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Koppold DA, Kandil FI, Müller A, Güttler O, Steckhan N, Meiss S, Breinlinger C, Nelle E, Rajput Khokhar A, Jeitler M, Hanslian E, Fischer JM, Michalsen A, Kessler CS. Effects of Prolonged Medical Fasting during an Inpatient, Multimodal, Nature-Based Treatment on Pain, Physical Function, and Psychometric Parameters in Patients with Fibromyalgia: An Observational Study. Nutrients 2024; 16:1059. [PMID: 38613092 PMCID: PMC11013748 DOI: 10.3390/nu16071059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/22/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Fibromyalgia syndrome (FMS) is a common chronic pain disorder and often occurs as a concomitant disease in rheumatological diseases. Managing FMS takes a complex approach and often involves various non-pharmacological therapies. Fasting interventions have not been in the focus of research until recently, but preliminary data have shown effects on short- and medium-term pain as well as on physical and psychosomatic outcomes in different chronic pain disorders. This single-arm observational study investigated the effects of prolonged fasting (3-12 days, <600 kcal/d) embedded in a multimodal treatment setting on inpatients with FMS. Patients who were treated at the Department of Internal Medicine and Nature-Based Therapies of the Immanuel Hospital Berlin, Germany, between 02/2018 and 12/2020 answered questionnaires at hospital admission (V0) and discharge (V1), and then again three (V2), six (V3), and 12 (V4) months later. Selected routine blood and anthropometric parameters were also assessed during the inpatient stay. A total of 176 patients with FMS were included in the study. The Fibromyalgia Impact Questionnaire (FIQ) total score dropped by 13.7 ± 13.9 (p < 0.001) by V1, suggesting an improvement in subjective disease impact. Pain (NRS: reduction by 1.1 ± 2.5 in V1, p < 0.001) and quality of life (WHO-5: +4.9 ± 12.3 in V1, p < 0.001) improved, with a sustainable effect across follow-up visits. In contrast, mindfulness (MAAS: +0.3 ± 0.7 in V1, p < 0.001), anxiety (HADS-A: reduction by 2.9 ± 3.5 in V1, p < 0.0001), and depression (HADS-D: reduction by 2.7 ± 3.0 in V1, p < 0.0001) improved during inpatient treatment, without longer-lasting effects thereafter. During the study period, no serious adverse events were reported. The results suggest that patients with FMS can profit from a prolonged therapeutic fasting intervention integrated into a complex multimodal inpatient treatment in terms of quality of life, pain, and disease-specific functional parameters. ClinicalTrials.gov Identifier: NCT03785197.
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Affiliation(s)
- Daniela A. Koppold
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany
| | - Farid I. Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
| | - Anna Müller
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
- State Institute of Forensic Medicine Berlin, 13437 Berlin, Germany
| | - Oliver Güttler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
- Connected Healthcare, Hasso Plattner Institute, University of Potsdam, 14482 Potsdam, Germany
| | - Sara Meiss
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
| | - Carolin Breinlinger
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | - Esther Nelle
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
| | - Anika Rajput Khokhar
- Department of Dermatology, Venereology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | - Etienne Hanslian
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
| | - Jan Moritz Fischer
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | - Christian S. Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany (A.M.); (N.S.); (S.M.); (C.B.); (J.M.F.)
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany
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Steckhan N, Ring R, Borchert F, Koppold DA. Triangulation of Questionnaires, Qualitative Data and Natural Language Processing: A Differential Approach to Religious Bahá'í Fasting in Germany. J Relig Health 2023:10.1007/s10943-023-01929-x. [PMID: 37878201 DOI: 10.1007/s10943-023-01929-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
Approaches to integrating mixed methods into medical research are gaining popularity. To get a holistic understanding of the effects of behavioural interventions, we investigated religious fasting using a triangulation of quantitative, qualitative, and natural language analysis. We analysed an observational study of Bahá'í fasting in Germany using a between-method triangulation that is based on links between qualitative and quantitative analyses. Individual interviews show an increase in the mindfulness and well-being categories. Sentiment scores, extracted from the interviews through natural language processing, positively correlate with questionnaire outcomes on quality of life (WHO-5: Spearman correlation r = 0.486, p = 0.048). Five questionnaires contribute to the first principal component capturing the spectrum of mood states (50.1% explained variance). Integrating the findings of the between-method triangulation enabled us to converge on the underlying effects of this kind of intermittent fasting. TRIAL REGISTRATION: NCT03443739.
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Affiliation(s)
- Nico Steckhan
- Digital Health, Hasso Plattner Institute, University of Potsdam, 14482, Potsdam, Germany.
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany.
- Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, 14109, Germany.
| | - Raphaela Ring
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Florian Borchert
- Digital Health, Hasso Plattner Institute, University of Potsdam, 14482, Potsdam, Germany
| | - Daniela A Koppold
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
- Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, 14109, Germany
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3
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Hansen B, Laczny CC, Aho VTE, Frachet-Bour A, Habier J, Ostaszewski M, Michalsen A, Hanslian E, Koppold DA, Hartmann AM, Steckhan N, Mollenhauer B, Schade S, Roomp K, Schneider JG, Wilmes P. Protocol for a multicentre cross-sectional, longitudinal ambulatory clinical trial in rheumatoid arthritis and Parkinson's disease patients analysing the relation between the gut microbiome, fasting and immune status in Germany (ExpoBiome). BMJ Open 2023; 13:e071380. [PMID: 37597865 PMCID: PMC10441058 DOI: 10.1136/bmjopen-2022-071380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/17/2023] [Indexed: 08/21/2023] Open
Abstract
INTRODUCTION Chronic inflammatory diseases like rheumatoid arthritis (RA) and neurodegenerative disorders like Parkinson's disease (PD) have recently been associated with a decreased diversity in the gut microbiome, emerging as key driver of various diseases. The specific interactions between gut-borne microorganisms and host pathophysiology remain largely unclear. The microbiome can be modulated by interventions comprising nutrition.The aim of our clinical study is to (1) examine effects of prolonged fasting (PF) and time-restricted eating (TRE) on the outcome parameters and the immunophenotypes of RA and PD with (2) special consideration of microbial taxa and molecules associated with changes expected in (1), and (3) identify factors impacting the disease course and treatment by in-depth screening of microorganisms and molecules in personalised HuMiX gut-on-chip models, to identify novel targets for anti-inflammatory therapy. METHODS AND ANALYSIS This trial is an open-label, multicentre, controlled clinical trial consisting of a cross-sectional and a longitudinal study. A total of 180 patients is recruited. For the cross-sectional study, 60 patients with PD, 60 patients with RA and 60 healthy controls are recruited at two different, specialised clinical sites. For the longitudinal part, 30 patients with PD and 30 patients with RA undergo 5-7 days of PF followed by TRE (16:8) for a period of 12 months. One baseline visit takes place before the PF intervention and 10 follow-up visits will follow over a period of 12 months (April 2021 to November 2023). ETHICS AND DISSEMINATION Ethical approval was obtained to plan and conduct the trial from the institutional review board of the Charité-Universitätsmedizin Berlin (EA1/204/19), the ethics committee of the state medical association (Landesärztekammer) of Hessen (2021-2230-zvBO) and the Ethics Review Panel (ERP) of the University of Luxembourg (ERP 21-001 A ExpoBiome). The results of this study will be disseminated through peer-reviewed publications, scientific presentations and social media. TRIAL REGISTRATION NUMBER NCT04847011.
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Affiliation(s)
- Bérénice Hansen
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Cédric C Laczny
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Velma T E Aho
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Audrey Frachet-Bour
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Janine Habier
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Marek Ostaszewski
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Andreas Michalsen
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Etienne Hanslian
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Daniela A Koppold
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Anika M Hartmann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Dermatology, Venereology and Allergology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
- Digital Health-Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Brit Mollenhauer
- Neurosurgery, University Medical Center Göttingen, Gottingen, Germany
- Movement disorders and Parkinson’s Disease, Paracelsus-Kliniken Deutschland GmbH, Osnabruck, Germany
| | - Sebastian Schade
- Neurosurgery, University Medical Center Göttingen, Gottingen, Germany
- Movement disorders and Parkinson’s Disease, Paracelsus-Kliniken Deutschland GmbH, Osnabruck, Germany
| | - Kirsten Roomp
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Jochen G Schneider
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Internal Medicine and Psychiatry, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Paul Wilmes
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Life Sciences and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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4
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Kappattanavar AM, Hecker P, Moontaha S, Steckhan N, Arnrich B. Food Choices after Cognitive Load: An Affective Computing Approach. Sensors (Basel) 2023; 23:6597. [PMID: 37514891 PMCID: PMC10386123 DOI: 10.3390/s23146597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
Psychology and nutritional science research has highlighted the impact of negative emotions and cognitive load on calorie consumption behaviour using subjective questionnaires. Isolated studies in other domains objectively assess cognitive load without considering its effects on eating behaviour. This study aims to explore the potential for developing an integrated eating behaviour assistant system that incorporates cognitive load factors. Two experimental sessions were conducted using custom-developed experimentation software to induce different stimuli. During these sessions, we collected 30 h of physiological, food consumption, and affective states questionnaires data to automatically detect cognitive load and analyse its effect on food choice. Utilising grid search optimisation and leave-one-subject-out cross-validation, a support vector machine model achieved a mean classification accuracy of 85.12% for the two cognitive load tasks using eight relevant features. Statistical analysis was performed on calorie consumption and questionnaire data. Furthermore, 75% of the subjects with higher negative affect significantly increased consumption of specific foods after high-cognitive-load tasks. These findings offer insights into the intricate relationship between cognitive load, affective states, and food choice, paving the way for an eating behaviour assistant system to manage food choices during cognitive load. Future research should enhance system capabilities and explore real-world applications.
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Affiliation(s)
| | - Pascal Hecker
- Digital Health-Connected Healthcare, Hasso Plattner Institute, University of Potsdam, 14482 Potsdam, Germany
| | - Sidratul Moontaha
- Digital Health-Connected Healthcare, Hasso Plattner Institute, University of Potsdam, 14482 Potsdam, Germany
| | - Nico Steckhan
- Digital Health-Connected Healthcare, Hasso Plattner Institute, University of Potsdam, 14482 Potsdam, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité, 10117 Berlin, Germany
| | - Bert Arnrich
- Digital Health-Connected Healthcare, Hasso Plattner Institute, University of Potsdam, 14482 Potsdam, Germany
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5
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Häupl T, Sörensen T, Smiljanovic B, Darcy M, Scheder-Bieschin J, Steckhan N, Hartmann AM, Koppold DA, Stuhlmüller B, Skriner K, Walewska BM, Hoppe B, Bonin M, Burmester GR, Schendel P, Feist E, Liere K, Meixner M, Kessler C, Grützkau A, Michalsen A. Intestinal Microbiota Reduction Followed by Fasting Discloses Microbial Triggering of Inflammation in Rheumatoid Arthritis. J Clin Med 2023; 12:4359. [PMID: 37445394 DOI: 10.3390/jcm12134359] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Rheumatoid arthritis (RA) synovitis is dominated by monocytes/macrophages with inflammatory patterns resembling microbial stimulation. In search of triggers, we reduced the intestinal microbiome in 20 RA patients (open label study DRKS00014097) by bowel cleansing and 7-day fasting (≤250 kcal/day) and performed immune monitoring and microbiome sequencing. Patients with metabolic syndrome (n = 10) served as a non-inflammatory control group. Scores of disease activity (DAS28/SDAI) declined within a few days and were improved in 19 of 20 RA patients after breaking the fast (median ∆DAS28 = -1.23; ∆SDAI = -43%) or even achieved remission (DAS28 < 2.6/n = 6; SDAI < 3.3/n = 3). Cytometric profiling with 46 different surface markers revealed the most pronounced phenomenon in RA to be an initially increased monocyte turnover, which improved within a few days after microbiota reduction and fasting. Serum levels of IL-6 and zonulin, an indicator of mucosal barrier disruption, decreased significantly. Endogenous cortisol levels increased during fasting but were insufficient to explain the marked improvement. Sequencing of the intestinal microbiota indicated that fasting reduced potentially arthritogenic bacteria and changed the microbial composition to species with broader metabolic capabilities. More eukaryotic, predominantly fungal colonizers were observed in RA, suggesting possible involvement. This study demonstrates a direct link between the intestinal microbiota and RA-specific inflammation that could be etiologically relevant and would support targeted nutritional interventions against gut dysbiosis as a causal therapeutic approach.
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Affiliation(s)
- Thomas Häupl
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
- Department of Rheumatology, Helios Fachklinik Vogelsang-Gommern GmbH, 39245 Gommern, Germany
| | - Till Sörensen
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Biljana Smiljanovic
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Marine Darcy
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Justus Scheder-Bieschin
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Anika M Hartmann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Daniela A Koppold
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Bruno Stuhlmüller
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Karl Skriner
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Barbara M Walewska
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Berthold Hoppe
- Institute of Laboratory Medicine, Unfallkrankenhaus Berlin, 12683 Berlin, Germany
| | - Marc Bonin
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Pascal Schendel
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
- Department of Rheumatology, Helios Fachklinik Vogelsang-Gommern GmbH, 39245 Gommern, Germany
| | - Karsten Liere
- Amedes Genetics, 10117 Berlin, Germany
- Services in Molecular Biology GmbH, 10115 Rüdersdorf, Germany
| | - Martin Meixner
- Amedes Genetics, 10117 Berlin, Germany
- Services in Molecular Biology GmbH, 10115 Rüdersdorf, Germany
| | - Christian Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | | | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
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6
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Koppold DA, Kandil FI, Güttler O, Müller A, Steckhan N, Meiß S, Breinlinger C, Nelle E, Hartmann AM, Jeitler M, Hanslian E, Fischer JM, Michalsen A, Kessler CS. Effects of Prolonged Fasting during Inpatient Multimodal Treatment on Pain and Functional Parameters in Knee and Hip Osteoarthritis: A Prospective Exploratory Observational Study. Nutrients 2023; 15:2695. [PMID: 37375597 DOI: 10.3390/nu15122695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Preliminary clinical data suggest that pain reduction through fasting may be effective for different diagnoses. This uncontrolled observational clinical study examined the effects of prolonged modified fasting on pain and functional parameters in hip and knee osteoarthritis. Patients admitted to the inpatient department of Internal Medicine and Nature-based Therapies of the Immanuel Hospital Berlin between February 2018 and December 2020 answered questionnaires at the beginning and end of inpatient treatment, as well as at 3, 6, and 12 months after discharge. Additionally, selected blood and anthropometric parameters, as well as subjective pain ratings, were routinely assessed during the inpatient stay. Fasting was the only common intervention for all patients, being performed as part of a multimodal integrative treatment program, with a daily caloric intake of <600 kcal for 7.7 ± 1.7 days. N = 125 consecutive patients were included. The results revealed an amelioration of overall symptomatology (WOMAC Index score: -14.8 ± 13.31; p < 0.001; d = 0.78) and pain alleviation (NRS Pain: -2.7 ± 1.98, p < 0.001, d = 1.48). Pain medication was reduced, stopped, or replaced by herbal remedies in 36% of patients. Improvements were also observed in secondary outcome parameters, including increased quality of life (WHO-5: +4.5 ± 4.94, p < 0.001, d = 0.94), reduced anxiety (HADS-A: -2.1 ± 2.91, p < 0001, d = 0.55) and depression (HADS-D: -2.3 ± 3.01, p < 0.001, d = 0.65), and decreases in body weight (-3.6 kg ± 1.65, p < 0.001, d = 0.21) and blood pressure (systolic: -6.2 ± 15.93, p < 0.001, d = 0.43; diastolic: -3.7 ± 10.55, p < 0.001, d = 0.43). The results suggest that patients with osteoarthritis of the lower extremities may benefit from prolonged fasting as part of a multimodal integrative treatment to improve quality of life, pain, and disease-specific functional parameters. Confirmatory randomized controlled trials are warranted to further investigate these hypotheses.
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Affiliation(s)
- Daniela A Koppold
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Farid I Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Oliver Güttler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Anna Müller
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- State Institute of Forensic Medicine Berlin, 10559 Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Connected Healthcare, Hasso Plattner Institute, University of Potsdam, 14482 Potsdam, Germany
| | - Sara Meiß
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Carolin Breinlinger
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | - Esther Nelle
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Anika M Hartmann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | - Etienne Hanslian
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Jan Moritz Fischer
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany
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7
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Hartmann AM, D’Urso M, Dell’Oro M, Koppold DA, Steckhan N, Michalsen A, Kandil FI, Kessler CS. Post Hoc Analysis of a Randomized Controlled Trial on Fasting and Plant-Based Diet in Rheumatoid Arthritis (NutriFast): Nutritional Supply and Impact on Dietary Behavior. Nutrients 2023; 15:nu15040851. [PMID: 36839208 PMCID: PMC9960429 DOI: 10.3390/nu15040851] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
This study aimed at comparing the nutrient supply and dietary behaviors during a plant-based diet (PBD) combined with time-restricted eating (TRE) to standard dietary recommendations in rheumatoid arthritis patients. In this open-label, randomized, controlled clinical trial, patients were assigned to either a 7-day fast followed by an 11-week PBD including TRE (A) or a 12-week anti-inflammatory diet following official German guidelines (German Nutrition Society, DGE) (B). Dietary habits were assessed by 3-day food records at weeks -1, 4 and 9 and food frequency questionnaires. 41 out of 53 participants were included in a post-hoc per protocol analysis. Both groups had similar energy, carbohydrate, sugar, fiber and protein intake at week 4. Group A consumed significantly less total saturated fat than group B (15.9 ± 7.7 vs. 23.2 ± 10.3 g/day; p = 0.02). Regarding micronutrients, group B consumed more vitamin A, B12, D, riboflavin and calcium (each p ≤ 0.02). Zinc and calcium were below recommended intakes in both groups. Cluster analysis did not show clear group allocation after three months. Hence, dietary counselling for a PBD combined with TRE compared to a standard anti-inflammatory diet does not seem to lead to two different dietary clusters, i.e., actual different dietary behaviors as expected. Larger confirmatory studies are warranted to further define dietary recommendations for RA.
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Affiliation(s)
- Anika M. Hartmann
- Department of Dermatology, Venereology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Correspondence:
| | - Marina D’Urso
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Gastroenterology, Infectiology and Rheumatology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Melanie Dell’Oro
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 10117 Berlin, Germany
| | - Daniela A. Koppold
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Nico Steckhan
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Connected Healthcare, Hasso Plattner Institute, University of Potsdam, 10117 Potsdam, Germany
| | - Andreas Michalsen
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 10117 Berlin, Germany
| | - Farid I. Kandil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Paediatric Oncology/Haematology, Otto-Heubner Centre for Paediatric and Adolescent Medicine (OHC), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Christian S. Kessler
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 10117 Berlin, Germany
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8
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Jeitler M, Storz MA, Steckhan N, Matthiae D, Dressler J, Hanslian E, Koppold DA, Kandil FI, Michalsen A, Kessler CS. Knowledge, Attitudes and Application of Critical Nutrient Supplementation in Vegan Diets among Healthcare Professionals-Survey Results from a Medical Congress on Plant-Based Nutrition. Foods 2022; 11:foods11244033. [PMID: 36553782 PMCID: PMC9777782 DOI: 10.3390/foods11244033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Plant-based diets are associated with numerous health benefits but also bear risks of micronutrient deficiencies if inadequately planned. The risk of nutrient deficiencies can be reliably reduced by supplementation but requires risk-awareness. We distributed a paper-and-pencil questionnaire to n = 902 healthcare professionals attending a congress on plant-based nutrition (VegMed 2018, Berlin). On the day of the survey (21 April 2018), n = 475 questionnaires were returned and analyzed descriptively. Of the n = 213 strict vegan participants, 2% (n = 5) took no supplements at all. All supplementing vegans reported taking vitamin B12. Almost three-quarters of vegans (73%, n = 152) took vitamin D, and 22% (n = 45) reported taking omega-3 fatty acids. Iron was supplemented by 13% (n = 28), iodine by 12% (n = 25), calcium by 11% (n = 22), zinc by 7% (n = 14), magnesium by 5% (n = 11), and selenium by 4% (n = 9). For 11%, a supplement other than vitamin B12 was subjectively most important. Nearly 50% had their vitamin B12 levels laboratory tested at least once a year; nearly one-quarter reported testing every two years, and another one-quarter rarely or never. Participants following a vegan diet were better informed about institutional recommendations of the German Nutrition Society and the Academy of Nutrition and Dietetics for vegan diets than participants following vegetarian or omnivorous diets. Vegan nutrition in pregnancy/lactation period and childhood was considered most appropriate by vegans. Despite a high awareness of potential health risks associated with vitamin B12 deficiency on a strict vegan diet and a comprehensive understanding of the official dietary recommendations of nutrition societies, use of supplements and performance of regular laboratory tests were only moderate among vegan healthcare professionals. Considering the paramount importance of adequate supplementation of critical nutrients to avoid nutrient deficiencies, scientific and public discourse should be further facilitated. Further investigation of the supplementation behavior of vegan health professionals could be of particular interest, as a possible correlation with the quality of their own nutrition counseling is not inconceivable.
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Affiliation(s)
- Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department for Complementary and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
- Correspondence:
| | - Maximilian Andreas Storz
- Department of Internal Medicine II, Center for Complementary Medicine, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, 14482 Potsdam, Germany
| | - Dorothea Matthiae
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Justina Dressler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Etienne Hanslian
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Daniela A. Koppold
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Farid I. Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department for Complementary and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | - Christian S. Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department for Complementary and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
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9
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Hartmann AM, Dell'Oro M, Spoo M, Fischer JM, Steckhan N, Jeitler M, Häupl T, Kandil FI, Michalsen A, Koppold-Liebscher DA, Kessler CS. To eat or not to eat—an exploratory randomized controlled trial on fasting and plant-based diet in rheumatoid arthritis (NutriFast-Study). Front Nutr 2022; 9:1030380. [PMID: 36407522 PMCID: PMC9667053 DOI: 10.3389/fnut.2022.1030380] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Background Fasting is beneficial in many diseases, including rheumatoid arthritis (RA), with lasting effects for up to 1 year. However, existing data dates back several decades before the introduction of modern therapeutic modalities. Objective This exploratory RCT compares the effects of a 7-day fast followed by a plant-based diet (PBD) to the effects of the dietary recommendations of the German society for nutrition (Deutsche Gesellschaft für Ernährung, DGE) on RA disease activity, cardiovascular (CV) risk factors, and well-being. Methods In this RCT we randomly assigned 53 RA patients to either a 7-day fast followed by an 11-week PBD or a 12-week standard DGE diet. The primary endpoint was the group change from baseline to 12 weeks on the Health Assessment Questionnaire Disability Index (HAQ-DI). Further outcomes included other disease activity scores, body composition, and quality of life. Results Of 53 RA patients enrolled, 50 participants (25 per group) completed the trial and were included into the per-protocol analysis. The primary endpoint was not statistically significant. However, HAQ-DI improved rapidly in the fasting group by day 7 and remained stable over 12 weeks (Δ-0.29, p = 0.001), while the DGE group improved later at 6 and 12 weeks (Δ-0.23, p = 0.032). DAS28 ameliorated in both groups by week 12 (Δ-0.97, p < 0.001 and Δ-1.14, p < 0.001; respectively), with 9 patients in the fasting but only 3 in the DGE group achieving ACR50 or higher. CV risk factors including weight improved stronger in the fasting group than in the DGE group (Δ-3.9 kg, p < 0.001 and Δ-0.7 kg, p = 0.146). Conclusions Compared with a guideline-based anti-inflammatory diet, fasting followed by a plant-based diet showed no benefit in terms of function and disability after 12 weeks. Both dietary approaches had a positive effect on RA disease activity and cardiovascular risk factors in patients with RA. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03856190, identifier: NCT03856190.
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Affiliation(s)
- Anika M. Hartmann
- Department of Dermatology, Venereology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- *Correspondence: Anika M. Hartmann
| | - Melanie Dell'Oro
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michaela Spoo
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Jan Moritz Fischer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Michael Jeitler
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Thomas Häupl
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Farid I. Kandil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Paediatric Oncology/Haematology, Otto-Heubner Centre for Paediatric and Adolescent Medicine (OHC), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Daniela A. Koppold-Liebscher
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Christian S. Kessler
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
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10
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Cramer H, Hohmann C, Lauche R, Choi KE(A, Schneider N, Steckhan N, Rathjens F, Anheyer D, Paul A, von Scheidt C, Ostermann T, Schneider E, Koppold-Liebscher DA, Kessler CS, Dobos G, Michalsen A, Jeitler M. Effects of Fasting and Lifestyle Modification in Patients with Metabolic Syndrome: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11164751. [PMID: 36012990 PMCID: PMC9410059 DOI: 10.3390/jcm11164751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lifestyle interventions, such as fasting, diet, and exercise, are increasingly used as a treatment option for patients with metabolic syndrome (MS). This study assesses the efficacy and safety of fasting followed by lifestyle modification in patients with MS compared to lifestyle modification only. METHODS Single-blind, multicenter, parallel, randomized controlled trial in two German tertiary referral hospitals in metropolitan areas. INTERVENTIONS (a) 5-day fasting followed by 10 weeks of lifestyle modification (modified DASH diet, exercise, mindfulness; n = 73); (b) 10 weeks of lifestyle modification only (n = 72). MAIN OUTCOMES AND MEASURES Co-primary outcomes were ambulatory systolic blood pressure and the homeostasis model assessment (HOMA) index at week 12. Further outcomes included anthropometric, laboratory parameters, and the PROCAM score at weeks 1, 12, and 24. RESULTS A total of 145 patients with metabolic syndrome (62.8% women; 59.7 ± 9.3 years) were included. No significant group differences occurred for the co-primary outcomes at week 12. However, compared to lifestyle modification only, fasting significantly reduced HOMA index (Δ = -0.8; 95% confidence interval [CI] = -1.7, -0.1), diastolic blood pressure (Δ = -4.8; 95% CI = -5.5, -4.1), BMI (Δ = -1.7; 95% CI = -2.0, -1.4), weight (Δ = -1.7; 95% CI = -2.0, -1.4), waist circumference (Δ = -2.6; 95% CI = -5.0, -0.2), glucose (Δ = -10.3; 95% CI = -19.0, -1.6), insulin (Δ = -2.9; 95% CI = -5.3, -0.4), HbA1c (Δ = -0.2; 95% CI = -0.4, -0.05;), triglycerides (Δ = -48.9; 95% CI = -81.0, -16.9), IL-6 (Δ = -1.2; 95% CI = -2.5, -0.005), and the 10-year risk of acute coronary events (Δ = -4.9; 95% CI = -9.5, -0.4) after week 1. Fasting increased uric acid levels (Δ = 1.0; 95% CI = 0.1, 1.9) and slightly reduced eGRF (Δ = -11.9; 95% CI = -21.8, -2.0). Group differences at week 24 were found for weight (Δ = -2, 7; 95% CI = -4.8, -0.5), BMI (Δ = -1.0; 95% CI = -1.8, -0.3), glucose (Δ = -7.7; 95% CI = -13.5, -1.8), HDL (Δ = 5.1; 95% CI = 1.5, 8.8), and CRP (Δ = 0.2; 95% CI = 0.03, 0.4). No serious adverse events occurred. CONCLUSIONS A beneficial effect at week 24 was found on weight; fasting also induced various positive short-term effects in patients with MS. Fasting can thus be considered a treatment for initializing lifestyle modification for this patient group; however, it remains to be investigated whether and how the multilayered effects of fasting can be maintained in the medium and longer term.
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Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Evangelische Kliniken Essen-Mitte, University of Duisburg-Essen, 45276 Essen, Germany
- Institute for General Practice and Interprofessional Care, University Hospital Tuebingen, 72076 Tuebingen, Germany
- Bosch Health Campus, 70376 Stuttgart, Germany
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore 2480, Australia
| | - Christoph Hohmann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Romy Lauche
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore 2480, Australia
| | - Kyung-Eun (Anna) Choi
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Nadia Schneider
- Department of Internal and Integrative Medicine, Evangelische Kliniken Essen-Mitte, University of Duisburg-Essen, 45276 Essen, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, 14469 Potsdam, Germany
| | - Florian Rathjens
- Department of Internal and Integrative Medicine, Evangelische Kliniken Essen-Mitte, University of Duisburg-Essen, 45276 Essen, Germany
| | - Dennis Anheyer
- Department of Internal and Integrative Medicine, Evangelische Kliniken Essen-Mitte, University of Duisburg-Essen, 45276 Essen, Germany
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore 2480, Australia
| | - Anna Paul
- Department of Internal and Integrative Medicine, Evangelische Kliniken Essen-Mitte, University of Duisburg-Essen, 45276 Essen, Germany
| | - Christel von Scheidt
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Witten/Herdecke University, 58455 Witten, Germany
| | - Elisabeth Schneider
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Daniela A. Koppold-Liebscher
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | - Christian S. Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Evangelische Kliniken Essen-Mitte, University of Duisburg-Essen, 45276 Essen, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, 14109 Berlin, Germany
- Correspondence:
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11
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Hecker P, Steckhan N, Eyben F, Schuller BW, Arnrich B. Voice Analysis for Neurological Disorder Recognition–A Systematic Review and Perspective on Emerging Trends. Front Digit Health 2022; 4:842301. [PMID: 35899034 PMCID: PMC9309252 DOI: 10.3389/fdgth.2022.842301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/25/2022] [Indexed: 11/25/2022] Open
Abstract
Quantifying neurological disorders from voice is a rapidly growing field of research and holds promise for unobtrusive and large-scale disorder monitoring. The data recording setup and data analysis pipelines are both crucial aspects to effectively obtain relevant information from participants. Therefore, we performed a systematic review to provide a high-level overview of practices across various neurological disorders and highlight emerging trends. PRISMA-based literature searches were conducted through PubMed, Web of Science, and IEEE Xplore to identify publications in which original (i.e., newly recorded) datasets were collected. Disorders of interest were psychiatric as well as neurodegenerative disorders, such as bipolar disorder, depression, and stress, as well as amyotrophic lateral sclerosis amyotrophic lateral sclerosis, Alzheimer's, and Parkinson's disease, and speech impairments (aphasia, dysarthria, and dysphonia). Of the 43 retrieved studies, Parkinson's disease is represented most prominently with 19 discovered datasets. Free speech and read speech tasks are most commonly used across disorders. Besides popular feature extraction toolkits, many studies utilise custom-built feature sets. Correlations of acoustic features with psychiatric and neurodegenerative disorders are presented. In terms of analysis, statistical analysis for significance of individual features is commonly used, as well as predictive modeling approaches, especially with support vector machines and a small number of artificial neural networks. An emerging trend and recommendation for future studies is to collect data in everyday life to facilitate longitudinal data collection and to capture the behavior of participants more naturally. Another emerging trend is to record additional modalities to voice, which can potentially increase analytical performance.
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Affiliation(s)
- Pascal Hecker
- Digital Health – Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
- audEERING GmbH, Gilching, Germany
- *Correspondence: Pascal Hecker ; orcid.org/0000-0001-6604-1671
| | - Nico Steckhan
- Digital Health – Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | | | - Björn W. Schuller
- audEERING GmbH, Gilching, Germany
- EIHW – Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
- GLAM – Group on Language, Audio, & Music, Imperial College London, London, United Kingdom
| | - Bert Arnrich
- Digital Health – Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
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12
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Hartmann AM, Kandil FI, Steckhan N, Häupl T, Kessler CS, Michalsen A, Koppold-Liebscher DA. POS0583 RHEUMATOID ARTHRITIS BENEFITS FROM FASTING AND PLANT-BASED DIET: AN EXPLORATORY RANDOMIZED CONTROLLED TRIAL (NUTRIFAST). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFasting has been shown to be beneficial in many diseases, including rheumatoid arthritis (RA). Among other effects, fasting stimulates ketogenic metabolism, induces autophagy, and harbors immunomodulatory functions. Recent studies have highlighted the role of the intestinal microbiota in the still unclear etiology of RA1. This could be a potential target for additional dietary therapy in RA.ObjectivesTo investigate the effect of therapeutic fasting followed by a plant-based diet compared to standard dietary recommendations in patients with RA.MethodsIn this pilot study2 patients with RA were randomized to either a 7-day fast (≤250kcal/d) followed by 11 weeks of plant-based diet or to conventional nutritional counselling according to the recommendations of the German Society for Nutrition (Deutsche Gesellschaft für Ernährung, DGE) for 12 weeks. Disease activity and treatment response in RA (including Health Assessment Questionnaire, HAQ; EULAR Response Criteria, ACR Response Criteria) were measured at baseline (T0), day 7 (T1), 6 weeks (T2) and 12 weeks (T3).ResultsA total of 50 from 53 enrolled participants were included into the per-protocol analysis. The mean age was 51.98 ± 9.4 years with symptoms duration of 6.8 ± 8.1 years; 92% were females and 78% were ACPA and/or RF IgM positive. At baseline, participants presented HAQ 0.8 ± 0.5, DAS28CRP 4.0 ± 1.3, CRP 3.1 ± 3.8 mg/L, and a BMI of 25.0 ± 3.7 kg/m2.The primary endpoint did not become significant. However, post-hoc analyses revealed clinically relevant improvements in the HAQ after 12 weeks in both the fasting and the DGE group (Δ-0.29; 95% CI, -0.45 to -0.13; p = 0.001; and Δ-0.23; 95% CI, -0.45 to -0.22; p = 0.032; respectively). Furthermore, the effect already set on by day 7 in the fasting group compared to week 6 in the DGE group (Figure 1). This effect was independent of antibody status, delivery mode of the intervention or previous dietary forms. CV risk factors including weight and total cholesterol levels improved stronger in the fasting group compared to the DGE group (Δ-3.9 kg vs. -0.7kg; 95% CI, 1.4 to 5.0; p = 0.001 and Δ-18.60 mg/dl vs Δ6.44 mg/dl; 95% CI, 7.3 to 42.8, p=0.007).Figure 1.EULAR and ACR Response until week 12 and HAQ up to 6 months. ACR, American College of Rheumatology; CI, confidence interval; HAQ, health assessment questionnaire.ConclusionFasting followed by a plant-based diet positively impacts disease activity and CV risk factors in RA, comparable to and no lesser than those of an anti-inflammatory diet according to the DGE. These results may open new perspectives by dietary interventions in an integrative therapeutic approach. Further confirmatory clinical studies with larger patient numbers are needed to confirm these exploratory findings.References[1]Ruff WE, Greiling TM, Kriegel MA. Host–microbiota interactions in immune-mediated diseases. Nature Reviews Microbiology 2020;18(9):521-38. doi: 10.1038/s41579-020-0367-2[2]Hartmann AM, Dell’Oro M, Kessler CS, et al. Efficacy of therapeutic fasting and plant-based diet in patients with rheumatoid arthritis (NutriFast): study protocol for a randomised controlled clinical trial. BMJ Open 2021;11(8):e047758. doi: 10.1136/bmjopen-2020-047758 [published Online First: 2021/08/13]Disclosure of InterestsAnika M. Hartmann: None declared, Farid I. Kandil: None declared, Nico Steckhan: None declared, Thomas Häupl: None declared, Christan S. Kessler: None declared, Andreas Michalsen Paid instructor for: co-founder and instructor in the Academy of Integrative Fasting, Daniela A. Koppold-Liebscher Paid instructor for: co-founder and instructor in the Academy of Integrative Fasting.
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13
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Jeitler M, Michalsen A, Schwiertz A, Kessler CS, Koppold-Liebscher D, Grasme J, Kandil FI, Steckhan N. Effects of a Supplement Containing a Cranberry Extract on Recurrent Urinary Tract Infections and Intestinal Microbiota: A Prospective, Uncontrolled Exploratory Study. J Integr Complement Med 2022; 28:399-406. [PMID: 35285701 PMCID: PMC9127832 DOI: 10.1089/jicm.2021.0300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Aim: Cranberries (Vaccinium macrocarpon) are traditionally used in prevention of urinary tract infections (UTIs). The authors' aim was to evaluate effects of a supplement containing cranberry extract, pumpkin seed extract, vitamin C, and vitamin B2 on recurrent uncomplicated UTIs in women and their intestinal microbiota. Methods: A prospective, uncontrolled exploratory study was conducted in women with recurrent uncomplicated UTIs. The primary exploratory outcome was the number of UTIs in a 6-month prospective observation period compared with a 6-month retrospective period. Further outcomes included number of antibiotics, quality of life (SF-36), intestinal microbiota (assessed by 16S rRNA amplicon sequencing), and evaluation questions. Parameters were assessed at baseline and after 1, 2, and 7 months (start of intake of cranberry supplement after 1 month for 6 months). p-Values were calculated with the pairwise Wilcoxon signed-rank test for α diversity and permutational multivariate analysis of variance. Results: Twenty-three women (aged 52.7 ± 12.4 years) were included in the study. Participants reported 2.2 ± 0.8 UTIs (at baseline) in the previous 6 months. After 6 months of cranberry intake, participants reported a significant decrease to 0.5 ± 0.9 UTIs (p < 0.001). Number of antibiotic therapies was also significantly (p < 0.001) reduced by 68% during 6 months of cranberry intake (0.14 ± 0.35) when compared with 6 months retrospectively (1.14 ± 0.71). The SF-36 physical component score increased from 44.9 ± 5.5 at baseline to 45.7 ± 4.6 at 7 months (p = 0.16). The SF-36 mental component score decreased slightly from the baseline value of 46.5 ± 6.5 to 46.2 ± 6.4 at 7 months (p = 0.74). No significant intragroup mean changes at genus, family, or species level for α and β diversity within the intestinal microbiota were found. In the evaluation questions, participants rated the cranberry extract positively and considered it beneficial. The supplement intake was safe. Conclusions: This study shows that women with recurrent uncomplicated UTIs benefit from cranberry intake. Future larger clinical studies with further investigation of the mechanisms of action are required to determine the effects of cranberries on participants with uncomplicated UTIs.
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Affiliation(s)
- Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | | | - Christian S. Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Daniela Koppold-Liebscher
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Grasme
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Farid I. Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
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14
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Jeitler M, Roth S, Steckhan N, Meier L, Koppold-Liebscher DA, Kandil FI, Ostermann T, Stange R, Kessler CS, Brinkhaus B, Michalsen A. Therapeutic Phlebotomy in Patients with Grade 1 Hypertension: A Randomized-Controlled Trial. J Integr Complement Med 2022; 28:530-539. [PMID: 35238614 DOI: 10.1089/jicm.2021.0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aim: Study aim was to investigate the effects of therapeutic phlebotomy on ambulatory blood pressure in patients with grade 1 hypertension. Methods: In this randomized-controlled intervention study, patients with unmedicated hypertension grade 1 were randomized into an intervention group (phlebotomy group; 500 mL bloodletting at baseline and after 6 weeks) and a control group (waiting list) and followed up for 8 weeks. Primary endpoint was the 24-h ambulatory mean arterial pressure between the intervention and control groups after 8 weeks. Secondary outcome parameters included ambulatory/resting systolic/diastolic blood pressure, heart rate, and selected laboratory parameters (e.g., hemoglobin, hematocrit, erythrocytes, and ferritin). Resting systolic/diastolic blood pressure/heart rate and blood count were also assessed at 6 weeks before the second phlebotomy to ensure safety. A per-protocol analysis was performed. Results: Fifty-three hypertension participants (56.7 ± 10.5 years) were included in the analysis (n = 25 intervention group, n = 28 control group). The ambulatory measured mean arterial pressure decreased by -1.12 ± 5.16 mmHg in the intervention group and increased by 0.43 ± 3.82 mmHg in the control group (between-group difference: -1.55 ± 4.46, p = 0.22). Hemoglobin, hematocrit, erythrocytes, and ferritin showed more pronounced reductions in the intervention group in comparison with the control group, with significant between-group differences. Subgroup analysis showed trends regarding the effects on different groups classified by serum ferritin concentration, body mass index, age, and sex. Two adverse events (AEs) (anemia and dizziness) occurred in association with the phlebotomy, but no serious AEs. Conclusions: Study results showed that therapeutic phlebotomy resulted in only minimal reductions of 24-h ambulatory blood pressure measurement values in patients with unmedicated grade 1 hypertension. Further high-quality clinical studies are warranted, as this finding contradicts the results of other studies.
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Affiliation(s)
- Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universitaät zu Berlin, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Sandra Roth
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universitaät zu Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universitaät zu Berlin, Berlin, Germany.,Hasso Plattner Institute, Digital Health Center, University of Potsdam, Potsdam, Germany
| | - Larissa Meier
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universitaät zu Berlin, Berlin, Germany
| | - Daniela A Koppold-Liebscher
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universitaät zu Berlin, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Farid I Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universitaät zu Berlin, Berlin, Germany
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Rainer Stange
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universitaät zu Berlin, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universitaät zu Berlin, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Benno Brinkhaus
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universitaät zu Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universitaät zu Berlin, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
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15
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Peters B, Koppold-Liebscher DA, Schuppelius B, Steckhan N, Pfeiffer AFH, Kramer A, Michalsen A, Pivovarova-Ramich O. Effects of Early vs. Late Time-Restricted Eating on Cardiometabolic Health, Inflammation, and Sleep in Overweight and Obese Women: A Study Protocol for the ChronoFast Trial. Front Nutr 2021; 8:765543. [PMID: 34869534 PMCID: PMC8634676 DOI: 10.3389/fnut.2021.765543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Time-restricted eating is a promising dietary strategy for weight loss, glucose and lipid metabolism improvements, and overall well-being. However, human studies demonstrated contradictory results for the restriction of food intake to the beginning (early TRE, eTRE) or to the end of the day (late TRE, lTRE) suggesting that more carefully controlled studies are needed. Objective: The aim of the ChronoFast trial study is to determine whether eTRE or lTRE is a better dietary approach to improve cardiometabolic health upon minimized calorie deficits and nearly stable body weight. Methods: Here, we present the study protocol of the randomized cross-over ChronoFast clinical trial comparing effects of 2 week eTRE (8:00 to 16:00 h) and lTRE (13:00 to 21:00 h) on insulin sensitivity and other glycemic traits, blood lipids, inflammation, and sleep quality in 30 women with overweight or obesity and increased risk of type 2 diabetes. To ensure timely compliance and unchanged dietary composition, and to minimize possible calorie deficits, real-time monitoring of dietary intake and body weight using a smartphone application, and extensive nutritional counseling are performed. Continuous glucose monitoring, oral glucose tolerance test, 24 h activity tracking, questionnaires, and gene expression analysis in adipose tissue and blood monocytes will be used for assessment of study outcomes. Discussion: The trial will determine whether eTRE or lTRE is more effective to improve cardiometabolic health, elucidate underlying mechanisms, and contribute to the development of recommendations for medical practice and the wider population. Clinical Trial Registration:www.ClinicalTrials.gov, Identifier [NCT04351672]
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Affiliation(s)
- Beeke Peters
- Research Group Molecular Nutritional Medicine, Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.,Institute of Human Nutrition and Food Science, Faculty of Agriculture and Food Sciences, Christian-Albrecht-University Kiel, Kiel, Germany
| | - Daniela A Koppold-Liebscher
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Bettina Schuppelius
- Research Group Molecular Nutritional Medicine, Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.,Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Digital Health-Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Andreas F H Pfeiffer
- Department of Endocrinology, Diabetes and Nutrition, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Achim Kramer
- Laboratory of Chronobiology, Institute for Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Olga Pivovarova-Ramich
- Research Group Molecular Nutritional Medicine, Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.,Department of Endocrinology, Diabetes and Nutrition, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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16
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Michalsen A, Jeitler M, Kessler CS, Steckhan N, Robens S, Ostermann T, Kandil FI, Stankewitz J, Berger B, Jung S, Kröz M, Büssing A. Yoga, Eurythmy Therapy and Standard Physiotherapy (YES-Trial) for Patients With Chronic Non-specific Low Back Pain: A Three-Armed Randomized Controlled Trial. J Pain 2021; 22:1233-1245. [PMID: 33892154 DOI: 10.1016/j.jpain.2021.03.154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
We aimed to evaluate the effects of yoga and eurythmy therapy compared to conventional physiotherapy exercises in patients with chronic low back pain. In a three-armed, multicentre, randomized controlled trial, patients with chronic low back pain were treated for 8 weeks in group sessions (75 minutes once per week). Primary outcome was patients' physical disability (measured by RMDQ) from baseline to week 8. Secondary outcome variables were pain intensity and pain-related bothersomeness (VAS), health-related quality of life (SF-12) and life satisfaction (BMLSS). Outcomes were assessed at baseline, after the intervention at 8 weeks and at a 16-week follow up. Data of 274 participants were used for statistical analyses. There were no significant differences between the three groups for the primary and all secondary outcomes. In all groups, RMDQ decreased comparably at 8 weeks, but did not reach clinical meaningfulness. Pain intensity and pain-related bothersomeness decreased, while quality of life increased in all 3 groups. In explorative general linear models for the SF-12's mental health component participants in the eurythmy arm benefitted significantly more compared to physiotherapy and yoga. Furthermore, within-group analyses showed improvements of SF-12 mental score for yoga and eurythmy therapy only. All interventions were safe. Clinical Trials Register: DRKS-ID: DRKS00004651 Perspective: This article presents the results of a multicentre three-armed randomized controlled trial on the clinical effects of three 8-week programs in patients with chronic low back pain. Compared to the 'gold standard' of conventional physiotherapeutic exercises, eurythmy therapy and yoga therapy lead to comparable symptomatic improvements in patients with chronic low back pain. However, the within-group effect sizes were small to moderate and did not reach clinical meaningfulness on patients' physical disability (RMDQ).
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Affiliation(s)
- Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Germany.
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Germany
| | - Sibylle Robens
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Germany
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Germany
| | - Farid I Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | | | - Bettina Berger
- Institute of Integrative Medicine, Witten/Herdecke University, Germany
| | - Sonny Jung
- Institute of Integrative Medicine, Witten/Herdecke University, Germany
| | - Matthias Kröz
- Research Institute Havelhöhe (FIH), Berlin, Germany; Institute of Integrative Medicine, Witten/Herdecke University, Germany; Department of Research and Sleep Medicine Arlesheim Hospital, Arlesheim, Switzerland
| | - Arndt Büssing
- Institute of Integrative Medicine, Witten/Herdecke University, Germany
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17
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Jeitler M, Wottke T, Schumann D, Puerto Valencia LM, Michalsen A, Steckhan N, Mittwede M, Stapelfeldt E, Koppold-Liebscher D, Cramer H, Wischnewsky M, Murthy V, Kessler CS. Ayurvedic vs. Conventional Nutritional Therapy Including Low-FODMAP Diet for Patients With Irritable Bowel Syndrome-A Randomized Controlled Trial. Front Med (Lausanne) 2021; 8:622029. [PMID: 34552937 PMCID: PMC8450363 DOI: 10.3389/fmed.2021.622029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 08/11/2021] [Indexed: 12/12/2022] Open
Abstract
Aims: To compare the effects of Ayurvedic and conventional nutritional therapy in patients with irritable bowel syndrome (IBS). Methods: Sixty-nine patients with IBS were randomized to Ayurvedic (n = 35) or conventional nutritional therapy according to the recommendations of the German Nutrition Society including the low-FODMAP diet (n = 34). Study visits took place at baseline and after 1, 3, and 6 months. The primary outcome was IBS symptom severity (IBS-SSS) after 3 months; secondary outcomes included stress (CPSS), anxiety and depression (HADS), well-being (WHO-5) and IBS-specific quality of life (IBS-QOL). A repeated measures general linear model (GLM) for intent-to-treat-analyses was applied in this explorative study. Results: After 3 months, estimated marginal means for IBS-SSS reductions were 123.8 [95% confidence interval (95% CI) = 92.8–154.9; p < 0.001] in the Ayurvedic and 72.7 (95% CI = 38.8–106.7; p < 0.001) in the conventional group. The IBS-SSS reduction was significantly higher in the Ayurveda group compared to the conventional therapy group (estimated marginal mean = 51.1; 95% CI = 3.8–98.5; p = 0.035) and clinically meaningful. Sixty-eight percentage of the variance in IBS-SSS reduction after 3 months can be explained by treatment, 6.5% by patients' expectations for their therapies and 23.4% by IBS-SSS at pre-intervention. Both therapies are equivalent in their contribution to the outcome variance. The higher the IBS-SSS score at pre-intervention and the larger the patients' expectations, the greater the IBS-SSS reduction. There were no significant group differences in any secondary outcome measures. No serious adverse events occurred in either group. Conclusion: Patients with IBS seem to benefit significantly from Ayurvedic or conventional nutritional therapy. The results warrant further studies with longer-term follow-ups and larger sample sizes. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03019861, identifier: NCT03019861.
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Affiliation(s)
- Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Till Wottke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dania Schumann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Martin Mittwede
- Department of Religious Studies, Goethe-University, Frankfurt am Main, Germany
| | - Elmar Stapelfeldt
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Daniela Koppold-Liebscher
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, University of Duisburg-Essen, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Manfred Wischnewsky
- Department of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - Vijayendra Murthy
- College of Medicine, London, United Kingdom.,Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
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18
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Hartmann AM, Dell'Oro M, Kessler CS, Schumann D, Steckhan N, Jeitler M, Fischer JM, Spoo M, Kriegel MA, Schneider JG, Häupl T, Kandil FI, Michalsen A, Koppold-Liebscher DA. Efficacy of therapeutic fasting and plant-based diet in patients with rheumatoid arthritis (NutriFast): study protocol for a randomised controlled clinical trial. BMJ Open 2021; 11:e047758. [PMID: 34380725 PMCID: PMC8359474 DOI: 10.1136/bmjopen-2020-047758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous studies have shown beneficial effects of therapeutic fasting and plant-based dietary interventions on disease activity in patients with rheumatoid arthritis (RA) for a duration of up to 1 year. To date, the effects of such interventions on the gut microbiome and on modern diagnostic markers in patients with RA have not been studied. This trial aims to investigate the clinical effects of therapeutic fasting and a plant-based diet in patients with RA, additionally considering current immunological diagnostic tools and microbiome analyses. METHODS/DESIGN This trial is an open-label, single-centre, randomised, controlled, parallel-group clinical trial. We will randomly assign 84 patients with RA under a stable standard therapy to either (1) therapeutic fasting followed by a plant-based dietary intervention or (2) to a conventional nutritional counselling focusing on an anti-inflammatory dietary pattern according to the recommendations of the Deutsche Gesellschaft für Ernährung (German society for nutrition). Primary outcome parameter is the group difference from baseline to 12 weeks on the Health Assessment Questionnaire (HAQ). Other secondary outcomes include established clinical criteria for disease activity and treatment response in RA (Disease Activity Score 28, Simple Disease Activity Index, ACR-Response Criteria), changes in self-reported health and physical functional ability, mood, stress, quality of life, dietary behaviour via 3-day food records and a modified Food Frequency Questionnaire, body composition, changes in the gut microbiome, metabolomics and cytometric parameters. Outcomes will be assessed at baseline and day 7, after 6 weeks, 12 weeks and after 6 months. ETHICS AND DISSEMINATION Ethical approval to process and analyse data, and to publish the results was obtained through the institutional review board of Charité-Universitätsmedizin Berlin. Results of this trial will be disseminated through peer-reviewed publications and scientific presentations. TRIAL REGISTRATION NUMBER NCT03856190.
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Affiliation(s)
- Anika M Hartmann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Melanie Dell'Oro
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Dania Schumann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Jan Moritz Fischer
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michaela Spoo
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Martin A Kriegel
- Institute for Musculoskeletal Medicine, Department of Translational Rheumatology and Immunology, University of Münster, Münster, Germany
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jochen G Schneider
- Department of Internal Medicine II, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg, Luxembourg
| | - Thomas Häupl
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Farid I Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Neurology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Daniela A Koppold-Liebscher
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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19
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Koppold-Liebscher DA, Klatte C, Demmrich S, Schwarz J, Kandil FI, Steckhan N, Ring R, Kessler CS, Jeitler M, Koller B, Ananthasubramaniam B, Eisenmann C, Mähler A, Boschmann M, Kramer A, Michalsen A. Effects of Daytime Dry Fasting on Hydration, Glucose Metabolism and Circadian Phase: A Prospective Exploratory Cohort Study in Bahá'í Volunteers. Front Nutr 2021; 8:662310. [PMID: 34395487 PMCID: PMC8358295 DOI: 10.3389/fnut.2021.662310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Religiously motivated Bahá'í fasting (BF) is a form of intermittent dry fasting celebrated by abstaining from food and drinks during daylight hours every year in March for 19 consecutive days. Aim: To test the safety and effects of BF on hydration, metabolism, and the circadian clock. Methods: Thirty-four healthy Bahá'í volunteers (15 women) participated in this prospective, exploratory cohort study. Laboratory examinations were carried out in four study visits: before fasting (V0), in the third week of fasting (V1) as well as 3 weeks (V3) and 3 months (V4) after fasting. Data collection included blood and urine samples, anthropometric measurements and bioelectrical impedance analysis. At V0 and V1, 24- and 12-hour urine and serum osmolality were measured. At V0–V2, alterations in the circadian clock phase were monitored in 16 participants. Our study was augmented by an additional survey with 144 healthy Bahá'í volunteers filling out questionnaires and with subgroups attending metabolic measurements (n = 11) and qualitative interviews (n = 13), the results of which will be published separately. Results: Exploratory data analysis revealed that serum osmolality (n = 34, p < 0.001) and 24-hour urine osmolality (n = 34, p = 0.003) decreased during daytime fasting but remained largely within the physiological range and returned to pre-fasting levels during night hours. BMI (body mass index), total body fat mass, and resting metabolic rate decreased during fasting (n = 34, p < 0.001), while body cell mass and body water appeared unchanged. The circadian phase estimated by transcript biomarkers of blood monocytes advanced by 1.1 h (n = 16, p < 0.005) during fasting and returned to pre-fasting values 3 weeks after fasting. Most observed changes were not detectable anymore 3 months after fasting. Conclusions: Results indicate that BF (Bahá'í fasting) is safe, has no negative effects on hydration, can improve fat metabolism and can cause transient phase shifts of circadian rhythms. Trial Registration:https://www.clinicaltrials.gov/, identifier: NCT03443739.
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Affiliation(s)
- Daniela A Koppold-Liebscher
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Caroline Klatte
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah Demmrich
- Department of Sociology, Cluster of Excellence Religion and Politics, University of Münster, Münster, Germany
| | - Julia Schwarz
- Department of Oecotrophology, Hochschule Niederrhein, University of Applied Science, Mönchengladbach, Germany
| | - Farid I Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Raphaela Ring
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Barbara Koller
- Laboratory of Chronobiology, Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | | | - Anja Mähler
- Experimental and Clinical Research Center-a Joint Cooperation Between Charité-Universitätsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Boschmann
- Experimental and Clinical Research Center-a Joint Cooperation Between Charité-Universitätsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Achim Kramer
- Laboratory of Chronobiology, Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
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Kappattanavar AM, Steckhan N, Sachs JP, Freitas da Cruz H, Böttinger E, Arnrich B. Monitoring of Sitting Postures With Sensor Networks in Controlled and Free-living Environments: Systematic Review. JMIR Biomed Eng 2021. [DOI: 10.2196/21105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
A majority of employees in the industrial world spend most of their working time in a seated position. Monitoring sitting postures can provide insights into the underlying causes of occupational discomforts such as low back pain.
Objective
This study focuses on the technologies and algorithms used to classify sitting postures on a chair with respect to spine and limb movements.
Methods
A total of three electronic literature databases were surveyed to identify studies classifying sitting postures in adults. Quality appraisal was performed to extract critical details and assess biases in the shortlisted papers.
Results
A total of 14 papers were shortlisted from 952 papers obtained after a systematic search. The majority of the studies used pressure sensors to measure sitting postures, whereas neural networks were the most frequently used approaches for classification tasks in this context. Only 2 studies were performed in a free-living environment. Most studies presented ethical and methodological shortcomings. Moreover, the findings indicate that the strategic placement of sensors can lead to better performance and lower costs.
Conclusions
The included studies differed in various aspects of design and analysis. The majority of studies were rated as medium quality according to our assessment. Our study suggests that future work for posture classification can benefit from using inertial measurement unit sensors, since they make it possible to differentiate among spine movements and similar postures, considering transitional movements between postures, and using three-dimensional cameras to annotate the data for ground truth. Finally, comparing such studies is challenging, as there are no standard definitions of sitting postures that could be used for classification. In addition, this study identifies five basic sitting postures along with different combinations of limb and spine movements to help guide future research efforts.
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21
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Pappe CL, Steckhan N, Hoedke D, Jepsen S, Rauch G, Keller T, Michalsen A, Dommisch H. Prolonged multimodal fasting modulates periodontal inflammation in female patients with metabolic syndrome: A prospective cohort study. J Clin Periodontol 2021; 48:492-502. [PMID: 33393121 DOI: 10.1111/jcpe.13419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/19/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022]
Abstract
AIM To determine the potential anti-inflammatory effect of a multimodal periodic fasting programme on surrogate parameters of periodontal inflammation in hospitalized patients diagnosed for metabolic syndrome (MetS). MATERIAL AND METHODS A total of 47 patients were recruited and hospitalized in an integrative ward for an intensified two-week multimodal fasting, diet and lifestyle programme. Patients were periodontally examined at baseline (t1), after the 2-week fasting protocol (t2) and, subsequently, 4 months after fasting (t3). The following parameters were determined: periodontal screening index (PSI), bleeding on probing (BOP), gingival crevicular fluid volume (GCF), plaque index (PI), C-reactive protein (CRP), blood pressure (BP), waist circumference (WC), fasting glucose (FGLU), triglycerides (TRG), high-density lipoprotein (HDL) and HbA1c. RESULTS A total of 28 female and 8 male patients fulfilled the defined criteria for MetS and were analysed separately by gender. At t2, BOP and GCF were reduced when compared to t1 (median: t2 = 39; t1 = 33.1%; p < .001 and t2 = 73.9; t1 = 59.3 Periotron units p = .02, respectively). BOP reduction correlated to FGLU (R = .37, p = .049) and weight reduction (R = .4, p = .04). CONCLUSION This study showed for the first time that clinically supervised periodic fasting in female patients with MetS may facilitate the reduction of periodontal inflammation.
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Affiliation(s)
- Christina Laetitia Pappe
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nico Steckhan
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany.,Digital Engineering Faculty, Hasso Plattner Institute, University of Potsdam, Germany
| | - Daniela Hoedke
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany
| | - Geralinde Rauch
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Theresa Keller
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Michalsen
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Henrik Dommisch
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Periodontology, Health Science Center, University of Washington, Seattle, WA, USA
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Stritter W, Gross MM, Miltner D, Rapp D, Wilde B, Eggert A, Steckhan N, Seifert G. More than just warmth-The perception of warmth and relaxation through warming compresses. Complement Ther Med 2020; 54:102537. [PMID: 33183659 DOI: 10.1016/j.ctim.2020.102537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To differentiate the effect of ginger and mustard as warming ingredients from the effect of calmness & attentiveness and thermal warmth in chest compress application. DESIGN & SETTING In an exploratory, controlled, single-blinded study, we compared the effect of ginger and mustard in healthy adults. INTERVENTIONS Participants received four different chest compress types over four weeks: simple dry, hot water, with ginger powder and with mustard flour. OUTCOME MEASURES The somatic and psychological experience of the participants was collected through psychometric measurements (list of somatic complaints (B-L), questionnaire on mental state (MDBF), 5-point-rating scale (RS) containing eight questions on the experience of relaxation and warmth) and was further complemented through qualitative interview data. RESULTS Participants (15 female and 15 male) ranged between 21-36 years (M = 27). No significant changes in the B-L could be found. The MDBF found significant change towards calmness after every application (P < 0.05). Significant improvement in mood was found after the ginger compress (P = 0.00). The RS found significant changes towards relaxation (P = 0.00), emotional balance (P = 0.03), deep (P = 0.03) and slow (P = 0.00) breathing as well as warm hands (P = 0.03) and feet (P = 0.00) with the ginger compress. No significant changes on the RS could be found after the mustard compress. Qualitative-phenomenological data underlined the difference between ginger and mustard in quality of warmth. No adverse effects were reported. CONCLUSIONS Ginger and mustard induced a strong and lasting response on perceived distribution of warmth and relaxation. Compound effect quality could be differentiated: mustard triggered a strong relaxing effect after the intervention and ginger a warmth quality that spread throughout the body.
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Affiliation(s)
- Wiebke Stritter
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Marie Michelle Gross
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Doris Rapp
- Gemeinschaftskrankenhaus Havelhöhe, Clinic for Anthroposophic Medicine, Berlin, Germany
| | - Britta Wilde
- Gemeinschaftskrankenhaus Havelhöhe, Clinic for Anthroposophic Medicine, Berlin, Germany
| | - Angelika Eggert
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nico Steckhan
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitaetsmedizin Berlin, Germany
| | - Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; University of São Paulo, Faculty of Medicine, Department of Pediatrics, São Paulo, Brazil
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23
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Koppold-Liebscher D, Kessler CS, Steckhan N, Bähr V, Kempter C, Wischnewsky M, Hübner M, Kunz B, Paul M, Zorn S, Sari S, Jeitler M, Stange R, Michalsen A. Short-term fasting accompanying chemotherapy as a supportive therapy in gynecological cancer: protocol for a multicenter randomized controlled clinical trial. Trials 2020; 21:854. [PMID: 33059765 PMCID: PMC7559781 DOI: 10.1186/s13063-020-04700-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022] Open
Abstract
Background/objectives A few preliminary studies have documented the safety and feasibility of repeated short-term fasting in patients undergoing chemotherapy. However, there is a lack of data from larger randomized trials on the effects of short-term fasting on quality of life, reduction of side effects during chemotherapy, and a possible reduction of tumor progression. Moreover, no data is available on the effectiveness of fasting approaches compared to so-called healthy diets. We aim to investigate whether the potentially beneficial effects of short-term fasting can be confirmed in a larger randomized trial and can compare favorably to a plant-based wholefood diet. Methods This is a multicenter, randomized, controlled, two-armed interventional study with a parallel group assignment. One hundred fifty patients, including 120 breast cancer patients and 30 patients with ovarian cancer, are to be randomized to one of two nutritional interventions accompanying chemotherapy: (1) repeated short-term fasting with a maximum energy supply of 350–400 kcal on fasting days or (2) repeated short-term normocaloric plant-based diet with restriction of refined carbohydrates. The primary outcome is disease-related quality of life, as assessed by the functional assessment of the chronic illness therapy measurement system. Secondary outcomes include changes in the Hospital Anxiety and Depression Score and as well as frequency and severity of chemotherapy-induced side effects based on the Common Terminology Criteria of Adverse Events. Explorative analysis in a subpopulation will compare histological complete remissions in patients with neoadjuvant treatments. Discussion/planned outcomes Preclinical data and a small number of clinical studies suggest that repeated short-term fasting may reduce the side effects of chemotherapy, enhance quality of life, and eventually slow down tumor progression. Experimental research suggests that the effects of fasting may partly be caused by the restriction of animal protein and refined carbohydrates. This study is the first confirmatory, randomized controlled, clinical study, comparing the effects of short-term fasting to a short-term, plant-based, low-sugar diet during chemotherapy on quality of life and histological tumor remission. Trial registration ClinicalTrials.gov NCT03162289. Registered on 22 May 2017
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Affiliation(s)
- Daniela Koppold-Liebscher
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Vanessa Bähr
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Manfred Wischnewsky
- Department of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Marisa Hübner
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Barbara Kunz
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marion Paul
- Vivantes Hospital Breast Centre, Berlin, Germany
| | - Stefanie Zorn
- Department of Medicine I, Section of Clinical Nutrition and Dietetics, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Sophia Sari
- Department of Nutrition, Technische Universität München, Munich, Germany
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Rainer Stange
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Berlin, Germany
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Thaele-Franz MA, Steckhan N, Michalsen A, Stange R. Ketosis in patients undergoing medically supervised therapeutic fasting-results from an observational trial. Eur J Clin Nutr 2020; 74:43-47. [PMID: 32873956 DOI: 10.1038/s41430-020-0694-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/AIM Medically supervised fasting has long tradition and broad acceptance in some European countries. The exact amount to which ketone bodies are produced as well as their possible contribution to beneficial effects in this procedure are open. METHODS Open-label observational trial with in-patients undergoing medically supervised fasting with supplementation of approximately 40 g/d carbohydrates as part of an established routine care. Daily finger-stick blood samples for measurement of glucose and ß-hydroxybutyrate. Descriptive analysis for all data. RESULTS Complete sets of data of 17 patients (5 m, mean age 63.1) could be evaluated. Mean concentrations of ß-hydroxybutyrate rose continuously to a mean maximum of 3.6 mmol/L with an individual maximum of 5.1 mmol/L, while glucose decreased within normal range. Two patients with type 2 diabetes produced significantly less ß-hydroxybutyrate. Courses for ß-hydroxybutyrate and glucose showed a weak inverse correlation, while no serious adverse effects could be observed. CONCLUSION Medically supervised fasting with definite small amounts of carbohydrates by fluid intake may lead to limited increases of ketone bodies in their biopositive range, as known e.g. from epileptology or sports medicine. Clinical consequences deserve further research.
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Affiliation(s)
| | - Nico Steckhan
- Department of Internal and Integrative Medicine, Charité - Universitätsmedizin Berlin, Institue for social medicine, epidemiology and health economy, and Immanuel Hospital, Berlin, Germany
| | - Andreas Michalsen
- Department of Internal and Integrative Medicine, Charité - Universitätsmedizin Berlin, Institue for social medicine, epidemiology and health economy, and Immanuel Hospital, Berlin, Germany
| | - Rainer Stange
- Department of Internal and Integrative Medicine, Charité - Universitätsmedizin Berlin, Institue for social medicine, epidemiology and health economy, and Immanuel Hospital, Berlin, Germany.
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25
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Frank J, Seifert G, Schroeder R, Gruhn B, Stritter W, Jeitler M, Steckhan N, Kessler CS, Michalsen A, Voss A. Yoga in school sports improves functioning of autonomic nervous system in young adults: A non-randomized controlled pilot study. PLoS One 2020; 15:e0231299. [PMID: 32282842 PMCID: PMC7153865 DOI: 10.1371/journal.pone.0231299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 03/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background Yoga in school is a beneficial tool to promote the good health and well-being of students by changing the way they react to stress. The positive effects of yoga—taught in schools—on children, youth and young adults have been demonstrated in former studies using mostly subjective psychometric data. Aim The present trial aims to evaluate the potential effects of yoga on autonomic regulation in young adults by analyzing heart rate variability (HRV). Methods This study is a non-randomized, explorative, two-arm-pilot study with an active control group. Fourteen healthy young adults took part in a 10-week yoga program (90 min once a week) in school and were compared to a control group of 11 students who participated in conventional school sports (90 min once a week over 10 weeks). 24-hour electrocardiograms (ECGs) were recorded at baseline and following the 10-week intervention. From 20-minute of nocturnal sleep phases, HRV parameters were calculated from linear (time and frequency domain) and nonlinear dynamics (such as symbolic dynamics and Poincaré plot analysis). Analyses of variance (ANOVA) followed by t-tests as post-hoc tests estimating both statistical significance and effect size were used to compare pre-post-intervention for the two groups. Results The statistical analysis of the interaction effects did not reveal a significant group and time interaction for the individual nocturnal HRV indices. Almost all indices revealed medium and large effects regarding the time main effects. The changes in the HRV indices following the intervention were more dramatic for the yoga group than for the control group which is reflected in predominantly higher significances and stronger effect sizes in the yoga group. Conclusion In this explorative pilot trial, an increase of HRV (more parasympathetic dominance and overall higher HRV) after ten weeks of yoga in school in comparison to regular school sports was demonstrated, showing an improved self-regulation of the autonomic nervous system.
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Affiliation(s)
- Julia Frank
- Department of Pediatrics, Jena University Hospital, Jena, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin, Berlin, Germany
- * E-mail: (GS); (JF)
| | - Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin, Berlin, Germany
- * E-mail: (GS); (JF)
| | - Rico Schroeder
- Institute of Innovative Health Technologies IGHT, Ernst-Abbe-Hochschule Jena, Jena, Germany
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - Wiebke Stritter
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin, Berlin, Germany
| | - Michael Jeitler
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital, Berlin, Germany
| | - Nico Steckhan
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital, Berlin, Germany
| | - Christian S. Kessler
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital, Berlin, Germany
| | - Andreas Michalsen
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital, Berlin, Germany
| | - Andreas Voss
- Institute of Innovative Health Technologies IGHT, Ernst-Abbe-Hochschule Jena, Jena, Germany
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26
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Steckhan N, Arnrich B. Quantified Complementary and Alternative Medicine: Convergence of Digital Health Technologies and Complementary and Alternative Medicine. Complement Med Res 2020; 27:131-133. [PMID: 32222717 DOI: 10.1159/000506672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/18/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Nico Steckhan
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany, .,Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany,
| | - Bert Arnrich
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
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27
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Jeitler M, Kessler CS, Zillgen H, Högl M, Stöckigt B, Peters A, Schumann D, Stritter W, Seifert G, Michalsen A, Steckhan N. Yoga in school sport - A non-randomized controlled pilot study in Germany. Complement Ther Med 2020; 48:102243. [PMID: 31987242 DOI: 10.1016/j.ctim.2019.102243] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 10/09/2019] [Accepted: 11/11/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Distress is an increasing public health problem for adolescents and young adults. We aimed to evaluate potential effects of a 10-week 90-minute once-a-week yoga course. METHODS A non-randomized controlled study with a school sport control group was implemented in two German secondary schools. Primary outcome was stress on the Perceived Stress Scale from baseline to week 10. Secondary outcomes included depression/anxiety, attention, quality of life, mood, visual analogue scales (for pain, headache, neck tension, exhaustion, sleep), and yoga-efficacy. Parameters were assessed at pre-baseline (before holidays), baseline (after 3-week holidays, before interventions started), week 10, and at a 6-months follow-up. An intention-to-treat analysis using ANCOVA was performed. RESULTS 92 participants (67 % female; 19.6 ± 2.2 years) were included into the study. No significant differences were observed between the groups with regard to PSS, at either 10 weeks (Δ=-1.4; 95 % CI: -3.6;0.8; p = 0.22) or 6 months (Δ = 2; 95 % CI: -0.2;4.2, p = 0.08). Only VAS headache in favour of yoga and HADS-D in favour of school sport showed significant group differences at the 6-months follow-up. Significant intra-group mean changes for the primary outcome and several secondary outcomes were found in the yoga group. CONCLUSIONS Young adults in German secondary school settings might benefit from yoga, as the found effects were more prominent in the yoga group. However, the effects might be attributed to non-specific effects due to the chosen study design. Further studies are needed, which include high-quality study designs including randomization, longer-term follow-ups and larger sample sizes.
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Affiliation(s)
- Michael Jeitler
- Institute for Social Medicine, Epidemiology and Health Economics, Germany; Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Germany.
| | - Christian S Kessler
- Institute for Social Medicine, Epidemiology and Health Economics, Germany; Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Germany
| | - Hannah Zillgen
- Institute for Social Medicine, Epidemiology and Health Economics, Germany; Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Manuel Högl
- Department of Psychology, University of Potsdam, Germany
| | - Barbara Stöckigt
- Institute for Social Medicine, Epidemiology and Health Economics, Germany; Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Alexander Peters
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Germany
| | - Dania Schumann
- Institute for Social Medicine, Epidemiology and Health Economics, Germany; Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Wiebke Stritter
- Department of Pediatrics, Division of Oncology and Hematology, Berlin, Germany
| | - Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Berlin, Germany
| | - Andreas Michalsen
- Institute for Social Medicine, Epidemiology and Health Economics, Germany; Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Germany
| | - Nico Steckhan
- Institute for Social Medicine, Epidemiology and Health Economics, Germany
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28
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Kessler CS, Stange R, Schlenkermann M, Jeitler M, Michalsen A, Selle A, Raucci F, Steckhan N. Corrigendum to 'A nonrandomized controlled clinical pilot trial on 8 wk of intermittent fasting (24 h/wk)' Nutrition. 2018;46:143-152.e2. Nutrition 2020; 74:110701. [PMID: 31932097 DOI: 10.1016/j.nut.2019.110701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Christian S Kessler
- Charité- Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany.
| | - Rainer Stange
- Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Maike Schlenkermann
- Charité- Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Michael Jeitler
- Charité- Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Andreas Michalsen
- Charité- Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Antonia Selle
- Karl von Ossietzky University Oldenburg, Faculty V for Mathematics and Natural Sciences, Institute for Biology and Environmental Sciences, Oldenburg, Germany
| | - Franca Raucci
- IFOM FIRC Institute of Molecular Oncology, Milan, Italy
| | - Nico Steckhan
- Charité- Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
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29
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Bahr LS, Bock M, Liebscher D, Bellmann-Strobl J, Franz L, Prüß A, Schumann D, Piper SK, Kessler CS, Steckhan N, Michalsen A, Paul F, Mähler A. Ketogenic diet and fasting diet as Nutritional Approaches in Multiple Sclerosis (NAMS): protocol of a randomized controlled study. Trials 2020; 21:3. [PMID: 31898518 PMCID: PMC6941322 DOI: 10.1186/s13063-019-3928-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common inflammatory disease of the central nervous system in young adults that may lead to progressive disability. Since pharmacological treatments may have substantial side effects, there is a need for complementary treatment options such as specific dietary approaches. Ketone bodies that are produced during fasting diets (FDs) and ketogenic diets (KDs) are an alternative and presumably more efficient energy source for the brain. Studies on mice with experimental autoimmune encephalomyelitis showed beneficial effects of KDs and FDs on disease progression, disability, cognition and inflammatory markers. However, clinical evidence on these diets is scarce. In the clinical study protocol presented here, we investigate whether a KD and a FD are superior to a standard diet (SD) in terms of therapeutic effects and disease progression. METHODS This study is a single-center, randomized, controlled, parallel-group study. One hundred and eleven patients with relapsing-remitting MS with current disease activity and stable immunomodulatory therapy or no disease-modifying therapy will be randomized to one of three 18-month dietary interventions: a KD with a restricted carbohydrate intake of 20-40 g/day; a FD with a 7-day fast every 6 months and 14-h daily intermittent fasting in between; and a fat-modified SD as recommended by the German Nutrition Society. The primary outcome measure is the number of new T2-weighted MRI lesions after 18 months. Secondary endpoints are safety, changes in relapse rate, disability progression, fatigue, depression, cognition, quality of life, changes of gut microbiome as well as markers of inflammation, oxidative stress and autophagy. Safety and feasibility will also be assessed. DISCUSSION Preclinical data suggest that a KD and a FD may modulate immunity, reduce disease severity and promote remyelination in the mouse model of MS. However, clinical evidence is lacking. This study is the first clinical study investigating the effects of a KD and a FD on disease progression of MS. TRIAL REGISTRATION ClinicalTrials.gov, NCT03508414. Retrospectively registered on 25 April 2018.
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Affiliation(s)
- Lina Samira Bahr
- NeuroCure Clinical Research Center and Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität Berlin, Berlin, Germany
| | - Markus Bock
- Institute of Biochemistry, University Medicine Berlin-Charité, Charitéplatz 1, D-10117, Berlin, Germany.,Department of Medicine B, Ruppin General Hospital, Brandenburg Medical School, 16816, Neuruppin, Germany.,Department of Hand Surgery, Upper Extremity and Foot Surgery, Center for Orthopedics and Trauma Surgery, Hospital Waldfriede, Argentinische Allee 40, 14163, Berlin, Germany
| | - Daniela Liebscher
- Institute of Social Medicine, Epidemiology & Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center and Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität Berlin, Berlin, Germany.,Experimental and Clinical Research Center, a cooperation between Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin, Germany
| | - Liane Franz
- NeuroCure Clinical Research Center and Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität Berlin, Berlin, Germany
| | - Alexandra Prüß
- Institute of Social Medicine, Epidemiology & Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dania Schumann
- Institute of Social Medicine, Epidemiology & Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sophie K Piper
- Berlin Institute of Health, Berlin, Germany.,Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117, Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology & Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology & Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology & Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität Berlin, Berlin, Germany.,Experimental and Clinical Research Center, a cooperation between Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Anja Mähler
- Experimental and Clinical Research Center, a cooperation between Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin, Germany. .,Berlin Institute of Health, Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
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30
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Morassi Sasso A, Datta S, Jeitler M, Steckhan N, Kessler CS, Michalsen A, Arnrich B, Böttinger E. HYPE: Predicting Blood Pressure from Photoplethysmograms in a Hypertensive Population. Artif Intell Med 2020. [DOI: 10.1007/978-3-030-59137-3_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Avery EG, Balogh A, Bartolomaeus H, Löber U, Steckhan N, Markó L, Wilck N, Hamad I, Šušnjar U, Mähler A, Hohmann C, Lesker TR, Strowig T, Dechend R, Bzdok D, Kleinewietfeld M, Michalsen A, Müller DN, Forslund SK. Abstract P2072: Integrative Network Analysis Of Microbiome-Immune Axis In Metabolic Syndrome Patients During A Fasting Intervention. Hypertension 2019. [DOI: 10.1161/hyp.74.suppl_1.p2072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fasting can prolong survival and reduce disease burden in rodent models, and possibly in humans. The relationship between diet, gut microbiota, immune system and host (patho)physiology has only recently been explored, and information is lacking on how periodic fasting affects the gut microbiome in patients with metabolic syndrome (MetS). We show a 5-day fast (FAST) in humans, followed by a modified DASH diet is more effective than DASH alone (DASH) at reducing systolic blood pressure (SBP change measured by ABPM, 95% CI; FAST: [-7.053,-1.142], DASH: [-5.880,1.477]), need for antihypertensive medication (FAST: n=15 of n=35, DASH: n=6 of n=36 patients), and body-mass index at three months post intervention. Fasting altered the gut microbiome, impacting bacterial taxa and functional gene modules associated with the production of short-chain fatty acids (e.g.
Faecalibacterium prausnitzii
,
Eubacterium rectale, Coprococcus comes
), previously linked to vascular health and immunity. Immunophenotyping and cross-system analyses revealed that SBP changes correlated with circulating Il-2
+
TNFα
+
mucosa-associated invariant T (MAIT) cells (FDR-corr P(q) =0.044, Spearman’s rho=0.44), Il-17
-
IFNγ
+
MAITs (FDR-corr P(q) =0.022, Spearman’s rho=0.49), and effector CD4
+
T cells (FDR-corr P(q)=0.047, Spearman’s rho=0.43). By stratifying the fasting group into BP responders and non-responders, we identified a set of 76 microbial and 99 immune responder-specific features. Machine learning algorithms could predict long-term SBP responsiveness from baseline immunome data, identifying changes in effector CD8
+
T cells, Th17 cells and Tregs as discriminators (Single-subject prediction: 71%). This is the first high-resolution multi-omics characterization of fasting in MetS. Fasting induced long-term reduction in body weight and SBP, accompanied by changes in microbiome and immune homeostasis. Our data implicate fasting as a promising non-pharmacological intervention in MetS.
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Affiliation(s)
- Ellen G Avery
- Experimental and Clinical Rsch Cntr (Max Delbrück Cntr for Molecular Medicine & Charité Universitätsmedizin), Berlin, Germany
| | - András Balogh
- Experimental and Clinical Rsch Cntr (Max Delbrück Cntr for Molecular Medicine & Charité Universitätsmedizin), Berlin, Germany
| | - Hendrik Bartolomaeus
- Experimental and Clinical Rsch Cntr (Max Delbrück Cntr for Molecular Medicine & Charité Universitätsmedizin), Berlin, Germany
| | - Ulrike Löber
- Experimental and Clinical Rsch Cntr (Max Delbrück Cntr for Molecular Medicine & Charité Universitätsmedizin), Berlin, Germany
| | - Nico Steckhan
- Charité Universitätsmedizin & Immanuel Krankenhaus, Berlin, Germany
| | - Lajos Markó
- Experimental and Clinical Rsch Cntr (Max Delbrück Cntr for Molecular Medicine & Charité Universitätsmedizin), Berlin, Germany
| | - Nicola Wilck
- Experimental and Clinical Rsch Cntr (Max Delbrück Cntr for Molecular Medicine & Charité Universitätsmedizin), Berlin, Germany
| | - Ibrahim Hamad
- VIB Cntr for Inflammation Rsch (IRC), UHasselt, Hasselt, Belgium
| | - Urša Šušnjar
- Experimental and Clinical Rsch Cntr (Max Delbrück Cntr for Molecular Medicine & Charité Universitätsmedizin), Berlin, Germany
| | - Anja Mähler
- Experimental and Clinical Rsch Cntr (Max Delbrück Cntr for Molecular Medicine & Charité Universitätsmedizin), Berlin, Germany
| | | | - Till R Lesker
- Helmholtz Cntr for Infection Rsch, Braunschweig, Germany
| | - Till Strowig
- Helmholtz Cntr for Infection Rsch, Braunschweig, Germany
| | - Ralf Dechend
- Experimental and Clinical Rsch Cntr (Max Delbrück Cntr for Molecular Medicine & Charité Universitätsmedizin), Berlin, Germany
| | - Danilo Bzdok
- Dept of Psychiatry, Psychotherapy, and Psychosomatics, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen Univ, Aachen, Germany
| | | | | | - Dominik N Müller
- Experimental and Clinical Rsch Cntr (Max Delbrück Cntr for Molecular Medicine & Charité Universitätsmedizin), Berlin, Germany
| | - Sofia K Forslund
- Experimental and Clinical Rsch Cntr (Max Delbrück Cntr for Molecular Medicine & Charité Universitätsmedizin), Berlin, Germany
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Hohmann CD, Stange R, Steckhan N, Robens S, Ostermann T, Paetow A, Michalsen A. The Effectiveness of Leech Therapy in Chronic Low Back Pain. Dtsch Arztebl Int 2018; 115:785-792. [PMID: 30636672 DOI: 10.3238/arztebl.2018.0785] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/03/2018] [Accepted: 07/20/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Leech therapy has been found to be effective in the treatment of a number of chronic musculoskeletal pain syndromes. Leeches are also often used empirically to treat chronic low back pain, but data from clinical trials have been lacking to date. We therefore conducted the first randomized trial of leech therapy for chronic low back pain. METHODS Patients with chronic low back pain were randomized to receive either a single session of local treatment with 4-7 leeches or four weekly sessions of exercise therapy (1 hour each) led by a physical therapist. The primary endpoint was a change in average back pain intensity, as measured using a 100-mm visual analog scale (VAS), after 28 days. Secondary end- points included functional impairment (Roland-Morris Disability Questionnaire, Hannover Functional Ability Questionnaire), quality of life (Short-Form Health Questionnaire [SF 36]), pain perception (pain perception scale = Schmerzempfindungsskala [SES]), depressivity (Center for Epidemiological Studies Depression Scale [CES-D]), and analgesic consumption (questionnaire/ diary). Trial visits took place before treatment and on days 28 ± 3 and 56 ± 5 after the start of treatment; the overall duration of the trial was 56 ± 5 days. RESULTS The mean low back pain score improved from 61.2 ± 15.6 before treatment to 33.1 ± 22.4 on day 28 in the leech ther- apy group (n = 25) and from 61.6 ± 14.8 to 59.8 ± 16.7 in the exercise therapy group (n = 19) (group difference -25.2; 95% con- fidence interval [-41.0; -9.45]; p = 0.0018). Significant benefits of leech therapy were also found at both time points with respect to physical impairment and function as well as physical quality of life. The patients' expectations from treatment were higher in the leech therapy group but did not significantly affect the findings. CONCLUSION A single session of leech therapy is more effective over the short term in lowering the intensity of pain over the short term and in improving physical function and quality of life over the intermediate term (4 weeks and 8 weeks, respectively). The limitations of this trial are the lack of blinding and the small number of patients. Leech therapy appears to be an effective treat- ment for chronic low back pain.
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Affiliation(s)
- Christoph-Daniel Hohmann
- Charité - University Medicine Berlin, corporate member of the Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Foundation Chair of Clinical Naturopathy; Department of Internal Medicine, Division of Naturopathy, Immanuel Hospital Berlin; Department of Psychology, Faculty of Health, Witten/Herdecke University; KPW Garbsen, Center for Physiotherapy
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33
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Balogh A, Steckhan N, Forslund SK, Wilck N, Hamad I, Avery EG, Šušnjar U, Hohmann C, Strowig T, Dechend R, Kleinewietfeld M, Michalsen A, Mueller DN. Abstract P372: The Effect of Periodic Fasting on Patients With Hypertension and Metabolic Syndrome. Hypertension 2018. [DOI: 10.1161/hyp.72.suppl_1.p372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Periodic fasting may serve as therapeutic strategy for the management of hypertension and metabolic syndrome. We hypothesize that fasting affects the gut microbiome and promotes immune cell homeostasis resulting in lower blood pressure. Patients suffering from metabolic syndrome and hypertension were randomized either to 7-day periodic fasting combined with lifestyle change or Dietary Approaches to Stop Hypertension (DASH) intervention. Data derived from clinical parameters, 16S sequencing of the gut microbiome and immunophenotyping were collected at baseline, at day 7 and 3 months post intervention. At baseline, 21 out 30 patients in the fasting and 23 out of 31 in the DASH group had elevated systolic office blood pressure (SBP >130 mmHg), which dropped significantly by 10 mmHg after fasting, and remained lower 3 months post intervention (7 mmHg). In the DASH group, SBP significantly decreased by 12 mmHg after 1 week and 8 mmHg after 3 months. At 3 months post intervention, 24-h ABPM confirmed the decrease in fasting, but not in DASH. Fasting, but not DASH significantly reduced body weight and BMI after 7 days compared to baseline, and this effect persisted for 3 months post-intervention. Furthermore, 50 % (15/30) of patients in fasting and 23 % (7/31) in DASH were able to decrease their use of medications for treatment of metabolic syndrome. Spearman correlation tests showed that fasting, but not DASH, altered the gut microbiome. After fasting
Bacteroides
,
Lachnoclostridium
,
Coprococcus
, and
Ruminococcus
Operational Taxonomic Units (OTUs) decreased, while the
Eubacterium rectale
OTU increased. In contrast to DASH, fasting significantly reduced the frequency of CD4+ Th17 cells, active CD69+ mucosa-associated invariant T cells (MAIT) and IFNg+IL-2+ or TNFa+ MAITs indicating the anti-inflammatory effect of fasting. While some of these changes reverted to baseline after 3 months, several persisted. Despite a similar decrease in office SBP in both study arms, the periodic fasting intervention is more beneficial in reducing body weight and BMI compared to baseline. Fasting altered the prevalence of certain gut microbes and influenced immune cell signatures whereas DASH did not, suggesting a distinct role of fasting for improving cardiometabolic health.
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Affiliation(s)
- Andras Balogh
- Experimental and Clinical Rsch Cntr & Charité Universitätsmedizin Berlin & DZHK, Berlin, Germany
| | - Nico Steckhan
- Charité Universitätsmedizin Berlin & Immanuel Hosp Berlin, Berlin, Germany
| | - Sofia K Forslund
- Experimental and Clinical Rsch Cntr & Charité Universitätsmedizin Berlin & Max Delbrück Cntr for Molecular Medicine & BIH, Berlin, Germany
| | - Nicola Wilck
- Experimental and Clinical Rsch Cntr & Charité Universitätsmedizin Berlin & DZHK, Berlin, Germany
| | - Ibrahim Hamad
- VIB Cntr for Inflammation Rsch (IRC), Hasselt Univ, Diepenbeek, Netherlands
| | - Ellen G Avery
- Experimental and Clinical Rsch Cntr & Max Delbrück Cntr for Molecular Medicine, Berlin, Germany
| | - Urša Šušnjar
- Experimental and Clinical Rsch Cntr & Max Delbrück Cntr for Molecular Medicine, Berlin, Germany
| | - Christoph Hohmann
- Charité Universitätsmedizin Berlin & Immanuel Hosp Berlin, Berlin, Germany
| | - Till Strowig
- Helmholtz Cntr for Infection Rsch, Braunschweig, Germany
| | - Ralf Dechend
- Experimental and Clinical Rsch Cntr & Charite Unviersitätsmedizin Berlin & DZHK & BIH & Helios Hosp, Berlin, Germany
| | | | - Andreas Michalsen
- Charité Universitätsmedizin Berlin & Immanuel Hosp Berlin, Berlin, Germany
| | - Dominik N Mueller
- Experimental and Clinical Rsch Cntr & Max Delbrück Cntr for Molecular Medicine, Charite Unviersitätsmedizin Berlin & DZHK & BIH, Berlin, Germany
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Bauersfeld SP, Kessler CS, Wischnewsky M, Jaensch A, Steckhan N, Stange R, Kunz B, Brückner B, Sehouli J, Michalsen A. The effects of short-term fasting on quality of life and tolerance to chemotherapy in patients with breast and ovarian cancer: a randomized cross-over pilot study. BMC Cancer 2018; 18:476. [PMID: 29699509 PMCID: PMC5921787 DOI: 10.1186/s12885-018-4353-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 04/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background This pilot trial aimed to study the feasibility and effects on quality of life (QOL) and well-being of short-term fasting (STF) during chemotherapy in patients with gynecological cancer. Methods In an individually-randomized cross-over trial patients with gynecological cancer, 4 to 6 planned chemotherapy cycles were included. Thirty-four patients were randomized to STF in the first half of chemotherapies followed by normocaloric diet (group A;n = 18) or vice versa (group B;n = 16). Fasting started 36 h before and ended 24 h after chemotherapy (60 h-fasting period). QOL was assessed by the FACIT-measurement system. Results The chemotherapy-induced reduction of QOL was less than the Minimally Important Difference (MID; FACT-G = 5) with STF but greater than the MID for non-fasted periods. The mean chemotherapy-induced deterioration of total FACIT-F was 10.4 ± 5.3 for fasted and 27.0 ± 6.3 for non-fasted cycles in group A and 14.1 ± 5.6 for non-fasted and 11.0 ± 5.6 for fasted cycles in group B. There were no serious adverse effects. Conclusion STF during chemotherapy is well tolerated and appears to improve QOL and fatigue during chemotherapy. Larger studies should prove the effect of STF as an adjunct to chemotherapy. Trial registration This trial was registered at clinicaltrials.gov: NCT01954836.
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Affiliation(s)
- Stephan P Bauersfeld
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Manfred Wischnewsky
- Department of Mathematics and Computer Science, University of Bremen, PB 330440, Bremen, 28334, Germany
| | - Annette Jaensch
- Department of Internal and Integrative Medicine, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rainer Stange
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Barbara Kunz
- Department of Internal and Integrative Medicine, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Barbara Brückner
- Department of Gynecology, Krankenhaus Waldfriede, Argentinische Allee 40, 14163, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. .,Department of Internal and Integrative Medicine, Immanuel Krankenhaus Berlin, Berlin, Germany.
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Weinberger S, Klarholz-Pevere C, Liefeldt L, Baeder M, Steckhan N, Friedersdorff F. Influence of CT-based depth correction of renal scintigraphy in evaluation of living kidney donors on side selection and postoperative renal function: is it necessary to know the relative renal function? World J Urol 2018; 36:1327-1332. [PMID: 29569036 DOI: 10.1007/s00345-018-2272-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/16/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE To analyse the influence of CT-based depth correction in the assessment of split renal function in potential living kidney donors. METHODS In 116 consecutive living kidney donors preoperative split renal function was assessed using the CT-based depth correction. Influence on donor side selection and postoperative renal function of the living kidney donors were analyzed. Linear regression analysis was performed to identify predictors of postoperative renal function. RESULTS A left versus right kidney depth variation of more than 1 cm was found in 40/114 donors (35%). 11 patients (10%) had a difference of more than 5% in relative renal function after depth correction. Kidney depth variation and changes in relative renal function after depth correction would have had influence on side selection in 30 of 114 living kidney donors. CT depth correction did not improve the predictability of postoperative renal function of the living kidney donor. In general, it was not possible to predict the postoperative renal function from preoperative total and relative renal function. In multivariate linear regression analysis, age and BMI were identified as most important predictors for postoperative renal function of the living kidney donors. CONCLUSIONS Our results clearly indicate that concerning the postoperative renal function of living kidney donors, the relative renal function of the donated kidney seems to be less important than other factors. A multimodal assessment with consideration of all available results including kidney size, location of the kidney and split renal function remains necessary.
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Affiliation(s)
- Sarah Weinberger
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Carola Klarholz-Pevere
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Lutz Liefeldt
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michael Baeder
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nico Steckhan
- Department of Internal and Complementary Medicine, Immanuel Hospital and Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
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Kessler CS, Eisenmann C, Oberzaucher F, Forster M, Steckhan N, Meier L, Stapelfeldt E, Michalsen A, Jeitler M. Ayurvedic versus conventional dietary and lifestyle counseling for mothers with burnout-syndrome: A randomized controlled pilot study including a qualitative evaluation. Complement Ther Med 2017; 34:57-65. [PMID: 28917376 DOI: 10.1016/j.ctim.2017.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Ayurveda claims to be effective in the treatment of psychosomatic disorders by means of lifestyle and nutritional counseling. DESIGN In a randomized controlled study mothers with burnout were randomized into two groups: Ayurvedic nutritional counseling (according to tradition), and conventional nutritional counseling (following the recommendations of a family doctor). Patients received five counseling sessions over twelve weeks. MAIN OUTCOME MEASURES Outcomes included levels of burnout, quality of life, sleep, stress, depression/anxiety, and spirituality at three and six months. It also included a qualitative evaluation of the communication processes. RESULTS We randomized thirty four patients; twenty three participants were included in the per protocol analysis. No significant differences were observed between the groups. However, significant and clinically relevant intra-group mean changes for the primary outcome burnout, and secondary outcomes sleep, stress, depression and mental health were only found in the Ayurveda group. The qualitative part of the study identified different conversational styles and counseling techniques between the two study groups. In conventional consultations questions tended to be category bound, while counseling-advice was predominantly admonitory. The Ayurvedic practitioner used open-ended interrogative forms, devices for displaying understanding, and positive re-evaluation more frequently, leading to an overall less asymmetrical interaction. CONCLUSIONS We found positive effects for both groups, which however were more pronounced in the Ayurvedic group. The conversational and counseling techniques in the Ayurvedic group offered more opportunities for problem description by patients as well as patient-centered practice and resource-oriented recommendations by the physician. TRIAL REGISTRATION NCT01797887.
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Affiliation(s)
- Christian S Kessler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Clemens Eisenmann
- University of Konstanz, Department of History and Sociology, Konstanz, Germany
| | - Frank Oberzaucher
- University of Konstanz, Department of History and Sociology, Konstanz, Germany
| | - Martin Forster
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Nico Steckhan
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Larissa Meier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Elmar Stapelfeldt
- Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Andreas Michalsen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Michael Jeitler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany.
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Kessler CS, Stange R, Schlenkermann M, Jeitler M, Michalsen A, Selle A, Raucci F, Steckhan N. A nonrandomized controlled clinical pilot trial on 8 wk of intermittent fasting (24 h/wk). Nutrition 2017; 46:143-152.e2. [PMID: 29031771 DOI: 10.1016/j.nut.2017.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/31/2017] [Accepted: 08/06/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate whether intermittent fasting (IF) is an effective preventive measure, and whether it is feasible for healthy volunteers under every day conditions. METHODS A nonrandomized controlled clinical trial on IF was performed with healthy volunteers over a period of 8 wk, and a subsequent 4-mo follow-up. Outcomes were assessed at baseline, after 8 wk, and after 6 mo. Volunteers who were not interested in fasting served as a control group. Participants in the fasting group were asked to continue their regular nutritional habits on the nonfasting days, whereas the control group maintained their habitual nutrition throughout the whole period. Outcomes included changes of metabolic parameters (insulin, glucose, insulin resistance, insulin-like growth factor-1, brain-derived neurotropic factor, lipids, liver enzymes, hemoglobin A1c) and coagulation markers; bioelectrical impedance analysis; body mass index; abdominal girth; blood pressure; general quality of life (five-item World Health Organization Well-Being Index [WHO-5] questionnaire), as well as mood and anxiety (Hospital Anxiety and Depression Scale [HADS], Profile of Mood States, Flourishing-Scale, visual analog scale, Likert scales). The intervention consisted of a fasting day, which was repeated every week for 8 wk, with abstinence from solid food between 00:00 and 23:59 at minimum and a maximum caloric intake of 300 kcal on each fasting day. A per-protocol analysis was performed. P < 0.05 was considered significant. RESULTS Thirty-six volunteers were included; 22 allocated themselves to the fasting group, and 14 to the control group. Thirty-three data sets were included in the final analysis. Although significant in-group changes were observed in both groups for a number of outcomes after 8 wk and 6 mo, no significant between-group differences were observed for any outcome other than overall body fat mass after 8 wk as well as for the HADS total score and the WHO-5 total score after 6 mo, all in favor of the fasting group. However, none of the between-group differences were clinically relevant. CONCLUSIONS We did not find any clinically relevant differences between groups in this controlled clinical pilot trial of 8 wk of IF in healthy volunteers. Further clinical research in this field is warranted to further analyze mechanisms and effects of IF.
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Affiliation(s)
- Christian S Kessler
- Charité- Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany.
| | - Rainer Stange
- Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Maike Schlenkermann
- Charité- Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Michael Jeitler
- Charité- Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Andreas Michalsen
- Charité- Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Antonia Selle
- Karl von Ossietzky University Oldenburg, Faculty V for Mathematics and Natural Sciences, Institute for Biology and Environmental Sciences, Oldenburg, Germany
| | - Franca Raucci
- IFOM FIRC Institute of Molecular Oncology, Milan, Italy
| | - Nico Steckhan
- Charité- Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
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Ee C, Thuraisingam S, Pirotta M, French S, Xue C, Teede H, Kristoffersen AE, Sirois F, Stub T, Engler J, Joos S, Güthlin C, Felenda J, Beckmann C, Stintzing F, Evans R, Bronfort G, Keefe D, Taberko A, Hanson L, Haley A, Ma H, Jolton J, Yarosh L, Keefe F, Nam J, Evans R, Ojala L, Kreitzer MJ, Hanson L, Fink C, Kraft K, Flower A, Lewith G, Harman K, Stuart B, Bishop FL, Frawley J, Füleki L, Kiss E, Vancsik T, Krenacs T, Funabashi M, Pohlman KA, Mior S, Thiel H, Hill MD, Cassidy DJ, Westaway M, Yager J, Hurwitz E, Kawchuk GN, O’Beirne M, Vohra S, Gaboury I, Morin C, Gaertner K, Torchetti L, Frei-Erb M, Kundi M, Frass M, Gallo E, Maggini V, Comite M, Sofi F, Baccetti S, Vannacci A, Di Stefano M, Monechi MV, Gori L, Rossi E, Firenzuoli F, Mediati RD, Ballerini G, Gardiner P, Lestoquoy AS, Negash L, Stillman S, Shah P, Liebschutz J, Adelstein P, Farrell-Riley C, Brackup I, Penti B, Saper R, Sampedro IG, Carvajal G, Gleiss A, Gross MM, Brendlin D, Röttger J, Stritter W, Seifert G, Grzanna N, Stange R, Guendling PW, Gu W, Lu Y, Wang J, Zhang C, Hajimonfarednejad M, Hannan N, Hellsing R, Wode K, Nordberg JH, Nordberg JH, Andermo S, Arman M, von Hörsten I, Torrielo PV, Bai H, Vilaró CLA, Cabrera FC, Huber R, Hui H, Ziea E, Tsui D, Hsieh J, Lam C, Chan E, Jensen MP, He Y, Battalio SL, Chan J, Edwards KA, Gertz KJ, Day MA, Sherlin LH, Ehde DM, Kim KH, Jang S, Jang BH, Zhang X, Go HY, Park S, Ko SG, Kraft K, Janik H, Börner A, Lee J, Lee B, Chang GT, Menassa A, Zhang Z, Motoo Y, Müller J, Rabini S, Vinson B, Kelber O, Storr M, Kraft K, Niemeijer M, Baars E, Hoekman J, Wang D, Ruijssenaaars W, Njoku FC, Klose P, Brinkhaus B, Michalsen A, Dobos G, Cramer H, Norheim AJ, Alræk T, Okumus F, Meng F, Oncu-Celik H, Hagel A, Albrecht H, Vollbracht C, Dauth W, Hagel W, Vitali F, Ganzleben I, Schultis H, Konturek P, Stein J, Neurath M, Raithel M, Hagel A, Vollbracht C, Raithel M, Konturek P, Krick B, Haller H, Klose P, Dobos G, Kümmel S, Cramer H, Haller H, Saha FJ, Kowoll A, Ebner B, Berger B, Dobos G, Choi KE, He L, Wang H, He X, Gu C, Zhang Y, Zhao L, Tong X, He L, Wang H, He X, Gu C, Zhang Y, Zhao L, Tong X, He L, Wang H, He X, Gu C, Zhang Y, Zhao L, Tong X, Ho RST, Chung VCH, Wu X, Wong CHL, Wu JCY, Wong SYS, Lau AYL, Sit RWS, Wong W, Holmes M, Bishop F, Calman L, Holmes M, Bishop F, Lewith G, Newell D, Field J, Htut WL, Han D, Choi DI, Choi SJ, Kim HY, Hwang JH, Huang CW, Jang BH, Chen FP, Ko SG, Huang W, Jin D, Lian F, Jang S, Kim KH, Lee EK, Sun SH, Go HY, Ko Y, Park S, Jang BH, Shin YC, Ko SG, Janik H, Greiffenhagen N, Bolte J, Kraft K, Jaworski M, Adamus M, Dobrzynska A, Jeitler M, Jaspers J, von Scheidt C, Koch B, Michalsen A, Steckhan N, Kessler C, Jin D, Huang WJ, Pang B, Lian FM, Jong M, Baars E, Glockmann A, Hamre H, Kainuma M, Murakami A, Kubota T, Kobayashi D, Sumoto Y, Furusyo N, Ando SI, Shimazoe T, Kelber O, Verjee S, Gorgus E, Schrenk D, Kemper K, Hill E, Kemper K, Rao N, Gascon G, Mahan J, Kienle G, Dietrich J, Schmoor C, Huber R, Kim WH, Han D, Ahmed M, He L, Hwang JH, Kiss E, Vancsik T, Meggyeshazi N, Kovago C, Krenacs T, Klaus AK, Zerm R, Pranga D, Ostermann T, Reif M, von Laue HB, Brinkhaus B, Kröz M, Klaus AK, Zerm R, Pranga D, Recchia DR, Ostermann T, Reif M, von Laue HB, Brinkhaus B, Kröz M, Klein-Laansma CT, Jong M, von Hagens C, Jansen JP, van Wietmarschen H, Jong MC, Ko Y, Sun SH, Go HY, Jeon CY, Song YK, Ko SG, Koch AK, Rabsilber S, Lauche R, Kümmel S, Dobos G, Langhorst J, Cramer H, Koch AK, Trifunovic-Koenig M, Klose P, Cramer H, Dobos G, Langhorst J, Koster E, Baars E, Delnoij D, Kroll L, Weiss K, Kubo A, Hendlish S, Altschuler A, Connolly N, Avins A, Lauche R, Recchia DR, Cramer H, Wardle J, Lee D, Sibbritt D, Adams J, Ostermann T, Lauche R, Sibbritt D, Park C, Mishra G, Adams J, Cramer H, Lechner J, Lee I, Chae Y, Lee J, Cho SH, Choi Y, Lee JY, Ryu HS, Yoon SS, Oh HK, Hyun LK, Kim JO, Yoon SW, Lee JY, Shin SH, Jang M, Müller I, Park SHJ, Lestoquoy AS, Laird L, Negash L, Mitchell S, Gardiner P, Li X, Wang Y, Zhen J, Yu H, Liu T, Gu X, Liu H, Ma W, Zhang C, Shang X, Bai Y, Meng F, Liu W, Rooney C, Smith A, Lopes S, Demarzo M, do Patrocínio Nunes M, Lorenz P, Gründemann C, Heinrich M, Garcia-Käufer M, Grunewald F, Messerschmidt S, Herrick A, Gruber K, Beckmann C, Knödler M, Huber R, Steinborn C, Stintzing F, Lu T, Wang L, Wu D, Luberto CM, Hall DL, Chad-Friedman E, Lechner S, Park ER, Luberto CM, Park E, Goodman J, Luer S, Heri M, von Ammon K, Frei-Erb M, Ma W, Meng F, Maggini V, Gallo E, Landini I, Lapucci A, Nobili S, Mini E, Firenzuoli F, McDermott C, Lewith G, Richards S, Cox D, Frossell S, Leydon G, Eyles C, Raphael H, Rogers R, Selby M, Adler C, Allam J, Meng F, Gu W, Zhang C, Bai H, Zhang Z, Wang D, Bu X, Zhang H, Zhang J, Liu H, Mikolasek M, Berg J, Witt C, Barth J, Miskulin I, Lalic Z, Miskulin M, Dumic A, Sebo D, Vcev A, Mohammed NAA, Han D, Ahmed M, Choi SJ, Im HB, Hwang JH, Mukherjee A, Kandhare A, Bodhankar S, Mukherjee A, Kandhare A, Thakurdesai P, Bodhankar S, Munk N, Evans E, Froman A, Kline M, Bair MJ, Musial F, Kristoffersen AE, Alræk T, Hamre HJ, Stub T, Björkman L, Fønnebø VM, Pang B, Lian FM, Ni Q, Tong XL, Li XL, Liu WK, Feng S, Zhao XY, Zheng YJ, Zhao XM, Lin YQ, Pang B, Lian FM, Tong XL, Zhao TY, Zhao XY, Phd HC, Zhang C, Pang B, Liu F, Tong XL, Zhao LH, Zhao XM, Ye R, Gu CJ, Pang B, Ni Q, Tong XL, Lian FM, Zhao XY, Jin D, Zhao XM, Zheng YJ, Lin YQ, Peng W, Lauche R, Sibbritt D, Adams J, Peng W, Wardle J, Cramer H, Mishra G, Lauche R, Pohlman KA, Mior S, Funabashi M, De Carvalho D, El-Bayoumi M, Haig B, Kelly K, Wade DJ, O’Beirne M, Vohra S, Portalupi E, Gobo G, Bellavita L, Guglielmetti C, Raak C, Teuber M, Molsberger F, von Rath U, Reichelt U, Schwanebeck U, Zeil S, Vogelberg C, Veintimilla DR, Vollbracht C, Mery GT, Villavicencio MM, Moran SH, Sachse C, Gündlin PW, Stange R, Sahebkarkhorasani M, Azizi H, Schumann D, Lauche R, Sundberg T, Leach MJ, Cramer H, Seca S, Greten H, Selliah S, Shakya A, Han D, Kim HY, Choi DI, Im HB, Choi SJ, Sherbakova A, Ulrich-Merzenich G, Kelber O, Abdel-Aziz H, Sibinga E, Webb L, Ellen J, Skrautvol K, Nåden D, Song R, Grabowska W, Osypiuk K, Diaz GV, Bonato P, Park M, Hausdorff J, Fox M, Sudarsky LR, Tarsy D, Novakowski J, Macklin EA, Wayne PM, Song R, Hwang I, Ahn S, Lee MA, Wayne PM, Sohn MK, Sorokin O, Steckhan N, Heydeck D, Borchert A, Hohmann CD, Kühn H, Michalsen A, Kessler C, Steckhan N, Hohmann CD, Cramer H, Michalsen A, Dobos G, von Scheidt C, Kirschbaum C, Stalder T, Stöckigt B, Teut M, Suhr R, Sulmann D, Brinkhaus B, Streeter C, Gerbarg P, Silveri M, Brown R, Jensen J, Stritter W, Rutert B, Eggert A, Längler A, Seifert G, Holmberg C, Sun J, Deng X, Li WY, Wen B, Robinson N, Liu JP, Sung HK, Yang N, Go HY, Shin SM, Jung H, Kim YJ, Jung WS, Park TY, Suzuki K, Ito T, Uchida S, Kamohara S, Ono N, Takamura M, Yokochi A, Maruyama K, Tapia P, Thabaut K, Brinkhaus B, Stöckigt B, Thronicke A, Kröz M, Steele M, Matthes H, Herbstreit C, Schad F, Tian J, Lian F, Yang L, Tong X, Tian T, Zhang H, Tian X, Wang C, Chai QY, Zhang L, Xia R, Huang N, Fei Y, Liu J, Trent N, Miraglia M, Dusek J, Pasalis E, Khalsa SB, Trifunovic-König M, Klose P, Cramer H, Lauche R, Koch A, Dobos G, Langhorst J, Uebelacker L, Tremont G, Gillette L, Epstein-Lubow G, Strong D, Abrantes A, Tyrka A, Tran T, Gaudiano B, Miller I, Ullmann G, Ullmann G, Li Y, Vaidya S, Marathe V, Vale AC, Motta J, Donadão F, Valente AC, Valente LCC, Ghelman R, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Ruscuklic G, Baksa D, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Ruscuklic G, Baksa D, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Ruscuklic G, Baksa D, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Vrca K, Dunjic S, Vincent A, Wahner-Roedler D, Whipple M, Vogelius MM, Vollbracht C, Friesecke I, Gündling PW, Wahner-Roedler D, Mahapatra S, Hynes R, Van Rooy K, Looker S, Ghosh A, Bauer B, Cutshall S, Walach H, Flores AB, Walach H, Ofner M, Kastner A, Schwarzl G, Schwameder H, Alexander N, Strutzenberger G, Wang J, Lu Y, Gu W, Zhang C, Bu X, Zhang H, Zhang J, He Y, Zhang X, Meng F, Wang S, Yu H, Shi J, Hao Y, Liu T, Wu J, Qiu Z, Gu X, Wang YH, Lou CJ, Watts S, Wayne P, Osypiuk K, Vergara-Diaz G, Bonato P, Gow B, Hausdorff J, Miranda J, Sudarsky L, Tarsy D, Fox M, Macklin E, Wode K, Bergqvist J, Bernhardsson BM, Nordberg JH, Kienle G, Sharp L, Henriksson R, Woo Y, Hyun MK, Wu H, Wang TF, Zhao Y, Wei Y, Tian L, He L, Wang X, Wu R, Feng S, Han M, Caldwell PHY, Liu S, Zhang J, Liu J, Xia R, Chai Q, Fei Y, Guo Z, Wang C, Liu Z, Li X, Zhang Y, Liu J, Yang IJ, Lincha VR, Ahn SH, Lee DU, Shin HM, Yang L, Sibbritt D, Peng W, Adams J, Yang N, Sung H, Shin SM, Go HY, Jung H, Kim Y, Park TY, Yap A, Kwan YH, Tan CS, Ibrahim S, Ang SB, Yayi A, Han D, Im HB, Hwang JH, Choi SJ, Yoo JE, Yoo HR, Jang SB, Lee HL, Youssef A, Ezzat S, Motaal AA, El-Askary H, Yu X, Cui Y, Zhang Y, Lian F, Yun Y, Ko Y, Ahn JH, Jang BH, Kim KS, Ko SG, Choi I, Zerm R, Glinz A, Pranga D, Berger B, ten Brink F, Reif M, Büssing A, Gutenbrunner C, Kröz M, Zerm R, Helbrecht B, Pranga D, Brinkhaus B, Michalsen A, Kröz M, Zhang H, Fang T, Wang J, Zhang C, He Y, Zhang X, Zhang Z, Wang D, Meng F, Zhang J, Zhang C, Bai H, Shen Z, Ma W, Liu H, Bai Y, Shang X, Meng F, Zhang R, Wu F, Li M, Xuan X, Shen X, Ren K, Berman B, Zhen J, Li X, Gu X, Yu H, Zheng Z, Wan Y, Wang Y, Ma X, Dong F, Liu T, Zhen J, Li X, Gu X, Yu H, Zheng Z, Wan Y, Wang Y, Ma X, Dong F, Liu T, Zick S, Harris R, Bae GE, Kwon JN, Lee HY, Nam JK, Lee SD, Lee DH, Han JY, Yun YJ, Lee JH, Park HL, Park SH, Bocci C, Ivaldi GB, Vietti I, Meaglia I, Guffi M, Ruggiero R, Gualea M, Longa E, Bonucci M, Croke S, Rodriguez LD, Caracuel-Martínez JC, Fajardo-Rodríguez MF, Ariza-García A, la Fuente FGD, Arroyo-Morales M, Estrems MS, Gómez VG, Estrems MS, Sabater MV, Ferreri R, Bernardini S, Pulcri R, Cracolici F, Rinaldi M, Porciani C, Firenzuoli F, Baccetti S, Di Stefano M, Monechi MV, Gallo E, Maggini V, Gori L, Rossi E, Fisher P, Hughes J, Mendoza A, MacPherson H, Witt C, Filshie J, Lewith G, Di Francesco A, Bernardini A, Messe M, Primitivo V, Iasella PA, Ghelman R, Taminato M, Alcantara JDC, De Oliveira KR, Rodrigues DCDA, Mumme JRC, Sunakozawa OKM, Filho VO, Seifert G, Goldenberg J, Day A, Sasagawa M, Ward L, Cooley K, Gunnarsdottir T, Hjaltadottir I. World Congress Integrative Medicine & Health 2017: part two. BMC Complement Altern Med 2017. [PMCID: PMC5498867 DOI: 10.1186/s12906-017-1783-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Brinkhaus B, Falkenberg T, Haramati A, Willich SN, Briggs JP, Willcox M, Linde K, Theorell T, Wong LM, Dusek J, Wu D, Eisenberg D, Haramati A, Berger B, Kemper K, Stock-Schröer B, Sützl-Klein H, Ferreri R, Kaplan G, Matthes H, Rotter G, Schiff E, Arnon Z, Hahn E, Luberto CM, Martin D, Schwarz S, Tauschel D, Flower A, Gramminger H, Gupta HH, Gupta SN, Kerckhoff A, Kessler CS, Michalsen A, Kessler CS, Kim ES, Jang EH, Kim R, Jan SB, Mittwede M, Mohme W, Ben-Arye E, Bonucci M, Saad B, Breitkreuz T, Rossi E, Kebudi R, Daher M, Razaq S, Gafer N, Nimri O, Hablas M, Kienle GS, Samuels N, Silbermann M, Bandelin L, Lang AL, Wartner E, Holtermann C, Binstock M, Riebau R, Mujkanovic E, Cramer H, Lauche R, Michalsen A, Ward L, Cramer H, Irnich D, Stör W, Burnstock G, Schaible HG, Ots T, Langhorst J, Lauche R, Sundberg T, Falkenberg T, Amarell C, Amarell C, Anheyer M, Eckert M, Eckert M, Ogal M, Eckert M, Amarell C, Schönauer A, Reisenberger B, Brand B, Anheyer D, Dobos G, Kroez M, Martin D, Matthes H, Ammendola A, Mao JJ, Witt C, Yang Y, Dobos G, Oritz M, Horneber M, Voiß P, Reisenberger B, von Rosenstiel A, Eckert M, Ogal M, Amarell C, Anheyer M, Schad F, Schläppi M, Kröz M, Büssing A, Bar-Sela G, Matthes H, Schiff E, Ben-Arye E, Arnon Z, Avshalomov D, Attias S, Schönauer A, Haramati A, Witt C, Brinkhaus B, Cotton S, Jong M, Jong M, Scheffer C, Haramati A, Tauschel D, Edelhäuser F, AlBedah A, Lee MS, Khalil M, Ogawa K, Motoo Y, Arimitsu J, Ogawa M, Shimizu G, Stange R, Kraft K, Kuchta K, Watanabe K, Bonin D, Büssing A, Gruber H, Koch S, Gruber H, Pohlmann U, Caldwell C, Krantz B, Kortum R, Martin L, Wieland LS, Kligler B, Gould-Fogerite S, Zhang Y, Wieland LS, Riva JJ, Lumpkin M, Ratner E, Ping L, Jian P, Hamme GM, Mao X, Chouping H, Schröder S, Hummelsberger J, Wullinger M, Brodzky M, Zalpour C, Langley J, Weber W, Mudd LM, Wayne P, Witt C, Weidenhammer W, Fønnebø V, Boon H, Steel A, Bugarcic A, Rangitakatu M, Steel A, Adams J, Sibbritt D, Wardle J, Leach M, Schloss J, Dieze H, Boon H, Ijaz N, Willcox M, Heinrich M, Lewith G, Flower A, Graz B, Adam D, Grabenhenrich L, Ortiz M, Binting S, Reinhold T, Brinkhaus B, Andermo S, Sundberg T, Falkenberg T, Nordberg JH, Arman M, Bhasin M, Fan X, Libermann T, Fricchione G, Denninger J, Benson H, Berger B, Stange R, Michalsen A, Martin DD, Boers I, Vlieger A, Jong M, Brinkhaus B, Teut M, Ullmann A, Ortiz M, Rotter G, Binting S, Lotz F, Roll S, Canella C, Mikolasek M, Rostock M, Beyer J, Guckenberger M, Jenewein J, Linka E, Six C, Stoll S, Stupp R, Witt CM, Chuang E, Kligler B, McKee MD, Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos G, Chung VCH, Wong HLC, Wu XY, Wen GYG, Ho RST, Ching JYL, Wu JCY, Coakley A, Flanagan J, Annese C, Empoliti J, Gao Z, Liu X, Yu S, Yan X, Liang F, Hohmann CD, Steckhan N, Ostermann T, Paetow A, Hoff E, Michalsen A, Hu XY, Wu RH, Logue M, Blonde C, Lai LY, Stuart B, Flower A, Fei YT, Moore M, Liu JP, Lewith G, Hu XY, Wu RH, Logue M, Blonde C, Lai LY, Stuart B, Flower A, Fei YT, Moore M, Liu JP, Lewith G, Jeitler M, Zillgen H, Högl M, Steckhan N, Stöckigt B, Seifert G, Michalsen A, Kessler C, Khadivzadeh T, Bashtian MH, Aval SB, Esmaily H, Kim J, Kim KH, Klocke C, Joos S, Koshak A, Wie L, Koshak E, Wali S, Alamoudi O, Demerdash A, Qutub M, Pushparaj P, Heinrich M, Kruse S, Fischer I, Tremel N, Rosenecker J, Leung B, Takeda W, Liang N, Feng X, Liu JP, Cao HJ, Luberto CM, Shinday N, Philpotts L, Park E, Fricchione GL, Yeh G, Munk N, Zakeresfahani A, Foote TR, Ralston R, Boulanger K, Özbe D, Gräßel E, Luttenberger K, Pendergrass A, Pach D, Bellmann-Strobl J, Chang Y, Pasura L, Liu B, Jäger SF, Loerch R, Jin L, Brinkhaus B, Ortiz M, Reinhold T, Roll S, Binting S, Icke K, Shi X, Paul F, Witt CM, Rütz M, Lynen A, Schömitz M, Vahle M, Salomon N, Lang A, Lahat A, Kopylov U, Ben-Horin S, Har-Noi O, Avidan B, Elyakim R, Gamus D, NG S, Chang J, Wu J, Kaimiklotis J, Schumann D, Buttó L, Langhorst J, Dobos G, Haller D, Cramer H, Smith C, de Lacey S, Chapman M, Ratcliffe J, Johnson N, Lyttleton J, Boothroyd C, Fahey P, Tjaden B, van Vliet M, van Wietmarschen H, Jong M, Tröger W, Vuolanto P, Aarva P, Sorsa M, Helin K, Wenzel C, Zoderer I, Pammer P, Simon P, Tucek G, Wode K, Henriksson R, Sharp L, Stoltenberg A, Nordberg JH, Xiao-ying Y, Wang LQ, Li JG, Liang N, Wang Y, Liu JP, Balneaves L, Capler R, Bocci C, Guffi M, Paolini M, Meaglia I, Porcu P, Ivaldi GB, Dragan S, Bucuras P, Pah AM, Badalica-Petrescu M, Buleu F, Hogea-Stoichescu G, Christodorescu R, Kao L, Cho Y, Klafke N, Mahler C, von Hagens C, Uhlmann L, Bentner M, Schneeweiss A, Mueller A, Szecsenyi J, Joos S, Neri I, Ortiz M, Schnabel K, Teut M, Rotter G, Binting S, Cree M, Lotz F, Suhr R, Brinkhaus B, Rossi E, Baccetti S, Firenzuoli F, Monechi MV, Di Stefano M, Amunni G, Wong W, Chen B, Wu J, Amri H, Haramati A, Kotlyanskaya L, Anderson B, Evans R, Kligler B, Marantz P, Bradley R, Booth-LaForce C, Zwickey H, Kligler B, Brooks A, Kreitzer MJ, Lebensohn P, Goldblatt E, Esmel-Esmel N, Jiménez-Herrera M, Ijaz N, Boon H, Jocham A, Stock-Schröer B, Berberat PO, Schneider A, Linde K, Masetti M, Murakozy H, Van Vliet M, Jong M, Jong M, Agdal R, Atarzadeh F, Jaladat AM, Hoseini L, Amini F, Bai C, Liu T, Zheng Z, Wan Y, Xu J, Wang X, Yu H, Gu X, Daneshfard B, Nimrouzi M, Tafazoli V, Alorizi SME, Saghebi SA, Fattahi MR, Salehi A, Rezaeizadeh H, Zarshenas MM, Nimrouzi M, Fox K, Hughes J, Kostanjsek N, Espinosa S, Lewith G, Fisher P, Latif A, Lefeber D, Paske W, Öztürk AÖ, Öztürk G, Boers I, Tissing W, Naafs M, Busch M, Jong M, Daneshfard B, Sanaye MR, Dräger K, Fisher P, Kreitzer MJ, Evans R, Leininger B, Shafto K, Breen J, Sanaye MR, Daneshfard B, Simões-Wüst AP, Moltó-Puigmartí C, van Dongen M, Dagnelie P, Thijs C, White S, Wiesener S, Salamonsen A, Stub T, Fønnebø V, Abanades S, Blanco M, Masllorens L, Sala R, Al-Ahnoumy S, Han D, He L, Kim HY, In Choi D, Alræk T, Stub T, Kristoffersen A, von Sceidt C, Michalsen A, Bruset S, Musial F, Anheyer D, Cramer H, Lauche R, Saha FJ, Dobos G, Anheyer D, Haller H, Lauche R, Dobos G, Cramer H, Azizi H, Khadem N, Hassanzadeh M, Estiri N, Azizi H, Tavassoli F, Lotfalizadeh M, Zabihi R, Esmaily H, Azizi H, Shabestari MM, Paeizi R, Azari MA, Bahrami-Taghanaki H, Zabihi R, Azizi H, Esmaily H, Baars E, De Bruin A, Ponstein A, Baccetti S, Di Stefano M, Rossi E, Firenzuoli F, Segantini S, Monechi MV, Voller F, Barth J, Kern A, Lüthi S, Witt C, Barth J, Zieger A, Otto F, Witt C, Beccia A, Dunlap C, Courneene B, Bedregal P, Passi A, Rodríguez A, Chang M, Gutiérrez S, Beissner F, Beissner F, Preibisch C, Schweizer-Arau A, Popovici R, Meissner K, Beljanski S, Belland L, Rivera-Reyes L, Hwang U, Berger B, Sethe D, Hilgard D, Heusser P, Bishop F, Al-Abbadey M, Bradbury K, Carnes D, Dimitrov B, Fawkes C, Foster J, MacPherson H, Roberts L, Yardley L, Lewith G, Bishop F, Al-Abbadey M, Bradbury K, Carnes D, Dimitrov B, Fawkes C, Foster J, MacPherson H, Roberts L, Yardley L, Lewith G, Bishop F, Holmes M, Lewith G, Yardley L, Little P, Cooper C, Bogani P, Maggini V, Gallo E, Miceli E, Biffi S, Mengoni A, Fani R, Firenzuoli F, Brands-Guendling N, Guendling PW, Bronfort G, Evans R, Haas M, Leininger B, Schulz C, Bu X, Wang J, Fang T, Shen Z, He Y, Zhang X, Zhang Z, Wang D, Meng F, Büssing A, Baumann K, Frick E, Jacobs C, Büssing A, Grünther RA, Lötzke D, Büssing A, Jung S, Lötzke D, Recchia DR, Robens S, Ostermann T, Berger B, Stankewitz J, Kröz M, Jeitler M, Kessler C, Michalsen A, Cheon C, Jang BH, Ko SG, Huang CW, Sasaki Y, Ko Y, Cheshire A, Ridge D, Hughes J, Peters D, Panagioti M, Simon C, Lewith G, Cho HJ, Han D, Choi SJ, Jung YS, Im HB, Cooley K, Tummon-Simmons L, Cotton S, Luberto CM, Wasson R, Kraemer K, Sears R, Hueber C, Derk G, Lill JR, An R, Steinberg L, Rodriguez LD, la Fuente FGD, De la Vega M, Vargas-Román K, Fernández-Ruiz J, Cantarero-Villanueva I, Rodriguez LD, García-De la Fuente F, Jiménez-Guerrero F, Vargas-Román K, Fernández-Ruiz J, Galiano-Castillo N, Diaz-Saez G, Torres-Jimenez JI, Garcia-Gomez O, Hortal-Muñoz L, Diaz-Diez C, Dicen D, Diezel H, Adams J, Steel A, Wardle J, Diezel H, Steel A, Frawley J, Wardle J, Broom A, Adams J, Dong F, Yu H, Liu T, Ma X, Yan L, Wan Y, Zheng Z, Gu X, Dong F, Yu H, Wu L, Liu T, Ma X, Ma J, Yan L, Wan Y, Zheng Z, Zhen J, Gu X, Dubois J, Rodondi PY, Edelhäuser F, Schwartze S, Trapp B, Cysarz D. World Congress Integrative Medicine & Health 2017: Part one. Altern Ther Health Med 2017. [PMCID: PMC5498855 DOI: 10.1186/s12906-017-1782-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Li C, Sadraie B, Steckhan N, Kessler C, Stange R, Jeitler M, Michalsen A. Effects of A One-week Fasting Therapy in Patients with Type-2 Diabetes Mellitus and Metabolic Syndrome - A Randomized Controlled Explorative Study. Exp Clin Endocrinol Diabetes 2017; 125:618-624. [PMID: 28407662 DOI: 10.1055/s-0043-101700] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is increasing experimental evidence for beneficial effects of calorie restriction and intermittent fasting in type 2 diabetes mellitus (T2DM). In humans, prolonged fasting is established as a health-promoting complementary treatment in Europe and claimed to improve metabolism by a complex hormetic response. We aimed to investigate effects of a one-week fasting period compared to usual care in T2DM by means of a pilot trial. Patients with manifest T2DM medically treated with oral hypoglycemic agents and/or insulin were randomly assigned to a 7-day fasting program followed by dietary advice or to usual care and dietary advice only. Fasting was performed according to the method of Buchinger with a nutritional energy intake of 300kcal/day by liquids only and stepwise re-introduction of solid food thereafter. Outcomes were assessed baseline and after 4 months. Of 46 enrolled participants, 32 (n=16 each group) completed the trial and were included for final analyses. Fasting was well accepted, there were no serious adverse events. After 4 months mean weight decreased by 3.5 kg and 2.0 kg in the fasting vs. control group (p=0.03) paralleled by greater reduction of abdominal circumference (p=0.001). Fasting led to a significant decrease of systolic/diastolic blood pressure (p=0.01; p=0.003) and increased quality-of-life (p=0.04), while for HbA1c, insulin and HOMA-index only non-significant improvements were observed. Results of this study suggest that prolonged fasting is feasible and might have beneficial clinical effects. The effectiveness of fasting should be proved in larger confirmatory trials that include intermittent fasting in follow-ups to enable more pronounced and long-term effects.
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Affiliation(s)
- Chenying Li
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin
| | - Badri Sadraie
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin
| | - Christian Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin
| | - Rainer Stange
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin
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Jeitler M, Jaspers J, von Scheidt C, Koch B, Michalsen A, Steckhan N, Kessler CS. Mind-body medicine and lifestyle modification in supportive cancer care: A cohort study on a day care clinic program for cancer patients. Psychooncology 2017; 26:2127-2134. [PMID: 28370730 DOI: 10.1002/pon.4433] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We developed an integrative day care clinic program for cancer patients focusing on mind-body techniques and health-promoting lifestyle modification (7-hour once-per-week group sessions over 12 weeks). METHODS A cohort study design with a waiting group was implemented. Outcome parameters were assessed at the beginning, at the end of the active program, and at a 6-month follow-up. Patients waiting >4 and <12 weeks before treatment start were allocated to the waiting group and additionally assessed at the start of their day care program. Outcome measures included quality of life (FACT-G, FACT-B/C, WHO-5), fatigue (FACIT-F), depression/anxiety (HADS), and mood states (ASTS). A per protocol analysis using mixed linear models was performed. RESULTS One hundred patients were screened on-site for eligibility. Eighty-six cancer survivors (83% female; mean age 53.7 ± 9.7 years; 49% breast cancer) were included into the study. Sixty-two patients were allocated to the intervention group and 24 patients, to the waiting group (mean waiting time 5 ± 1 weeks). Sixty-six data sets were included in the final analysis. Significant improvements were observed in favor of the intervention group after 12 weeks compared with the waiting group at the end of the waiting period for quality of life, anxiety/depression, and fatigue. Results from the 6-month follow-up for the whole study population showed lasting improvement of quality of life. CONCLUSIONS The program can be considered as an effective means to improve quality of life, fatigue, and mental health of cancer patients. Moreover, it appears to have a sustainable effect, which has to be proved in randomized trials.
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Affiliation(s)
- Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Jessica Jaspers
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany
| | - Christel von Scheidt
- Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Barbara Koch
- Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
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Steckhan N, Hohmann CD, Kessler C, Dobos G, Michalsen A, Cramer H. Effects of different dietary approaches on inflammatory markers in patients with metabolic syndrome: A systematic review and meta-analysis. Nutrition 2015; 32:338-48. [PMID: 26706026 DOI: 10.1016/j.nut.2015.09.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Chronic low-grade inflammation has been associated with insulin resistance, diabetes, atherosclerosis, obesity, and metabolic syndrome (MetS). A proinflammatory environment contributes to several metabolic disturbances and possibly the development of MetS. Dietary approaches have defined impact on immune function and putative antiinflammatory effects. The aim of this study was to assess the effects of different dietary approaches on markers of inflammation in patients with MetS. Further effects on weight loss and fasting insulin were analyzed. METHODS Medline/PubMed, Scopus, and the Cochrane Library were screened in September 2014 for randomized controlled trials (RCTs) on different dietary approaches for participants with MetS as defined by National Cholesterol Education Program Adult Treatment Panel III. Primary outcomes were markers of the immune system. Secondary outcome was body weight and fasting insulin. Standardized mean differences (SMD) and 95% confidence intervals (95% CIs) were calculated. RESULTS Thirteen randomized controlled trials with a total of 2017 patients were included. Low-fat diets (29 ± 2% energy from fats) decreased C-reactive protein compared with control diets (SMD: -0.98; 95% CI: -1.6 to -0.35; P = 0.002). Low-carbohydrate diets (23 ± 10% energy from carbohydrates; SMD: -0.33; 95% CI: -0.63 to -0.03; P = 0.004) and multimodal interventions (SMD: -1.02; 95% CI: -1.97 to -0.07; P = 0.04) were able to induce significant weight loss. Low-carbohydrate diets were able to decrease insulin (SMD: -0.33; 95% CI: -0.63 to -0.03; P = 0.03). CONCLUSIONS C-reactive protein; however, this effect is also dependent on weight loss. Furthermore, low-carbohydrate diets have beneficial effects on insulin and body weight. Dietary approaches should mainly be tried to reduce macronutrients and enrich functional food components such as vitamins, flavonoids, and unsaturated fatty acids. People with MetS will benefit most by combining weight loss and anti-inflammatory nutrients.
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Affiliation(s)
- Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-University Medical Centre, Berlin, Germany and Immanuel Hospital Berlin; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany.
| | - Christoph-Daniel Hohmann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-University Medical Centre, Berlin, Germany and Immanuel Hospital Berlin; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Christian Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-University Medical Centre, Berlin, Germany and Immanuel Hospital Berlin; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-University Medical Centre, Berlin, Germany and Immanuel Hospital Berlin; Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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Hohmann CD, Cramer H, Michalsen A, Kessler C, Choi KE, Steckhan N, Dobos G. Effects of high phenolic olive oil on cardiovascular risk factors: A systematic review and meta-analysis. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kessler CS, Steckhan N, Forster M, Meier L, Stapelfeldt E, Michalsen A. Ayurvedic versus conventional dietary and lifestyle counseling for mothers with burnout-syndrome: A randomized controlled pilot study. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.09.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Zimmermann-Viehoff F, Steckhan N, Meissner K, Deter HC, Kirschbaum C. Influence of a Suggestive Placebo Intervention on Psychobiological Responses to Social Stress: A Randomized Controlled Trial. J Evid Based Complementary Altern Med 2015; 21:3-9. [PMID: 26047827 DOI: 10.1177/2156587215588642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/28/2015] [Indexed: 12/30/2022] Open
Abstract
We tested the hypothesis that a suggestive placebo intervention can reduce the subjective and neurobiological stress response to psychosocial stress. Fifty-four healthy male subjects with elevated levels of trait anxiety were randomly assigned in a 4:4:1 fashion to receive either no treatment (n = 24), a placebo pill (n = 24), or a herbal drug (n = 6) before undergoing a stress test. We repeatedly measured psychological variables as well as salivary cortisol, alpha-amylase, and heart rate variability prior to and following the stress test. The stressor increased subjective stress and anxiety, salivary cortisol, and alpha-amylase, and decreased heart rate variability (all P < .001). However, no significant differences between subjects receiving placebo or no treatment were found. Subjects receiving placebo showed increased wakefulness during the stress test compared with no-treatment controls (P < .001). Thus, the suggestive placebo intervention increased alertness, but modulated neither subjective stress and anxiety nor the physiological response to psychosocial stress.
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Hohmann CD, Cramer H, Michalsen A, Kessler C, Steckhan N, Choi K, Dobos G. Effects of high phenolic olive oil on cardiovascular risk factors: A systematic review and meta-analysis. Phytomedicine 2015; 22:631-640. [PMID: 26055128 DOI: 10.1016/j.phymed.2015.03.019] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/09/2015] [Accepted: 03/11/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Cardiovascular diseases are the world's leading cause of death. Prevention by nutrition is an easy and effective approach especially by advising foods with nutraceutic properties like high phenolic olive oil (HPOO). AIM The aim of this review was to systematically access and meta-analyse the effects of HPOO on risk factors of the cardiovascular system and thusly to evaluate its use as a nutraceutical in prevention. DATA SYNTHESIS Medline/PubMed, EMBase, the Cochrane Library, CAMbase and CAM-QUEST were searched through July 2013. Randomized controlled trials (RCTs) comparing high vs. low (resp. non) phenolic olive oils in either healthy participants or patients with cardiovascular diseases were included. For study appraisal the Cochrane Collaboration's risk of bias tool was used. Main outcomes were blood pressure, serum lipoproteins and oxidation markers. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated and analysed by the generic inverse variance methods using a random effects model. Eight cross over RCTs comparing ingestion (21-90 d) of high vs. low (resp. non) phenolic olive oils with a total of 355 subjects were included. RESULTS There were medium effects for lowering systolic blood pressure (n = 69; SMD -0.52; CI -0.77/-0.27; p < 0.01) and small effects for lowering oxLDL (n = 300; SMD -0.25; CI [-0.50/0.00]; p = 0.05). No effects were found for diastolic blood pressure (n = 69; SMD -0.20; CI -1.01/0.62; p = 0.64); malondialdehyde (n = 71; SMD -0.02; CI [-0.20/0.15]; p = 0.79), total cholesterol (n = 400; SMD -0.05; CI [-0.16/0.05]; p = 0.33); HDL (n = 400; SMD -0.03; CI [-0.14/0.08]; p = 0.62); LDL (n = 400; SMD -0.03; CI [-0.15/0.09]; p = 0.61); and triglycerides (n = 360; SMD 0.02; CI [-0.22/0.25]; p = 0.90). LIMITATIONS The small number of studies/participants limits this review. CONCLUSIONS HPOO provides small beneficial effects on systolic blood pressure and serum oxidative status (oxLDL). HPOO should be considered as a nutraceutical in cardiovascular prevention.
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Affiliation(s)
- C D Hohmann
- Department of Internal and Complementary Medicine, Immanuel Hospital and Institute of Social Medicine, Epidemiology & Health Economics, Charité-University Medical Centre, Research Coordination, Königstr. 63, 14109 Berlin, Germany.
| | - H Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - A Michalsen
- Department of Internal and Complementary Medicine, Immanuel Hospital and Institute of Social Medicine, Epidemiology & Health Economics, Charité-University Medical Centre, Research Coordination, Königstr. 63, 14109 Berlin, Germany
| | - C Kessler
- Department of Internal and Complementary Medicine, Immanuel Hospital and Institute of Social Medicine, Epidemiology & Health Economics, Charité-University Medical Centre, Research Coordination, Königstr. 63, 14109 Berlin, Germany
| | - N Steckhan
- Department of Internal and Complementary Medicine, Immanuel Hospital and Institute of Social Medicine, Epidemiology & Health Economics, Charité-University Medical Centre, Research Coordination, Königstr. 63, 14109 Berlin, Germany
| | - K Choi
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - G Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to evaluate the quality of evidence and the strength of recommendation for yoga as a therapeutic means in the management of prehypertension and hypertension. METHODS MEDLINE/Pubmed, Scopus, CENTRAL, and IndMED were screened through February 2014 for randomized controlled trials (RCTs) on the effects of yoga interventions (≥8 weeks) compared with usual care or any active control intervention on blood pressure in patients with prehypertension (120-139/80-89 mm Hg) or hypertension (≥140/≥90 mm Hg). Risk of bias was assessed using the Cochrane risk of bias tool; quality of evidence was assessed according to the GRADE recommendations. RESULTS Seven RCTs with a total of 452 patients were included. Compared with usual care, very low-quality evidence was found for effects of yoga on systolic (6 RCTs, n = 278; mean difference (MD) = -9.65 mm Hg, 95% confidence interval (CI) = -17.23 to -2.06, P = 0.01; heterogeneity: I (2) = 90%, χ(2) = 48.21, P < 0.01) and diastolic blood pressure (6 RCTs, n = 278; MD = -7.22 mm Hg, 95% CI = -12.83 to -1.62, P = 0.01; heterogeneity: I (2) = 92%, χ(2) = 64.84, P < 0.01). Subgroup analyses revealed effects for RCTs that included hypertensive patients but not for RCTs that included both hypertensive and prehypertensive patients, as well as for RCTs that allowed antihypertensive comedication but not for those that did not. More adverse events occurred during yoga than during usual care. Compared with exercise, no evidence was found for effects of yoga on systolic or diastolic blood pressure. CONCLUSIONS Larger studies are required to confirm the emerging but low-quality evidence that yoga may be a useful adjunct intervention in the management of hypertension.
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Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany;
| | - Heidemarie Haller
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Romy Lauche
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Nico Steckhan
- Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Berlin, Germany
| | - Andreas Michalsen
- Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Berlin, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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