Dose-effect relation between regular consumption of 100% cocoa powder and blood pressure in young, healthy black Africans

BACKGROUND

Some previous works have focused on dose-response relationship between cocoa consumption and blood pressure in Caucasians. As black subjects have lower nitric oxide bioavailability, the aim of this work was to determine the dose-effect relation between cocoa and blood pressure in black Africans.

METHOD

One hundred and thirty healthy black African males aged 18-30 were randomly assigned into four groups: three groups consuming 10 g, 5 g, or 2 g of cocoa powder daily for three weeks and one control group that did not consume cocoa. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured on day 1 (D1, before any subject consumed cocoa), D8, D15, and D22. Means of the parameters at each of the four visits and changes of the means were compared among the groups.

RESULTS

Significant decrease in SBP was noted in consumers of 10 g compared to controls in the 1st week, and compared to consumers of 2 g in the 2nd and 3rd weeks of follow-up. Means and changes of DBP were statistically similar among the four groups.

CONCLUSION

Among our cohort, decrease in SBP was significantly greater in the heavy cocoa consumer group (10 g) compared to the low consumer group (2 g), but there was no statistically significant difference when compared with the intermediate consumer group (5 g). The dose-response relationship between cocoa consumption and changes in SBP was not linear. No relationship was found between cocoa consumption and DBP.

[Features of a drinking regimen and signs of deficiency of magnesium at elderly patients with removable stomatologic orthopedic constructions.]

The purpose was to study features of a drinking regimen and signs of deficiency of magnesium at elderly patients with removable stomatologic orthopedic constructions. Questioning of 1 388 elderly patients who coming for the dentistry office. Patients were divided into three groups: the 1st was characterized by existence only of fixed stomatologic orthopedic constructions (n=419); the 2nd group was characterized by existence of partially removable constructions (n=512); the 3rd group was characterized by existence of full-removable constructions (n=457). We defined symptoms of the central obesity as rising of BMI and a circle of a waist. Patients were tested for possible deficiency of magnesium. At patients of the 3rd group have more often symptoms of the central obesity, than at the 1st and 2nd groups (52,5% against 21,5 and 41,8%, p<0.05). Patients of the 3rd group have more often signs of deficiency of magnesium, than other patients (62,3% against 11,7 and 22,3%, p<0.05). Patients of the 3rd group more often than others intake cocoa (54,1% against 5,7 and 10,4%, p<0.05), carbonated drinks (24,5% against 7,6 and 4,3%, p<0,05), hard alcoholic beverages (23% against 10 and 10,2%, p<0,05). All elderly patients extremely seldom use bottled water.

Markers of Hypoxia and Oxidative Stress in Aging Volunteers Ingesting Lycosomal Formulation of Dark Chocolate Containing Astaxanthin

OBJECTIVE

To determine if ingestion of lycosome-formulated dark chocolate (DC) containing astaxanthin (ASTX) improves bioavailability of ASTX and affects markers of hypoxia and oxidative stress in aging individuals.

DESIGN

Randomized, blinded, four-arm, prospective study.

SETTINGS

Lycotec Ltd, Cambridge, United Kingdom and Institute of Cardiology, Saratov, Russian Federation.

PARTICIPANTS

32 healthy individuals aged 60-70 years with confirmed signs of oxidative stress (increased serum levels of oxidized LDL and malonic dialdehyde) randomized into four study groups (8 volunteers each).

INTERVENTION

Volunteers of first group were given orally 10 gr of dark chocolate (DC). Individuals from the second group received 7 mg of astaxanthin (ASTX). Third group of volunteers was supplemented with 10 gr of DC and 7 mg of ASTX ingested simultaneously as two separate formulations. Last group of the individuals was given 10 gr of a lycosomal formulation of DC containing 7 mg of co-crystalized ASTX (L-DC-ASTX), a newly developed highly bioavailable nutraceutical composition of DC containing 2 groups of antioxidants (cocoa flavanols and ASTX). All formulations were given orally, once daily for a month.

MEASUREMENTS

Serum ASTX was measured by high-performance liquid chromatography. Nitric oxide, malonic dialdehyde and oxidized LDL were quantified spectrophotometrically. Oxygenation parameters were evaluated by near-infrared spectroscopy.

RESULTS

One month ingestion of singular formulation of ASTX lead to a 20 fold buildup in serum ASTX level whereas the 4 week ingestion of L-DC-ASTX formulation was accompanied by more prominent accumulation of ASTX in serum (a 40 fold increase over the basal values) at the same daily dose of ASTX. Both antioxidants taken separately decreased serum levels of oxidized LDL and malonic dialdehyde. However effect of L-DC-ASTX formulation was more prominent. ASTX ingested alone caused a borderline increase (p=0.054) in serum nitric oxide (NO) levels, whereas DC ingestion lead to small but statistically significant increase in serum NO concentration. Higher values of NO level were seen after co-ingestion of DC and ASTX, especially in case of L-DC-ASTX formulation suggesting additive/synergistic effects of DC and ASTX on nitric oxide production. These changes were in agreement with the increase in plasma oxygen transport and tissue oxygen saturation seen in the volunteers supplemented with L-DC-ASTX formulation.

CONCLUSION

The nutraceutical formulation of DC and ASTX with an enhanced bioavailability of ASTX can be efficiently used for the correction of oxidative status in aging individuals.

Effect of exclusion of frequently consumed dietary triggers in a cohort of children with chronic primary headache

BACKGROUND

Although dietary factors are known to trigger headaches, the relationship between food and headache in children remains unclear. This prospective, observational case series aimed to evaluate the effect of exclusion of frequently-consumed foods in a cohort of children with headache.

METHODS

One hundred and fifteen children aged 3-15 (mean 10.5) years with primary headache were followed in a paediatric outpatient clinic. Patients who frequently consumed foods or food additives known to trigger headaches were advised to exclude them for six weeks and to return for follow-up with headache and food diary.

RESULTS

One hundred patients attended follow-up. Of these 13 (13%) did not respond to dietary exclusion; 87 (87%) achieved complete resolution of headaches by exclusion of 1-3 of the identified food(s). Caffeine was the most common implicated trigger (28), followed by monosodium glutamate (25), cocoa (22), aspartame (13), cheese (13), citrus (10) and nitrites (six). One patient was sensitive to tomatoes.

CONCLUSIONS

This study demonstrates the potential scale and significance of seven frequently consumed foods or food additives as triggers for primary headache in children. Also this is the first study to show that headaches can be triggered by the cumulative effect of a food that is frequently consumed, rather than by single time ingestion.

When chocolate seeking becomes compulsion: gene-environment interplay

BACKGROUND

Eating disorders appear to be caused by a complex interaction between environmental and genetic factors, and compulsive eating in response to adverse circumstances characterizes many eating disorders.

MATERIALS AND METHODS

We compared compulsion-like eating in the form of conditioned suppression of palatable food-seeking in adverse situations in stressed C57BL/6J and DBA/2J mice, two well-characterized inbred strains, to determine the influence of gene-environment interplay on this behavioral phenotype. Moreover, we tested the hypothesis that low accumbal D2 receptor (R) availability is a genetic risk factor of food compulsion-like behavior and that environmental conditions that induce compulsive eating alter D2R expression in the striatum. To this end, we measured D1R and D2R expression in the striatum and D1R, D2R and α1R levels in the medial prefrontal cortex, respectively, by western blot.

RESULTS

Exposure to environmental conditions induces compulsion-like eating behavior, depending on genetic background. This behavioral pattern is linked to decreased availability of accumbal D2R. Moreover, exposure to certain environmental conditions upregulates D2R and downregulates α1R in the striatum and medial prefrontal cortex, respectively, of compulsive animals. These findings confirm the function of gene-environment interplay in the manifestation of compulsive eating and support the hypothesis that low accumbal D2R availability is a "constitutive" genetic risk factor for compulsion-like eating behavior. Finally, D2R upregulation and α1R downregulation in the striatum and medial prefrontal cortex, respectively, are potential neuroadaptive responses that parallel the shift from motivated to compulsive eating.

Chocolate and migraine: the history of an ambiguous association

Migraine is a highly prevalent condition and an important cause of disability. Although the pathogenesis of this condition is complex and multifaceted, several environmental factors have been associated with development and aggravation of headache attacks. Among the various foods that have been implicated in migraine, chocolate has been regarded as detrimental on the basis of old and mostly anecdotal evidence. Therefore, this article is aimed to provide an overview on the current scientific evidence about the relationship between chocolate and migraine. Taken together, the information gathered from epidemiological and provocative studies attests that the potential causal association between chocolate and migraine remains largely enigmatic. The analysis of epidemiological surveys reveals a highly heterogeneous picture, with frequency of migraine episodes attributable to chocolate ranging from 0 to 22.5%. Even in those studies reporting a more convincing association, the risk of migraine after chocolate ingestion was found to be 2- to 3-fold lower than that reported for exposure to other conventional triggers such as stress, fasting, lack of sleep and alcohol beverages. The results of the double-blind studies are instead unequivocal, and clearly demonstrate that the risk of developing a headache attack after ingestion of chocolate is as likely as administering placebo in patients with migraine. It can hence be concluded that the widespread belief that chocolate and cocoacontaining foods should be absolutely avoided by migraine patients lacks of a reliable scientific basis.

Food as trigger and aggravating factor of migraine

A relevant proportion of patients say that their migraine attacks may be precipitated by dietary items, the percentage of patients reporting foods as trigger ranging in different study from 12 to 60 %. Fasting, alcohol, chocolate and cheese are the dietary precipitating factors more frequently reported. The finding that diet-sensitive migraineurs are usually sensitive to several and different foods, lead to the hypothesis of antigenic similarities between these disparate foods or common chemical constituents, but a clear scientific explanation of the mechanisms implicated in the development of migraine attacks supposedly precipitated by food is still lacking. The possibility that the elimination diets based on the hypothesis of food hypersensivity IgE or IgG-mediated improve migraine has been explored in different studies but the results are inconclusive. Fasting as trigger for migraine is frequently reported. Some migraineurs show reactive hypoglycaemia due to diet-induced hyperinsulinism. In conclusion, identification of environmental factors (including dietary factors) that consistently trigger migraine in some subjects may be helpful to reduce attacks frequency. The biological mechanism by means of triggers in general and food in particular precipitate migraine attacks remains obscure.

[Dark or white chocolate? Cocoa and cardiovascular health]

Epidemiological data show that a regular dietary intake of plant-derived foods reduces the risk of cardiovascular disease. Recent research indeed demonstrates interesting data about cocoa consumption, with high concentrations of polyphenols, and beneficial effects on blood pressure, insulin resistance and platelet function. Although still debated, a range of potential mechanisms through which cocoa might exert their benefits on cardiovascular health have been suggested: activation of nitric oxide, antioxidant, anti-inflammatory, anti-platelet effects, which might in turn improve endothelial function, lipid levels, blood pressure and insulin resistance. This article reviews available data about the effects of the consumption of cocoa and different types of chocolate on cardiovascular health, and outlines potential mechanisms involved on the basis of recent studies.

Does diet really affect acne?

Acne vulgaris has anecdotally been attributed to diet by individuals affected by this skin condition. In a 2009 systematic literature review of 21 observational studies and 6 clinical trials, the association between acne and diet was evaluated. Observational studies, including 2 large controlled prospective trials, reported that cow's milk intake increased acne prevalence and severity. Furthermore, prospective studies, including randomized controlled trials, demonstrated a positive association between a high-glycemic-load diet, hormonal mediators, and acne risk. Based on these findings, there exists convincing data supporting the role of dairy products and high-glycemic-index foods in influencing hormonal and inflammatory factors, which can increase acne prevalence and severity. Studies have been inconclusive regarding the association between acne and other foods.

Quantitative risk assessment relating to adventitious presence of allergens in food: a probabilistic model applied to peanut in chocolate

Peanut allergy is a public health concern, owing to the high prevalence in France and the severity of the reactions. Despite peanut-containing product avoidance diets, a risk may exist due to the adventitious presence of peanut allergens in a wide range of food products. Peanut is not mentioned in their ingredients list, but precautionary labeling is often present. A method of quantifying the risk of allergic reactions following the consumption of such products is developed, taking the example of peanut in chocolate tablets. The occurrence of adventitious peanut proteins in chocolate and the dose-response relationship are estimated with a Bayesian approach using available published data. The consumption pattern is described by the French individual consumption survey INCA2. Risk simulations are performed using second-order Monte Carlo simulations, which separately propagates variability and uncertainty of the model input variables. Peanut allergens occur in approximately 36% of the chocolates, leading to a mean exposure level of 0.2 mg of peanut proteins per eating occasion. The estimated risk of reaction averages 0.57% per eating occasion for peanut-allergic adults. The 95% values of the risk stand between 0 and 3.61%, which illustrates the risk variability. The uncertainty, represented by the 95% credible intervals, is concentrated around these risk estimates. Children have similar results. The conclusion is that adventitious peanut allergens induce a risk of reaction for a part of the French peanut-allergic population. The method developed can be generalized to assess the risk due to the consumption of every foodstuff potentially contaminated by allergens.

Chocolate-induced prolonged angiooedema in an elderly patient

This report presents a 93-year-old woman with prolonged angioedema associated with diabetic chocolate and chronic angiotensin-converting enzyme inhibitor use.

Hyperexcitability syndrome in a newborn infant of chocoholic mother

We present a case of hyperexcitability syndrome observed in a neonate born to a mother who was a heavy user of cocoa and chocolate during pregnancy and lactation. The infant presented jitteriness, irritability, inconsolable crying, excessive sucking, and sleeping difficulties almost immediately after birth. The infant underwent extensive diagnostic studies, but none of the usual causes for its symptoms were identified. The symptoms resolved after the interruption of maternal chocolate consumption. We hypothesize that the heavy exposure to chocolate could be responsible for the hyperexcitability syndrome.

Trigger factors of migraine and tension-type headache: experience and knowledge of the patients

The objective was to examine potential trigger factors of migraine and tension-type headache (TTH) in clinic patients and in subjects from the population and to compare the patients’ personal experience with their theoretical knowledge. A cross-sectional study was carried out in a headache centre. There were 120 subjects comprising 66 patients with migraine and 22 with TTH from a headache outpatient clinic and 32 persons with headache (migraine or TTH) from the population. A semistructured interview covering biographic data, lifestyle, medical history, headache characteristics and 25 potential trigger factors differentiating between the patients’ personal experience and their theoretical knowledge was used. The most common trigger factors experienced by the patients were weather (82.5%), stress (66.7%), menstruation (51.4%) and relaxation after stress (50%). The vast majority of triggers occurred occasionally and not consistently. The patients experienced 8.9±4.3 trigger factors (range 0–20) and they knew 13.2±6.0 (range 1–27). The number of experienced triggers was smallest in the population group (p=0.002), whereas the number of triggers known did not differ in the three study groups. Comparing theoretical knowledge with personal experience showed the largest differences for oral contraceptives (65.0 vs. 14.7%, p<0.001), chocolate (61.7 vs. 14.3%, p>0.001) and cheese (52.5 vs. 8.4%, p<0.001). In conclusion, almost all trigger factors are experienced occasionally and not consistently by the majority of patients. Subjects from the population experience trigger factors less often than clinic patients. The difference between theoretical knowledge and personal experience is largest for oral contraceptives, chocolate and cheese.

Morphometric and functional abnormalities of kidneys in the progeny of mice fed chocolate during pregnancy and lactation

Even most commonly consumed beverages like tea, coffee, chocolate and cocoa contain methylxanthines, biogenic amines and polyphenols, among them catechins, that exhibit significant biological activity and might profoundly affect the organism homeostasis. We have previously shown that 400 mg of bitter chocolate or 6 mg of theobromine added to the daily diet of pregnant and afterwards lactating mice affected embryonic angiogenesis and caused bone mineralization disturbances as well as limb shortening in 4-weeks old offspring. The aim of the present study was the morphometric and functional evaluation of kidneys in the 4-weeks old progeny mice fed according to the protocol mentioned above. Progeny from the mice fed chocolate presented considerable morphometric abnormalities in the kidney structure, with the lower number of glomeruli per mm2 and their increased diameter. Moreover, higher serum creatinine concentration was observed in that group of offspring. No morphometric or functional irregularities were found in the progeny of mice fed theobromine. Abnormalities demonstrated in the offspring of mice fed chocolate are not related to its theobromine content. Consequently, identification of active compound(s) responsible for the observed effects is of vital importance.

Cocoa supplementation for copper deficiency associated with tube feeding nutrition

OBJECTIVE

Because of an increasing number of case reports of copper deficiency associated with long-term tube feeding nutrition in Japan, we identified patients with copper deficiency associated with long-term tube feeding and described the prevalence, clinical data and cocoa treatment for these patients.

MATERIALS AND METHODS

We conducted a retrospective study to identify patients who were referred from long-term care institutions and had copper deficiency associated with tube feeding. We reviewed all serum copper concentration data during a 6-year period. We also compared admission and post-treatment peripheral blood counts.

RESULTS

Among 210 consecutive admissions with nutritional tube feeding from long-term care institutions (N=210), we identified 13 (6.2%) patients with copper deficiency (aged 46-91; 12 women). All patients had anemia, while most had neutropenia. The range of serum copper concentrations of these patients was 0.1-2.4 microg/L (normal; 6.8-12.8 microg/L). Their feeding formulas revealed a low copper content (5 to 12 microg per 100 kcal of each formula). Cocoa powder was used as the treatment. With cocoa supplements, the blood leukocyte count and hemoglobin significantly improved in all patients. Median leukocyte counts were 1,800 /mm(3)at admission and 6,300/mm(3) at follow-up (p=0.001). Median hemoglobin were 7.0 g/dl at admission and 10.3 g/dl at follow-up (p=0.001). Two patients developed transient tachycardia as a possible adverse effect of cocoa.

CONCLUSION

We identified many cases with copper deficiency associated with tube feeding in Okinawa, Japan. Cocoa supplement appeared to be a safe and effective treatment. Increasing the copper content of Japanese tube feeding formulas should be considered for its prevention.

A systematic review of the evidence for 'myths and misconceptions' in acne management: diet, face-washing and sunlight

BACKGROUND

Lay perceptions that diet, hygiene and sunlight exposure are strongly associated with acne causation and exacerbation are common but at variance with the consensus of current dermatological opinion.

OBJECTIVES

The objective of this study was to carry out a review of the literature to assess the evidence for diet, face-washing and sunlight exposure in acne management.

METHODS

Original studies were identified by searches of the Medline, EMBASE, AMED (Allied and Complementary Medicine), CINAHL, Cochrane, and DARE databases. Methodological information was extracted from identified articles but, given the paucity of high quality studies found, no studies were excluded from the review on methodological grounds.

RESULTS

Given the prevalence of lay perceptions, and the confidence of dermatological opinion in rebutting these perceptions as myths and misconceptions, surprisingly little evidence exists for the efficacy or lack of efficacy of dietary factors, face-washing and sunlight exposure in the management of acne. Much of the available evidence has methodological limitations.

CONCLUSIONS

Based on the present state of evidence, clinicians cannot be didactic in their recommendations regarding diet, hygiene and face-washing, and sunlight to patients with acne. Advice should be individualized, and both clinician and patient cognizant of its limitations.

The perceived effect of various foods and beverages on stool consistency

AIM

Some people believe that chocolate and other foods or beverages may cause constipation. This study was undertaken to quantify the effect of potentially constipating foods and beverages on apparently healthy and constipated populations of German individuals.

METHODS

A questionnaire asking for the effect of certain foods and beverages on stool form (perceived consistency) was answered by 200 healthy controls, 122 patients with chronic constipation, and 766 patients with irritable bowel syndrome with constipation (IBS-C).

RESULTS

Patients with constipation or IBS-C reported altered stool form after food and beverage consumption more often than controls (controls 42.5% vs constipation 52.0% vs IBS-C 57.0%, P < 0.001). Controls experienced hardening of stools less often and experienced softening more often than either constipation or IBS-C patients. When patients were asked which foods or beverages caused constipation (open ended question), chocolate was most frequently mentioned, followed by white bread and bananas. The results of systematic questioning yielded chocolate (48-64% of respondents), bananas (29-48%), and black tea (14-24%) as constipating, while prunes (41-52%), coffee (14-24%), wine (8-30%), beer (14-24%), and smoking (42-70% in those who smoked) were considered stool softeners.

CONCLUSION

Several foodstuffs may exert an effect on stool consistency. Chocolate, bananas and black tea are perceived to cause constipation, while prunes are perceived to soften stools in many people. Coffee, wine and beer were perceived to soften stools in a minority of people. Cigarettes are perceived to soften stools by about half of the smokers.

Itch and skin rash from chocolate during fluoxetine and sertraline treatment: case report

BACKGROUND

The skin contains a system for producing serotonin as well as serotonin receptors. Serotonin can also cause pruritus when injected into the skin. SSRI-drugs increase serotonin concentrations and are known to have pruritus and other dermal side effects.

CASE PRESENTATION

A 46-year-old man consulted his doctor due to symptoms of depression. He did not suffer from any allergy but drinking red wine caused vasomotor rhinitis. Antidepressive treatment with fluoxetine 20 mg daily was initiated which was successful. After three weeks of treatment an itching rash appeared. An adverse drug reaction (ADR) induced by fluoxetine was suspected and fluoxetine treatment was discontinued. The symptoms disappeared with clemastine and betametasone treatment. Since the depressive symptoms returned sertraline medication was initiated. After approximately two weeks of sertraline treatment he noted an intense itching sensation in his scalp after eating a piece of chocolate cake. The itch spread to the arms, abdomen and legs and the patient treated himself with clemastine and the itch disappeared. He now realised that he had eaten a chocolate cake before this episode and remembered that before the first episode he had had a chocolate mousse dessert. He had never had any reaction from eating chocolate before and therefore reported this observation to his doctor.

CONCLUSIONS

This case report suggests that there may be individuals that are very sensitive to increases in serotonin concentrations. Dermal side reactions to SSRI-drugs in these patients may be due to high activity in the serotonergic system at the dermal and epidermo-dermal junctional area rather than a hypersensitivity to the drug molecule itself.

Platelet function abnormalities in qualified whole-blood donors: effects of medication and recent food intake

BACKGROUND AND OBJECTIVES

Platelet function abnormalities have been reported in blood donors who have not consumed aspirin. Our objective was to identify factors other than aspirin that may contribute to impaired platelet function in qualified volunteer blood donors.

MATERIALS AND METHODS

Blood samples were obtained from 24 donors following routine blood donation. Donors completed a study questionnaire that included questions about recent food consumption, medication and medical history. Platelet activation was measured using monoclonal antibodies and flow cytometry. CD62P expression and PAC-1 binding on platelets were used as indicators of platelet activation. Platelet function was measured on a platelet function analyser (PFA-100) using both collagen/epinephrine (cEPI) and collagen/ADP (cADP) cartridges.

RESULTS

Fifty-four per cent of donors (13 of 24) had normal platelet function. Thirty-eight per cent (nine of 24) had prolonged cEPI closure times, of whom four (17%) had no cEPI closure (> 300 seconds). No closure was associated with aspirin use (two donors) or chocolate consumption (two donors) before donation. Two donors (8%) had either a shortened cEPI or cADP closure time.

CONCLUSIONS

Platelet dysfunction in qualified blood donors is underestimated. Platelet function screening can identify donors with diet-related platelet dysfunction or with poor recollection of aspirin use.

Intolerance to dietary biogenic amines: a review

OBJECTIVE

To evaluate the scientific evidence for purported intolerance to dietary biogenic amines.

DATA SOURCES

MEDLINE was searched for articles in the English language published between January 1966 and August 2001. The keyword biogenic amin* was combined with hypersens*, allerg*, intoler*, and adverse. Additionally, the keywords histamine, tyramine, and phenylethylamine were combined with headache, migraine, urticaria, oral challenge, and oral provocation. Articles were also selected from references in relevant literature.

STUDY SELECTION

Only oral challenge studies in susceptible patients were considered. Studies with positive results (ie, studies in which an effect was reported) were only eligible when a randomized, double-blind, placebo-controlled design was used. Eligible positive result studies were further evaluated according to a number of scientific criteria. Studies with negative results (ie, studies in which no effect was reported) were examined for factors in their design or methods that could be responsible for a false-negative outcome. Results of methodologically weak or flawed studies were considered inconclusive.

RESULTS

A total of 13 oral challenge studies (5 with positive results and 8 with negative results) were found. Three of them (all with positive results) were considered ineligible. By further evaluation of the 10 eligible studies, 6 were considered inconclusive. The 4 conclusive studies all reported negative results. One conclusive study showed no relation between biogenic amines in red wine and wine intolerance. Two conclusive studies found no effect of tyramine on migraine. One conclusive study demonstrated no relation between the amount of phenylethylamine in chocolate and headache attacks in individuals with headache.

CONCLUSIONS

The current scientific literature shows no relation between the oral ingestion of biogenic amines and food intolerance reactions. There is therefore no scientific basis for dietary recommendations concerning biogenic amines in such patients.

Photosensitivity in feedlot calves apparently related to cocoa shells

Primary photosensitization was observed in 11/78 cross-breed calves. The skin lesions were diffuse dermatitis with thickening and wrinkling with areas of alopecia. The severe photosensitivity dermatitis was associated with cocoa shell ingestion. The lesions resolved after removal of the cocoa shells from the feed ration and prevention of exposure to sunlight. Cocoa shells may contain photodynamic agents that cause photosensitization in calves.

Food and headache attacks. A comparison of patients with migraine and tension-type headache

BACKGROUND

The role of foods as headache precipitants is still matter of debate. Several studies reported that dietary constituents may precipitate migraine attacks. Some authors reported that also tension type headache attacks may be provoked by foods. The purpose of this study was to evaluate the role of foods as headache triggers in both groups of patients.

METHODS

We compared the role of foods as headache trigger in patients with migraine and tension type headache. Three hundred and nine patients were involved in the study and divided into six groups: 1) migraine without aura, 2) migraine with aura, 3) episodic tension type headache, 4) chronic tension type headache, 5) migraine without aura associated with episodic tension type headache, 6) migraine without aura associated with chronic tension type headache.

RESULTS

Approximately one third of the patients reported susceptibility to certain foods. The percentage of food sensitivity was not significantly different between patients with migraine or tension type headache. The foods more commonly reported as headache triggers were alcoholic drinks, chocolate and cheese. No difference in specific food sensitivity between groups was found. The comparison of food-sensitive with food non-sensitive patients showed no significant difference in the clinical features.

CONCLUSIONS

Our study suggests that foods may trigger not only migraine but also tension type headache attacks.

Pharmacologic effects of cocoa and rye flour extracts on isolated guinea pig trachea

Confectionery workers are exposed to a wide variety of organic dusts and aerosols. Previous studies with workers in a confectionery plant working with cocoa and rye flour indicate that these workers are at risk of developing adverse respiratory symptoms and lung function impairment. The effects of cocoa and rye flour extract on isolated guinea pig tracheal smooth muscle were studied using water-soluble extracts from cocoa and rye flour obtained from the studied confectionery plant. Dose-related contractions of nonsensitized guinea pig tracheal rings were demonstrated using both cocoa and rye flour extracts. Pharmacologic studies were performed by pretreating guinea pig tracheal tissue with drugs known to modulate smooth muscle contraction: atropine, indomethacin, pyrilamine, nordihydroguaiaretic acid (NDGA), acivicin, bromophenacyl bromide (BPB), 3,4,5-trimethoxybenzoate 8-(N,N-diethylamino)octyl ester (TMB8), captopril, and capsaicin. Constrictor effects of the dust extracts were inhibited by these agents, the pattern of which depended on the dust extract. Atropine consistently and significantly reduced the contractile effects of both extracts. These observations suggest a release of parasympathetic mediators by these extracts or more directly an interaction with muscarinic receptors. In addition, the constrictor effect of cocoa and rye flour extracts was significantly, but only partially, reduced by indomethacin, pyrilamine, BPB, and TMB8. Acivicin also partially decreased the constrictor effect of cocoa extract. Pretreatment of tracheal tissue with capsaicin also decreased the constrictor effects of high concentrations of cocoa and rye flour extracts. Data suggest that cocoa and rye flour extracts cause a dose-related constriction of airway smooth muscle by non immunological mechanisms involving cholinergic pathways and airway mediators such as histamine and the products of the arachadonic acid cascade. This effect is not dependent on the presensitization of guinea pigs.

[Some clinical symptoms and allergens on asthma-prurigo syndrome]

The group of 146 patients suffering from asthma-prurigo syndrome (85 adults and 64 children) have been inquired in many various clinical centers. It was established that in 79.6% of the patients the first symptoms of illness appeared already in infancy and only 28.2% of the patients had negative familiar anamnesis on the allergy. In 73.2% of the patients with asthma-prurigo syndrome the symptoms of atopic dermatitis persisted longer than asthma symptoms and in 89.9% of them asthma-prurigo symptoms accompanied other form of allergic diseases. The most important causal allergens provoking asthma-prurigo symptoms were: house dust (in 64.4% of the patients), chocolate (in 42.2%), cat epithelia (in 40.2%) and cow milk proteins (in 29.5% of the patients).

Adolescents' knowledge of common foods and drinks and the importance of the pattern of consumption: a study undertaken in an area of high dental needs

OBJECTIVE

To assess the knowledge of adolescents concerning the cariogenic status of a range of foods and drinks. To determine the associations between this knowledge and their awareness of the importance of the ways sugars may be consumed in order to reduce tooth decay.

DESIGN

Self-complete questionnaires assessing the above factors in a cross sectional study.

PARTICIPANTS

Four hundred and fifteen 14-15-year-old young people attending second level schools.

SETTING

North and West Belfast area, Northern Ireland.

OUTCOME MEASURES

Students rated the dental safety of common foods and drinks, and their views on the necessity of reducing all sugars, and avoiding them between meals were recorded.

RESULTS

Correct assessment of harmful items ranged from 96.9% for chocolate and 92.8% for cola to 39.0% for orange squash and 17.8% for plain biscuits. For non-harmful products there were high levels for most items and somewhat lower levels for crisps (57.6%). Significant links were established between this knowledge and children's awareness of the role of eating patterns, although the items involved varied. A majority recognised the importance of eating patterns in relation to dental caries.

CONCLUSION

Health educators should be aware that many adolescents have poor knowledge of the cariogenic status of some of the foods and drinks they consume and some are unsure of the importance of eating patterns.

Childhood caffeine tic syndrome

OBJECTIVE

To determine whether caffeine ingestion was temporally correlated with tics in 2 healthy children.

METHODS

Two first-degree cousins were observed over a period of approximately 3 years, and the presence and absence of tics was recorded and correlated with consumption of or abstinence from caffeinated foods or beverages.

RESULTS

Appearance and disappearance of tics were closely and clearly temporally correlated with ingestion and elimination of caffeine in the cousins' diets.

CONCLUSIONS

Our observations suggest that caffeine may precipitate tics in susceptible children.

Modern life' in the epidemiology of inflammatory bowel disease: a case-control study with special emphasis on nutritional factors

OBJECTIVE

The rising incidence of inflammatory bowel disease (IBD) since the Second World War coincides with profound changes of the dietary pattern. The aim of the study was to investigate the possible pathogenic role of some characteristic 'modern life' dietary factors in IBD.

DESIGN

Case-control, studying risk factors in recently diagnosed cases, 290 with Crohn's disease and 398 with ulcerative colitis, compared with 616 population controls. Smoking, age, gender and education were taken into account by using logistic regression analysis.

SETTING

Hospital cases and population controls.

INTERVENTIONS

Questionnaires.

MAIN OUTCOME MEASURES

Logistic regression-derived odds ratios.

RESULTS

A positive association with cola drinks [OR: 2.2 (95% CI 1.5-3.1)], chewing gum [OR: 1.5 (95% CI: 1.1-2.1)] and chocolate consumption [OR: 2.5 (95% CI: 1.8-3.5)] and a negative association with citrus fruit consumption [OR: 0.5 (95% CI 0.3-0.7)] and the development of Crohn's disease were found. Consumption of cola drinks [OR: 1.6 (95% CI 1.1-2.3)] and chocolate consumption [OR: 2.5 (95% CI 1.8-3.5)] were positively associated with developing ulcerative colitis. There was a negative association between the intake of citrus fruits [OR: 0.5 (95% CI 0.4-0.8)] and 'having a stuffed pet' for a period longer than 5 years [OR: 0.6 (95% CI 0.4-0.9)] and developing the disorder. No association with the frequency of tooth brushing and developing IBD was found.

CONCLUSION

All the nutritional items mentioned may be true risk factors or they just might be the expression of a modern life-style also involving other risk factors for the development of IBD which at the present are still unknown.

A double-blind provocative study of chocolate as a trigger of headache

A provocative double-blind study of headache was performed using chocolate as the active agent and carob as the placebo. The chocolate and carob samples were formulated to duplicate products used in an earlier study (1) in which strong differential effects between the ability of chocolate and carob to trigger headache in migraine were shown. Sixty-three women with chronic headache (50% migraine, 37.5% tension-type, 12.5% combined migraine and tension-type) participated in the study. After 2 weeks of following a diet that restricted vasoactive amine-rich foods, each subject underwent double-blinded provocative trials with two samples of chocolate and two of carob presented in random order. Diaries were maintained by the subjects throughout the study, monitoring diet and headache. The results demonstrated that chocolate was not more likely to provoke headache than was carob in any of the headache diagnostic groups (chi2(2)=0.36, p=0.83). Interestingly, these results were independent of subjects' beliefs regarding the role of chocolate in the instigation of headache (chi2(1)=0.73, p=0.39). Headache diagnosis and the concomitant use of additional vasoactive amine-containing foods were also not associated with chocolate acting as a headache trigger. Thus, contrary to the commonly held belief of patients and physicians, chocolate does not appear to play a significant role in triggering headaches in typical migraine, tension-type, or combined headache sufferers.

Maternal intake of cruciferous vegetables and other foods and colic symptoms in exclusively breast-fed infants

OBJECTIVE

We sought to assess relationships among components of maternal diet and the presence of colic symptoms among exclusively breast-fed infants aged < or = 4 months.

DESIGN

Data were collected by means of a mailed questionnaire that solicited information on the presence of symptoms of colic in infants and maternal intake of 15 foods (including four cruciferous vegetables) during the week before completion of the questionnaire.

SUBJECTS

Exclusively breast-feeding women (n = 272) and their 273 infants aged < or = 4 months.

STATISTICAL ANALYSES PERFORMED

Dietary variables were analyzed categorically by logistic regression. Two-by-two tables were used to calculate relative risks.

RESULTS

Relative risks (RRs) and 95% confidence intervals (CIs) for colic symptoms by food items the mothers consumed ranged from 0.7 (CI = 0.3 to 1.5) for beef to 2.0 (CI = 1.1 to 3.5) for cow's milk. Maternal intake of cabbage (RR = 1.3, CI = 1.1 to 1.5), cauliflower (RR = 1.2, CI = 1.0 to 1.4), broccoli (RR = 1.3, CI = 1.0 to 2.2), cow's milk (RR = 2.0, CI = 1.1 to 3.5), onion (RR = 1.7, CI = 1.1 to 2.5), and chocolate (RR = 1.5, CI = 1.0 to 2.2) were significantly related to colic symptoms. Maternal intake of more than one cruciferous vegetable was associated with an RR of 1.6 (CI = 1.1 to 2.4) for infants experiencing one or more colic symptoms.

CONCLUSION

Results of this study provide initial evidence that maternal intake of cruciferous vegetables, cow's milk, onion, or chocolate during exclusive breast-feeding is associated with colic symptoms in young infants.