Clinical Monitor
33 September 2010
by Kerry Bone
Green Tea in CLL and Prostate Cancer
Recent clinical studies suggest a potentially valuable
role for green tea extracts in patients with chronic
lymphocytic leukaemia (CLL) and prostate cancer.
Extracts standardised for green tea catechins (GTCs)
were generally studied.
In the case of CLL, the Mayo clinic initiated a small
phase I trial1 after the report of 4 cases of remission or
regression of the disease during green tea
consumption.2 The proprietary green tea extract used
was relatively well-tolerated over the dosage range
tested. Declines in lymphocyte count and/or
lymphadenopathy were observed in the majority of
patients. Specifically, among the 12 patients with
palpable lymphadenopathy at the beginning of the
trial, 11 (92%) experienced at least a 50% reduction.
Following this highly promising phase I dose-finding
trial, a phase II trial was initiated. A relatively high dose
of extract (containing 4000 mg/day of the major green
tea catechin epigallocatechin 3-gallate (EGCG)) was
selected for this open-label study. This was the highest
dose used in the phase I trial. The phase II trial is
currently under way, but preliminary results were
recently released at the annual meeting of the
American Society of Clinical Oncology.3 Thirty-one
patients had completed 6 months of green tea
treatment at the time of reporting, with another 11 still
part way through the trial. One patient has experienced
a partial remission, 31% demonstrated a sustainable
lowering of lymphocyte count and 66% a reduction of
more than 50% in lymphadenopathy. Such a massive
dose of green tea extract was not without its
drawbacks: 43% of patients exhibited elevated liver
enzymes (transaminitis), 30% experienced abdominal
pain and 57% complained of nausea.
High-grade prostatic intraepithelial neoplasia (HG-PIN)
is the main premalignant lesion of prostate cancer. It is
associated with a substantial risk for subsequent
prostate cancer development over a 1-year period
(around 30%). At present no conventional medical
treatment is offered for HG-PIN if it is detected in a
prostatic biopsy. Following some promising results from
experimental models, a group of Italian scientists
initiated a double blind, placebo-controlled, proof-of-
© Copyright 2010 MediHerb. Not for Public Distribution. For Education of Health Care Professionals Only.
e-Monitor No.
principle clinical study into the potential role of a green
tea extract in patients with HG-PIN.4 Sixty men received
either a placebo or 600 mg/day of GTCs for one year.
At the end of the trial only one tumour was diagnosed
in the green tea group (3% incidence) versus 9 in the
control group (30% incidence) (p < 0.01 for green tea
versus placebo). Prostate specific antigen (PSA) levels
did not change significantly, although they were lower
in the green tea group at 9 and 12 months. There were
improvements in the International Prostate Symptom
Score (IPSS) and quality of life score in men with
coexistent benign prostatic hyperplasia receiving green
tea, reaching statistical significance for IPSS (p < 0.05).
A key question that arose from this study was whether
the progression to prostate cancer was merely delayed
by the green tea intervention. Hence the authors
initiated a follow-up study two years later in a subset
of 22 men from the initial study (9 from the placebo
arm and 13 from the green tea arm).5 Neither group
had received any green tea supplementation over the
two years. In all, three more prostate cancers were
detected following biopsy, two in the placebo group
and another one in the green tea group. The final
difference in cancer prevalence was highly statistically
significant (p < 0.01) and suggested that one year of
green tea consumption provided a long-lasting 80%
protection against prostate cancer progression from HG-
PIN.
Comment
While the dose of green tea used in the Mayo phase II
trial was highly effective in CLL, the observed side
effects are not surprising from such a high dose. GTCs
are basically hydrolysable tannins, which in high doses
can act as gastrointestinal irritants, causing abdominal
pain and nausea.6 The observed liver damage has also
been described for green tea extracts, especially those
prepared with solvents other than hot water (see
e-Monitor No. 20 March 2008). However, the trial
results are still a very encouraging finding. It should
also be kept in mind that the initial 4 positive case
reports that triggered the clinical trial did not involve
very high intakes of GTCs. Hence lower and safer doses
of green tea are probably still beneficial in CLL,
especially perhaps if taken over a longer period of
time.
1

The fact that green tea can reduce the progression of a
precancerous lesion such as HG-PIN is a very impressive
finding that possibly reflects on a broader strength of
phytotherapy. The dose used in the study is readily
achieved via the use of GTC supplements alone, or in
combination with green tea taken as a beverage.
Unfortunately, the authors do not provide any data
concerning the regression of HG-PIN in the study
participants. However, this was investigated in a
recently published study. A complex protocol, mainly
involving an anti-inflammatory herbal formula
(rosemary, turmeric, ginger, holy basil, green tea,
Polygonum, Coptis, barberry, oregano and Baical
skullcap), was evaluated over 18 months in 23 men
with HG-PIN in an open-label trial.7 The mean starting
PSA was 6.13 ± 3.56 ng/mL and by the end of the trial
48% of the men demonstrated a 25 to 50% reduction
in this parameter. Of the 15 participants who had the
18-month biopsy, 60% had regressed to benign, 27%
still had HG-PIN and only 13% had progressed to
prostate cancer (Gleason Score 6), against an expected
progression rate of greater than 30%. Interestingly, key
markers of inflammation in prostatic tissue, namely
serum C-reactive protein and NF-κB, were significantly
reduced by the treatment protocol, as assessed from
biopsy specimens.
REFERENCES
1 Shanafelt TD, Call TG, Zent CS et al. J Clin Oncol 2009; 27(23):
3808-3814
2 Shanafelt TD, Lee YK, Call TG et al. Leuk Res 2006; 30(6): 707-712
3 Shanafelt TD, Call T, Zent S et al. J Clin Oncol 200; 28(15 Suppl):
Abstract 6522
4 Bettuzzi S, Brausi M, Rizzi F et al. Cancer Res 2006; 66(2): 1234-
1240
5 Brausi M, Rizzi F, Bettuzzi S. Eur Urol 2008; 54(2): 472-473
6 Mills S, Bone K. Principles and Practice of Phytotherapy: Modern
Herbal Medicine. Churchill Livingstone, Edinburgh, 2000, pp 34-
37.
7 Capodice JL, Gorroochurn P, Cammack S et al. J Soc Integr Oncol
2009; 7(2): 43-51
St Mary’s Thistle: Safe and Effective
around Chemotherapy?
St Mary’s thistle (Silybum marianum), especially as the
concentrated extract containing a defined level of the
silymarin complex of flavanolignans, is being
increasingly prescribed by herbal clinicians around
cancer chemotherapy. It is mainly being used to assist
detoxification after chemotherapy, for liver protection
during chemotherapy and to ameliorate any long-term
effects of cancer treatment.1 The aim is to not only
improve quality of life, but also to favourably affect
treatment outcomes, since the patient might be able to
better tolerate chemotherapy at the optimum dose.
However, concerns are often expressed in the
mainstream medical literature that herbs (especially
© Copyright 2010 MediHerb. Not for Public Distribution. For Education of Health Care Professionals Only.
e-Monitor No. 33 September 2010
antioxidant herbs) should not be used in conjunction
with chemotherapy because they might compromise
cytotoxic effects on cancer cells. Also, there is the
added concern for St Mary’s thistle that its detoxifying
properties might lead to increased clearance of cancer
drugs.
A recently-published clinical trial is an encouraging
development in this debate. In this double blind,
placebo-controlled trial, 50 children (1 to 21 years)
with acute lymphoblastic leukaemia (ALL) were
randomly assigned to receive a proprietary St Mary’s
thistle extract or placebo over a period of 28 days
during maintenance chemotherapy.2 Chemotherapy is
frequently interrupted in the treatment of children with
ALL because of liver toxicity, especially during the
maintenance phase of treatment. The extract contained
only two compounds from the flavanolignan complex,
namely silybin A and B (target dose for trial
participants 5.1 mg/kg/day), together with soy
phosphatidylcholine (to improve bioavailability). The
intravenous chemotherapy drugs administered to the
children included vincristine, prednisone, methotrexate
and 6-mercaptopurine. No significant differences in
frequency of side effects, incidence and severity of
toxic reactions, infections or liver parameters were
observed at the end of the trial (Day 28). However, by
Day 56 the St Mary’s thistle group had a significantly
lower aspartate transaminase (AST, p = 0.05) and a
trend toward a significantly lower alanine transaminase
(ALT, p = 0.07) compared to baseline. AST in the
treatment arm was also significantly different to
placebo at Day 56 (p = 0.04). Although not significant,
chemotherapy doses had to be reduced in 61% of the
St Mary’s thistle group, compared to 72% for placebo.
These results occurred despite the relatively poor
treatment compliance: adherence to St Mary’s thistle
treatment was just 68%, versus 96% for placebo
(p = 0.02). Younger children exhibited better
compliance than teenagers. The concurrent use of St
Mary’s thistle did not appear to compromise the
activity of the chemotherapy drug cocktails.
In addition to the above finding, there have been
several clinical studies published in the last decade that
have sought to understand any potential interaction of
St Mary’s thistle extract with prescribed drugs. The
majority of studies have found no or minimal
interaction. Perhaps surprisingly, given that the herb is
regarded as a “detoxifying” agent, any significant
effects that have been demonstrated generally reflect
on decreased, not increased, drug metabolism.
One highly relevant study evaluated the impact of St
Mary’s thistle on human cytochrome P450 (CYP)
activity using various probe drug cocktails.3 St Mary’s
thistle extract (350 mg/day standardised to 80%
silymarin) for 28 days had no impact on CYP1A2,
2
 e-Monitor No. 33 September 2010

CYP2D6, CYP2E1 and CYP3A4. These CYP enzymes are Comment

involved in the metabolism of many common drugs,
There is an earlier case study from 1993 where St
including those used in cancer chemotherapy, CYP3A4
Mary’s thistle extract (800 mg/day) was given to a 34-
is especially important. A meta-analysis of 3 trials
year-old female patient with acute promyelocytic
involving concurrent use of St Mary’s thistle (450 to
leukaemia.13 Maintenance chemotherapy for this type
525 mg/day of a typical 80% silymarin extract for 12
of leukaemia with drugs such as methotrexate and 6-
to 28 days) and the anti-HIV drug indinavir found no
mercaptopurine also leads to potential problems with
impact on drug levels.4 St Mary’s thistle (600 mg/day
liver toxicity. The patient was started on such a regime,
of an 80% silymarin extract) for 4 or 12 days had no
but therapy was only intermittent due to her elevated
impact on the metabolism of the anticancer drug
liver enzymes. During 4 months of St Mary’s thistle
irinotecan in 6 cancer patients.5 By studying the herb
treatment in combination with maintenance
bioavailability and drug metabolites, the authors
chemotherapy, liver enzymes were maintained at
concluded that silybin concentrations in plasma were
normal levels for the first time ever for this patient.
too low to significantly affect the function of the phase
From this case study it might be reasonably concluded
I enzyme CYP3A4 and the phase II enzyme UGT1A1.
that high-end doses of a normal (as opposed to a
They noted that irinotecan is highly susceptible to
combination with soy phosphatidylcholine) St Mary’s
CYP3A4 inhibition (which silymarin demonstrates in
thistle extract should also be able to counter
vitro) and concluded that the herbal extract: “... poses
chemotherapy toxic effects.
little risk of interfering with the pharmacokinetic profile
of chemotherapeutic agents that are substrates for
The majority of human clinical herb-drug interaction
CYP3A4 and UGT1A1.”. A similar conclusion (that St
studies show that St Mary’s thistle is not likely to
Mary’s thistle is not a potent CYP3A4 inducer) was
interfere with drug metabolism. If it does interact at all
reached after a short-term study of the impact of the
this typically results in increased, not reduced, drug
herbal extract on the calcium channel blocking drug
levels. Also it should be noted that the occasional
nifedipine in 16 healthy male volunteers.6
effects observed on P-gp induction are not likely to
impact on levels of intravenously administered drugs.
Interference with transporter proteins such as P-
Clearly the possibility that St Mary’s thistle will reduce
glycoprotein (P-gp) can also result in significant herb-
the efficacy of chemotherapeutic drugs by increasing
drug interactions, as is the case for St John’s wort,
their clearance from the body is rather unlikely on
(Hypericum perforatum). In this context it was found
current evidence. While it might instead result in
that 900 mg/day of St Mary’s thistle extract for 14 days
increased drug levels, such an effect is not likely to be
had a small and non-significant impact on digoxin
large for the more aggressive doses used during
pharmacokinetics in 16 healthy volunteers.7 In contrast,
intravenous chemotherapy. However, for added safety
an Indian study found that levels of the antibiotic drug
St Mary’s thistle extract is probably best used in
metronidazole were significantly reduced by just
conjunction with other non-specific antitoxic herbs such
140 mg/day of St Mary’s thistle extract for 9 days, due
as adaptogens.
to suspected induction of intestinal and perhaps hepatic
expression of P-gp and CYP3A4.8 This is the only human
A final point worth noting is the existence of several in
herb-drug interaction study for St Mary’s thistle that
vitro studies that show the silymarin complex
has found reduced drug levels, so clearly this study
potentiates the action of chemotherapeutic drugs on
needs to be repeated. Also induction of P-gp was the
cancer cells. For example, silymarin exerted synergistic
proposed mechanism, in contrast with other studies
effects on the antiproliferative activities of doxorubicin
that found inhibition of or no effect on this transporter
and paclitaxel in both sensitive and (at higher silymarin
(see immediately below and above).
concentrations) multidrug-resistant (MDR) colon cancer
cells.14 Silymarin is a known inhibitor of cellular MDR
A few studies have demonstrated increased drug
pumps that confer resistance to toxins and, in the case
levels. For example 420 mg/day of St Mary’s thistle
of bacteria, antibiotics. It also demonstrated
extract (80% silymarin) for 14 days increased levels of
antiproliferative activity on its own.14 Hence the upside
the beta-blocker talinolol by around 36%.9 Inhibition of
is that St Mary’s thistle might not just be a passive
P-gp was suggested as a possible mechanism. The
bystander during cancer chemotherapy. At the very
same authors also found that St Mary’s thistle extract
least these studies cast doubt on the proposition that
at the same dose appeared to inhibit the metabolism
the herb will reduce the cytotoxic activity of
of the hypotensive drug losartan in individuals with a
chemotherapeutic drugs.
particular CYP2C9 genotype.10 Two other studies have
shown reduced clearance of ornidazole11 and
REFERENCES
sirolimus.12 1 Greenlee H, Abascal K, Yarnell E et al. Integr Cancer Ther 2007;
6(2): 158-165

© Copyright 2010 MediHerb. Not for Public Distribution. For Education of Health Care Professionals Only. 3
 e-Monitor No. 33 September 2010

2 Ladas EJ, Kroll DJ, Oberlies NH et al. Cancer 2010; 116(2): 506-
513
3 Gurley BJ, Gardner SF, Hubbard MA et al. Clin Pharmacol Ther
2004; 76(5): 428-440
4 Mills E, Wilson K, Clarke M et al. Eur J Clin Pharmacol 2005; 61(1):
1-7
5 van Erp NPH, Baker SD, Zhao M et al. Clin Cancer Res 2005;
11(21): 7800-7806
6 Fuhr U, Beckmann-Knopp S, Jetter A et al. Planta Med 2007;
73(14): 1429-1435
7 Gurley BJ, Barone GW, Williams DK et al. Drug Metab Dispos
2006; 34(1): 69-74
8 Rajnarayana K, Reddy MS, Vidyasagar J et al. Arzneim-Forsch
Drug Res 2004; 54(2); 109-113
9 Han Y, Guo D, Chen Y et al. Xenobiotica 2009; 39(09): 694-699
10 Han Y, Guo D, Chen Y et al. Eur J Clin Pharmacol 2009; 65(6): 585-
591
11 Repalle SS, Yamsani SK, Gannu R et al. Acta Pharm Sci 2009;
51(1): 15-20
12 Jiao Z, Shi XJ, Li ZD et al. Br J Clin Pharmacol 2009; 68(1): 47-60
13 Invernizzi R, Bernuzzi S, Ciani D et al. Haematologica 1993; 78(5):
340-341
14 Colombo V, Lupi M, Falcetta F et al. Cancer Chemother Pharmacol
2010 Apr 30 [Epub ahead of print]

© Copyright 2010 MediHerb. Not for Public Distribution. For Education of Health Care Professionals Only. 4
Clinical Research Review e-Monitor No. 33 September 2010

by Michelle Morgan

Clinical Studies Evaluating Herbs

A clinical study on the management of generalized anxiety disorder with Centella asiatica.
Jana U, Sur TK, Maity LN et al. Nepal Med Coll J 2010; 12(1): 8-11

An uncontrolled trial conducted in India used gotu kola (Centella asiatica) to treat 33 volunteers with generalised
anxiety disorder. They received gotu kola extract (about 9 g/day dried herb equivalent) for 60 days. Participants were
initially assessed for mental status using the Brief Psychiatric Rating Scale. Results using self-assessment questionnaires
revealed significant improvements (p < 0.01) from baseline in anxiety, stress, depression, adjustment and attention at
day 30 and day 60.

Reviewer’s Note: In a previous controlled trial, gotu kola was found to improve calmness, alertness and working
memory in healthy elderly volunteers (J Ethnopharmacol 2008; 116(2): 325-332, see e-Monitor No. 21 May 2008).

Key Finding: Gotu kola has shown benefit in the treatment of generalised anxiety disorder in a preliminary trial.

Effects of Korean red ginseng (Panax ginseng C.A. Mayer) and its isolated ginsenosides and
polysaccharides on arterial stiffness in healthy individuals.
Jovanovski E, Jenkins A, Dias AG et al. Am J Hypertens 2010; 23(5): 469-472

A randomised, double-blind, crossover trial assessed the effect of Korean ginseng (Panax ginseng) and its constituents
on arterial stiffness in healthy volunteers. A single dose of each of the following were administered, with a separation
of at least 3 days between each: placebo; dried, ground Korean ginseng rootlet (3 g); ginsenoside extract (105 mg of
total ginsenosides) and polysaccharide fraction (172 mg of polysaccharides). The amount of ginsenoside and
polysaccharide given in the ginsenoside extract and polysaccharide fraction were equivalent to the amount present in
the dried rootlet. The same batch of dried herb was used to prepare the extract and fraction. Arterial stiffness (as the
augmentation index (AI)) was measured noninvasively using the radial artery. Compared to placebo, radial AI was
significantly lowered by Korean ginseng (4.6%) and ginsenoside fraction (4.8%). Polysaccharides had no effect on radial
AI. There was no effect on blood pressure.

Key Finding: A single-dose study has found that Korean ginseng may improve arterial stiffness. Ginsenosides, and not
polysaccharides, were the active constituents in this regard.

Safety, Adverse Reactions, Herb-Drug Interactions

Genistein aglycone does not affect thyroid function: results from a three-year, randomized,
double-blind, placebo-controlled trial.
Bitto A, Polito F, Atteritano M et al. J Clin Endocrinol Metab 2010; 95(6): 3067-7302

Genistein is an isoflavone present in small quantities in red clover flower (Trifolium pratense). Soy beans (Glycine max)
are also a source of genistein, derived from its glycoside genistin (the sugar group is cleaved in the intestine or upon
fermentation prior to ingestion). Although several trials have not found an adverse effect for isoflavones on the
thyroid, a larger and longer-term trial using genistein was conducted in Italy. Three hundred and eighty-nine
osteopaenic, postmenopausal women received genistein (54 mg/day) or placebo plus calcium and vitamin D3 at

© Copyright 2010 MediHerb. Not for Public Distribution. For Education of Health Care Professionals Only. 5
 e-Monitor No. 33 September 2010

therapeutic doses for 24 months in a randomised, double-blind trial. A subgroup of 138 patients continued treatment
for an additional year. Circulating thyroid hormones (free T3, free T4, thyroid stimulating hormone) were unchanged,
suggesting no changes in thyroid function. There was also no effect on thyroid autoantibodies (thyroid peroxidase,
thyroglobulin, thyroid microsomal antigen) or expression of thyroid hormone receptors and retinoid receptors of
peripheral blood monocytes. Serum total and low-density lipoprotein cholesterol were significantly decreased over 3
years in the genistein group (in comparison to baseline values and the placebo group).

Key Finding: Intake of genistein (54 mg/day) for 2–3 years did not significantly increase the risk of clinical or
subclinical hypothyroidism.

Disease Understanding, Diet, Lifestyle

Anxiety and risk of incident coronary heart disease: a meta-analysis.
Roest AM, Martens EJ, de Jonge P et al. J Am Coll Cardiol 2010; 56(1): 38-46

A meta-analysis investigated the association of anxiety with the incidence of coronary heart disease (CHD) in initially
healthy individuals. Twenty studies comprising 249846 people and a mean follow-up period of 11.2 years provided data
for analysis. Those with anxiety were at significant risk of CHD (hazard ratio: 1.26 i.e. an increase in risk of 26%;
p < 0.0001) and cardiac death (HR: 1.48 i.e. an increase in risk of 48%; p = 0.003). These results were independent of
demographic variables, biological risk factors and health behaviours. There was a nonsignificant trend for an association
between anxiety and nonfatal myocardial infarction.

Adverse effect of paroxetine on sperm.

Tanrikut C, Feldman AS, Altemus M et al. Fertil Steril 2010; 94(3): 1021-1026

In a prospective study undertaken in a medical centre in the United States, healthy men (aged 18–65 years) with
normal semen received an escalating dose of paroxetine over a period of 5 weeks.
• Mean sperm DNA fragmentation was significantly higher for men while on paroxetine (30.3%) compared to
baseline (13.8%).
• The percentage of patients with abnormal DNA fragmentation (TUNEL score greater than or equal to 30%)
increased from 9.7% at baseline to 50% at week 4.
• The odds ratio of having abnormal DNA fragmentation while taking paroxetine was 9.33. The correlation was
confirmed after correcting for age and body mass index.
• Up to 35% of men noted significant changes in erectile function and up to 47% of men reported ejaculatory
difficulties while on medication. Recovery to near-normal sexual function was noted after stopping treatment.
• Standard semen parameters (volume, concentration, motility, morphology) were not significantly altered during
intake of paroxetine. Serum testosterone and oestradiol were decreased, although within the normal range.

White rice, brown rice, and risk of type 2 diabetes in US men and women.
Sun Q, Spiegelman D, van Dam RM et al. Arch Intern Med 2010; 170(11): 961-969

Data from three prospective cohort studies conducted in the United States which involved 39 765 men and 157 463
women was examined for the effect of rice on the risk of type 2 diabetes.
• After adjustment for age and other lifestyle and dietary risk factors, higher intake of white rice (greater than or
equal to 5 servings per week vs less than one serving per month) was associated with a higher risk of type 2
diabetes (relative risk: 1.17 i.e. increase in risk of 17%; p < 0.001 for trend).
• High intake of brown rice (greater than or equal to 2 servings per week vs less than one per month) was associated
with a lower risk of type 2 diabetes (relative risk: 0.89 i.e. decrease in risk of 11%; p < 0.005 for trend).
• Replacing 50 g/d (uncooked, equivalent to one-third serving per day) intake of white rice with the same amount of
brown rice may be associated with a 16% lower risk of type 2 diabetes. The same replacement with whole grains
(which includes brown rice) was associated with a 36% lower diabetes risk.

© Copyright 2010 MediHerb. Not for Public Distribution. For Education of Health Care Professionals Only. 6
 e-Monitor No. 33 September 2010

Calcium absorption in Australian osteopenic post-menopausal women: an acute comparative

study of fortified soymilk to cows' milk.
Tang AL, Walker KZ, Wilcox G et al. Asia Pac J Clin Nutr 2010; 19(2): 243-249

Milk made from soy beans inherently contains less calcium than cow’s milk. Manufacturers often add calcium to soy
milk to address this. There is some questioning as to whether such calcium is absorbed efficiently. A randomised,
single-blind, crossover trial conducted in Australia compared calcium absorption from a fortified soy milk with
absorption from cow’s milk. Twelve osteopaenic postmenopausal women who had not received hormone replacement
therapy within the previous 12 months participated by drinking a 20 mL test sample of each milk on two occasions,
separated by a washout period of at least 3 weeks. The hourly fractional calcium absorption rate from fortified soy milk
was found to be comparable to that of cow’s milk.

Housing, Heating and Health Study Research Team. More effective home heating reduces
school absences for children with asthma.
Free S, Howden-Chapman P, Pierse N et al. J Epidemiol Community Health 2010; 64(5): 379-386

New Zealand homes are underheated by international standards, with average indoor temperatures below the World
Health Organization recommended minimum of 18 °C. A randomised, single-blind, controlled trial investigated the
connection between low indoor temperatures and a particular adverse health outcome: school absence for children with
asthma. The trial included 409 households containing an asthmatic child aged 6-12 years, where the previous heating
was an open fire, plug-in electric heater or unflued gas heater. A more effective heater of at least 6 kW was installed
before the winter of 2006 in half the houses. The control group received a replacement heater at the end of the trial.
Compared with the control group, children in households receiving the intervention experienced on average 21%
(p = 0.02) fewer days of absence from school during winter. Results reported in a previous publication (BMJ 2008; 337:
a1411) indicate that symptoms of asthma were also reduced.

Television- and screen-based activity and mental well-being in adults.

Hamer M, Stamatakis E, Mishra GD. Am J Prev Med 2010; 38(4): 375-380

The association between leisure-time sedentary behaviour (measured by television- and screen-based entertainment
(TVSE) time) and mental health was examined in the 2003 Scottish Health Survey, using a nationally representative
sample of 3920 men and women. About 25% of participants engaged in at least 4 hours/day of TVSE. An independent
association between leisure-time sedentary behaviour and lower scores on two measures of mental health (General
Health Questionnaire, Mental Health Component) was found. The finding was independent of physical activity level and
physical function. Adjustment for basic indicators of healthy eating such as fruit and vegetable consumption did not
substantially alter the results (although further study is required).

Effect of pranayama & yoga-asana on cognitive brain functions in type 2 diabetes-P3 event
related evoked potential (ERP).
Kyizom T, Singh S, Singh KP et al. Indian J Med Res 2010; 131: 636-640

Delayed cognition can be observed in diabetes mellitus using the electrophysiological measurement of evoked
potentials, specifically P300. The P300 wave is a component of cerebral evoked response that assesses cognitive
processes underlying attention allocation and updating of memory. A controlled study in India assessed the effect of
yoga in patients with type 2 diabetes who were receiving conventional medical therapy (most commonly oral
hypoglycaemic drugs). The yoga group was taught pranayama (breathing exercises) and yoga asana (postures) and
were recalled weekly for supervision. Baseline recordings of P300 and blood glucose were taken at the time of
recruitment and second recordings repeated after 45 days for both groups (yoga and control). The control group merely
maintained their medication. Blood glucose decreased in both groups, but the reduction was statistically significant only
for the yoga group. Statistically significant improvement in the latency and the amplitude of P300 was observed in the
yoga group as compared to the control group. This indicates that yoga has a beneficial effect on P300 and in

© Copyright 2010 MediHerb. Not for Public Distribution. For Education of Health Care Professionals Only. 7
 e-Monitor No. 33 September 2010

conjunction with conventional medical therapy such as oral hypoglycaemic drugs, may improve cognitive function in
diabetics.

© Copyright 2010 MediHerb. Not for Public Distribution. For Education of Health Care Professionals Only. 8