Cruciferous Vegetables

Rachael Link wrote . . . . . . . . .

Cruciferous vegetables such as broccoli, cauliflower, Brussels sprouts, arugula, and kale are considered pillars of a healthful diet and have secured a slot in nearly every set of dietary guidelines around the globe. They’re easy to prepare and versatile and can liven up any dish almost instantly.

In recent years, emerging research has continued to strengthen the purported benefits of this unique family of plants, with studies showing that cruciferous vegetables host an impressive array of antioxidants, nutrients, and sulfur-containing compounds, all of which are responsible for their potent medicinal and health properties.

In addition, although patients with thyroid issues and hormone problems once were advised to eliminate cruciferous vegetables from their diets, many recent studies show that these ingredients are unlikely to have an effect on thyroid function—especially when cooked—and can be enjoyed by nearly everyone in moderation.

This continuing education course explores the research on the health effects of cruciferous vegetable consumption, including its potential impact on inflammation, cancer, glycemic control, heart health, and hormone balance. It also addresses the most common concerns about cruciferous vegetables, particularly those related to thyroid health and digestion.

Cruciferous Vegetable Classification

Cruciferous vegetables are any type of vegetable in the Brassicaceae family of plants, also known as the Cruciferae family. The name is derived from the New Latin word for “cross-bearing,” which is due to the crosslike shape of the four petals found in many species.

There are about 375 different genera and roughly 3,200 unique species within the Brassicaceae family. However, many of the most commonly cultivated crops belong to a single species, Brassica oleracea, which includes plants such as kale, cabbage, collard greens, cauliflower, Brussels sprouts, and broccoli. Of these vegetables, nearly every part of the plant is cultivated and used as a food product, including the leaves, stems, flowers, buds, roots, and seeds.

In addition to the Brassica genus, other cruciferous vegetable genera include Armoracia, Barbarea, Diplotaxis, Eruca, Lepidium, Nasturtium, Raphanus, and Wasabia.

Apart from Brassica, most of these genera contain only one or two edible plant species. Within the Eruca genus, for instance, arugula is the only edible vegetable, while watercress is most notable among plants in the Nasturtium genus. Certain types also are considered edible but aren’t commonly consumed. Siberian kale, wrapped heart mustard cabbage, and field pepperweed are a few examples of cruciferous vegetables that often aren’t cultivated commercially and may not be as recognizable to consumers.

The table on page 48 lists some of the most common edible cruciferous vegetables as well as their respective scientific classifications.

Nutritional Value

Besides similarities in terms of appearance and classification, most cruciferous vegetables have a comparable nutrient profile. They’re generally good sources of fiber, vitamin C, vitamin K, and phytonutrients such as sulforaphane. In addition, they’re rich in other micronutrients such as vitamin A and potassium and sulfur-containing compounds called glucosinolates, which are responsible for their pungent arom and bitter flavor.

Glucobrassicin is one of the most notable glucosinolates found in cruciferous vegetables. When the vegetables are chopped or chewed, glucobrassicin is exposed to the enzyme myrosinase, which hydrolyzes glucobrassicin to produce a glucose molecule and an aglycone known as thiohydroximate-O-sulfonate. The release of a sulfate ion then causes the formation of an intermediate compound, 3-indolyl-methyl-isothiocyanate, which is later split into a thiocyanate ion and indole-3-carbinol.

Indole-3-carbinol is an important phytochemical associated with several significant health benefits. It’s produced primarily in raw cruciferous vegetables because myrosinase is deactivated during the cooking process, ultimately hindering the hydrolysis of glucobrassicin into indole-3-carbinol. This process still may occur during digestion due to small amounts of myrosinase activity in the intestines, but to a much lesser degree when consumed cooked rather than raw.

Cooking cruciferous vegetables also can alter other aspects of nutritional content. For example, water-soluble vitamins such as vitamin C are dramatically reduced during the cooking process. A study by Yuan and colleagues evaluated the effects of different cooking methods on the nutritional value of broccoli and found that stir-frying broccoli and then boiling it led to the greatest nutritional loss, causing a 38% decrease in vitamin C content. This was closely followed by methods such as boiling alone, microwaving, and stir-frying alone. However, microwaving, steaming, and stir-frying all were mostly effective at retaining the overall content of carotenoids, which are insoluble in water and less heat sensitive than vitamin C.

Concentrations of other antioxidants can be increased during cooking. In a study by Miglio and colleagues, steaming, boiling, and frying broccoli all improved scores of several tests used to determine antioxidant content, including Trolox equivalent antioxidant capacity, total radical-trapping antioxidant parameter, and ferric reducing antioxidant power.

Health Benefits of Cruciferous

Vegetables Reduction of Inflammation

Several studies have found that higher consumption of cruciferous vegetables is associated with multiple reduced markers of inflammation. In particular, cruciferous vegetables have been linked to lower levels of tumor necrosis factor-alpha (TNFalpha), interleukin 1 beta (IL-1-beta), and interleukin 6.

Chronic inflammation is thought to be at the root of a variety of health problems, and some research suggests it may contribute to the development of conditions such as heart disease, diabetes, obesity, and cancer. Systemic inflammation also is involved in the pathology of autoimmune disorders such as rheumatoid arthritis, type 1 diabetes, multiple sclerosis, inflammatory bowel disease, and psoriasis.

Cruciferous vegetables are high in anti-inflammatory antioxidants that can help prevent oxidative stress, fight free radical damage, and potentially aid in disease prevention. For example, kale is rich in beta-carotene and vitamin C, especially when consumed raw rather than cooked. According to a study by Sikora and Bodziarczyk, cooking kale decreased concentrations of vitamin C, polyphenols, and beta-carotene by 89%, 56%, and 5%, respectively.

Meanwhile, Brussels sprouts and broccoli are high in kaempferol, a natural flavonol with potent anti-inflammatory properties. In 2013, an animal study by Kong and colleagues demonstrated how powerful this compound can be by measuring the effects of kaempferol on inflammatory markers in rabbits. Kaempferol was administered at doses of 30 mg/kg or 150 mg/kg, and rabbits were fed either a normal or high-cholesterol diet for 10 weeks. At the end of the study, levels of TNF-alpha and IL-1-beta were decreased, while serum concentrations of superoxide dismutase, a type of antioxidant that prevents free radical damage, were increased in rabbits treated with kaempferol.

Indole-3-carbinol is another naturally occurring anti-inflammatory compound that’s produced by the breakdown of glucobrassicin. It helps inhibit the production of nitric oxide, which is associated with a decrease in the synthesis of inflammatory markers such as TNF-alpha and interleukin 10 by immune cells.

Anticancer Effects

Some research shows that regular consumption of cruciferous vegetables may be associated with a reduced risk of several types of cancer, especially stomach, colon, rectal, and lung cancers.18,19 It may be linked to a lower risk of bladder, breast, prostate, ovarian, and endometrial cancers as well, although current research is limited and inconsistent.

This reduced risk is likely due to the presence of certain cancer-fighting compounds, such as selenium and glucosinolate hydrolysis products, found in cruciferous vegetables. These compounds may aid in cancer prevention by altering the metabolism of estrogen, preventing oxidative damage caused by reactive oxygen species, slowing the growth of tumor cells, and promoting apoptosis in cancer cells.

Other compounds present in cruciferous vegetables also may offer protection against cancer. Sulforaphane, for instance, has been shown to block cancer cell proliferation, induce apoptosis, prevent metastasis, and slow the progression of benign tumor cells into malignant tumors in certain in vitro studies. It also has been shown to induce phase 2 enzymes, which offer chemoprotection against cancer formation by increasing the generation of antioxidants and preventing oxidative damage to DNA.

Kaempferol may be effective at killing cancer cells while preserving the viability of healthy cells. In vitro studies show that kaempferol also may help decrease angiogenesis—the formation of new blood vessels—a process closely linked to cancer development that helps provide tumor cells with oxygen and nutrients, enabling them to grow and spread to other parts of the body. Specifically, kaempferol has been shown to inhibit vascular endothelial growth factor, a type of signal protein that’s considered a marker of angiogenesis.

Meanwhile, indole-3-carbinol can help regulate estrogen levels and suppress the growth of breast, colon, prostate, and endometrial cancer cells in vitro. Although the exact mechanisms remain unclear, it’s thought to interact with several signaling pathways directly involved in cancer development. Certain reaction products of indole-3-carbinol, such as diindolylmethane, have been shown to play a role in the induction of specific phase 1 detox enzymes that can aid in the breakdown of carcinogenic substances. It also may promote autophagy of cancer cells and protect against damage to DNA.

Although many of these compounds have been isolated and processed into powders and capsules, supplementation may not have the same impact as eating whole cruciferous vegetables. In fact, according to a review published by Katz and colleagues, cruciferous vegetables contain an intricate array of indole metabolites that work synergistically to aid in cancer prevention, giving them an advantage over individual compounds or antioxidants available in supplement form.

Improved Glycemic Control

Cruciferous vegetables can have a powerful effect on glycemic control, and several studies have found that higher intake may be associated with a lower risk of type 2 diabetes. For example, in a meta-analysis conducted by Carter and colleagues, consuming 1.35 servings of cruciferous vegetables per day was correlated with a 14% reduction in the risk of developing diabetes compared with consuming 0.2 servings daily.

Not only are cruciferous vegetables high in dietary fiber, which can slow the absorption of glucose to help manage blood sugar levels, but they’re also a good source of antioxidants and other natural compounds that can promote glycemic control.

Studies show that several types of cruciferous vegetables can offer benefits for serum glucose levels and insulin resistance. For example, Bahadoran and colleagues evaluated the effects of broccoli sprouts on insulin resistance in individuals with type 2 diabetes by administering 10 g of broccoli sprout powder, 5 g of broccoli sprout powder, or a placebo daily to participants over a four-week period. By the end of the study, consumption of 10 g/day of broccoli sprout powder was found to significantly decrease serum insulin levels and reduce scores for the Homeostatic Model Assessment of Insulin Resistance.

Kale has been shown to be beneficial for blood sugar levels. In one study, Kondo and colleagues found that consuming 7 g (0.25 oz) of kale powder alongside a high-carbohydrate meal significantly suppressed postprandial glucose levels compared with a placebo in 42 participants. Of note, consuming 7 g in a single dose was shown to be equally as effective at decreasing postprandial glucose as a higher dosage of up to 14 g (0.49 oz).

Although current research is limited to animal models, some studies have found that cabbage also may possess antidiabetic effects. One study by Islam and Choi reported that consuming freeze-dried Chinese cabbage improved glucose tolerance and lowered fasting blood glucose levels in rats within four weeks. Another study by Kataya and Hamza showed that red cabbage lowered blood sugar levels, improved kidney function, and increased antioxidant capacity in rats with diabetes, something that could aid in the treatment of diabetic nephropathy.

Obesity Prevention

Cruciferous vegetables can be a vital component of a healthful weight-loss diet. In fact, a large meta-analysis conducted by Bertoia and colleagues demonstrated that each daily serving of cruciferous vegetables was associated with significant weight loss, totaling an average of 0.68 lbs over a four-year period.

Several mechanisms may explain the antiobesity effects observed with cruciferous vegetable consumption. First, they have a low energy density, which may be predictive of weight loss over time. A study by Flood and colleagues evaluated the correlation between BMI and energy density of foods consumed in healthy adults older than 18 and reported that decreased energy density of foods was predictive of weight loss. Over the course of the study, participants in the quartile representing the greatest decrease in energy density had a mean change in BMI of -3.34 kg/m2, most of which occurred within the first six months of the trial. Compared with those in the quartile representing the smallest decrease in energy density, this was an average difference of about -1.95 kg/m2 over the 18-month period.

In addition to their low energy density, cruciferous vegetables generally are high in fiber, which can support satiety and weight loss. According to a review published by Howarth and colleagues, increasing daily fiber intake by 14 g per day for at least two days may be associated with a 10% decrease in daily energy intake, plus an average weight loss of 1.9 kg (4.2 lbs) over 3.8 months.

Improvements in Heart Health

Multiple studies have found that cruciferous vegetable consumption can improve several aspects of heart health. Intake has been linked to a lower risk of not only total and CVD mortality but also development of CVD itself. One review by Pollock analyzed the effects of leafy green and cruciferous vegetable consumption on CVD risk and showed a 15.8% reduced incidence of CVD for those in the highest quartile of cruciferous vegetable consumption compared with those in the lowest quartile.

Several types of cruciferous vegetables also have been shown to improve lipid profiles, which could enhance heart health and help reduce heart disease risk. For example, a study by Kim and colleagues noted that men with hypercholesterolemia consuming 150 mL of kale juice each day for 12 weeks increased HDL cholesterol by 27% and reduced LDL cholesterol concentration and atherogenic index of plasma by 10% and 24.2%, respectively.

Another study by Suido and colleagues evaluated the effects of a canned vegetable mixed beverage containing broccoli and cabbage on lipid levels in adults with hypercholesterolemia. After consuming two 160-g cans per day for three weeks, total cholesterol and LDL cholesterol levels both decreased by an average of 0.65 mmol/L.

For this reason, it should come as no surprise that heart-healthy eating patterns such as Dietary Approaches to Stop Hypertension, Therapeutic Lifestyle Changes, and Mediterranean diets all emphasize the importance of consuming plenty of vegetables, including cruciferous vegetables, as part of a balanced and nutritious diet.

Hormone Balance

Certain cruciferous vegetables and extracts have been shown to have antiestrogenic effects due to the presence of indole glucosinates, a type of phytochemical found within plants of the Brassica genus that can shift estrogen metabolism by increasing urinary estrogen excretion to help balance hormone levels.

In particular, indole-3-carbinol has been shown to modify levels of circulating estrogen while also decreasing urinary excretion of metabolites such as estradiol, estriol, 16-alpha hydroxyestrone, and estrone, all of which may be positively associated with an increased risk of certain types of reproductive cancers. Preliminary research also suggests that consumption of cruciferous vegetables may increase the ratio of specific estrogen metabolites that may help protect against breast cancer. This also may have far-reaching effects on other hormone-sensitive forms of cancer as well, including prostate cancer, endometrial cancer, cervical cancer, colon cancer, and leukemic cells.

Hormonal imbalances may contribute to other issues as well, including irregular menstruation, bloating, weight gain, infertility, and polycystic ovary syndrome. In men, high levels of estrogen can cause problems such as erectile dysfunction, infertility, and gynecomastia. However, existing research on the potential hormone-balancing effects of cruciferous vegetables mostly is limited to in vitro studies. Additional high-quality, large-scale studies are needed to determine how cruciferous vegetable consumption may affect hormone levels and hormone-related conditions in the general population.

Common Concerns Associated With Consumption

Despite the many health benefits associated with cruciferous vegetables, some concerns need to be addressed. Many patients with thyroid conditions such as hypothyroidism and Hashimoto’s disease are advised to avoid cruciferous vegetables due to their content of goitrogens, a substance that can interfere with thyroid gland function by inhibiting the uptake of iodine in the thyroid.

However, recent research suggests that the goitrogens found in cruciferous vegetables are most likely to affect those with an iodine deficiency or those consuming excessive amounts of the vegetables (eg, multiple servings every day). For instance, a study by Truong and colleagues looked at the relationship between thyroid cancer and consumption of goitrogen-containing cruciferous vegetables and iodine-rich foods. While they found an association between high cruciferous vegetable consumption and thyroid cancer, it was observed only in women with very low intakes of iodine at less than 96 mcg/day, which is just 64% of the DV.

Furthermore, cooking cruciferous vegetables can deactivate myrosinase, an enzyme responsible for the release of goitrin, which is considered the active goitrogenic principle. For this reason, it’s typically recommended to cook cruciferous vegetables before consumption, particularly for those with concerns about thyroid function.

Of note, while cooking cruciferous vegetables can help block the release of goitrin, it also may limit the hydrolysis of glucobrassicin, which is converted into indole-3-carbinol. Cooking cruciferous vegetables also can reduce the content of water-soluble vitamins such as vitamin C and vitamin B6. However, pairing these vegetables with a variety of other nutrient-rich foods can be an effective way to offset any potential nutrient losses associated with cooking.

In addition, some people may experience digestive symptoms after consuming cruciferous vegetables. Gas, bloating, and abdominal discomfort are a few of the most common side effects associated with cruciferous vegetable consumption. This is because they’re typically high in fiber as well as raffinose, a complex carbohydrate that’s fermented in the gut, causing a buildup of gas in the colon. Staying well hydrated, increasing intake gradually, and chewing foods slowly all can help ease symptoms related to increased fiber consumption. Enzymes such as alpha-galactosidase can help break down gas-causing complex carbohydrates such as raffinose and are available in over-the-counter products such as Beano.

Keep in mind that most cruciferous vegetables are high in vitamin K, an important fat-soluble vitamin involved in blood clotting. Patients taking anticoagulants such as Coumadin (warfarin) should be mindful about vitamin K intake from cruciferous vegetables and other green vegetables, as sudden changes in consumption could potentially impact the efficacy of these medications.

Culinary Uses

When encouraging clients to increase their consumption of cruciferous vegetables, RDs should be sure to emphasize their versatility. Cruciferous vegetables can be prepared and enjoyed in a variety of ways as part of a well-rounded meal, snack, or side dish.

Broccoli, for example, can be steamed, roasted, baked, or boiled and added to stir-fries, casseroles, stews, and slaws. Leafy greens such as kale, cabbage, and arugula can be enjoyed as a base for salads or used in omelets, pasta dishes, pizza, smoothies, and more. Brussels sprouts often are roasted or sautéed and paired with honey, balsamic vinegar, nuts, cheese, or lemon juice to help balance their flavor.

Cauliflower is a popular low-carb, low-calorie alternative to other ingredients such as rice, grains, and potatoes. It can be ground into a fine consistency and used to make tortillas, pizza crust, breadsticks, and baked goods, as well as cauliflower gratin, rice, casseroles, falafel, and tots. Other cruciferous vegetables such as cabbage and collard greens can be swapped in for wraps, tortillas, and buns for those cutting back on carbohydrates.

Cruciferous vegetables can be added to smoothies, sauces, sandwiches, salads, and soups for a quick and convenient way to take advantage of the many health benefits these vibrant vegetables have to offer.

Source: Today’s Dietitian

Vegan Rainbow Spring Rolls with Peanut Dipping Sauce

Ingredients

2 ounces uncooked rice vermicelli noodles
4 ounces (1/4 of a 16-ounce block) extra-firm tofu, pressed and sliced into strips
5 round rice paper wrappers
1/2 red bell pepper, thinly sliced
1 cup shredded carrots
1/2 yellow bell pepper, thinly sliced
1/3 cup fresh mint leaves
1/3 cup fresh cilantro leaves
1/2 cup shredded purple cabbage

Peanut Dipping Sauce

2 tablespoons soy sauce
2 tablespoons lime juice
1 tablespoon rice vinegar
2 teaspoons sugar
1/2 teaspoon ground ginger
1 teaspoon garlic powder
1/4 teaspoon red chili pepper flakes
1/2 cup creamy peanut butter
5 tablespoons water

Method

  1. For the peanut dipping sauce, in a medium bowl, combine all ingredients except for water and whisk until blended. Add water 1 tablespoon at a time until dippable sauce consistency is achieved. Set aside.
  2. For the spring rolls, cook noodles according to package directions. Drain and rinse noodles under cold water to prevent sticking, and place in a bowl of cold water until ready to use.
  3. Clear a clean, flat work surface (such as a large cutting board). Fill a large bowl with warm water. Working one at a time, dip rice paper into water and submerge completely for about 5 seconds to soften. Don’t leave in water too long or it will tear easily. Remove from water, and transfer to work surface.
  4. In the center of 1 wrapper, lay horizontally a small amount of vermicelli noodles, tofu, red bell pepper slices, shredded carrots, yellow bell pepper slices, mint leaves, cilantro leaves, and shredded purple cabbage. Leave at least 1-1/2 inches on all four sides bare for wrapping.
  5. To wrap spring roll, fold two opposite sides of wrap over fillings to create closed ends of roll. Then, starting from vermicelli noodle end, use both hands to fold rice paper over noodles and begin to tightly roll rice paper and fillings into a tube-shaped spring roll, being careful not to tear rice paper. Repeat with remaining rice paper wrappers and fillings. Serve with peanut dipping sauce.

Makes 2 servings.

Source: The Friendly Vegan Cookbook

The World’s First-ever Robot Restaurant Complex in Guangdong, China

On June 22, the first robot restaurant complex built by Qianxi Robot Catering Group (Qianxi Group), a subsidiary of Country Garden, opened in Shunde, a city in China’s Guangdong province. Powered by the latest in advanced technologies, the restaurant has separate sections for Chinese food, hot pot and fast food and features a wide selection of dishes, each one of which is delivered to the waiting diner within seconds.

In the 2,000 square meters of modern restaurant space, more than 20 in-house developed robots for different restaurant styles (Chinese cuisine, clay-pot rice, noodle shops) are on hand to assume their assigned role in terms of food preparation and cooking. The dining space, imbued in pink as the background color while replete with the sense of metallic technology, can serve nearly 600 diners at one time. The restaurant’s 200 menu items can each be served up in as little as 20 seconds.

Under the epidemic, robot-run restaurants reduce human-to-human contact across the board. This new style of dining is seen to be in line with the current situation and the trend in the future.

“The Qianxi robot restaurant has innovatively achieved both software-hardware integration and man-machine cooperation. It helps to better run a smooth operation through the practical application of robots,” said Zhao Chunsheng, mechanical engineering specialist and academician at the Chinese Academy of Sciences. “Qianxi has the most advanced technology with a vast product lineup. It fills the market gap and will have a significant impact on benchmarking in adding value to industry development as well.”

Country Garden assistant executive officer and Qianxi Group general manager Qiu Mi explained that Qianxi Group has built a complete industry chain encompassing back-end supply production (the centralized kitchens) and robotic cooking alongside the operation of restaurants and the management of robots. During 2020, the group plans to build more centralized kitchens to further expand in the cities of Guangdong-Hong Kong-Macao Greater Bay Area, while achieving mass production of robots with an expected output of some 5,000 units per year.

China officially released the technical specification for robot safety certification in the food sector on June 22. The technical specification, jointly formulated by the National Robot Testing and Accreditation Center (NRTAC) and Qianxi Group’s technology subsidiary Zhiyuan, is the first of its kind in the country. Qianxi Group’s lineup of second-generation robots, including some trained to cook clay pot rice and others trained to make mini-ice creams, have taken the lead in receiving China Robot (CR) certifications from the NRTAC.

Moreover, Qianxi Group and Beijing Beichen Industrial Group Co., Ltd. (Beijing Beichen) jointly announced a comprehensive strategic cooperation, whereby smart dining services will be provided at Beijing Beichen’s convention centers. In January 2022, phase two of the China National Convention Center, a venue developed and operated by Beijing Beichen, will be put into operation, and Qianxi Group’s robots will be on duty at the site providing 7×24 smart dining services, giving a glimpse of how world-leading smart technologies integrate with Chinese cuisine culture.

On the same day as the opening of the restaurant, Qianxi Group also inked a strategic cooperation agreement with Siemens (China) whereby both parties entered into a long-term strategic partnership to boost the digital development of the smart dining segment, including joint development of the industry’s first innovative smart dining IoT platform. Bai Liping, vice president of digital industries at Siemens (China), said that the company will join hands with Qianxi Group to accelerate the growth of the segment.

Source : Yahoo!

Study: Started Early, Drug Combo Eases Fatigue of Rheumatoid Arthritis

Early and intensive treatment with methotrexate and prednisone can ease fatigue in people with rheumatoid arthritis (RA), according to a new study.

RA causes chronically inflamed joints and that inflammation can lead to severe fatigue that isn’t relieved by resting, according to the European League Against Rheumatism (EULAR).

“In addition to pain, profound fatigue reduces the quality of life for many people, even more than the swelling of the joints,” EULAR’s president, Iain McInnes, said in a league news release. He’s a professor of rheumatology at the University of Glasgow in Scotland.

But doctors often don’t pay enough attention to patients’ fatigue, he added.

“Up to 90% of patients with rheumatoid arthritis report profound fatigue,” said study author Diederik De Cock, a researcher at KU Leuven in Belgium.

His two-year study included 80 RA patients who began a drug regimen immediately after their diagnosis. They received either 15 mg of methotrexate a week (control group) or a combination therapy. The combo included 15 mg of methotrexate and 30 mg of cortisone (prednisone) weekly, which was eventually reduced to 5 mg a week.

Methotrexate suppresses RA-related inflammation, while prednisone eases joint pain and inflammation.

Patients who had intensive treatment with the drug combo for two years were less tired than those in the control group, even though both groups had similar disease activity over time, the study found.

Differences in fatigue levels between the two groups appeared to increase over time, according to the study.

“The early course of the disease could provide an opportunity to manage fatigue,” De Cock said in the release.

The study was presented as an abstract online for EULAR’s E-Congress 2020, which began earlier this month. Findings presented at meetings are typically viewed as preliminary until they’ve been published in a peer-reviewed journal.

Based on the findings, EULAR recommends early consideration of intensive treatment even in low-risk patients with RA.

RA affects about 1% people worldwide, according to EULAR.

Source: HealthDay

Pulse Pressure: A Game Changer in the Fight Against Dementia

A recent paper published in Frontiers in Neuroscience, outlines a pulse-pressure-induced pathway of cognitive decline that sheds light on why previous treatments for dementia may have failed and proposes promising new directions for the prevention and treatment of dementia.

“Over the last couple years, a sea change in dementia and Alzheimer’s disease research has occurred. Focus has shifted from solely targeting amyloid-beta in the brain to the opinion that more fruitful progress could be made by addressing factors that compromise the blood brain barrier,” explains co-author Mark Carnegie, of The Brain Protection Company based in Australia. “Elements of the constellation include chronic age-related inflammation, genetic predisposition, and cardiovascular abnormalities, notably high blood pulse pressure.”

Connecting a large and rapidly growing body of evidence, the researchers elucidate how elevated pulse pressure may cause dementia. Pulse pressure is the difference between systolic and diastolic blood pressure and commonly increases with age.

The researchers propose that elevated pulse pressure in blood travelling to the brain can cause inflammation, oxidative stress, mechanical stress, cellular dysfunction, and cell death in the blood brain barrier that leads to brain damage.

The link between blood brain barrier breakdown and dementia is intuitive, as the blood brain barrier has specifically evolved to support and protect delicate brain tissue by keeping circulating cells, pathogens, and other unhealthy substances in blood from infiltrating the brain. There is significant evidence supporting that disruption of the blood brain barrier is a key driver of cognitive decline and dementia.

Senior author of the paper, Prof. David Celermajer of The Brain Protection Company, says that “this is an important paradigm shift in our understanding of the pathogenesis of dementia.”

He further adds that “although there are likely several causes of blood brain barrier disruption, recent human cell culture experiments, animal models, and epidemiological evidence have pointed to high blood pulse pressure as one potential key cause.”

Pulse pressure may therefore be a promising new therapeutic target for preventing or slowing cognitive impairment, which gives new hope in the fight against dementia.

Moreover, the authors discuss how elevated pulse pressure may have also prevented previous treatment strategies from working optimally against dementia.

For the past two decades, a primary focus of drug development for Alzheimer’s disease, the most prevalent form of dementia, has been to target the molecule amyloid-beta. However, despite billions of dollars spent on R&D, that approach has yet to be successful.

The researchers suggest that targeting amyloid-beta alone to treat dementia may be an uphill battle since concurrent elevated pulse pressure will continue to activate secretion of various inflammatory and oxidative molecules and amyloid-beta from the blood brain barrier into brain tissue.

Also, stem and progenitor cell therapies have gained significant attention as potential strategies to repair blood brain barrier damage and treat dementia, but chronic inflammatory and oxidative stress due to elevated pulse pressure can impact the health of stem and progenitor cells.

Dr. Rachel Levin, lead author of the paper, says that “combination therapy has been paramount in the treatment of other challenging diseases, in particular cancer. Therefore, in dementia, reducing elevated pulse pressure could prove to be synergistic with other therapeutic approaches such as anti-amyloid-beta drugs or stem cell therapy.”

The authors issue a call to action for academic and industry leaders to develop novel drug candidates or devices that reduce elevated pulse pressure and progress them to clinical trials. Celermajer states that “strong animal model data already supports the role of high pulse pressure in blood brain barrier disruption and dementia pathology; now more human studies are needed.”

Source: EurekAlert!


Read the paper at Frontiers in Nuroscience . . . . .


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