A widely available and inexpensive form of vitamin B can reduce the risk of some types of skin cancer, according to new research from Australia.
Presented in a press release in advance of the American Society of Clinical Oncology’s 2015 Annual Meeting (and in advance of skin cancer season in the northern hemisphere), the results of the Oral Nicotinamide to Reduce Actinic Cancer (ONTRAC) trial show that nicotinamide (aka niacin or vitamin B3), effectively reduces the rates of new skin cancers among individuals at high risk of the disease.
This large Australian study included 386 patients with a history of at least two non-melanoma skin cancers (NMSC) within the past five years, thus indicating their high-risk status. Participants had a mean of 8 occurrences of NMSC in the last five years.
Mirroring the makeup of typical skin cancer clinic patients, 63% of the study’s participants were men -- as skin cancer is more common in men -- and the average age among participants was 66 years. Many exhibited additional chronic medical conditions including heart disease, arthritis, high blood pressure, and lung disease.
The subjects were randomly assigned to either 500 mg of nicotinamide per day or placebo pills for 12 months.
After one year of treatment, the rate of new NMSC diagnoses was 23% lower in the nicotinamide group than in the placebo group.
Additionally, patients who took the nicotinamide supplement had fewer actinic keratoses. Incidence of these lesion decreased by 11% at three months, 14% at 6 months, and 20% at nine months of vitamin B3 treatment.
NMSC is the most common type of cancer that affects light-skinned individuals globally. The two most prevalent forms of NMSC are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Notably, in the ONTRAC trial, nicotinamide showed comparable efficacy in preventing both BCC and SCC.
These results suggest nicotinamide holds huge promise for prevention of and possibly even the treatment of skin cancer.
“This is the first clear evidence that we can reduce skin cancers using a simple vitamin,” said senior study author and Dermatology University of Sydney professor Diona Damian, MBBS, PhD. “We hope that these findings can be immediately translated into clinical practice.”
Most skin cancers are caused by exposure to ultraviolet (UV) radiation, which can lead to DNA damage and the suppression of skin immunity. Previous studies have found that nicotinamide enhances DNA repair and prevents cutaneous immune suppression following UV light exposure.
Overall, the most effective way of preventing NMSC (and melanoma for that matter) is to reduce exposure to sunlight. Nicotinamide may ultimately prove to be another important tool.
Until further research confirms the efficacy of nicotinamide in reducing skin cancer formation, Dr. Damian suggested that it be selectively applied to high-risk patients with frequent skin cancers.
But she is optimistic that this safe, cheap, and readily accessible over-the-counter supplement, nicotinamide could “have the potential to decrease the health burden and economic cost of skin cancer,” with major implications for enhanced cancer treatment worldwide.
The combination of chondroitin and glucosamine may be as effective as a commonly prescribed NSAID in treating painful knee osteoarthritis, according to data from a large multicenter trial headed by investigators at the University of Maryland.
Standard OA management focuses on pain reduction through the use of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). However, NSAIDs are associated with a range of adverse gastrointestinal and cardiovascular side effects, raising numerous concerns about their long-term use.
Previous studies, including the NIH’s Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), have examined the efficacy of natural supplements as an alternative to mainstream OA pain treatment. In particular, glucosamine and chondroitin sulfate, two naturally occurring substances, have been widely promoted in OA pain management.
Glucosamine, an amino sugar, and chondroitin sulfate, a complex carbohydrate, are both found in connective tissue and can help to reduce pain and inflammation, improve joint function, and slow the deterioration of cartilage.
Building on the GAIT results, the recently published MOVES (Multicenter Osteoarthritis InterVEntion Study) trial evaluated the efficacy and safety of chondroitin sulfate plus glucosamine hydrochloride (CS+GH) versus celecoxib in patients with knee osteoarthritis and severe pain (Hochberg, et al. Ann Rheum Dis. 2015. doi:10.1136/annrheumdis-2014-206792).
A total of 606 study participants with Kellgren and Lawrence grades 2-3 knee OA and moderate to severe pain (WOMAC score ≥301; 0–500 scale) were randomized to either 200 mg celecoxib, or the combination of 400 mg CS plus 500 mg GH thrice daily for 6 months. All outcome measures were assessed at 30, 60, 120, and 180 days.
The researchers found that both treatments were equally effective in reducing arthritis symptom burden. In the CS+GH group, the adjusted mean change (95% CI) in WOMAC pain was −185.7 (−200.3 to −171.1), a 50.1% decrease. Those in the celecoxib group showed a strikingly similar −186.8 decrease (−201.7 to −171.9) .
Additionally, after 6 months of treatment, 79.7% of patients taking the nutraceutical combination and 79.2% of those on the prescription drug fulfilled OMERACT-OARSI criteria for designation as treatment "responders." Both groups displayed a >50% reduction in joint swelling and effusion.
The authors note that adverse event rates were low and similarly distributed between the two groups.
Patients treated with celecoxib appeared to demonstrate superior results at the 1-4 month mark, in terms of changes on the WOMAC scores and Huskisson's visual analogue scale. However, by 6 months both treatment groups showed similar levels of improvement.
While chondroitin sulfate and glucosamine may have a slower onset of response, the investigators argue, their ability to provide long-lasting pain relief and functional improvement in OA is equivalent to celecoxib.
The results of the MOVES trial suggest that chondroitin sulfate plus glucosamine is not only an effective treatment for OA, but may also offer a safer alternative for patients with cardiovascular or gastrointestinal conditions for whom NSAIDS are contraindicated.
As reported by the National Institutes of Health (NIH), an estimated 27 million adults in the United States live with osteoarthritis (OA). The most common type of arthritis, OA is a degenerative joint disease caused by the breakdown of cartilage. It typically affects large weight-bearing joints such as the knees and hips and is characterized by pain, joint damage, and limited range of motion.
Given the continued aging of the US population, the prevalence of OA is not likely to abate, underscoring the need for safe and effective non-pharma treatment options.
Among its many other known benefits, vitamin D may improve survival among colon cancer patients, according to new research presented at the American Society of Clinical Oncology's 2015 Gastrointestinal Cancers Symposium.
Kimmie Ng, MD, PhD, of the Dana-Farber Cancer Institute, reported in patients with newly diagnosed metastatic colorectal cancer, those with higher levels of vitamin D in their blood lived longer and experienced greater disease-free survival following cancer treatment than those with lower vitamin D levels.
Previous studies have shown correlations between higher levels of 25-hydroxyvitamin D [25(OH)D] and improved survival in patients with colorectal cancer (CRC). Ng’s research adds to the body of evidence, and more specifically explores the relationship between 25(OH)D and metastatic CRC outcomes.
Her study involved 1,043 previously untreated patients enrolled in CALGB 80405, a randomized phase III trial of chemotherapy plus additional cancer treatment drugs including either bevacizumab, cetuximab, or both. Participants’ plasma 25(OH)D levels were measured at baseline by radioimmunoassay, and their median plasma 25(OH)D was found to be 17.2 ng/mL (range 2.2-72.7).
The researchers also collected information regarding the participants’ dietary and lifestyle behaviors via self-administered questionnaires. Elderly and black patients, those with lower dietary and supplemental vitamin D intake, higher body mass index, lower physical activity, and those who had blood draws during winter and spring months had significantly lower levels of 25(OH)D. Few participants reported vitamin D supplementation.
Patients with higher vitamin D levels lived a median of 8 months longer than those with lower levels. Those in the highest vitamin D quintile had a median overall survival (OS) of 32.6 months, versus 24.5 months in those in the lowest quintile (HR 0.67, 95% CI, 0.53-0.86; p trend 0.002).
The study also identified a correlation between higher vitamin D levels and improved progression-free survival. Patients with high vitamin D counts experienced a median 12.2-month period before disease progression, versus a median 10.1 months in the lowest quintile (HR 0.80, 95% CI, 0.64-1.01; p trend 0.02). No significant differences in progression-free survival were noted with regard to treatment type.
Ng and colleagues concluded that higher concentrations of plasma 25(OH)D are associated with significantly improved survival in metastatic CRC patients treated with chemotherapy and other anti-cancer drugs.
In addition to its key role in maintaining bone health, vitamin D is a natural anti-inflammatory agent that possesses numerous anti-cancer properties, including the capacity to suppress tumor growth and metastasis. It can also promote diseased cell death, while inhibiting angiogenesis (Chakraborti, CK. Ind J Pharmacol. 2011; 43(2): 113-120).
Though it may be too soon to suggest vitamin D as a treatment for colon cancer, the results of Ng’s study suggest that supplementation could help to improve the outcomes of patients receiving conventional cancer therapies. She encouraged practitioners to recommend vitamin D testing for cancer patients and to consider supplementation where appropriate.
B vitamins are widely promoted for the treatment and prevention of many forms of dementia. But new research raises questions about the efficacy of B vitamins for slowing cognitive decline.
A Dutch multicenter study published last December in Neurology investigated the effects of folic acid and vitamin B12 on cognitive performance in elderly people with elevated homocysteine (Hcy) levels (van der Zwaluw, et al. Neurol. 2014; 83(23): 2158-2166).
The double-blind, randomized, placebo-controlled trial included 2,919 participants aged 65 years and older with Hcy levels between 12 and 50 µmol/L. Over the course of two years, each participant received either a daily tablet containing 400 µg folic acid and 500 µg vitamin B12 (B-vitamin group) or a placebo. All tablets also contained 15 µg vitamin D3.
The cognitive function analysis was actually a sub-project of the B-PROOF trial (B vitamins for Prevention of Osteoporotic Fractures).
The Using the Mini-Mental State Examination (MMSE), researchers assessed participants’ global cognitive function at baseline and again after two years. They looked at various aspects of cognitive function, including episodic memory, attention, working memory, information processing speed, and executive function.
Following a two year supplementation period, there were no clinically significant differences in cognitive function between the B-vitamin and placebo groups, leading the authors to conclude that folic acid and vitamin B12 supplementation does not confer any benefit on cognitive performance among elderly people.
Supplementation did slow the rate of decline in global cognition, but the difference was slight, and, the authors say, could have been due to chance.
The absence of cognitive improvements was despite the fact that supplementation did reduce Hcy levels significantly. Hcy concentrations were decreased significantly by 5.0 µmol/L in the B-vitamin group (95% confidence interval −5.3 to −4.7), and 1.3 µmol/L in the placebo group (−1.6 to −0.9).
The lack of apparent cognitive benefit was unexpected, and the observations seem to run counter to the view that chronic systemic inflammation--indicated by Hcy elevations--is a major driver of cognitive decline in older age. They also raise questions about whether B-vitamins should be recommended for treatment and prevention of dementia
A substantial body of past research suggested that that B-vitamin status can affect age-related cognitive performance and decline (Morris, M. Adv Nutr. 2012; 3(6): 801–812), and this makes sense given the diverse roles B-vitamins play in cell metabolism.
In particular, vitamin B12 -- or cyancobalamin (Cbl) -- plays a vital part in red blood cell development and healthy nervous system functioning. Vitamin B12 deficiency can manifest in a variety of symptoms, including anemia, changes in mood and cognition, motor weakness, poor muscle control, and nonspecific gastrointestinal symptoms.
Previous research has indicated that elevated Hcy is a risk factor for Alzheimer’s disease (Jager, et al. Int J Ger Psy. 2012; 27: 592-600). Low folate and elevated Hcy levels have been associated with poor cognitive function and increased risk for dementia (Raman, et al. J Nut. 2007;137(7): 1789-1794).
Additionally, folates, and vitamin B12 support healthy brain metabolism and are implicated in the prevention of various conditions, including central nervous system development disorders, mood disorders, and dementias, including Alzheimer’s disease and vascular dementia (Reynolds, E. Lancet Neurol. 2006; 5(11): 949–960).
It was certainly logical, then, to think that vitamin B supplementation might improve cognition in at-risk elderly people, especially if the regimen could produce a meaningful decrease in Hcy, though small trials looking at this question have produced inconsistent results.
The recent Dutch study is by far the largest to date on this important subject.
In a piece published in the European Journal of Clinical Nutrition shortly after the van der Zwaluw paper made the news, Thakkar and Billa underscore the fact that, like many physiological phenomena, the interactions between the B vitamins and the human nervous system are more complex than we might like them to be.
They note that there are two active co-enzyme forms of vitamin B12 -- methylcobalamin (MeCbl) and adenosylcobalamin (AdCbl) -- which are formed as a result of two distinct metabolic cascades. Both forms of the vitamin are essential and fulfill distinct functions, contributing to confusion among researchers and healthcare providers around exactly which form to use in the context of patient care (Thakkar & Billa. Eur J Clin Nut. 2015; 69, 1-2).
MeCbl, along with folate, primarily supports blood cell and brain development during childhood. Found in the cytosol, MeCbl “predominates in blood and in other body fluids.” AdCbl, on the other hand, is “the major form in cellular tissues stored in the mitochondria.” AdCbl deficiency disrupts carbohydrate, fat, and amino-acid metabolism and affects neuronal myelin synthesis.
Today, as Thakkar and Billa explain, MeCbl is largely used and promoted as the preferred treatment for vitamin B12 deficiency. As an active form of the vitamin, some have argued, it may be more effective than cyanocobalamin. That may not be the case.
They suggest that rather than choosing one form over the other, clinicians ought to treat B12 deficiency with either a combination of both MeCbl and AdCbl, or to use cyanocobalamin on its own, in order to support the vitamin’s neurological and haematopoietic pathways.
Another important fact to consider in assessing the clinical significance of the van der Zwaluw study is that the study was not designed specifically to look at cognitive function, nor were the subjects stratified according to baseline B vitamin levels. The findings may not be generalizable to older people with frank B-vitamin deficiencies or to younger individuals.
As research into the influence of vitamin B12 status on cognitive performance continues, the distinctions between its many forms and functions may become clearer. B vitamins may not, in and of themselves, be a quick fix for the problem of age-associated cognitive decline, but given what we know about the role of these vitamins in neuronal, digestive, and cardiovascular function it makes good clinical sense to screen patients for B12 deficiency through all stages of life.
Daily supplementation with plant-derived carotenoids can reduce the risk of age-associated macular degeneration, and may also have a role in prevention of Alzheimer's disease, according to James Stringham, PhD, of the Nutritional Neuroscience Laboratory at the University of Georgia, Atlanta.
The Federal RDAs for vitamin D are, "grossly inadequate" for most ordinary people, let alone people with pronounced vitamin D deficiencies, according to a detailed analysis of 3,885 episodes of vitamin D supplementation in over 1,300 individuals.
As the number of people taking dietary supplements has grown, and products such as omega-3s and probiotics have become a more common part of clinical practice, there has been increasing scrutiny on the quality of the ingredients that comprise them.
The Federal RDAs for vitamin D are “grossly inadequate” for most ordinary people, let alone people with pronounced vitamin D deficiencies, according to a detailed analysis of 3,885 episodes of vitamin D supplementation in over 1,300 individuals.
Twice daily supplementation with N-Acetylcysteine improves respiratory function and markedly reduces morbidity in elderly people with chronic obstructive pulmonary disease (COPD), according to data from a large, year-long, placebo-controlled clinical trial.
Researchers in Spain have shown a definitive link between low serum vitamin D and the prevalence of obesity. Rather than being a consequence of obesity, the vitamin deficiency may play a causative role.