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Welcome! Here we publish our views on new research and insights from the field of pulmonary medicine, most often focusing on topics related to exercise, nutrition, and other self-management techniques for those who suffer from chronic shortness of breath.

Whether you have COPD, currently smoke, or are just concerned about persistent shortness of breath and/or cough, read our articles to explore COPD treatment options and self-management techniques that can help you feel better NOW!



Thursday, January 27, 2011

Gold Kiwi – Powerful Fruit for a Healthy Heart

So you know the old adage – “an apple a day helps keep the doctor away”, right? Well, when it comes to heart health it appears the better option is gold kiwi fruit by a long-shot, so says a new study published this month in the journal Biological and Pharmaceutical Bulletin.

In their study, the Japanese research team examined seven fruits that are known to have high antioxidant content: gold kiwi, green kiwi, navel orange, mandarin orange, white grapefruit, ruby grapefruit, and apple (the researchers did not specify the apple type tested). ¹

In particular, the study team desired to know which of the fruits had the highest concentration of polyphenols (powerful antioxidants that offset the effects of molecules known as free radicals), which were most effective in reducing lipid oxidation (the process whereby fatty acids are turned into free radicals that damage cells), and which were most effective in eliminating free ranging hydrogen peroxide (another type of free radical produced as a byproduct of the body’s process to create and use energy at the cellular level).

People with high levels of unhealthy lipids (LDL cholesterol) in their blood serum (oxidized LDL in particular) are considered at high risk for cardiovascular conditions such as atherosclerosis, heart attacks, strokes and other maladies. By reducing the amount of oxidized lipids and the number of other free radicals in blood serum, physicians believe people can significantly reduce their risk of heart disease. A common way to reduce free radicals and oxidized lipids is to consume more antioxidant rich food, hence the interest of the researchers in these fruits.

The short takeaway – gold kiwi crushed the competing fruits on all measures. In fact, apples came in dead last on every measure!

For example, to assess polyphenol content, the researchers cut equal weight pieces of each fruit flesh and blended in a mixer for about 30 seconds. The blended fruit juices were then processed through a centrifuge for 10 minutes and subsequently strained through a filter. The strained juice was centrifuged again – this time for one hour - and then samples were taken of the remaining, centrifuged juice.

Using this method, the researchers found that gold kiwi’s polyphenols content was approximately 1.04 milligrams per milliliter, green kiwi was second with 0.85 mg/ml, navel oranges were third at 0.80 mg/ml, while apples were dead last at 0.13 mg/ml!

To assess the antioxidant properties of these polyphenols, the researchers then mixed a 1% concentration of the fruit juice solutions with lipids from egg yolk and then irradiated the mixture for various time intervals (irradiation via UV rays causes the lipids to oxidize). After irradiation, the study team examined the counts of oxidized lipid molecules remaining in the respective fruit juice mixtures. They found gold kiwi and navel orange both inhibited oxidation of 60% of the lipids. Again, apples were dead last at 23%.

To further evaluate the antioxidant properties of the various fruits, the researchers mixed a 5% concentration of the fruit juice solutions with hydrogen peroxide and let the mixture sit for two hours. Then the researchers measured the amount of hydrogen peroxide eliminated by the fruit juices. Once again, gold kiwi significantly outperformed the other fruits, eliminating over 60% of the hydrogen peroxide. No other fruit achieved greater than 30% elimination and apples again lagged the field at less than 10%.

The study authors concluded, “Therefore, we propose the novel possibility that daily consumption of kiwi fruit is effective on decrease of oxidative stress and further prevention of disease by excessive oxidation…All these indicators showed the highest activity for gold kiwi, demonstrating that gold kiwi has strong anti-oxidant effects. Overall, green kiwi had lower anti-oxidant effects than gold kiwi, but had stronger effects than the other fruits.”

So, if you’d like to add an easy, tasty and heart healthy fruit to your daily diet, consider gold kiwi. It’s a little more challenging to find in a retail grocery store (and a little more expensive to buy) so you may need to look for it in a specialty/gourmet food store.

According to the prime producer of gold kiwi fruit, a New Zealand company called Zespri, the biggest difference between the green and gold kiwi is taste, “ While green kiwifruit has a tangier, more tart flavor, gold kiwifruit is mellow and tropical, a mixture of mango, melon and citrus flavors. People who find green kiwifruit too tart usually love gold. As for other differences, the color is gold, instead of green, and it is tear-drop shaped, with a smooth skin and a crown on the top. Finally, while you might need to wait a few days for green to ripen, gold kiwifruit is always ready to eat.” ²

(Article by Kevin P. Donoghue originally published on January 13, 2011 for Peak Health Advocate, www.peakhealthadvocate.com)


¹ Iwasawa H, et al. Anti-oxidant Effects of Kiwi Fruit in Vitro and in Vivo. Biol Pharm Bull. 2011;34(1):128-34.

² Zespri Kiwifruit North America web site, http://www.zesprikiwi.com/faqs.htm, accessed January 12, 2011.

Monday, January 24, 2011

Pulmonary rehabilitation increases exercise capacity and reduces shortness of breath

This month, a new study published in the journal Archives of Physical Medicine and Rehabilitation, clearly demonstrated again the physical gains achieved by COPD patients participating in a pulmonary rehabilitation program.

As regular readers of our articles can attest, we believe strongly in the COPD treatment, pulmonary rehabilitation, and its proven ability to reduce shortness of breath, improve physical endurance and strength, as well as its impact in improving COPD patient quality of daily living. Still, it remains an under-prescribed treatment by physicians and an underutilized resource by COPD patients.

As further evidence of pulmonary rehab’s effectiveness, a group of Dutch researchers examined the impact of a 12 week pulmonary rehab program in 18 moderate-to-severe COPD patients. They discovered the 12 week program of aerobic exercise and strength training improved cycling endurance of the study participants by 160% and walking distance achieved in a 6-minute timed test improved by 14%. In addition, at the end of the program, self-reported dyspnea (shortness of breath) during the activities tested had declined by 9-17%. [1]

The study was intended to assess whether conditioning tests traditionally used to validate pulmonary rehab’s effectiveness are better measures than observed improvements in training performance. In other words, is a comparison of 6 minute walk test distances recorded at the beginning and end of a rehab program a better way to determine whether COPD patients derived benefit from the program versus measuring increases in how much weight a patient could lift or how much more resistance a patient could withstand during cycling.

The researchers ultimately concluded that the traditional conditioning tests are better measurements of COPD patient improvement, but to us the value of the study was in reaffirming the benefits of pulmonary rehab in general – regardless of measurement preference.

The pulmonary rehab program in the study involved 1.5 hour exercise sessions, 3 days per week over a 12 week period. The exercises included in each session (with intermittent rest breaks) included:

• 20 minutes of interval cycling (alternating sessions of heavy and light intensity cycling),
• 5 minutes of unsupported arm dumbbell lifting exercises (2.5 minutes for each arm)
• 5 minute sit/walk slalom course designed to simulate everyday sit/walk activities at home
• 6-12 minutes of endurance walking exercise on a treadmill
• Additional strength resistance training of abdominal, shoulder, and leg muscle groups

Prior to beginning the rehab program, and again following the last rehab session, the researchers had the study participants perform three conditioning tests (constant work-rate cycling, 6-minute walk test and maximal incremental cycling). To determine the rehab program’s effectiveness, researchers evaluated the pre- and post- rehab conditioning test results of the study subjects. They also assessed improvements in the amount of weight lifted in the arm exercise and resistance load achieved during the interval cycling from the beginning of the program to the end.

While the patients did see significant improvements in amount of weight lifted, number of repetitions performed, and resistance load achieved during interval cycling, the researchers found the traditional conditioning tests to be a better gauge of the pulmonary rehabilitation program’s impact.

The study authors concluded, “Indeed, in the current study, exercise duration and walking distance during submaximal exercise tests (constant workrate cycling, 6-min walk test) increased by 160% and 14%, respectively, and both of these have been reported to be of clinical relevance…The current study also included the training activities in the evaluation. During the 12 weeks of training, all patients were able to perform training activities with higher loads and weight for a longer duration, and with a trend toward less dyspnea and fatigue.”

Pulmonary rehabilitation works and if you are a COPD patient interested in improving how you feel, you owe it to yourself to discuss pulmonary rehabilitation with your pulmonologist. If you can’t gain entry to a rehab program in your area (or if one is not offered), we recommend asking your doctor to recommend an exercise program appropriate for your particular circumstance.

Alternatively, we have created a pulmonary-rehab style exercise program based on guidelines established by the American Thoracic Society and European Respiratory Society that is available in our Breathe Better for Life guidebook, www.breathebetterforlife.com. Our program also incorporates guidelines established by the American College of Sports Medicine for those with chronic respiratory conditions.
 
[1] Hanneke A, et al. Exercises Commonly Used in Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Cardiopulmonary Responses and Effect Over Time. Arch Phys Med Rehabil. 2011;92:111-117.

Friday, January 21, 2011

Skipping breakfast is bad medicine for smokers

In researching an article about the dangers of skipping breakfast we wrote recently for a different publication, we came across a 2009 study that examined the breakfast eating habits of current smokers. Though the research is not hot off the presses, we thought the results were worth sharing with you knowing that many of you are active smokers. The most startling finding in the study - current smokers who regularly omitted a morning meal were 4.7 times more likely to develop diabetes than current smokers who ate breakfast every day. ¹

The Japan-based research team also found that 63% of current smokers in their study regularly skipped breakfast, evidently echoing previous studies that have shown a strong correlation between smokers and breakfast skipping tendencies.

In other studies, skipping breakfast has been shown to increase fasting lipids (fats in the blood stream), elevate blood sugar, and impair insulin control. All of these impacts are considered contributing factors in the development of diabetes. The researchers in this study speculated that smoking seems to accelerate these effects of breakfast skipping leading to a pronounced increase in the odds of developing diabetes.

How strong is the influence of breakfast skipping combined with smoking in the risk of developing diabetes? Well, the results of this study indicated that smokers who regularly ate breakfast had the same, low odds of developing diabetes as never smokers who regularly ate breakfast. But when compared with smokers who never or rarely eat breakfast, the odds ratio of developing diabetes were 4.7 times higher than both groups of regular breakfast consumers.

In addition to diabetes risk, there are a host of other studies that have been published over the past few years that highlight other significant health risks associated with eschewing a morning meal including increased risk for cardiovascular disease and obesity. Further, a number of previously reported papers have shown strong correlations between breakfast skipping and poor mental focus, poor sleep quality and persistent fatigue.

In fact, in the Japanese smoker/breakfast skipping study, the paper’s authors also noted that smokers who skipped breakfast were more than 2 times likely than regular breakfast eaters (both smokers and non-smokers) to report poor sleep quality.

If you are interested in adding a morning meal to your daily routine, a number of breakfast-oriented studies have determined the healthiest choice is ready-to-eat cereal made from whole grains combined with low-fat milk. For those wishing to spice it up a bit, add a piece of fruit into the mix.

Cereals made with whole grains typically have a higher fiber content, lower glycemic index value (glycemic index is a measure applied by dieticians to assess the blood sugar raising effects of various foods), and less harmful fats/oils. Before you start to groan imagining eating tasteless, coarse cereals, check out this list of healthy and unhealthy cereal choices developed by Dr. Diane Mirkin.

If you can’t see your way chomping on bran flakes to start your day, at least try to avoid breakfast foods that have been shown to possess a high glycemic index. High glycemic index foods are strongly correlated with obesity, diabetes, high blood pressure and other cardiovascular risk factors. Some of the biggest breakfast offenders on this list include doughnuts, waffles, bagels, and toast made from white bread.

However, this study points out smokers would be well served to add a regular meal to begin the day (regardless of breakfast food choice) so as to avoid the risk of adding insult to injury by compounding the respiratory effects of smoking by increasing the odds of contracting diabetes.

¹ Nishiyama M, et al. The Combined Unhealthy Behaviors of Breakfast Skipping and Smoking Are Associated with the Prevalence of Diabetes Mellitus. Tokohu J. Exp. Med. 2009;218:259-264.



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Monday, January 17, 2011

Mate tea reduces inflammation caused by cigarette smoke

On many occasions we have written about the power of antioxidants in reducing oxidative stress and inflammation among smokers and those with respiratory conditions such as COPD. We’ve discussed studies examining dietary antioxidant supplements, foods with high antioxidant content, and even cigarettes laced with antioxidants. Now comes a new study about an antioxidant rich beverage, Mate tea, and its ability to reduce inflammation caused by cigarette smoke. (1)

Mate tea is a beverage made by brewing the dried leaves and twigs of the herb yerba mate. Once steeped, it can be served hot or cold and is a popular beverage in many Latin American and Arabian countries. Yerba mate is known to be a rich source of an antioxidant form called xanthines. Interestingly, caffeine is considered one of the more powerful xanthines.

The research article, published online ahead of print in the journal Experimental Lung Research, investigated supplementing Mate tea to cigarette smoke-exposed laboratory mice. The researchers divided 60 laboratory mice into four groups. The control group received no exposure to cigarette smoke and Mate tea. A second group received the Mate tea but no cigarette smoke. A third group was exposed to cigarette smoke but received no Mate tea. The last group was exposed to both cigarette smoke and Mate tea.

The groups exposed to cigarette smoke received the equivalent of 12 cigarettes a day over a 60 day period. The groups receiving Mate tea received 500 milligrams per kilogram of body weight daily over the same 60 day period. At the end of the study, the mice were euthanized, their lungs removed and analyzed. The researchers evaluated both statistical measures of inflammation (counting certain white blood cells known to be present in high numbers in inflamed lung tissue), and observational differences in lung tissue samples examined under a microscope.

They found dramatic differences in both evaluation sets. For example, counts of inflammation related white blood cells known neutrophils were measured at 8.7 squared millimeters in the control group while the cigarette smoke exposed group measured 71 (a huge difference and a clear indication of the impact of cigarette smoke’s ability to inflame lung tissue). By comparison, the neutrophil count in cigarette smoke exposed mice who also received Mate tea was only 27. In other words, while the cigarette/Mate group showed some inflammation, it was significantly lower than the mice exposed to cigarette smoke only (61% lower). Similar results were found for other inflammation related white blood cell types measured by the study team.

When looking at samples of lung tissue under a microscope, the researchers found significantly enlarged air spaces in the cigarette smoke exposed mice in comparison to the control group (enlarged air spaces are indicative of emphysema and are a by-product of persistent inflammation). On average, the volume density of the air spaces in the cigarette group was 16% higher than the control. By comparison, the volume density of the cigarette/Mate group was only 6% higher than the control group. Again, this shows that the antioxidant properties of Mate tea were effective in reducing inflammation associated with cigarette smoke.

The researchers concluded, “This study examined Mate tea in response to CS (cigarette smoke) exposure in the mouse. The protection observed, by both histological and biochemical analyses, leads us to suggest that Mate tea provides beneficial effects against lung damage caused by CS exposure in the mouse. In the CS+Mate group, few alterations to the alveolar spaces were observed, elastic fibers were preserved, and there were fewer macrophages and neutrophils recruited to alveoli compared to the CS group... Our results point to Mate tea as a nutritional antioxidant against lung injury in mice exposed chronically to CS and support efforts to investigate the beneficial effects of Mate tea on CS related lung injury in other animal models and humans.”

While many pulmonology professionals will be reluctant to recommend consuming Mate tea to COPD patients and smokers based on a mouse study, we think it is of value to share the study results with you. In the pursuit of better breathing, it is clear that regular consumption of antioxidants by any means possible is beneficial to those who smoke and have respiratory conditions. And certainly, there is no harm in adding a cup of Mate tea to your daily routine.

If you don’t think Mate is your cup of tea (sorry for the bad pun) to receive antioxidants, we recommend you either consider adding an antioxidant-rich multi-nutrient such as our Resplenish dietary supplement, www.resplenish.com, and/or adding antioxidant rich foods to your daily diet – an excellent choice is gold kiwi (check out our new article on gold kiwi in our e-letter Breathe Better for Life News). For other articles we’ve written regarding inflammation, oxidative stress, and antioxidants studied by respiratory health researchers, visit our Breathe Better Blog.

(1)  Lanzetti M, et al. Mate tea ameliorates emphysema in cigarette smoke-exposed mice. Experimental Lung Research. 2011 Jan 6. [Epub ahead of print].