Nutritional Therapies for Ulcerative Colitis: Literature Review, Chart Review Study, and Future Research

Few clinical studies suggest a significant influence of diet or nutritional supplementation on ulcerative colitis. One reason is that ulcerative colitis, like many chronic diseases, is multifactorial. This article reviews the relevant literature and presents the results of a retrospective chart review study that was done at a complimentary medicine office

Effects of a Sugar-Free Hypoallerdenic Diet and Nutrtional Supplementation on Ulcerative Colitis

Few clinical studies have found that dietary or nutritional factors significantly influence ulcerative colitis (UC}(l,2}. It is noteworthy, however, that a range of factors have been researched including dietary components such as refined sugars (3,4}, allergenic foods (1,5,6} and fast foods (7), as well as nutritional supplement effects from fish oil (2), zinc (8), glutamine (9), folate (10, 11} and alpha-tocopherolquinone (12}. More recently investigators have also examined the interelationships between bowel flora and UC, including factors such as flora changes (13,14), endotoxemia (15} and supplementation effects with Lactobacillous species (16,17). These studies taken together and a recent review of UC (18) suggest that nutritional influences on UC may likely be multifactorial. We therefore report the findings of a retrospective chart review study of 24 consecutive UC patients who presented to an outpatient medical office in which treatment emphasized a comprehensive nutritional regimen, including a sugar-free hypoallergenic diet and nutritional supplementatio

The BraveNet prospective observational study on integrative medicine treatment approaches for pain

BACKGROUND: Chronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a number of other related patient-reported outcome measures. METHODS: Our prospective, non-randomized, open-label observational evaluation was conducted over six months, at nine clinical sites. Participants received a non-standardized, personalized, multimodal approach to chronic pain. Validated instruments for pain (severity and interference levels), quality of life, mood, stress, sleep, fatigue, sense of control, overall well-being, and work productivity were completed at baseline and at six, 12, and 24 weeks. Blood was collected at baseline and week 12 for analysis of high-sensitivity C-reactive protein and 25-hydroxyvitamin D levels. Repeated-measures analysis was performed on data to assess change from baseline at 24 weeks. RESULTS: Of 409 participants initially enrolled, 252 completed all follow-up visits during the 6 month evaluation. Participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain. At baseline, 52% of patients reported symptoms consistent with depression. At 24 weeks, significantly decreased pain severity (−23%) and interference (−28%) were seen. Significant improvements in mood, stress, quality of life, fatigue, sleep and well-being were also observed. Mean 25-hydroxyvitamin D levels increased from 33.4 (17.05) ng/mL at baseline to 39.6 (16.68) ng/mL at week 12. CONCLUSIONS: Among participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures. TRIAL REGISTRATION: ClinicalTrials.gov, NCT0118634

Cobalamin status and cognition in geropsychiatric patients

PLEASE NOTE: This work is protected by copyright. Downloading is restricted to the BU community: please click Download and log in with a valid BU account to access. If you are the author of this work and would like to make it publicly available, please contact [email protected] (D.Sc.D.)--Boston University. Henry M. Goldman School of Graduate Dentistry, 1990 (Nutritional Sciences)Bibliography: leaves 136-148.Few studies have carefully examined the relationship between cobalamin status and psychiatric disorders; there are no cobalamin status measurements that effectively identify cobalamin-related neuropsychiatric abnormalities. This research examined cobalamin status in 58 consecutively admitted patients to the geriatric unit of a private psychiatric hospital - subjects were 47 females and 11 males (mean age 75.1 years). Primary diagnoses included major depression (n=31), bipolar disorder (n=7), dementias (n=11), alcohol abuse (n=6) and other diagnoses (n=3). Of special attention was the sensitivity with which serum methylmalonic acid (MMA) and homocysteine (HCYST) (functional measures of B12) could identify related hematologic and psychiatric pathology. A subset (n=28) of the first group with major depression was therefore interviewed to assess cognition and other factors which might contribute to lower B12 intake and nutritional status. Results of this research indicated that MMA and HCYST are not more sensitive indices of cobalamin status than serum B12 for hematological or psychiatric pathology. The prevalence of deficiency as indicated by the metabolite and serum B12 1evels was not different (9% vs. 11 %). Also, MMA and HCYST did not correlate with MCV, although no indices correlated with MCV.　Serum creatinine correlated with MMA (r=.75, p[less than].001) and HCYST(r=.45, p[less than].01). Blood smears showed significant macrocytosis (33% Ss with MCVs [greater than] 95 fl) and hypersegmented PMNs (26 % of 19 Ss). Also, comparisons of psychotic and non-psychotic depressive showed a significant difference for MCV (t=2.0, df=32, p=.05), although there were no significant differences for serum cobalamin, folate, MMA or HCYST. With respect to cobalamin status associations to cognition, there were no single indices that correlated with cognitive measures. When subjects with the lowest cobalamin status were compared to the rest of the subject sample, there were still no significant differences. Factors examined for influence on cobalamin intake and nutritional status did not produce significant effects, although sample sizes were small. However, there was a significant positive association between age of onset of psychiatric disorder and serum HCYST (r=.47, p[less than].01). In summary, this research did not find that MMA and HCYST are more sensitive indicators of cobalamin status than serum cobalamin in this population. However, there may be evidence for inadequate utilization of cobalamin and/or folate in MCVs and PMNs even though serum cobalamin levels were not different. AIso, the findings suggested several factors that could influence these relationships and should be considered in future research

Nutritional and Integrative Medical Approaches to Inflammatory Bowel Disease

Overall goals and objectives: 1. Understand the characteristics and differences of the two primary Inflammatory Bowel Diseases, Crohn\u27s Disease and Ulcerative Colitis. 2. Appreciate the dietary guidelines and nutritional supplements that may be beneficial for patients with IBD. 3. Describe lifestyle and integrative medical approaches that may be helpful for IBD patients. 4. Understand a theoretical model of integrative medical approaches to IBD and how it might be applied in clinical practice

Health Beliefs and Their Associations With Dietary Intake, Exercise, and Metabolic Syndrome Characteristics in an Overweight and Obese Family Medicine Population

Increasing prevalences of obesity and type 2 diabetes (T2DM) increase cardiovascular risks. Since poor diet and inadequate exercise are primary behavioral causes of obesity and T2DM, our objective was to examine health beliefs and associations with diet, exercise, and metabolic syndrome (MetSyndr) characteristics. A total of 117 overweight and obese family medicine patients enrolled in this study. Subjects completed questionnaires for health beliefs and vegetable, fruit, and fat intake; other data were from medical charts. Seventy-four percent of subjects were women; 69% were black, 72% were obese, 36% were hypertensive, 22% had T2DM, and 23% had hypertriglyceridemia. MetSyndr subjects had significantly higher triglyceride levels and a higher percentage of hypertension and T2DM. Although not statistically significant, overweight subjects without MetSyndr had higher vegetable and fruit intake and lower fat intake than obese subjects without MetSyndr and subjects with MetSyndr. More exercise was associated with less MetSyndr and less obesity; however, this also was not statistically significant. For health beliefs, there were no significant differences between subjects with MetSyndr versus those without MetSyndr or for subjects without MetSyndr who were obese versus those who were overweight. However, for subjects with above-median nutrition scores and exercise, scores were significantly higher for the health belief “certainty” compared to those with below-median scores ( P < .0001). This research suggests that health beliefs and specifically less certainty may be a useful marker for individuals who require more education and/or training. Effective programs that address certainty may promote better diets, more exercise, and reduced cardiovascular risk

Perceived Stress in Patients with Common Gastrointestinal Disorders: Associations with Quality of Life, Symptoms and Disease Management

Objective and methodsResearch supports relationships between stress and gastrointestinal (GI) symptoms and disorders. This pilot study assesses relationships between perceived stress, quality of life (QOL), and self-reported pain ratings as an indicator of symptom management in patients who self-reported gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD).ResultsIn the full sample (n = 402) perceived stress positively correlated with depression (r = 0.76, P &lt; .0001), fatigue (r = 0.38, P &lt; .0001), sleep disturbance (r = 0.40, P &lt; .0001), average pain (r = 0.26, P &lt; .0001), and worst pain (r = 0.25, P &lt; .0001). Higher perceived stress also correlated with lower mental health-related QOL. Similar correlations were found for the participants with GERD (n = 188), IBS (n = 132), and IBD (n = 82). Finally, there were significant correlations in the GERD cohort between perceived stress, and average pain (r = 0.34, P &lt; .0001) and worst pain (r = 0.29, P &lt; .0001), and in the IBD cohort between perceived stress, and average pain (r = 0.32, P &lt; .0001), and worst pain (r = 0.35, P &lt; .01).ConclusionsPerceived stress broadly correlated with QOL characteristics in patients with GERD, IBS, and IBD, and their overall QOL was significantly lower than the general population. Perceived stress also appeared to be an indicator of symptom management (self-reported pain ratings) in GERD and IBD, but not IBS. While future research using objective measures of stress and symptom/disease management is needed to confirm these associations, as well as to evaluate the ability of stress reduction interventions to improve perceived stress, QOL and disease management in these GI disorders, integrative medicine treatment programs would be most beneficial to study

The BraveNet prospective observational study on integrative medicine treatment approaches for pain

Abstract Background Chronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a number of other related patient-reported outcome measures. Methods Our prospective, non-randomized, open-label observational evaluation was conducted over six months, at nine clinical sites. Participants received a non-standardized, personalized, multimodal approach to chronic pain. Validated instruments for pain (severity and interference levels), quality of life, mood, stress, sleep, fatigue, sense of control, overall well-being, and work productivity were completed at baseline and at six, 12, and 24 weeks. Blood was collected at baseline and week 12 for analysis of high-sensitivity C-reactive protein and 25-hydroxyvitamin D levels. Repeated-measures analysis was performed on data to assess change from baseline at 24 weeks. Results Of 409 participants initially enrolled, 252 completed all follow-up visits during the 6 month evaluation. Participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain. At baseline, 52% of patients reported symptoms consistent with depression. At 24 weeks, significantly decreased pain severity (−23%) and interference (−28%) were seen. Significant improvements in mood, stress, quality of life, fatigue, sleep and well-being were also observed. Mean 25-hydroxyvitamin D levels increased from 33.4 (17.05) ng/mL at baseline to 39.6 (16.68) ng/mL at week 12. Conclusions Among participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures. Trial Registration ClinicalTrials.gov, NCT0118634