Manganese and Skin health

Manganese is a chemical that can be considered both an heavy metal pollutant and a essential trace mineral for all known living beings. The human body contains about 12-20 mg of manganese (200 times less than iron), which is stored mainly in the bones, liver and kidneys. In the human brain the manganese is bound to manganese metalloproteins.

BIOLOGICAL ACTIVITY:
Manganese(II) ions function as cofactors or a number of enzymes in higher organisms, where they are essential in detoxification of superoxide free radicals. It aids in the formation of connective tissue. It enables the body to utilize vitamin C, B1, biotin as well as choline. It is a cofctor in metabolism of fat, sex hormones and breast milk in females.

IN LARGER AMOUNTS: and with greater activity by inhalation, manganese can cause a poisoning syndrome in mammals, with neurological damage which is sometimes irreversible (impaired motor skills and cognitive disorders).

MANGANESE IN FOODS: you can found Manganese almonds, wallnuts, avocados, eggs, brown rice, spices, whole grains, leafy greens, liver, tea and coffee.

NUTRITION TIP: A daily cup of tea proves a good portion of your manganese intake.

DEFICIENCES: Severe deficiencies are rare and can cause growth retardation, changes in circulating HDL cholesterol and glucose levels, reproductive failure. Serious deficiency in children can result in paralysis, deafness and blindness. Sub-clinical deficiencies can be linked to depression, weakness, tremors, irrational behaviour, leg cramps.

RDA (Recommended Daily Allowance) in Italy: is 1-10 mg a day (LARN 1996).
According to the Italian law nutritional supplements can not contain more that 10mg per day per dose for adults. This follow the European Union Population Reference Intake for males aged 18 years and over that indicate "acceptable range of intakes": 1-10 mg.

ABSORPTION: Manganese is not easily absorbed but we need only small amounts that are generally retreived from food in healthy subjects. Leaky gut sindrome, chronic inflammatory diseases and alterations of the intestinal barrier can reduce Mn absorpition. Absorption is also negatively influenced in the presence of calcium, phosphorous, zinc, cobalt and soy proteins. Don’t forget that refined grains contain only 50% of whole grains, so a diet based on refined food can lead to a sub-clinical deficiency.

LAB TESTS: Serum manganese concentrations in combination with lymphocyte manganese-dependent superoxide dismutase (MnSOD) activity and perhaps blood arginase activity, appear to be the best ways to monitor ingestion of insufficient manganese. Serum manganese concentrations in combination with brain MRI (magnetic resonance imaging) scans, and perhaps a battery of neurofunctional tests, appear to be the best ways to monitor excessive exposure to manganese.

ANTIAGING ACTIVITY AND SKIN HEALTH

The role of Manganese for skin health can be summarized as follow:
- structural;

• Needed to build collagen




• It helps to have a high bone density




• Necessary for energy production




• Active in DNA repair

- related to the cofactor activity in the MnSOD.
Antioxidants scavenge damaging particles in the body known as free radicals. These particles occur naturally in the body but can damage cell membranes, interact with genetic material, and possibly contribute to the aging process as well as the development of a number of health conditions. Antioxidants such as MnSOD can neutralize free radicals and may reduce or even help prevent some of the damage they cause.
Recent studies have shown that antioxidant enzyme expression and activity are drastically reduced in most human skin diseases, leading to propagation of oxidative stress and continuous disease progression. Numerous studies have shown that MnSOD can be induced to protect against pro-oxidant insults resulting from cytokine treatment, ultraviolet light, irradiation, certain tumors, amyotrophic lateral sclerosis, and ischemia/reperfusion. In addition, overexpression of MnSOD has been shown to protect against pro-apoptotic stimuli as well as ischemic damage. Regulation of antioxidant activity is a new target for dermatologists.
Probably the role of MnSOD beyond its essential role for survival and suggest a novel strategy for an antioxidant approach to cancer intervention.

SUPPLEMENTS WITH Mn: There are several forms of supplementary manganese including: manganese gluconate, manganese sulfate, manganese ascorbate, and manganese amino acid chelates. Typical supplemental intake of manganese ranges from 2 to 5 milligrams daily. Interactions can occur if taken together with oral contraceptives (not recommended). The regulatory mechanisms of Mn homeostasis are bypassed via the parenteral route so elimination via the hepatobiliary system is impaired, resulting in tissue or brain accumulation. It is unnecessary for Mn to be prescribed routinely for pediatric or long-term PN patients.

MANGANESE AND approved EU health claim for skin health:
EU states that Mn is requested for production of enzimes involved in proteic and lipidic metabolism. Mn contributes to the normalmanifacture of collagen.

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Almonds and diabetes

Walnuts and almonds consumption can help you fighting and preventing diabetes.
Adding these nuts to your diet can result in ameliorations in obesity, hyperlipidemia, hypertension, and hyperglycemia.
MedDiets and nuts-enriched MedDiets seem to be effective in the prevention of diabetes in subjects at high cardiovascular risk, and a preventive effect is demonstrated also in healthy subjects.
Women in a Harvard School of Public Health study who reported eating 5 or more 1 ounce servings of nuts/peanuts per week reduced their risk of Type 2 diabetes by almost 30 percent compared to those who rarely or never ate nuts.


HCP are usually cautious in recommending walnuts and almonds regular consumption due to their high caloric power and high fat content.
That's true. Infact:
100g of Wallnuts provides Kcalories 582- 650
100g of Almonds provides Kcalories 578- 600

But it is not needed to eat 1Kg, nor it is recommended!!!!

PORTION: 1 oz or 28g is equal to 20-22 almonds or 14 half wallnuts or 28 penuts
It's 160-180 KCalories.

CAUTION: Nuts in general are among the 5 most frequent food allergens.
Be sure not to be allergic to nuts befor adding them to your diet.

J Am Coll Nutr. 2010 Jun;29(3):189-97.
Almond consumption and cardiovascular risk factors in adults with prediabetes
Tested: Insulin sensitivity and CV risks
Comparedwith: nut free diet
Conclusions:An ADA diet consisting of 20% of calories as almonds over a 16-week period is effective in improving markers of insulin sensitivity and yields clinically significant improvements in LDL-C in adults with prediabetes

Nutr Metab (Lond). 2011 Jan 28;8(1):6.
Acute and second-meal effects of almond form in impaired glucose tolerant adults: a randomized crossover trial
Tested: Postprandial concentrations of blood glucose, insulin, non-esterified free fatty acids (NEFA), glucagon-like peptide-1 (GLP-1) and appetitive sensations
Conclusions: Inclusion of almonds in the breakfast meal decreased blood glucose concentrations and increased satiety both acutely and after a second-meal in adults with IGT. The lipid component of almonds is likely responsible for the immediate post-ingestive response, although it cannot explain the differential second-meal response to AB versus WA and AO

Metabolism. 2011 Apr;60(4):474-9. Epub 2010 May 23.
Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus
Tested: fasting insulin, fasting glucose, and homeostasis model assessment of insulin resistance index
Conclusions: incorporation of almonds into a healthy diet has beneficial effects on adiposity, glycemic control, and the lipid profile, thereby potentially decreasing the risk for cardiovascular disease in patients with type 2 diabetes mellitus

J Nutr. 2006 Dec;136(12):2987-92.
Almonds decrease postprandial glycemia, insulinemia, and oxidative damage in healthy individuals
Tested:effect of decreasing postprandial glucose excursions on measures of oxidative damage
Conclusions: Almonds are likely to lower this risk by decreasing the glycemic excursion and by providing antioxidants

European Journal of Clinical Nutrition(2009)
Long-term effects of increased dietary polyunsaturated fat from walnuts on metabolic parameters in type II diabetes
Conclusions:Dietary fat can be manipulated with whole foods such as walnuts, producing reductions in fasting insulin levels.

In 2003, the U.S. Food and Drug Administration (FDA) approved this package label "qualified" health claim for nuts:
“Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.”

Apple's apps for HCP: my opinion

A new section of Apple store dedicated to Health Care Professionals started in September.
We can find six cathegories of apps:
reference apps
educational apps
EMR & patient monitoring apps
imaging apps
point of care apps

The sixth cathegory, called personal care apps, is for consumers.
In this sections we can find many "must have" for anybody involved in health care, like PubMed On tap, and Micromedex Drug and iTriage.
I like iTriage even if it is focused on USA and many services are not working in Europe yet.
I already congratulated with the people who developed the app and I think that they are doing well in this "early stage" sector without having the investments of Google Health!
I like the Merk manual but it costs 27,99 euro.
I tested Muscle trigger points and I think that it can be useful for students and FKTR's.
Patients can benefit of iHealth BPM and Diabetes Buddy to keep on track fighting their chronic disease. Don't forget that diabetes and hypertension are the most terrible cardiovascular killers.
In the near future mobile apps for health care will be commonly used and I think that governative authorities should immediately play a central role helping developers in standardizing protocols, languages and data formats.
This will allows HCP to access patient's data everywhere and whenever is needed.
Governative authorities could also plan to use the "open data" generated by the people to promote research and population studies.

Present and Future of Probiotics

Human-Bacteria positive interactions: Present and Future of Probiotics on Prezi

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Stevia is eventually going to be approved in Italy

Used for centuries in South America and some Asian countries,
Stevia is a plant that attracts considerable attention from the food industry for its use as sweetener especially after that Coca cola co. and Pepsi co. started to use one of its extract as ingredient of their soft drinks.

The genus Stevia is composed of 240 shrubs and herbs of the Asteraceae family.
The most famous specie is Stevia rebaudiana, well known for its sweet leaves with a licorice-lke after taste.
Extracts of the Stevia rebaudiana with a 95% purity of rebaudioside A (Reb A) were given the FDA thumbs up in the US in late 2008.
In Europe the EU declined approval for dried stevia in 2000, however, saying more research was needed.
In January 2011, EFSA revised their consumer exposure estimates.

For high consumers, the estimates are up to four times the EFSA established Acceptable Daily Intake (ADI) of 4 mg per kg body weight per day (mg/kg bw/day).

The revised exposure estimates for high consumers are: children from 1.7 to 16.3 mg/kg bw/day; adults from 5.6 to 6.8 mg/kg bw/day.
Wim Debeuckelaere of the Directorate General for Health and Consumers (DG Sanco) stated in June 2011 that stevia is on schedule for approval by the EC before the end of 2011 at the latest.
Meanwhile, France approved 97% rebaudioside sweeteners, under a clause that allows pre-emption of EU approval for a two year period.
Industrial suppliers of stevia sweeteners are moving in to take advantage of these opportunities starting from Jan 2012.

But in Italy, the extracts and dried portions of the plant cannot currently be used as food ingredient yet and they are sold in strange ways, like "bath salts".

Stevia leaves and exstracts counts no calories and consequently they have a low glycaemic index (which means it does not cause the same spike in blood sugar levels as sucrose and other refined carbohydrates).
So Stevia and its extracts can be considered elective sweeteners for diabetic patients.
30 years of free use in Japan seems to confirm the safety profile.

Some positive effects on blood pressure and glicemic control are currently scientifically investigated.

I personally tested both the dried leaves and the rebaudioside extracts and I was astonished by the sweetener power. Beeing hundreds of time more sweet than sugar you need only very low quantities to change the taste of drinks and foods.

I personally don't like the persistence af sweet taste after (sometimes) minutes of use but the problem can be solved using lower quantities.

Licorice-like after tast can be avoided using different extracts but some people like it.

Gastrointestinal Health and OTC sales in Italy

Looking at the OTC sales in Italy (Q1-2 2011) we can see that gastrointestinal health accounts for about 50%.
We can find a low dosed probiotic at 3° and 4° position, for about 4.9 million boxes and rectal glycerin formulations for constipation at position 9° and 10° for more than 3 million boxes.

Italians seems not much interested in quality looking at this data.
Infact they prefer to use a rectal formulation for the acute constipation instead of a prebiotic with adaptogen effects.
They ignore Ministero della Salute guidelines on the use of probiotics that recommend to use only live organisms and a dose of at least 10billion a day for the adults.

As usual, first 2 positions are strongly held by diclofenac and paracetamol brands that may have well known side effects on the gastrointestinal tract.

We find first antiacid at position 17° with 1 million boxes sold. Antiacids are generally safe but patients should not ignore possible interactions with frequently prescribed drugs like antibiotics tetracyclines and fluoroquinolones or bisphosfonates.

A recent study published on "Drug" described "Clinically significant drug interactions with antacids: an update"

The authors explain that antiacids-drug interactions are more frequent now that antiacids are sold without prescription and suggestions from health care professionals.

Antiacid-drug interactions can be more important if the antiacid is coupled with a proton pump inhibitor and the mechanisms can be a gastric pH-dependent by H2RAs and a cation-mediated chelation by antacids.

Adiposity in children and its correlation with BP

The effect of adiposity on blood pressure in children is minimal until the body mass index reaches the 85th percentile, at which point it intensifies, according to a study published online Oct. 3 in Hypertension.

Wanzhu Tu, Ph.D. followed 1,111 children for 4.5 years. Blood tests and BP were measured.

"There is a marked intensification of the influence of adiposity on BP when children reach the categories of overweight and obese. Among the possible pathways, leptin may be a potentially important mediator acting through the sympathetic nervous system (reflected in heart rate)," the authors write.



BMI was used in this study to meaure adiposity but a new index can give furter information about the real fat percentage.




This new index is called Body Adiposity Index (BAI) and it is calculated using Hip circumference and Height.





Try to calculate your BAI and compare it with your BMI.

Here you can calculate your BMI



Are the 2 indexes telling you the same story?