Helicobacter pylori--in vitro susceptibility to garlic (Allium sativum) extract

In Vitro and In Vivo Study of Combined Effect of Some Algerian Medicinal Plants and Probiotics against Helicobacter pylori

Helicobacter pylori causes gastritis, peptic ulcers and gastric cancer and affects more than half of the world's population. Although this infection can have serious consequences, no novel cure or remedy have been discovered, the present therapy still relies on a variety of known antibiotics and anti-secretory agents. In the present study, the potential effect of combinations between methanolic extracts of four Algerian medicinal plants, garlic (Allium sativum), red onion (Allium cepa), cumin (Cuminum cyminum L.) and fenugreek (T. foenum-graecum L.), with different strains of lactic acid bacteria against H. pylori, was investigated. Similarly, the in vivo antibacterial effect of fenugreek extract combined with Bifidobacterium breve on H. pylori colonization potential to confirm the enhanced effect of the mixture was explored. Helicobacter pylori was inhibited by all combined mixtures of extracts and probiotics with varying results. The highest anti-H. pylori activities were found in fenugreek/B. breve, cumin/B. breve, garlic/B. breve and onion/B. breve combinations with inhibition diameters of 29, 26, 23 and 25 mm, respectively. Preliminary studies on the effect of probiotics against H. pylori revealed that the inhibition was due to lactic acid and bacteriocins and it was also related to the presence of phenolic compounds in the studied plants, such as gallic acid, caffeic acid, quercetin and vanillic acid. Fenugreek extract was found to inhibit the growth of H. pylori in a concentration-dependent manner. When H. pylori-infected rats were administered B. breve, the infection rate of H. pylori was significantly reduced, while the combination of B. breve and fenugreek extract effectively inhibited H. pylori. In addition, the B. breve and fenugreek extract mixture significantly reduced gastritis in H. pylori-infected rats. These results suggest that this complex mixture may be an alternative to treating diseases caused by H. pylori infection.

Savory, Oregano and Thyme Essential Oil Mixture (HerbELICO®) Counteracts Helicobacter pylori

Fifty percent of the world's population is infected with Helicobacter pylori, which can trigger many gastrointestinal disorders. H. pylori eradication therapy consists of two to three antimicrobial medicinal products, but they exhibit limited efficacy and may cause adverse side effects. Alternative therapies are urgent. It was assumed that an essential oil mixture, obtained from species from genera Satureja L., Origanum L. and Thymus L. and called the HerbELICO^® essential oil mixture, could be useful in H. pylori infection treatment. HerbELICO^® was analyzed by GC-MS and assessed in vitro against twenty H. pylori clinical strains isolated from patients of different geographical origins and with different antimicrobial medicinal products resistance profiles, and for its ability to penetrate the artificial mucin barrier. A customer case study included 15 users of HerbELICO^®liquid/HerbELICO^®solid dietary supplements (capsulated HerbELICO^® mixture in liquid/solid form). Carvacrol and thymol were the most dominant compounds (47.44% and 11.62%, respectively), together with p-cymene (13.35%) and γ-terpinene (18.20%). The minimum concentration required to inhibit in vitro H. pylori growth by HerbELICO^® was 4-5% (v/v); 10 min exposure to HerbELICO^® was enough to kill off the examined H. pylori strains, while HerbELICO^® was able to penetrate through mucin. A high eradication rate (up to 90%) and acceptance by consumers was observed.

Allium vegetable intake associated with the risk of incident gastric cancer: a continuous follow-up study of a randomized intervention trial

BACKGROUND

Allium vegetable components have antibacterial, antioxidative, and immune modulation properties, thus potentially exhibiting antitumor effects. Despite evidence from case-control studies, prospective studies linking allium vegetables with gastric cancer (GC) have been sparse.

OBJECTIVE

In a prospective study, we examined whether allium vegetable intake would change the risk of GC occurrence and whether the associations would be modified by vitamin supplementation, garlic supplementation, and Helicobacter pylori (H. pylori) treatment.

METHODS

The study was conducted on the basis of the Shandong Intervention Trial, a randomized, placebo-controlled, factorial-designed trial (1995-2003) in a well-recognized high-risk area for GC in China. Participants were continuously followed up to December 2017 for 22.3 y (1995-2017). A total of 3229 subjects were included, with information on the intake of allium vegetables (garlic vegetables and scallions), collected by structured questionnaires in 1994. The associations of total and individual allium vegetable intake with the risk of GC were examined, respectively.

RESULTS

During the follow-up, 144 incident cases of GC were identified. Garlic vegetable intake was associated with a decreased risk of incident GC (P-trend = 0.02; OR: 0.83; 95% CI: 0.70, 0.98, per 1 kg/y increment), whereas scallion intake showed no association (P-trend = 0.80). An inverse association of the risk of GC with total allium vegetable and garlic vegetable intake was particularly stronger among those receiving the placebo for vitamin supplementation or garlic supplementation, indicating potential effect modifications by nutritional supplementation on allium vegetable intake and the risk of developing GC. Similar findings were found for analyses of the combined prevalence of dysplasia or GC.

CONCLUSIONS

We found a significant reduction in the risk of developing GC with increasing dietary intake of allium vegetables, particularly garlic vegetables. The findings add to the literature on the potential inverse association of garlic vegetable intake with the risk of GC, therefore holding public health implications for dietary recommendations. This trial was registered at clinicaltrials.gov as NCT00339768.

Allium vegetables intake and the risk of gastric cancer in the Stomach cancer Pooling (StoP) Project

BACKGROUND

The role of allium vegetables on gastric cancer (GC) risk remains unclear.

METHODS

We evaluated whether higher intakes of allium vegetables reduce GC risk using individual participant data from 17 studies participating in the "Stomach cancer Pooling (StoP) Project", including 6097 GC cases and 13,017 controls. Study-specific odds ratios (ORs) were pooled using a two-stage modelling approach.

RESULTS

Total allium vegetables intake was inversely associated with GC risk. The pooled OR for the highest versus the lowest study-specific tertile of consumption was 0.71 (95% confidence interval, CI, 0.56-0.90), with substantial heterogeneity across studies (I² > 50%). Pooled ORs for high versus low consumption were 0.69 (95% CI, 0.55-0.86) for onions and 0.83 (95% CI, 0.75-0.93) for garlic. The inverse association with allium vegetables was evident in Asian (OR 0.50, 95% CI, 0.29-0.86) but not European (OR 0.96, 95% CI, 0.81-1.13) and American (OR 0.66, 95% CI, 0.39-1.11) studies. Results were consistent across all other strata.

CONCLUSIONS

In a worldwide consortium of epidemiological studies, we found an inverse association between allium vegetables and GC, with a stronger association seen in Asian studies. The heterogeneity of results across geographic regions and possible residual confounding suggest caution in results interpretation.

Impacts of nutritive and bioactive compounds on cancer development and therapy

For persons who survive with progressive cancer, nutritional therapy and exercise may be significant factors to improve the health condition and life quality of cancer patients. Nutritional therapy and medications are essential to managing progressive cancer. Cancer survivors, as well as cancer patients, are mostly extremely encouraged to search for knowledge about the selection of diet, exercise, and dietary supplements to recover as well as maintain their treatment consequences, living quality, and survival of patients. A healthy diet plays an important role in cancer treatment. Different articles are studied to collect information and knowledge about the use of nutrients in cancer treatment as well as cancer prevention. The report deliberates nutrition and exercise strategies during the range of cancer care, emphasizing significant concerns during treatment of cancer and for patients of advanced cancer, but concentrating mostly on the requirements of the population of persons who are healthy or who have constant disease following their repossession from management. It also deliberates choice nutrition and exercise problems such as dietary supplements, food care, food selections, and weight; problems interrelated to designated cancer sites, and common questions about diet, and cancer survival. Decrease the side effects of medicines both during and after treatment.

Antibacterial Properties of Organosulfur Compounds of Garlic (Allium sativum)

Garlic (Allium sativum), a popular food spice and flavoring agent, has also been used traditionally to treat various ailments especially bacterial infections for centuries in various cultures around the world. The principal phytochemicals that exhibit antibacterial activity are oil-soluble organosulfur compounds that include allicin, ajoenes, and allyl sulfides. The organosulfur compounds of garlic exhibit a range of antibacterial properties such as bactericidal, antibiofilm, antitoxin, and anti-quorum sensing activity against a wide range of bacteria including multi-drug resistant (MDR) strains. The reactive organosulfur compounds form disulfide bonds with free sulfhydryl groups of enzymes and compromise the integrity of the bacterial membrane. The World Health Organization (WHO) has recognized the development of antibiotic resistance as a global health concern and emphasizes antibiotic stewardship along with the urgent need to develop novel antibiotics. Multiple antibacterial effects of organosulfur compounds provide an excellent framework to develop them into novel antibiotics. The review provides a focused and comprehensive portrait of the status of garlic and its compounds as antibacterial agents. In addition, the emerging role of new technologies to harness the potential of garlic as a novel antibacterial agent is discussed.

Allium sativum derived carbon dots as a potential theranostic agent to combat the COVID-19 crisis

Coronavirus disease 2019 (COVID-19) is one of the worst pandemics to have hit the humanity. The manifestations are quite varied, ranging from severe lung infections to being asymptomatic. Hence, there is an urgent need to champion new tools to accelerate the end of this pandemic. Compromised immunity is a primary feature of COVID-19. Allium sativum (AS) is an effective dietary supplement known for its immune-modulatory, antibacterial, anti-inflammatory, anticancer, antifungal, and anti-viral properties. In this paper, it is hypothesized that carbon dots (CDs) derived from AS (AS-CDs) may possess the potential to downregulate the expression of pro-inflammatory cytokines and revert the immunological aberrations to normal in case of COVID-19. CDs have already been explored in the world of nanobiomedicine as a promising theranostic candidates for bioimaging and drug/gene delivery. The antifibrotic and antioxidant effects of AS are elaborated, as demonstrated in several studies. It is found that the most active constituent of AS, allicin has a highly potent antioxidant and reactive oxygen species (ROS) scavenging effect. The antibacterial, antifungal, and anti-viral effects along with their capability of negating inflammatory effects and cytokine storm are discussed. The synthesis of theranostic CDs from AS may provide a novel weapon in the therapeutic armamentarium for the management of COVID-19 infection and, at the same time, could act as a diagnostic agent for COVID-19.

Helicobacter pylori: Perturbation and restoration of gut microbiome

Alternate remedies with natural products provides unlimited opportunities for new drug development. These can be either as pure compounds or as standardized set of compounds. The phytochemicals and secondary metabolites are in great demand for screening bioactive compounds and plays an important role towards drug development. Natural products have many advantages over to synthetic chemical drugs. Helicobacter pylori (H. pylori) a Gram-negative bacteria has been classified as Class I carcinogen by World Health Organization in 1994. Current treatment regimens for H. pylori is ‘triple therapy’ administrated for two weeks which includes a combination of two antibiotics like Amoxicillin and Clarithromycin and a proton pump inhibitor (PPI) like Lansoprazole, and for ‘quadruple therapy’ in addition to antibiotics and a PPI, Bismuth is used. Antibiotic resistance can be named as the main factor for failure of treatment of H. pylori infection. The need of the hour is to develop a herbal remedy that could combat the growth of H. pylori. Probiotics can also be used as ‘feasible’ tool for H. pylori infection management. Present review is an attempt to briefly discuss about the pathogenicity, genetic predisposition, perturbation of gut microbiota due to antibiotic treatment and restoration of healthy gut microbiota with phytochemicals and probiotics.

Allium vegetable consumption and health: An umbrella review of meta-analyses of multiple health outcomes

Previously, our meta-analysis and other studies have suggested that allium vegetable consumption is beneficial for health, but no umbrella review has been conducted to assess the evidence of the various health benefits of allium vegetable consumption. Therefore, we conducted this umbrella review on this topic. This umbrella review included a total of 16 meta-analyses with 50 unique outcomes. The most beneficial cancer-related outcome was shown for gastric cancer (risk ratio 0.78; 95% confidence interval [CI] 0.67-0.91). In addition, only 8 weeks of garlic consumption significantly decreased serum total cholesterol (weighted mean differences -17.20 mg/dl; 95% CI -23.10 to -11.30), and patients with dyslipidemia who consumed garlic experienced more benefits than the whole population. Diabetic patients with longer durations of garlic intake experienced more benefits in terms of fasting blood glucose (FBG), HbA1c, and serum fructosamine than healthy participants, and garlic intake was associated with blood pressure reduction in hypertensive patients but not in normotensive participants. Limited side effects of garlic, such as garlic odor and gastrointestinal complaints, were reported among the included meta-analyses. Our results suggested that allium vegetables might be beneficial for cancer prevention. In particular, garlic was comparatively safe and is recommended as a long-term dietary component for patients with dyslipidemia, diabetes, and hypertension.

Causal Relationship between Diet-Induced Gut Microbiota Changes and Diabetes: A Novel Strategy to Transplant Faecalibacterium prausnitzii in Preventing Diabetes

The incidence of metabolic disorders, including diabetes, has elevated exponentially during the last decades and enhanced the risk of a variety of complications, such as diabetes and cardiovascular diseases. In the present review, we have highlighted the new insights on the complex relationships between diet-induced modulation of gut microbiota and metabolic disorders, including diabetes. Literature from various library databases and electronic searches (ScienceDirect, PubMed, and Google Scholar) were randomly collected. There exists a complex relationship between diet and gut microbiota, which alters the energy balance, health impacts, and autoimmunity, further causes inflammation and metabolic dysfunction, including diabetes. Faecalibacterium prausnitzii is a butyrate-producing bacterium, which plays a vital role in diabetes. Transplantation of F. prausnitzii has been used as an intervention strategy to treat dysbiosis of the gut’s microbial community that is linked to the inflammation, which precedes autoimmune disease and diabetes. The review focuses on literature that highlights the benefits of the microbiota especially, the abundant of F. prausnitzii in protecting the gut microbiota pattern and its therapeutic potential against inflammation and diabetes.

The association of garlic with Helicobacter pylori infection and gastric cancer risk: A systematic review and meta-analysis

BACKGROUND

Garlic may be protective against Helicobacter pylori infection and gastric cancer development. We conducted this study to quantitatively update evidence on garlic intake and gastric cancer with the inclusion of most recent cohort studies and qualitatively summarize epidemiological studies of garlic consumption and Helicobacter pylori infection.

MATERIALS AND METHODS

PubMed, Embase, MEDLINE, and Cochrane Library were searched on April 2018. We conducted a meta-analysis to determine whether garlic intake reduced gastric cancer risk using random-effect models and a systematic review to summarize evidence on the association between garlic consumption and Helicobacter pylori infection. Risk of bias was assessed using tools of Cochrane risk of bias and Robins-I for randomized and nonrandomized studies, respectively.

RESULTS

Meta-analysis of 18 studies (142 921 subjects) demonstrated high garlic consumption (as comparing the highest category to the lowest) was associated with a reduced gastric cancer risk (OR = 0.51, 95% CI = 0.44-0.57). This association became nonsignificant if only derived from the prospective studies (OR = 0.95, 95% CI = 0.66-1.24). Thirteen studies (4889 participants) were included in the systematic review for garlic consumption and Helicobacter pylori infection; ten of which found no significant results. The majority of these studies were poor in quality given the small sample size and high risk of bias.

CONCLUSIONS

Pooled evidence, mainly from case-control studies, suggested a significant inverse association of garlic intake with gastric cancer risk. Given the limitations of included studies, current epidemiological evidence is not sufficient to reach any definite conclusion regarding the association of garlic with Helicobacter pylori infection.

Garlic intake and gastric cancer risk: Results from two large prospective US cohort studies

Although many case-control studies suggested that garlic intake may reduce gastric cancer risk, evidence from prospective cohort studies has been lacking. We examined the association between garlic intake and subsequent risk of gastric cancer among 77,086 women in the Nurses' Health Study (1984-2014) and 46,398 men in the Health Professionals Follow-Up Study (1986-2014). Relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated using Cox proportional hazards models. We additionally examined garlic intake in relation to Helicobacter pylori (H. pylori) infection among 613 participants using logistic regression. During up to 30 years of follow-up, 292 participants were diagnosed with gastric cancer. The pooled multivariable RR of gastric cancer among participants who ate garlic, as compared to those who did not, were 1.11 (95% CI = 0.81-1.51) for the intake of garlic less than once per week, 0.98 (95% CI = 0.71-1.36) for one to four times per week and 1.39 (95% CI = 0.89-2.17) for five or more times per week (p for trend = 0.23). Similarly, no statistically significant association was observed cross-sectionally between garlic intake and H. pylori infection (comparing five or more times per week to never, pooled multivariable odds ratio = 1.66, 95% CI = 0.89-3.09; p for trend = 0.11). The findings from this large prospective study do not support the hypothesis that high garlic intake reduces risk of gastric cancer.

Locally sourced probiotics, the next opportunity for developing countries?

We describe factors promoting the exploration of locally sourced probiotics, targeting local populations to balance human needs and market opportunities. This would be particularly beneficial for people in developing countries, who generally lack access to affordable probiotics and are often exposed to poor hygiene conditions, toxic compounds, malnutrition, and chronic enteric infections.

Challenges to the Treatment and New Perspectives for the Eradication of Helicobacter pylori

Helicobacter pylori (H. pylori) is one of the leading causes of gastric diseases such as chronic gastritis, peptic ulcer, and gastric adenocarcinoma. The current treatment of H. pylori infection with antibiotics and proton pump inhibitors has several limitations, including poor adherence and intrinsic patient-related factors, drug resistance, and the absence of adequate treatments. This review summarizes the current therapeutic approaches to eradicating H. pylori, the difficulties associated with its treatment, and several new perspectives aimed at improving existing treatment strategies.

Immunomodulation and anti-inflammatory effects of garlic compounds

The benefits of garlic to health have been proclaimed for centuries; however, only recently have Allium sativum and its derivatives been proposed as promising candidates for maintaining the homeostasis of the immune system. The complex biochemistry of garlic makes it possible for variations in processing to yield different preparations with differences in final composition and compound proportion. In this review, we assess the most recent experimental results, which indicate that garlic appears to enhance the functioning of the immune system by stimulating certain cell types, such as macrophages, lymphocytes, natural killer (NK) cells, dendritic cells, and eosinophils, by mechanisms including modulation of cytokine secretion, immunoglobulin production, phagocytosis, and macrophage activation. Finally, because immune dysfunction plays an important role in the development and progress of several diseases, we critically examined immunoregulation by garlic extracts and compounds isolated, which can contribute to the treatment and prevention of pathologies such as obesity, metabolic syndrome, cardiovascular disorders, gastric ulcer, and even cancer. We concluded that A. sativum modulates cytokine secretion and that such modulation may provide a mechanism of action for many of their therapeutic effects.

Nontraditional therapies to treat Helicobacter pylori infection

The Gram-negative pathogen Helicobacter pylori is increasingly more resistant to the three major antibiotics (metronidazole, clarithromycin and amoxicillin) that are most commonly used to treat infection. As a result, there is an increased rate of treatment failure; this translates into an overall higher cost of treatment due to the need for increased length of treatment and/or the requirement for combination or sequential therapy. Given the rise in antibiotic resistance, the complicated treatment regime, and issues related to patient compliance that stem from the duration and complexity of treatment, there is clearly a pressing need for the development of novel therapeutic strategies to combat H. pylori infection. As such, researchers are actively investigating the utility of antimicrobial peptides, small molecule inhibitors and naturopathic therapies. Herein we review and discuss each of these novel approaches as a means to target this important gastric pathogen.

Exploring alternative treatments for Helicobacter pylori infection

Helicobacter pylori (H. pylori) is a successful pathogen that can persist in the stomach of an infected person for their entire life. It provokes chronic gastric inflammation that leads to the development of serious gastric diseases such as peptic ulcers, gastric cancer and Mucosa associated lymphoid tissue lymphoma. It is known that these ailments can be avoided if the infection by the bacteria can be prevented or eradicated. Currently, numerous antibiotic-based therapies are available. However, these therapies have several inherent problems, including the appearance of resistance to the antibiotics used and associated adverse effects, the risk of re-infection and the high cost of antibiotic therapy. The delay in developing a vaccine to prevent or eradicate the infection has furthered research into new therapeutic approaches. This review summarises the most relevant recent studies on vaccine development and new treatments using natural resources such as plants, probiotics and nutraceuticals. In addition, novel alternatives based on microorganisms, peptides, polysaccharides, and intragastric violet light irradiation are presented. Alternative therapies have not been effective in eradicating the bacteria but have been shown to maintain low bacterial levels. Nevertheless, some of them are useful in preventing the adverse effects of antibiotics, modulating the immune response, gastroprotection, and the general promotion of health. Therefore, those agents can be used as adjuvants of allopathic anti-H. pylori eradication therapy.

Histological evaluation of the jejunum and ileum of rats after administration of high dose garlic aqueous extract

OBJECTIVES

This study investigated the adverse effects of excessive consumption of garlic on the small intestine (jejunum and ileum) of adult male Wistar rats.

METHODOLOGY

Sixteen (16) Wistar rats with average weight of 181.5 g were grouped into two: Control Group A which received distilled water, and Treatment Group B which received 1000 mg/kg/ml aqueous extract of garlic, orally for 28 weeks. The aqueous extraction of raw garlic was done to obtain a concentration of 1000 mg/kg/ml. The animals were sacrificed by cervical dislocation after the last day of administration, and tissues for histological studies were fixed in buffered formalin, while those for enzyme studies were homogenised, and appropriate biochemical kits used to study the activities of acid phosphatase (ACP), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH).

RESULTS

The histological sections of the jejunum of animals that received the high dose of aqueous garlic extract revealed the presence of vacuolations, cell death and loss of epithelium, and intact muscle layer; the Periodic-Acid Schiff (PAS) positivity also reduced, while the ileum also showed degeneration of the brush borders, loss of epithelial cells, reduction in the number of goblet cells, vacuolations, and a reduced intensity of PAS positivity. Activities of ACP, ALP and LDH in the jejunum and ileum were increased.

CONCLUSION

Consumption of excessive amount of garlic could cause structural changes to the intestinal tract, which are capable of affecting intestinal functions, such as decrease in glycogen activity in the small intestine, and impairment of the absorptive activities.

Effects of diet on gut microbiota profile and the implications for health and disease

Gut microbes are present in large concentrations on the human intestinal mucosal surface and play important roles in health and disease of the host. Numerous groups of gut microbes are associated with immunological and metabolic diseases and in maintaining health status of the host. Among these health- and disease-associated gut microbes, Bacteroides, Clostridium and Bifidobacterium appear regularly in the list. Scientific and clinical evidence available to date indicates that diet is a major driving factor for the establishment of the gut microbiome. Slow digestible carbohydrates (human milk glycan, inulin and fructooligosaccharide), insoluble complex carbohydrates and protein diets favor the growth of Bacteroides, Clostridium and Bifidobacterium. Fat on the other hand suppresses the number of Bacteroides, Clostridium and Bifidobacterium; whereas polyphenols in general suppress Bacteroides and Clodtridium but enhance the Bifodobacterium. The implication is that dietary habits could be a major determinant of health and disease susceptibility. Dietary strategies could be an effective means of potentially inducing changes in intestinal microbiota and are certainly achievable, thus facilitating correction of intestinal microbiome aberrations or imbalances to improve our health. Most of the physiological and functional interactions between individual dietary components and the concoction of foods in a meal and gut microbiota have not yet been well studied. A concerted effort is required to acquire better understanding of their interaction in order to rationally maintain our intestinal microbiome homeostasis and general health through dietary intervention.

In vitro sensitivity of Blastocystis hominis to garlic, ginger, white cumin, and black pepper used in diet

To determine the growth pattern and in vitro susceptibility of Blastocystis hominis to metronidazole (MTZ), garlic, ginger, white cumin, and black pepper. Stool specimens were collected from 16 irritable bowel syndrome (IBS) and 10 controls between July-November 2010. Stool microscopy and culture for B. hominis was performed. Drug susceptibility assays was done using 0.01 and 0.1 mg/ml of MTZ, garlic, ginger, white cumin, and black pepper. Effect was assessed on B. hominis culture after 48 h. Stool DNA was extracted using stool DNA extraction kit (Qiagen) and polymerase chain reaction (PCR) done using subtype-specific sequence-tagged-site primers. B. hominis genotype 3 and coinfection of 1 and 3 tended to grow well in culture compared to isolated type 1 infection. Exposed to MTZ at a concentration of 0.01 mg/ml, 38% (6/16) B. hominis from IBS did not grow in culture compared to 100% (10/10) of B. hominis from control (p = 0.001). When they were exposed to MTZ at 0.1 mg/ml, 56% (9/16) B. hominis from IBS did not grow in cultures compared to 100% (10/10) from control (p = 0.01). Forty-four percent (7/16) B. hominis from IBS did not grow in culture compared to 100% (10/10) B. hominis from control when exposed to garlic at a concentration of 0.01 mg/ml (p = 0.003) and following exposure to garlic at 0.1 mg/ml, 38% (6/16) B. hominis from IBS did not grow in cultures compared to 100% (10/10) from control (p = 0.001). B. hominis isolates from IBS had a cell count of 6,625 at a MTZ concentration of 0.01 mg/ml that reduced to 1,250 as MTZ concentration was increased to 0.1 mg/ml (p = 0.08). B. hominis from IBS with a mean cell count of 3 × 10(5) at baseline decreased to 1 × 10(4) when exposed to garlic at 0.01 mg/ml (p < 0.001) and to 1 × 10(3) (p < 0.001) when garlic was 0.1 mg/ml. B. hominis from IBS cell count decreased to 1 × 10(5) when exposed to white cumin at 0.01 mg/ml (p = 0.01) and to 1 × 10(5) (p < 0.001) when white cumin was 0.1 mg/ml. Exposed to black pepper at 0.1 mg/ml, cell count of B. hominis from IBS decreased to 1 × 10(5) (p = 0.01). B. hominis from IBS decreased to 1.3 × 10(5) exposed to ginger at 0.01 mg/ml (p = 0.001). B. hominis isolates were mostly genotypes 3, type 1 and 3 coinfection, and non-typeable B. hominis isolates. B. hominis isolates from IBS mostly genotype 1 demonstrated an increased sensitivity to garlic at 0.01 mg/ml with a B. hominis cell count of 3,714 compared to 6,142 when exposed to 0.01 mg/ml of MTZ. However, this sensitivity did not increase as garlic concentration was increased to 0.1 mg/ml, for B. hominis cell count was 6,000 compared to 1,428 as MTZ was increased to 0.1 mg/ml.

Consumption of large amounts of Allium vegetables reduces risk for gastric cancer in a meta-analysis

BACKGROUND & AIMS

The chemopreventive effects of Allium vegetables (onions, garlic, shallots, leeks, chives, and so forth) have been studied extensively, although their effect on gastric cancer risk is controversial. We performed a meta-analysis of cohort and case-control studies to analyze this association.

METHODS

We searched MEDLINE for studies of Allium vegetable consumption and gastric cancer that were published in any language, from January 1, 1966, to September 1, 2010. We analyzed 19 case-control and 2 cohort studies, of 543,220 subjects. We pooled the relative risks from individual studies using a random-effects model and performed dose-response, heterogeneity, and publication bias analyses.

RESULTS

In a pooled analysis of all studies, consumption of large amounts of Allium vegetables (in a comparison of the highest and lowest consumption groups) reduced the risk for gastric cancer (odds ratio, 0.54; 95% confidence interval, 0.43-0.65). Specific analyses for onion, garlic, leek, Chinese chive, scallion, garlic stalk, and Welsh onion yielded similar results, except for onion leaf. The estimated summary odds ratio for an increment of 20 g/day of Allium vegetables consumed (approximately the average weight of 1 garlic bulb) was 0.91 (95% confidence interval, 0.88-0.94), based on case-control studies from the dose-response meta-analysis.

CONCLUSIONS

In a meta-analysis, consumption of high levels of Allium vegetables reduced the risk for gastric cancer risk. Because of potential confounding factors and exposure misclassification, further studies are required to establish this association.

Garlic in health and disease

The present article reviews the historical and popular uses of garlic, its antioxidant, haematological, antimicrobial, hepatoprotective and antineoplastic properties and its potential toxicity (from sulfoxide). Garlic has been suggested to affect several cardiovascular risk factors. It has also been shown that garlic and its organic allyl sulfur components are effective inhibitors of the cancer process. Since garlic and its constituents can suppress carcinogen formation, bioactivation and tumour proliferation, it is imperative that biomarkers be established to identify which individuals might benefit most. Garlic powder, aged garlic and garlic oil have demonstrated antiplatelet and anticoagulant effects by interfering with cyclo-oxygenase-mediated thromboxane synthesis. Garlic has also been found to have synergistic effects against Helicobacter pylori with a proton pump inhibitor. The active compound allicin may affect atherosclerosis not only by acting as an antioxidant, but also by other mechanisms, such as lipoprotein modification and inhibition of LDL uptake and degradation by macrophages. Freshly prepared garlic homogenate protects against isoniazid+rifampicin-induced liver injury in experimental animal models. Several mechanisms are likely to account for this protection.

Dietary habits and gastric cancer risk in north-west Iran

OBJECTIVES

North-west Iran is a high-risk area for gastric cancer (GC). Dietary practices may increase risk of GC. For the first time, the diet-GC association in this area was assessed using a validated food frequency questionnaire.

METHODS

Cases and controls were recruited in a population-based study. In addition to collecting dietary data using a food frequency questionnaire, Helicobacter pylori antibody level was measured. Multiple logistic regression models were used to estimate odds ratios for associations between dietary factors and GC among 286 cases and 304 controls.

RESULTS

A positive association was estimated for total fat intake (OR = 1.33/20 g, 95% CI: 1.12-1.57) and risk of GC. Inverse associations were observed for vitamin C, iron, and zinc intake and risk of GC and its subgroups (cardia, non-cardia). Fruits and vegetables consumption and refrigerator use showed inverse associations (OR = 0.72/100 g, 95% CI: 0.65-0.80 and OR = 0.75/10 years, 95% CI: 0.60-0.95, respectively). Positive association was observed among those who preferred fried food (OR = 2.21, 95% CI: 1.45-3.37) or consumed highly salted/roasted seeds (OR = 1.97, 95% CI: 1.13-3.43).

CONCLUSION

GC in north-west Iran is associated with dietary practices: foods, nutrients and food preparation habits.

Utilização do óleo de alho e da amoxilina, metronidazol e omeprazol no controle de Helicobacter spp. em cães

Avaliaram-se a eficácia do óleo de alho e da terapia tripla (amoxicilina, metronidazol e omeprazol) no tratamento de 21 cães infectados por Helicobacter spp., que apresentavam alterações histológicas nas biopsias endoscópicas da mucosa gástrica e reação positiva ao teste de urease. Os animais foram distribuídos, aleatoriamente, em três grupos de sete cães, os quais receberam os seguintes tratamentos: grupo 1 - cápsulas vazias; grupo 2 - 500mg de óleo de alho em cápsulas, diariamente, por um período de 30 dias; grupo 3 - amoxicilina, metronidazol e omeprazol, respectivamente, nas doses de 20mg/kg a cada 12 horas, 25mg/kg e 20mg/kg a cada 24 horas, durante 15 dias. Ao final dos tratamentos, os cães foram submetidos à endoscopia com realização de biopsias da mucosa gástrica. O tratamento com amoxicilina, metronidazol e omeprazol resultou em erradicação de Helicobacter spp. tanto na região fúndica quanto na pilórica. No grupo 2, houve redução da degeneração glandular na região fúndica em dois animais e em outros dois na pilórica. O tratamento com óleo de alho não foi eficaz em erradicar Helicobacter spp., apenas reduziu a sua colonização em quatro dos animais tratados.

Inactivation of Jack Bean Urease by Allicin

Allicin--diallyl thiosulfinate--is the main biologically active component of freshly crushed garlic. Allicin was synthesized as described elsewhere and was tested for its inhibitory ability against jack bean urease in 20 mM phosphate buffer, pH 7.0 at 22 degrees C. The results indicate that allicin is an enzymatic inactivator. The loss of urease activity was irreversible, time- and concentration dependent and the kinetics of the inactivation was biphasic; each phase, obeyed pseudo-first-order kinetics. The rate constants for inactivation were measured for the fast and slow phases and for several concentrations of allicin. Thiol reagents, and competitive inhibitor (boric acid) protected the enzyme from loss of enzymatic activity. The studies demonstrate that urease inactivation results from the reaction between allicin and the SH-group, situated in the urease active site (Cys592).

Variação de peso, grau de escolaridade, saneamento básico, etilismo, tabagismo e hábito alimentar pregresso em pacientes com cancêr de estômago

RACIONAL: Cerca de 35% dos casos de câncer estão envolvidos com fatores advindos da dieta e de outros como o álcool, o fumo, a luz solar, agentes químicos e infecções por vírus. O câncer de estômago é o segundo tipo de câncer mais diagnosticado no mundo, sendo responsável por cerca de 9,9% de todos os diagnósticos e cerca de 12,1% das mortes. OBJETIVOS: Comparar o peso corpóreo atual e habitual, grau de escolaridade, saneamento básico, tabagismo, etilismo e freqüência pregressa de consumo de alimentos entre pacientes com câncer de estômago e população controle. MÉTODO: Setenta pacientes com câncer gástrico foram pareados a outros 70 indivíduos sem diagnóstico de neoplasia. Foram coletados peso, altura, informações sobre grau de escolaridade, saneamento básico, tabagismo e etilismo e preenchido um questionário de freqüência alimentar pregressa. RESULTADOS: Dos 75 pacientes elegíveis para o estudo, 42 eram homens, com média de idade de 59,5 anos. O grupo de pacientes com câncer apresentou menor peso e índice de massa corporal atual do que o grupo controle. Em relação ao grau de escolaridade, verificou-se que, no grupo de pacientes com câncer, 21 indivíduos nunca ingressaram na escola e dos que estudaram, cerca de 55% não conseguiram concluir o primeiro grau. Nesse grupo, 32,9% dos indivíduos tiveram acesso ao saneamento básico e 37,1% à eletricidade no passado; no grupo controle, esse percentual foi de 68,6% para cada uma das variáveis. No grupo caso, 58,6% dos pacientes moraram na zona rural, enquanto no grupo controle apenas 7,1%. No grupo caso, 65.7% eram fumantes versus 44.3%, no grupo controle. Observou-se também que os pacientes com câncer fumaram por período maior. O alcoolismo também foi mais freqüente entre os pacientes com câncer (45% versus 19%). Verificou-se que, entre os pacientes com câncer, houve maior consumo de alimentos ricos em sal, condimentos, nitratos, gordura animal saturada, carboidratos complexos, açúcar refinado e salgados fritos, comparado ao grupo controle. CONCLUSÃO: Os doentes com câncer gástrico, quando comparados ao grupo controle, apresentaram: perda de peso, queda da qualidade de vida verificada pelo baixo acesso a saneamento básico, eletricidade e escolaridade, residiram predominantemente em área rural, alta incidência de alcoolismo e alta ingestão de alimentos ricos em gorduras, alimentos industrializados e álcool.

New constituents of sweet Capsicum annuum L. fruits and evaluation of their biological activity

Four new acyclic diterpene glycosides named capsianosides (1-4), together with 12 known compounds, were isolated from the fresh sweet pepper fruits of Capsicum annuum L., a plant used as a vegetable food, spice, and external medicine. The chemical structures of new natural compounds, as well as their absolute configurations, were established by means of spectroscopic data including infrared, high-resolution mass spectrometry, and one- and two-dimensional nuclear magnetic resonance and by chemical derivatization. The known capsidiol (11) showed bacteriostatic properties in vitro against Helicobacter pylori with a minimum inhibitory concentration (MIC) of 200 microg/mL when compared with the commercial drug metronidazole (MIC, 250 microg/mL). Some purified components were also tested for their antioxidant activities.

Gastric cancer: global pattern of the disease and an overview of environmental risk factors

This first part of this chapter looks at the worldwide burden of gastric cancer at the beginning of the 21st century and summarises available population-based routine data that describes the variation in incidence of the disease in relation to age, sex, geography and time period. Consideration is also given to the differences in the descriptive epidemiology of gastric cancer arising in the proximal cardia region of the stomach. In the second part of the chapter, a brief review of the main identified environmental risk factors is conducted drawing, where available, on published systematic literature overviews and meta-analyses. Evidence relating the aetiology of gastric cancer to Helicobacter pylori infection, dietary factors, smoking, occupation, physical activity and anthropometry is presented.

Antimicrobial activities of Eugenol and Cinnamaldehyde against the human gastric pathogen Helicobacter pylori

BACKGROUND

Eradication of Helicobacter pylori is an important objective in overcoming gastric diseases. Many regimens are currently available but none of them could achieve 100% success in eradication. Eugenol and cinnamaldehyde that are commonly used in various food preparations are known to possess antimicrobial activity against a wide spectrum of bacteria.

AIM

The present study was performed to assess the in vitro effects of eugenol and cinnamaldehyde against indigenous and standard H. pylori strains, their minimum inhibitory concentrations (MICs) and time course lethal effects at various pH.

METHODS

A total of 31 strains (29 indigenous and one standard strain of H. pylori ATCC 26695, one strain of E. coli NCIM 2089) were screened. Agar dilution method was used for the determination of drug sensitivity patterns of isolates to the commonly used antibiotics and broth dilution method for the test compounds.

RESULTS

Eugenol and cinnamaldehyde inhibited the growth of all the 30 H. pylori strains tested, at a concentration of 2 mug/ml, in the 9th and 12th hours of incubation respectively. At acidic pH, increased activity was observed for both the compounds. Furthermore, the organism did not develop any resistance towards these compounds even after 10 passages grown at sub-inhibitory concentrations.

CONCLUSION

These results indicate that the two bioactive compounds we tested may prevent H. pylori growth in vitro, without acquiring any resistance.

Garlic natural health products exhibit variable constituent levels and antimicrobial activity against Neisseria gonorrhoeae, Staphylococcus aureus and Enterococcus faecalis

The composition of 19 garlic natural health products (NHPs) and fresh garlic extracts were determined, as was their antibacterial activity. The 19 NHPs and 5 fresh garlic extract standards were analysed for their principal active constituents. They were also extracted for 5, 10 or 15 min in water to fresh garlic equivalents of 200 mg/mL. The extract's minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) against three indicator microorganisms (Neisseria gonorrhoeae, Staphylococcus aureus and Enterococcus faecalis) were determined by the broth microdilution method. While 47% of the aqueous garlic NHP extracts exhibited activity against N. gonorrhoeae, only 16% of the aqueous extracts inhibited S. aureus or E. faecalis at all three timepoints. Generally, products with high antimicrobial activity contained higher levels of garlic constituents with comparable activity to fresh garlic extracts, while products with marginal antibacterial activity often contained lower concentrations of constituents than their product labels indicated. Different extraction times affected antibacterial activity only against N. gonorrhoeae and tended to be correlated with levels of allicin. Thus, many extracts showed discrepancies in both composition, allicin:alliin ratio and antimicrobial activity, raising concerns as to standards of preparation and quality control for these products.

Non-antibiotic therapies for Helicobacter pylori infection

Despite years of experience with Helicobacter pylori treatment, the ideal regimen for treating the infection has not been found. The most effective eradication treatment is the combination of a proton pump inhibitor with antibiotics, but 10-20% of the patients fail to obtain eradication of the infection. Antibiotic resistance is a major factor affecting the outcome of treatment. Non-antibiotic therapies, including phytomedicines, probiotics, and antioxidants, have been increasingly investigated as potential alternatives for the treatment of H. pylori. In this article, we review the non-antibiotic therapies for H. pylori infection.

Garlic arrests MDA-MB-435 cancer cells in mitosis, phosphorylates the proapoptotic BH3-only protein BimEL and induces apoptosis

Components of garlic (Allium sativum) can cause disruption of microtubules, cell cycle arrest, and apoptosis in cancer cells. We show here that a water-soluble extract of garlic arrested MDA-MB-435 cancer cells in mitosis and caused apoptosis. The proapoptotic BH3-only, bcl-2 family protein Bim_EL, which in healthy cells can be tightly sequestered to the microtubule-associated dynein motor complex, was modified after garlic treatment. The main effect of garlic on Bim_EL was a considerable increase in a phosphorylated form of the protein. This phosphorylation(s), probably partly dependent on c-jun N-terminal kinase activity, promoted mitochondrial localisation of Bim_EL. Furthermore, inhibition of extracellular signal-regulated kinases 1/2 increased the amount of another form of Bim_EL present in the mitochondrial cellular fraction. Treatment of cells with the garlic compound diallyl disulphide had similar effects on Bim_EL. The results indicate that the apoptotic effect of garlic and a combination of garlic and the inhibitor of extracellular signal-regulated kinases 1/2 in MDA-MB-435 cells partly is due to modifications that are necessary for translocation of the proapoptotic protein Bim_EL to mitochondria where it executes its proapoptotic function.

Bactericidal activity of wasabi (Wasabia japonica) against Helicobacter pylori

In this study, the bactericidal activity of Korean and Japanese wasabi roots, stems and leaves against Helicobacter pylori were examined. Allyl isothiocyanate (AIT) in roots, stems and leaves of Korean wasabi were 0.75, 0.18 and 0.32 mg/g, respectively. AIT in roots, stems and leaves of Japanese wasabi were 1.18, 0.41 and 0.38 mg/g, respectively. All parts of wasabi showed bactericidal activities against H. pylori strain NCTC 11637, YS 27 and YS 50. The leaves of both wasabi showed the highest bactericidal activities with the minimum bactericidal concentration of 1.05-1.31 mg of dry weight/ml against three strains of H. pylori. The roots showed a little lower bactericidal activity with 2.09-4.17 mg of dry weight/ml against them. The main component related to antimicrobial activity in wasabi is well known to be AIT. In this study, the bactericidal activity of leaves was higher than that of roots, although AIT amount of leaves was lower than that of roots. These results suggest that certain components besides AIT in wasabi are effective in killing H. pylori.

Allyl-thiosulfinates, the bacteriostatic compounds of garlic against Helicobacter pylori

Allicin and allyl-methyl plus methyl-allyl thiosulfinate from acetonic garlic extracts (AGE) have been isolated by high-performance liquid chromatography. These compounds have shown inhibition of the in vitro growth of Helicobacter pylori (Hp), the bacterium responsible for serious gastric diseases such as ulcers and even gastric cancer. A chromatographic method was optimized and used to isolate these thiosulfinates. The method developed has allowed the isolation of natural thiosulfinates extracted from garlic by organic solvents and is an easy and cheap methodology that avoids complex synthesis and purification procedures. The capacity and effectiveness of isolated natural thiosulfinates have been tested, and this has enabled the identification of the main compounds responsible for the bacteriostatic activity shown by AGE origin of these kinds of organosulfur compounds along with ethanolic garlic extracts (EGE). Additionally, microbiological analyses have suggested that these compounds show a synergic effect on the inhibition of the in vitro growth of Hp. The results described here facilitate the process of obtaining garlic extracts with optimal bacteriostatic properties. The product is obtained in a way that avoids expensive purification methods and will allow the design of live tests with the aim of investigating the potential for the use of these garlic derivatives in the treatment of patients with Hp infections.

Thermal degradation of allicin in garlic extracts and its implication on the inhibition of the in-vitro growth of Helicobacter pylori

Allicin, the main active principle related to Allium sativum chemistry, is considered to be responsible for the bacteriostatic properties of garlic. The work described here has demonstrated the direct implication of the allicin present in solvent-free garlic extracts obtained with ethanol (ethanolic garlic extract, EGE) and acetone (acetonic garlic extract, AGE) in the inhibition of the in-vitro growth of Helicobacter pylori (Hp), the bacterium responsible for serious gastric diseases such as ulcers and even gastric cancer. The evolution of allicin concentration as a function of time and temperature has been the subject of a kinetic study. The reaction order, activation energy, and preexponential factor (in accordance with Arrhenius theory) have been determined for the decomposition process of allicin in these organic media. First-order decomposition, an activation energy of 97.4 kJ/mol, and an Arrhenius preexponential factor of 8.9 x 10(10) s(-1) have been determined for allicin in EGE. For allicin in AGE the kinetic order determined was 1.5, the activation energy 184.5 kJ/mol, and the preexponential factor 3.1 x 10(24) s(-1) (mg/L)(-0.5). The presence or absence of allicin in these garlic products was found to be crucial for the inhibition of the in-vitro growth of Hp, as demonstrated by microbiological analysis for AGE. A relationship has been identified between the effectiveness and durability of the anti-Hp properties shown by AGE and the allicin content of these products. The bacteriostatic properties were active for up to 10 months if the samples were maintained at 6 degrees C.

Effect of red pepper Capsicum annuum var. conoides and garlic Allium sativum on plasma lipid levels and cecal microflora in mice fed beef tallow

Antihyperlipidemia or hypocholesterolaemic and antibacterial activities of red hot pepper and garlic are well known. To determine the effect of the dietary spices ingested to suppress blood lipids on the intestinal condition, we examined plasma lipid levels and cecal microflora in mice that were fed diets containing 19% (w/w) beef tallow and 2% red pepper Capsicum annuum var. conoides 'Takanotume' (RP) or garlic Allium sativum 'White' (GP) for 4-weeks. Plasma triacylglyceride level was suppressed by the spices. RP lowered cecal bacteroidaceae, a predominant bacterial group (from 9.4 to 9.0 log CFU/g), bifidobacteria (from 8.7 to 7.6 log CFU/g), and staphylococci. Although GP increased the cecal weight including their contents, significant differences were not shown in the cecal microflora. These results suggest that RP can affect the intestinal condition and host health through the disturbance of intestinal microflora.

Effects of Aqueous Extracts of Garlic (Allium sativum) and Neem (Azadirachta indica) Leaf on Hepatic and Blood Oxidant-Antioxidant Status During Experimental Gastric Carcinogenesis

The modifying effects of aqueous extracts of garlic and neem leaf during the pre-initiation and post-initiation phases of gastric carcinogenesis induced by N-methyl-N'-nitro-N-nitrosoguanidine were investigated in male Wistar rats. The extent of lipid peroxidation and the status of phase II biotransformation enzymes such as glutathione peroxidase and glutathione-S-transferase that use reduced glutathione (GSH) as substrate were used to biomonitor the chemopreventive potential of these extracts. Enhanced lipid peroxidation in the liver and blood of tumor-bearing animals was accompanied by significant decreases in the activities of GSH-dependent antioxidants in the pre-initiation as well as in the post-initiation phases. Our results suggest that the modulatory effects of garlic and neem leaf on hepatic and blood oxidant-antioxidant status may play a key role in preventing cancer development at extrahepatic sites.

Organosulfur compounds from alliaceae in the prevention of human pathologies

A strong association between elevated plasma low-density-lipoprotein (LDL) and the development of cardiovascular diseases (CVD) has been established. Oxidation of LDL (Ox-LDL) promotes vascular dysfunction, enhances the production and release of inflammatory mediators such as reactive oxygen species and contribute to the initiation and progression of atherosclerosis. In addition, Ox-LDL enhances the production and release of tumor necrosis factor (TNF-alpha), interleukin (IL)-6, arachidonic acid metabolites and nitric oxide (NO) that are responsible for various human pathologies including cancer. Organosulfur compounds (OSC) from alliaceae modulate the glutathione (GSH) redox cycle and inhibits NFkappa-B activation in human T cells. Furthermore, OSC bioactivities include antioxidant, antibacterial, anticarcinogenic, antiatherogenic, immunostimulatory, and liver protection potential.

Spicing up a vegetarian diet: chemopreventive effects of phytochemicals

Thousands of chemical structures have been identified in plant foods. Many are found in spices. Typically, spices are the dried aromatic parts of plants-generally the seeds, berries, roots, pods, and sometimes leaves-that mainly, but not invariably, grow in hot countries. Given the wide range of botanical species and plant parts from which spices are derived, they can contribute significant variety and complexity to the human diet. In the past, the medicinal uses of spices and herbs were often indistinguishable from their culinary uses, and for good reason: people have recognized for centuries both the inherent value, as well as the potential toxicity, of phytochemicals in relation to human health. Plants have the capacity to synthesize a diverse array of chemicals, and understanding how phytochemicals function in plants may further our understanding of the mechanisms by which they benefit humans. In plants, these compounds function to attract beneficial and repel harmful organisms, serve as photoprotectants, and respond to environmental changes. In humans, they can have complementary and overlapping actions, including antioxidant effects, modulation of detoxification enzymes, stimulation of the immune system, reduction of inflammation, modulation of steroid metabolism, and antibacterial and antiviral effects. Embracing a cuisine rich in spice, as well as in fruit and vegetables, may further enhance the chemopreventive capacity of one's diet.

Nutrition and diet in the development of gastrointestinal cancer

Diet plays a role in the prevention and development of gastrointestinal cancers. The majority of available research consists of case-control studies, but the number of clinical trials is growing. The dietary recommendations to reduce gastrointestinal cancer risk include lowering total energy, fat, and saturated fat intake; avoidance of grilled and smoked foods; avoidance of alcohol; and increasing intake of fruits, vegetables, and fiber. Studies of esophageal cancer support these dietary approaches, with the exception of dietary fat reduction and increased green tea intake. For gastric cancer, consuming additional fruits and vegetables, including those high in ascorbic acid, may reduce risk, and the capacity for diet to alter Helicobacter pylori infection should be explored. Recent interventional trials do not support a role for high-fiber or low-fat diets in reducing development of colon adenomas, although the evidence does not rule out efficacy at earlier stages of disease. Finally, the evidence for a relationship between pancreatic cancer and diet remains sparse and warrants additional investigation.