Improved arthritic knee health in a pilot RCT of phytotherapy

Although practitioner-prescribed 'western' herbal medicine (phytotherapy) is a popular complementary therapy in the UK, no clinical studies have been reported on patient-orientated outcomes. The objective of this pilot study was to investigate the effects of phytotherapy on symptoms of osteoarthritis of the knee. A previous study of Chinese herbal medicine for the treatment of irritable bowel syndrome, published in the Journal of the American Medical Association,(1) acted as a model in the development of the protocol of this investigation. Twenty adults, previously diagnosed with osteoarthritis of the knee, were recruited from two Inner London GP practices into this randomized, double-blind, placebo-controlled, pilot study carried out in a primary-care setting. All subjects were seen in consultation three times by a herbal practitioner who was blinded to the randomization coding. Each subject was prescribed treatment and given lifestyle advice according to usual practice: continuation of conventional medication where applicable, healthy-eating advice and nutrient supplementation, Individualized herbal medicine was prescribed for each patient, but only dispensed for those randomized to active treatment - the remainder were supplied with a placebo. At baseline and outcome (after ten weeks of treatment), subjects completed a food frequency questionnaire and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee health and Measure Yourself Outcome Profile (MYMOP) wellbeing questionnaires. Subjects completing the study per protocol (n = 14) reported an increased intake of wholegrain foods (p = 0.045) and oily fish (p = 0.039) compared to baseline, but no increase in fruit and vegetables and dairy products intakes. There was no difference in the primary outcome measure of knee health assessed as the difference in the mean response (baseline-week 10) in WOMAC score between the two treatment groups. However, there was, compared with baseline, improvement in the active group (n = 9) for the mean WOMAC stiffness sub-score at week 5 (p = 0.035) and week 10 (p = 0.060) but not in the placebo group (n = 5). Furthermore, for the active, but not the placebo group, the mean WOMAC total and sub-scores all showed clinically significant improvement (>= 20%) in knee symptoms at weeks 5 and 10 compared with baseline. Moreover, the mean MYMOP symptom 2 sub-score, mostly relating to osteoarthritis (OA), showed significant improvement at week 5 (p = 0.02) and week 10 (p = 0.008) compared with baseline for the active, but not for the placebo group. This pilot study showed that herbal medicine prescribed for the individual by a herbal practitioner resulted in improvement of symptoms of OA of the knee

Domestic source of phosphorus to sewage treatment works

Phosphorus is an element essential for life. Concerns regarding long-term security of supply and issues related to eutrophication of surface waters once released into the aquatic environment have led governments to consider and apply measures for reducing the use and discharge of phosphorus. Examples of source control include legislation to reduce phosphorus use in domestic detergents. This research shows that other domestic sources of phosphorus also contribute significantly to the domestic load to sewer and that overall, domestic sources dominate loads to sewage treatment works. Estimates provided here show that although the natural diet contributes 40% of the domestic phosphorus load, other potentially preventable sources contribute significantly to the estimated 44,000 tonnes of phosphorus entering UK sewage treatment works each year. In the UK, food additives are estimated to contribute 29% of the domestic load; automatic dishwashing detergents contribute 9% and potentially increasing; domestic laundry 14%, including contributions from phosphonates, but decreasing; phosphorus dosing to reduce lead levels in tap water 6%; food waste disposed of down the drain 1%; and personal care products 1%. Although UK data is presented here, it is anticipated that similar impacts would be expected for other developed economies. Consideration of alternatives to all preventable sources of phosphorus from these sources would therefore offer potentially significant reductions in phosphorus loads to sewage treatment works and hence to the aquatic environment. Combining all source control measures and applying them to their maximum extent could potentially lead to the prevention of over 22,000 tonnes-P/year entering sewage treatment works

Improving cereal grain carbohydrates for diet and health

AbstractStarch and cell wall polysaccharides (dietary fibre) of cereal grains contribute to the health benefits associated with the consumption of whole grain cereal products, including reduced risk of obesity, type 2 diabetes, cardiovascular disease and colorectal cancer. The physiological bases for these effects are reviewed in relation to the structures and physical properties of the polysaccharides and their behaviour (including digestion and fermentation) in the gastro-intestinal tract. Strategies for modifying the content and composition of grain polysaccharides to increase their health benefits are discussed, including exploiting natural variation and using mutagenesis and transgenesis to generate further variation. These studies will facilitate the development of new types of cereals and cereal products to face the major health challenges of the 21st century