studies utilized MD definitions from either Trichopolou et al (2003), or Fung et al (2005). In spite of this, a major strength for this review is the large number of subjects and included studies.

    Citation:

    Morze, J., Danielewicz, A., Przybyłowicz, K. et al. An updated systematic review and meta-analysis on adherence to mediterranean diet and risk of cancer. Eur J Nutr (2020). https://doi.org/10.1007/s00394-020-02346-6

    Link:

    DOI: 10.1007/s00394-020-02346-6