In the News

Diagnostic Delays of Cow’s Milk Protein Allergy Caused by Challenges Interpreting Non-specific Symptoms

Combination Setria Glutathione and L-Citrulline Supplementation Proven to Increase Post-Exercise Benefits

National College of Natural Medicine Receives $3,092,898 for NIH Research Grants

The Bravewell Collaborative Leaves a Legacy of Transforming Healthcare

Metagenics Healthcare Institute for Clinical Nutrition Collaborates on Innovative Study Focused on Methylation and Patient Outcomes

Diagnostic Delays of Cow’s Milk Protein Allergy Caused by Challenges Interpreting Non-specific Symptoms

Experts speaking at the European Society of Paediatric, Gastroenterology, Hepatology and Nutrition Meeting  ESPGHAN in May 2015 shared research showing that appropriate management of cow’s milk protein allergy (CMPA)—one the most commonly occurring food allergies in infants and young children—is usually delayed by months before an accurate diagnosis is made by pediatric specialists and a therapeutic elimination diet is prescribed, usually consisting of a hypoallergenic extensively hydrolyzed formula.

Speaking at the Nestlé Nutrition Institute Satellite Symposium “Cow’s Milk Protein Allergy: How can we improve standards of care in Pediatric Practice,” Professor Vandenplas, of the Brussels Academic Hospital, said: “Only in a minority of cases does the child have an immediate reaction to cow’s milk which makes CMPA easy to identify; but in the majority of cases, due to the genuine challenges facing primary healthcare professionals interpreting the mix of symptoms, there can be a considerable time lag before diagnosis by a specialist and application of a therapeutic diet. This delay can be deleterious to a child’s healthy development, as well as being distressing.”

The difficult to interpret non-specific symptoms referred to included crying, regurgitation, too hard or too soft stools, and skin and respiratory issues. There is no reliable biomarker for CMPA, and diagnosis must in most cases be confirmed by an elimination diet and food challenge.

Session chair and fellow speaker Professor Sibylle Koletzko, Hauner Children’s Hospital, Munich, referred to studies reflecting the current confusion not just about interpreting IgE and non-IgE mediated reactions, but also about how to apply current ESPGHAN guidelines, as a recent pilot study in Germany and Hungary indicated a lack of awareness of the guidelines regarding when to switch to an elimination diet and food challenge to confirm diagnosis: “The patient journey to accurate diagnosis is often prolonged as primary healthcare professionals struggle to interpret complex indications also associated with a range of other allergies and food intolerances. There have been few steps forward in the management approach since the EuroPrevall study that showed that the time lag between the occurrence of symptoms and a food challenge can be two to seven months. The EuroPrevall study strongly favored the recognition of IgE mediated CMPA, while cases with unspecific gastrointestinal manifestations negative for specific IgE were not captured due to the study design. With a higher degree of suspicion more children with non-IgE manifestations are found.”

New Symptom Awareness Tool 

Prof. Vandenplas focused upon a new awareness tool designed to help primary healthcare professionals recognize and assess non-specific symptoms earlier. The Cow’s Milk Related Symptom Scoring Tool (CoMiSS) has been developed by a panel of 11 experts, chaired by Prof. Vandenplas. It is designed to enable primary healthcare professionals to more easily assess a mix of non-specific symptoms from different organ systems associated with CMPA—including crying, regurgitation, stool, skin, and respiratory conditions. CoMiSS takes between 5 and 15 minutes to complete in conjunction with the child and parent. Prof. Vandenplas said, “Use of CoMiSS by primary healthcare professionals can raise awareness of the likelihood of CMPA at an earlier stage. Early data shows a predictive value of the tool in identifying infants at risk of CMPA of 80 percent. It is fast and user-friendly and, since its launch in April, is increasingly being used. To encourage further uptake, we will be recruiting study centers in various countries to validate the tool and its role in identifying children with CMPA symptoms earlier than the current norm.”

Prof. Sibylle Koletzko reiterated that accurate and early diagnosis is a stated goal of the relevant 2012 ESPGHAN guidelines: “Without an appropriate diagnostic work-up, including food challenge procedures, there is a high risk of over- and under-diagnosis and thus over- and under-treatment. A correct diagnosis allows the appropriate diet to be given to affected infants, thus supporting normal growth and development.”

The workshop with experts to review and discuss the development of CoMiSS was held in September 2014, supported by an unrestricted grant by Nestlé Health Science. The CoMiSS tool and the expert workshop report is currently available from Nestlé Health Science. It will shortly be published in various languages and on national Nestlé Health Science websites.

Source: The Nestlé Nutrition Institute, nestlenutrition-institute.org

Combination Setria Glutathione and L-Citrulline Supplementation Proven to Increase Post-Exercise Benefits

A new randomized, double-blind, placebo-controlled, human clinical trial published in the Journal of the International Society of Sports Nutrition found, for the first time, that one week of daily oral supplementation with 200 mg of Setria Glutathione and 2 grams of L-citrulline enhanced nitric oxide (NO) levels. Setria Glutathione led to longer lasting levels of NO by preventing its oxidative reaction when ingested in combination with L-citrulline.

The study, led by Dr. Darryn Willoughby of Baylor University, was designed to determine the effectiveness of Glutathione and L-citrulline on improving exercise performance, based on markers of nitric oxide (NO) synthesis. L-citrulline is known to impact NO levels as it's converted to L-arginine, which synthesizes NO when ingested. However, L-citrulline supplementation alone has shown conflicting results in reference to improving exercise performance. Previous studies have indicated that Glutathione stimulates L-arginine turnover and increases nitric oxide synthase (NOS). These results suggest that it may play a role in preventing oxidative reaction and sustaining the release of NO; however, its effectiveness, particularly in combination with L-citrulline, had not been determined prior to this study.

Results from the study found that after seven days of oral supplementation, levels of nitric oxide and NOx in the L-citrulline and Glutathione group showed a measured increase 30 minutes post exercise when compared with the placebo group. Participants of the study included 60 healthy, resistance-trained males aged 18 to 30, with a body mass index between 18.5 and 30 kg/m², divided into four groups that received either a placebo, Setria Glutathione (1 g), L-citrulline (2 g), or a combination of Setria Glutathione (200 mg) and L-citrulline (2 g) for one week. To measure the impact of supplementation or placebo during the seven day study period, the groups were evaluated after completing resistance exercise sessions, including three sets of 15 repetitions at 70 to 75 percent of the estimated 1-RM involving the elbow flexors.Participants were assessed on their maximum muscular strength at the beginning of the study, prior to supplementation, and following three sets of 15 repetitions of the elbow flexion exercise.

"In this study, we were able to determine that combining Setria Glutathione with L-citrulline not only increased blood levels of nitrite and NOx, but sustained the increases for a longer period of time, compared to placebo," said Dr. Willoughby, Baylor University, associate professor, Health, Human Performance, and Recreation, director, Exercise and Biochemical Nutritional Lab. "The results of this first-of-its kind study indicate that Setria Glutathione and L-citrulline may play a role in muscle protein synthesis and muscle performance when combined with resistance exercise."

"In addition to its immune health benefits, Setria Glutathione is known to work in the body to eliminate toxic chemicals, maintain cell proteins, and act as an antioxidant," said Danielle Citrolo, registered pharmacist and manager of technical services for Kyowa Hakko USA. "With its reputation as the 'master antioxidant,' due in part to its role in combatting oxidative stress, it's encouraging to see the benefits of Setria Glutathione supplementation extended to slowing the release of and sustaining the body's levels of NO with L-citrulline. These results give consumers a research-backed approach to increasing the effectiveness of resistance training with regular intake of L-citrulline and Setria Glutathione oral supplements."

In the same paper, similar results were seen in phase one in-vitro (cell culture) and phase two rodent studies. These results combined with the human clinical trial data shows that the combination of Setria Glutathione and L-citrulline has the same positive, long lasting benefit of enhancing nitric oxide across a variety of subjects, as well as blood levels of NOx.

Source: Kyowa Hakko USA Inc., kyowa-usa.com

National College of Natural Medicine Receives $3,092,898 for NIH Research Grants

The National Institutes of Health, through the National Center for Complementary and Integrative Health, has awarded nearly $3.1 million to the National College of Natural Medicine (NCNM) and its Helfgott Research Institute for two five-year complementary and integrative health research grants. The funding will support the study of multiple sclerosis and the development of inter-disciplinary clinical research training for naturopathic and medical doctors.

The National Institutes of Health, through the National Center for Complementary and Integrative Health (NCCIH), has awarded $3,092,898 to the Helfgott Research Institute at the National College of Natural Medicine (NCNM) for two five-year complementary integrative health (CIH) research grants.

The new grants will provide funding for studies involving mindfulness-based stress reduction for people with multiple sclerosis; and clinical research training for naturopathic doctors and Chinese medicine practitioners, as well as training in naturopathic and Chinese medicine modalities for conventional medicine researchers.

Said NCNM President David J. Schleich about the new funding: “The School of Research & Graduate Studies at NCNM and our Helfgott Research Institute are growing at an unprecedented pace—because there is a need. With the increasing use of complementary and alternative medicine, high-quality rigorous research is essential so that CIH therapies can be accurately evaluated to help keep the public informed. We are honored to be able to partner with our esteemed colleagues at OHSU and UW on these important projects to grow this critical field of research.”

The K23 Mindfulness-Based Stress Reduction for Multiple Sclerosis (Feasibility, Durability and Clinical Outcomes) program is being undertaken with Oregon Health & Science University (OHSU). The Building Research across Inter-Disciplinary Gaps (BRIDG)/ T90/R90 Clinical Research Training program in Complementary and Integrative Health is underway in collaboration with the University of Washington (UW) in Seattle. The two NCNM research programs have been awarded a total of $672,550 and $2,420,348 respectively. NCNM and its Helfgott Research Institute have received eight NIH awards totaling $6,046,183 since 2002.

“The NCCIH awards are gratifying—not only because of the recognition from our federal government for the value of our research, but also for furthering our ability to help NCNM students develop the skills they need to contribute to the evidence-base of natural medicine,” Schleich said.

K23 MINDFULNESS-BASED STRESS REDUCTION FOR MULTIPLE SCLEROSIS PROGRAM

Multiple sclerosis (MS) is the most common neurological condition affecting young adults in the United States. MS symptoms are diverse and unpredictable, and include diminished mobility, chronic pain, fatigue, depression, anxiety and cognitive impairment. Studies have shown that psychological stress can exacerbate MS symptoms and trigger relapses.

While Mindfulness-Based Stress Reduction (MBSR) clinical trials have demonstrated improved health conditions for many patient populations, few trials have been applied to people with neurological impairments. A recent study found that participation in a stress-reduction trial reduced the frequency of new lesion development in MS, suggesting that stress-management might not only improve symptoms, but may modify the disease progression.

The threefold aim of this program is to conduct research that will evaluate the feasibility of mindfulness-based stress reduction for people with multiple sclerosis; assess the durability of outcomes over a 12-month period; and understand which post-intervention activities and behaviors might support or inhibit sustainability.

NCNM researchers will introduce MBSR to study participants as an eight-week program consisting of weekly two-hour classes of meditation, breath work, yoga, self-reflection and awareness.

T90/R90 BRIDG CLINICAL RESEARCH TRAINING PROGRAM

The primary goal of the BRIDG program is cross-training promising investigators to translate CIH (formerly known as complementary and alternative medicine) concepts into testable, multi-disciplinary research hypotheses; and to apply translational research methods to CIH-oriented research. Recognizing that research in CIH requires a multi-disciplinary approach, NCNM and UW have combined their expertise in research, clinical care and CIH to create an immersive clinical research training program that will foster collaboration and respect among a variety of medical and research disciplines.

The program integrates doctoral-level CIH healthcare providers (e.g., doctors of naturopathic, chiropractic, and acupuncture and Oriental medicine) and conventionally trained researchers from biomedical and public health disciplines (e.g., medical doctors, doctors of public health, PhDs, etc.).

The R90/NCNM component of the BRIDG program will train post-doctoral researchers who want to learn clinical research in a variety of CIH practices, including naturopathy, Chinese medicine, herbal medicine, nutrition, and mind-body therapies. The T90/UW program component will train post-doctoral CIH clinicians in a variety of clinical research methods.

NCNM thanks the NCCIH for generously supporting these two research training programs (Senders K23—1K23AT008211 and Zwickey R90—1R90AT008924). Visit the National Center for Complementary and Integrative Health at the National Institutes of Health to learn more about NCCIH training and development grants.

Visit NCNM’s Helfgott Research Institute to learn more about the BRIDG program or other research studies underway. Visit NCNM’s School of Research & Graduate Studies to learn more about its postgraduate degree programs.

ABOUT NCNM

Founded in Portland, Oregon, in 1956, NCNM is the oldest accredited naturopathic medical school in North America and an educational leader in classical Chinese medicine and CAM research. NCNM offers both postgraduate and undergraduate degree programs: these include four-year graduate medical degrees in naturopathic and classical Chinese medicine; four Master of Science degrees in Integrative Medicine Research, Nutrition, Global Health, and Integrative Mental Health; and two Bachelor of Science degrees in Nutrition and Integrative Health Sciences. NCNM also provides community education through the NCNM Institutes: Women in Balance, Traditional Roots and Food as Medicine. NCNM’s teaching clinics, including NCNM Clinic, the Beaverton Clinic, and the college’s many community clinics, provide low-cost medical care throughout the Portland metropolitan area. NCNM practitioners, residents and student interns treat approximately 40,000 patient visits per year. Visit NCNM for more information.

The Bravewell Collaborative Leaves a Legacy of Transforming Healthcare

One of the nation's most innovative and highly influential philanthropic health foundations, The Bravewell Collaborative, will sunset its operations in June 2015. Since its founding in 2002, Bravewell has sought to shift the focus of our healthcare system to prevention, health maintenance, early intervention and patient-centered care.

The Bravewell Collaborative was formed when a group of like-minded philanthropists met to discuss how they could accelerate the adoption of integrative medicine. Believing they could accomplish more together than by working alone, they identified key leverage points where philanthropy could make a difference for the integrative movement. Central to its vision was the idea that integrative medicine has the power to transform economic models that impede our present system and to greatly improve public health—a concept that is now central to discussions of healthcare's future.

Over its 14-year existence, Bravewell members invested nearly $30 million in pursuit of this vision. With additional investments by collaborating partners, these like-minded philanthropists worked together to accelerate the adoption of integrative medicine. 

Among Bravewell's lasting contributions is "The New Medicine," an award-winning series on integrative medicine that aired on PBS. Early on, Bravewell funded the Academic Consortium for Integrative Medicine and Health, a group of respected medical schools developing clinical centers to deliver integrative care, helping the Consortium grow from 8 to 56 medical schools and health systems.  

As part of its sunsetting process, Bravewell underwrote two legacy projects that will continue to help transform healthcare after it has closed its doors. Bravewell funded the establishment of a national database of uniformly collected patient-reported outcomes and provider observations, PRIMIER (Patients Receiving Integrative Medicine Interventions Effectiveness Registry). Bravewell awarded a grant to Duke Integrative Medicine to create The Leadership Program in Integrative Healthcare. In assessing the future of healthcare, Bravewell recognized that the nation needed a host of integrative healthcare leaders to change and inspire excellence.

While Bravewell will conclude operations, its website, bravewell.org, will live on until 2020 as a resource. A book about The Bravewell Collaborative will be released in 2016. 

Metagenics Healthcare Institute for Clinical Nutrition Collaborates on Innovative Study Focused on Methylation and Patient Outcomes

Metagenics Healthcare Institute for Clinical Nutrition (mhicn.com) announced today an expanded clinical research program in collaboration with Erasmus Medical Center and ErasmusAGE, from Rotterdam, the Netherlands – a leading global healthcare center in epidemiology and health outcomes research. This project will expand the current work on cardiometabolic and women's health issues to now include nutrigenomic and epigenomic influences on the health status in both aging population groups as well as in child development. The focus of this new project will evaluate the role and influence of methylation status in population cohorts of over 30,000 individuals over a 30 year period. Selected DNA samples over this time period have been collected and will evaluate specific effects that certain dietary and lifestyle practices played in DNA methylation and the resulting influence in cardiovascular and cognitive performance. "This will be the first study and analysis of its kind using large population groups for better understanding of the role and influence that methylation processes play in health status and outcomes," commented Oscar Franco, MD, PhD, Professor and Executive Director of the project.

This collaboration will be able to provide new insights in clinical practices and better understanding of nutrigenomic influences on health. John Troup, PhD, Chief Science Officer at Metagenics notes, "Methylation is a key biochemical process critical for proper functioning of nearly all the body's systems. This 'first of its kind' assessment in large scale clinical nutrition studies will be essential in developing and supporting, targeted clinical solutions for the healthcare provider—and helping close the gap towards the goal of personalized and precision medicine."  

MHICN is a leader in clinical research in functional, integrative and lifestyle medicine and has maintained a longstanding academic and research collaboration with Erasmus Medical Center, ErasmusAGE and the leading work in epigenetics carried out at the institution. The project will be part of the Rotterdam Study and Generation-R projects – an ongoing population based study of nearly 15,000 individuals 45 years and over since 1990. Generation-R study is a population-based prospective cohort study from fetal life through young adulthood including nearly 10,000 mothers dating from April 2002 - January 2006. Repeated DNA methylation status and modification due to nutrition will be evaluated to determine how DNA methylation mediates the effect of nutrition on cardiovascular diseases, cognitive performance and diabetes. 

MHICN.com is an educational website offering current, evidence based information on clinical nutrition and lifestyle medicine and complimentary, AMA category 1, CME in clinical nutrition. 

SOURCE Metagenics Healthcare Institute for Clinical Nutrition