Americans Low In Vitamin E

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didyouknow?Royal River Natural Foods, a locally-owned independent natural health store in Freeport, Maine, reports a new study that found people of all ages are low in vitamin E, and particularly those 20 to 30 years old. Vitamin E may extend life, aid the brain, and help ensure healthy reproduction.

The report is part of the January 2016, issue of “Natural Insights for Well Being®”, which Royal River Natural Foods publishes free each month to help inform the Freeport community of the latest scientific discoveries in nutrition. Also in the January issue, college students with depression saw symptoms subside after taking omega-3 fish oil capsules for three weeks and postmenopausal women who continued taking vitamin D after stopping hormone replacement therapy were 26 percent less likely to develop breast cancer compared to women who stopped taking or who had never taken vitamin D, among other important findings.

“The findings this month are important for young adults looking to start a family, for students who want to do well in school, or women who want to reduce chances of breast cancer,” said Becky Foster, supplement manager. “New findings this month include studies from scientific journals such as the ‘Journal of the Public Library of Science – One,’ the ‘Journal of Nutrition,’ and the ‘Journal of Applied Physiology,’ among others.”

“Natural Insights for Well Being®” is free, and Royal River Natural Foods invites all those who wish to gain more valuable nutrition knowledge to stop in and pick up the January issue and meet the friendly, knowledgeable staff.

About the company:
Founded in 1994, Royal River Natural Foods is a unique community, natural food store. They are committed to well-being, body and soul. Experience their outstanding customer service in a warm and welcoming environment. Royal River Natural Foods proudly features local organic food, produce, locally-raised beef, chicken, lamb, pork and seafood, healthy takeout foods, bulk foods, snacks, special dietary products, specialty wines, micro-brewed beers, gourmet food made in Maine, unique gifts, eco-friendly products and much more. Royal River Natural Foods is committed to providing local, organic and sustainably-produced foods that enrich their customers’ lives. For more information about Royal River Natural Foods, visit their website at http://www.rrnf.com.

Radiofrequency Nerve Ablation: What’s In It For You?

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This article is courtesy of PRWeb, please share your comments below…..

didyouknow?Dr. Kaixuan Liu with Atlantic Spine Center explains differences, similarities between ablation and rhizotomy procedures and offers tips for understanding benefits.

Strangely enough, getting rid of back pain can involve using a lot of unusual words, such as “radiofrequency nerve ablation” or “facet rhizotomy.” In this case, however, both terms are closely related – and both can deaden chronic back pain by zapping painful nerves along the spine, according to Kaixuan Liu, MD, PhD, founder and president of Atlantic Spine Center.

Radiofrequency nerve ablation (RFA) is an emerging technique that can offer back or neck pain relief for up to 18 months. Similarly for facet rhizotomy, just one of many forms of radiofrequency ablation using a heated probe to disrupt pain signals from the spinal nerves to the brain.

“Radiofrequency uses heat to disrupt the nerves conducting pain signals, while rhizotomy can also be performed using laser energy,” explains Dr. Liu, who is fellowship-trained in minimally invasive spine surgery. “But either way, the advantages to patients are many: Prolonged pain relief with a minimally invasive, quick procedure that boasts a high success rate and a rapid recovery.”

Conditions treated with radiofrequency nerve ablation

Adding to the similarities between the two procedures, some of the same back conditions can be treated using RFA, including:

* Spinal arthritis

* Facet arthritis, which occurs in the spinal joints that enable bending and twisting

* Whiplash injury

All RFA patients have one thing in common: long-lasting low back or neck pain that hasn’t been eradicated by using more conservative measures, such as medication or physical therapy. Remarkably the procedure itself is fairly simple: In a surgical center, using mild sedation and local anesthesia, a physician correctly positions the radiofrequency ablation probe with x-ray guidance. After it’s placed along the affected nerves, an electrical current produced by a radio wave heats up a small area of nerve tissue, deadening pain signals there.

Facet rhizotomy is performed similarly, but may also be used for failed back surgery syndrome or facet hypertrophy, a degeneration of the facet joints. “When it’s done, patients get right up and walk around,” Dr. Liu explains. “Side effects are minimal, but the benefits can be huge.”

Tips for understanding the benefits

What are the benefits of RFA? Completed without damaging surrounding muscles or soft tissue, like traditional “open” spine surgery, RFA offers relatively long term (typically 6 months – 1 year) pain relief. Dr. Liu lists its many benefits, including:

* Minimally invasive, requiring only a tiny incision

* No blood loss

* Low infection risks

* Short recovery, home on the same day

* No discomfort during probe-heating portion of procedure

“Almost three-quarters of patients treated with RFA experience marked pain relief – whether their initial back or neck pain was due to an injury, arthritis or another cause,” Dr. Liu explains. “While the degree of pain relief varies by patient, the effects from RFA sometimes last for years. That’s an extremely good payoff from such a simple procedure.”

– Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC. http://www.atlanticspinecenter.com, http://www.atlanticspinecenter.nyc

– Kaixuan Liu, MD, PhD, is a board-certified physician who is fellowship-trained in minimally invasive spine surgery at Atlantic Spine Center.

Are You Really Getting Enough Exercise?

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An interesting topic from this past May courtesy of PRWeb, please share your comments below…..

BikingWorkouts that promise fitness with as little as four to seven minutes of high-intensity exercise a day are alluring. But can you really stay fit with such a small time commitment? “No,” says Dr. Howard Knuttgen, research associate in physical medicine and rehabilitation at Harvard-affiliated Spaulding Rehabilitation Hospital, in the May 2015 Harvard Women’s Health Watch.

Dr. Knuttgen has a file of articles and ads dating back to the 1960s promoting exercise regimens that offer to keep you fit with little investment of either time or effort. “This is exercise quackery. If a program sounds too good to be true, it probably is,” he says.

Exercise is any activity that uses muscles to generate force. The more force exerted, the more exercise. In general, aerobic workouts (also called cardiovascular workouts) call for moving the body by walking, running, cycling, rowing, swimming, or another activity. Strength-building workouts involve moving an object like a weight or working against resistance.

It doesn’t work to skimp on either intensity or amount of exercise. So how much aerobic activity is enough? Current guidelines suggest 150 minutes a week of “moderate aerobic exercise.” But a brisk clip for some people can be a snail’s pace for others. Using the talk test can help identify moderate activity: Not being able to carry on a conversation during the activity means it is strenuous. Being able to sing easily means it is too easy, and warrants stepping up the pace.

Strength training two to three times a week is also helpful. Always rest a day in between strength-training sessions.

Read the full-length article: “Are you getting enough exercise?”

Also in the May 2015 Harvard Women’s Health Watch:

* New options for treating menopause symptoms

* Easier colonoscopy preps

* 6 ways to use the mind to control pain

* How to get personalized healthcare

The Harvard Women’s Health Watch is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $20 per year. Subscribe at http://www.health.harvard.edu/newsletters/womens or by calling 877-649-9457 (toll-free).

Dietary Guidelines For Cardiovascular Disease

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This article is courtesy of PRWeb, please share your thoughts below…..although from August, it has a lot of valuable information…..

saladplateMore than 400 clinicians now hold a solution to help their patients combat the early signs and advanced stages of cardiovascular disease, the leading cause of death worldwide.

The nonprofit Physicians Committee concludes its third annual International Conference on Nutrition in Medicine (ICNM), accredited by the George Washington University School of Medicine and Health Sciences (GWSMHS), in Washington this weekend, led by an international panel of 21 cardiovascular disease researchers.

“We’re offering a scientifically proven way to save lives and curb skyrocketing health care costs,” says conference host Neal Barnard, M.D., president and founder of the Physicians Committee and an adjunct associate professor of medicine with the GWSMHS. “A dietary intervention treats both the symptoms and root cause of heart disease, which can start in utero.”

The Dietary Guidelines for Atherosclerosis Treatment and Prevention, available at 2 p.m. EST on Aug. 1, compiles key information from panelists, including findings from the Bogalusa Heart Study from Gerald Berenson, M.D., with Tulane University’s Center for Cardiovascular Health, to the effectiveness of a plant-based dietary intervention for cardiovascular disease treatment from both Kim Williams, M.D., president of the American College of Cardiology, and Caldwell Esselstyn, M.D., with the Cleveland Clinic Wellness Institute.

Dr. Barnard and David Katz, M.D., with Yale University’s Prevention Research Center, break down nutrition myths that surround dietary cholesterol and saturated fat, while Leena I. Kauppila, M.D., from Terveystalo Healthcare, and Stephen L. Kopecky, M.D., with the Mayo Clinic College of Medicine, discuss back pain and erectile dysfunction, two underlying symptoms of heart disease.

Physicians new to writing dietary prescriptions will have a first-hand taste of fiber-packed, cholesterol-lowering foods after sampling chia seed pudding, fresh kale and beet salads, and plant-based vegan entrées, including Thai yellow curry, quinoa sweet potato cakes, roasted tomato hummus with squash linguine and pineapple relish, and local tofu with carrots, snap peas, and bok choy.

Clinicians will leave Washington with 13 continuing medical education (CME) credits and travel-friendly workout tips from exercise physiologist Marco Borges, founder of 22 Days Nutrition, who is now as well known for his Saturday “Wake-Up Call Workout” as he is for helping top stars, like Beyoncé and Jennifer Lopez, stay in cardiovascular shape.

Visit PhysiciansCommittee.org/HeartHealth to download a copy of the Dietary Guidelines for Atherosclerosis Treatment and Prevention, to view speaker presentations, and to access heart-healthful nutrition tips and recipes.

CME videos of the conference’s presentations will be available later this year at NutritionCME.org.

4 Lifestyle Habits That Worsen Back Pain

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This article is courtesy of PRWeb and Dr. Michael A. Gleiber, MD, FAAOS.

newsThe millions of people who experience some level of back pain – from occasional aches, to chronic discomfort – are encouraged to read the latest article by minimally invasive spine surgeon Dr. Michael A. Gleiber, MD, FAAOS, in which he reveals the four most common lifestyle habits that trigger back pain and destroy spine health.

“Back pain isn’t always the result of an injury,” commented Dr. Gleiber, who is also a regular contributor to the Huffington Post and a Spokesperson for the American Academy of Orthopaedic Surgeons. “Often, it’s the things people do – or neglect to do – in their daily lives that is the root cause of their pain and deteriorating spine health. Tragically, many of these people don’t even know the damage that they’re doing until the pain becomes unbearable, and they can no longer carry out their day-to-day tasks at home or at work.”

According to Dr. Gleiber, the four lifestyle habits that are causing the most back pain and spine injury are:

1. A sedentary lifestyle that is virtually devoid of exercise. This causes the muscles that support the spine to become weak, and in turn forces the vertebrae and discs to absorb extra stress.

jumpingrope2. Exercising strenuously only on the weekends, and doing little or no exercise the rest of the week (“Weekend Warriors”). This imposes excessive strain on the back and spine, which is not prepared or strong enough to absorb the shock – ultimately causing back pain and, ironically, greatly increasing the risk of injury.

3. Sitting down for several hours a day at work. Staying for prolonged periods of time in any single position is damaging to spine health. However, to make matters worse, most people who sit for many hours each day have incorrect posture; often because they are hunching forward to see their computer screen.

4. Regularly eating junk food, which often leads to weight gain and therefore puts extra stress on the spine. In addition, people who eat too much junk food are typically not getting the nutrients they need to keep their spine strong and healthy, such as Calcium and Vitamin D.

Added Dr. Gleiber: “The good news is that with commitment and the right guidance, people can create new, better lifestyle habits that not only alleviates and ideally eliminates their back pain, but vastly improves their overall health and wellness. For instance, people can start exercising at least three times a week to strengthen their core muscles, get up from their desk once an hour to stretch and walk around a bit, and muster up all of their willpower to make eating junk food an occasional indulgence rather than a regular occurrence.”

The full version of Dr. Gleiber’s latest article entitled “How Your Lifestyle Can Contribute to Back Pain” is available on his website at http://michaelgleibermd.com/news/lifestyle-can-contribute-back-pain.

Additional articles by Dr. Gleiber on spine health, back pain relief, effective exercising and more are available at http://michaelgleibermd.com/news.

About Dr. Michael A. Gleiber, MD

– Dr. Michael A. Gleiber, MD is a trusted expert in the field of minimally invasive spine surgery. He currently serves as Spokesperson for the American Academy of Orthopaedic Surgeons, is a writer for The Huffington Post, and is frequently invited to provide his medical expertise in the media. Dr. Gleiber has been honored with multiple recognitions, including Castle Connolly Top Doctors for Spine Surgery, SuperDoctors of South Florida, Top 10 Spine Surgical Specialists Florida by Vitals.com, and is listed amongst Top 50 Spine Surgeon Leaders.

Learn more at http://michaelgleibermd.com

Brisk, Regular Walking Helps Lessen Heart Disease Risk

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This article is courtesy of PRWeb and Harvard Health Publications, please share your comments below…..

familywalk2A regular walking routine can lower blood pressure, stave off diabetes, and prevent heart disease. Finding walking buddies, using a pedometer, and following a walking workout plan may help people stick to a program.

Walking is a low-impact, do-anywhere exercise that helps lower blood pressure and stave off diabetes. And two large, long-term Harvard studies suggest that walking for about 20 minutes a day may cut the risk of heart disease by as much as 30%, according to the December 2015 Harvard Heart Letter.

But many people need some added inspiration to start — and stick with — a walking program. One of the best ways is to find walking buddies, says Dr. Lauren Elson, physical medicine and rehabilitation instructor at Harvard Medical School. “I find that if I can get someone to walk with — a partner, a spouse, or a friend — that helps a lot.” Even better is getting several friends to walk together, because they all hold each other accountable. “They call each other up and say, ‘Where are you?’” Dr. Elson says.

Other people find motivation by using a pedometer to track their steps and distance, says Dr. Elson. One review of 26 studies found that people who used pedometers raised their physical activity levels by nearly 27%, adding about 2,500 steps a day. Most stores that sell exercise equipment have inexpensive pedometers. Other options include smartphone apps that track steps, such as Moves, Breeze, or Pedometer++.

For people who’ve had a heart attack or been diagnosed with heart disease, walking is an ideal exercise because it can be easily adapted based on a person’s fitness level. People with heart failure should ask their physician to recommend a cardiac rehabilitation program to safely reap the benefits of exercise. This type of supervised exercise is particularly helpful for people who haven’t been active for a while.

Read the full-length article: “Marching orders: How to start a walking program”

Also in the November 2015 issue of the Harvard Heart Letter:

* Cardiac rehabilitation: Best medicine for recovery

* Heart-friendly holiday eating

* When blood pressure dips too low

The Harvard Heart Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $20 per year. Subscribe at http://www.health.harvard.edu/heart or by calling 877-649-9457 (toll-free).

Punching Up The Fitness Regimen

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Courtesy of PRWeb and Harvard Health Publications, feel free to comment below….

newsFitness boxing is a great aerobic activity. It also helps improve muscle strength, endurance, balance, and possibly eye-hand coordination.

Boxing isn’t just a sport anymore. It’s also a popular way to stay fit — even among older adults — through a version known as fitness boxing, reports the November 2015 Harvard Health Letter. “This kind of boxing has many health benefits, because it constantly requires you to think, change your position, and change your posture,” says physical therapist Linda Arslanian, director of rehabilitation services at Harvard-affiliated Brigham and Women’s Hospital.

Unlike traditional boxing that requires each boxer to spar with a partner, fitness boxing for older adults involves throwing punches at the air or at a punching bag, usually in a class. There are two main types of these exercise classes. In one, the class follows a leader and completes a series of boxing moves choreographed to bouncy music, similar to an aerobics class. The other type of exercise class involves strength training, stretching, and hitting a punching bag.

Don’t have the strength to stand and do boxing moves? Both types of classes are available for people who wish to remain seated while punching at the air or at a punching bag.

There’s no proof that fitness boxing is superior to any other types of exercise, but it does have many health benefits. It’s a great aerobic workout, it builds upper body strength, and it improves balance.

Read the full-length article: “Punch up your exercise routine with fitness boxing”

Also in the November 2015 issue of the Harvard Health Letter:

* Which blood pressure medication is the right one for you?

* How to tell if your medications are making you depressed

* Avoiding foodborne illness at home and at the holiday buffet

The Harvard Health Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $20 per year. Subscribe at http://www.health.harvard.edu/health or by calling 877-649-9457 (toll-free).

Strength Training Improves Heart Health

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This article is courtesy of PRWeb and Harvard Health….please share your comments below…..

healthyheartStrength training has been linked to several factors that improve heart health, including weight loss, less belly fat, and a lower risk of diabetes and high blood pressure.

Aerobic exercise, such as brisk walking, biking, and swimming, is good for the heart. Strength training, also known as weight training or resistance training, also has cardiovascular benefits, reports the June 2015 Harvard Heart Letter.

“Strength training maintains and may even increase muscle mass, which people tend to lose as they age,” says Dr. Rania Mekary, a visiting assistant professor of surgery at Harvard-affiliated Brigham and Women’s Hospital and assistant professor at MCPHS University. Increased muscle mass has a trickle-down effect that benefits blood vessels and the heart.

Boosting muscle mass speeds up metabolism, which helps people burn more calories, even at rest. A faster metabolism also helps prevent weight gain, which puts extra strain on the heart. Strength training seems to be especially important for keeping off belly fat. This so-called visceral fat, which surrounds the internal organs, is particularly dangerous.

Mekary and colleagues at the Harvard T.H. Chan School of Public Health found that healthy men who did weight training for 20 minutes a day had less of an age-related increase in abdominal fat compared with men who spent the same amount of time doing aerobic exercise.

Strength training can help control blood sugar levels by drawing glucose from the bloodstream to power muscles. High blood sugar, the hallmark of type 2 diabetes, is also a leading risk factor for heart disease. Building more muscle mass also makes the body more sensitive to the effects of insulin, the hormone that regulates blood sugar levels.

Read the full-length article: “Add strength training to your fitness plan”

Also in the June 2015 Harvard Heart Letter:

* Get cracking: why you should eat more nuts

* Get a leg up on varicose veins

* Bypass plus angioplasty: the best of both worlds?

The Harvard Heart Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $20 per year. Subscribe at http://www.health.harvard.edu/heart or by calling 877-649-9457 (toll-free).

When Back Or Neck Surgery Doesn’t Work

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This article is courtesy of PRWeb, please share your comments below…..

didyouknow?Dr. Praveen Kadimcherla with Atlantic Spine Center explains ‘failed spine surgery syndrome’ and offers tips and hope to patients.

Most of the time spine surgery achieves its goal, with pain relief being among the top benefits for beleaguered back or neck pain sufferers. But occasionally, a patient’s pain and other symptoms return – a situation known as failed back surgery syndrome – which isn’t necessarily as doom-and-gloom as it sounds, according to Praveen Kadimcherla, MD, an orthopedic spine surgeon at Atlantic Spine Center.

The vast majority of the 600,000 spine surgeries that take place in the United States each year are highly successful, decompressing nerve roots that are pinched or stabilizing painful spinal joints that have led to chronic pain, numbness or loss of function. But when back or neck surgery goes wrong, it can be devastating to both patient and surgeon, even if it’s statistically impossible for all surgeries to be effective.

“The amount of trauma, scarring, and hardware such as bone grafts and screws that are used in spinal surgery all factor into the chances someone may develop this condition,” explains Dr. Kadimcherla, who is fellowship-trained in orthopedic and spine neurosurgery. “Joints at the surgical site can also become inflamed, and scar tissue might form where a section of bone has been removed from the spine. In short, there are many reasons back or neck surgery can go wrong, so failed spine surgery syndrome is very difficult to totally prevent.”

Why might spine surgeries fail?
As a rule, spine surgeries are performed as a last resort when neck or lower back pain cannot be relieved by more conservative measures, such as medications or physical therapy. But at least 5% are left with lingering pain after an operation, Dr. Kadimcherla says. Symptoms may include back, leg or arm pain that is dull and aching; sharp, stabbing pain; and tingling, numbness or muscle weakness.

But why might spine surgeries fail? Dr. Kadimcherla offers these possible reasons:

* Residual disc herniation

* Recovery has created undue stress on another weakened portion of the spine

* Improper fusion after spinal fusion

* Misaligned spine hardware

* Incomplete bone removal

* Infection in a disc space

* Nerve damage

* Improper diagnosis of original problem

humanbody“Undergoing back surgery is rarely a decision patients take lightly or rush into, so when pain persists afterward it can be very distressing,” he says. “Yet, there are many viable options for improvement in these patients going forward. All is not lost if their back or neck surgery has been deemed a failure.”

Tips and hope for failed spine surgery patients
The first step toward relieving back or neck pain after a failed surgery is making sure a patient has the correct diagnosis, Dr. Kadimcherla says. This is done by using imaging tests such as X-rays, MRI or CT scans, and certain diagnoses can be confirmed with the help of procedures such as nerve blocks or other injections.

Once the reason for ongoing pain has been established, a multi-pronged approach for pain relief usually works best, Dr. Kadimcherla explains. Treatments can include:

* Physical therapy or exercise

* Psychological counseling

* Medication

* Procedures such as epidural steroid injections or nerve blocks

* Spinal cord stimulation, a device emitting electrical pulses into the spinal region

Tellingly, however, one of the best options for treating failed back surgery is undergoing another surgery, but not an “open” procedure involving a long incision and recovery. Dr. Kadimcherla often recommends endoscopic spine surgery – a minimally invasive approach with boasting a rapid recovery – to those experiencing lingering problems after an initial procedure.

“Endoscopic spine surgery can represent a safer, less risky and less complicated solution,” he says. “I’ve treated many patients after spine surgery with residual symptoms with endoscopic nerve decompression, and I strongly feel a patient with failed back surgery syndrome can benefit from consulting with a doctor who’s an experienced endoscopic surgeon.”

“Obviously, someone who’s experienced failed spine surgery already has dealt with a less-than-optimal scenario,” Dr. Kadimcherla adds. “But with a correct diagnosis and proper treatment, pain can often be eliminated or very well managed. “When all else fails, make sure you don’t let a failed spine surgery have the last word.”

Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC. http://www.atlanticspinecenter.com, http://www.atlanticspinecenter.nyc

– Praveen Kadimcherla, MD, is a board-certified orthopedic spine surgeon at Atlantic Spine Center.

Caffeinated Drinks Associated With Decreased Risk Of Liver Scarring

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This article is provided by the Baylor College of Medicine, please share your thoughts below…..

cupcoffeeModest daily consumption of caffeinated drinks is associated with less advanced liver scarring in people with hepatitis C, according to a recent study by Baylor College of Medicine researchers that appears online in the journal Clinical Gastroenterology and Hepatology.

Dr. Hashem El-Serag, chief of gastroenterology and hepatology at Baylor and at the Michael E. DeBakey Veterans Affairs Medical Center and lead author of the study, said the results showed that the risk of liver scarring in hepatitis C patients was decreased when individuals regularly consumed caffeinated coffee, and to a lesser extent tea and soda.

“We found that participants who drank caffeinated coffee daily had the best results,” he said. “This is most likely do to the fact that one coffee drink has more caffeine than tea or sodas.”

He said the researchers saw no benefit to patients who drank decaffeinated coffee, tea and soda.

This cross-sectional study consisted of 910 participants aged 18 to 70 years of age with confirmed hepatitis C who were not receiving antiviral therapy.

“We specifically chose to study hepatitis C patients because they are at an increased risk for hepatic fibrosis (liver scarring), and there is limited data on the effects of coffee or caffeine on the progression of scarring within this patient population,” said El-Serag, also a member of the Dan L. Duncan Cancer Center at Baylor.

Liver scarring can lead to cirrhosis of the liver, liver failure and liver cancer, and may require liver transplantation.

Of the participant study population, 37.6 percent of them had advanced liver scarring while 62.4 percent had milder scarring. Participants with advanced fibrosis were significantly older, more likely to have type 2 diabetes and were more likely to be overweight or obese.

“Most participants reported drinking caffeinated coffee, and about half of those drank one or more cups of coffee per day,” El-Serag said. “Patients with milder liver scarring had a higher average daily intake of caffeinated coffee compared to those with more advanced cases.”

“An estimated 100 milligrams of caffeine from coffee, tea or soda was associated with approximately one-third reduction of advanced scarring, and higher consumption didn’t produce an additional benefit,” he said.

Others who took part in this study include Natalia Khalaf, Donna White, Fasiha Kanwal, David Ramsey, Sahil Mittal, Shahriar Tavakoli-Tabasi and Jill Kuzniarek, all of Baylor.

This research was funded in part by a VA Clinical Research and Development Merit Award (H-22934, PI: El-Serag) and the National Institute of Diabetes Digestive and Kidney Diseases (R03 DK095082, PI: White). The efforts of White and El-Serag effort were supported in part by the National Institute of Diabetes Digestive and Kidney Diseases (K24 DK04-107 and K01 DK081736, respectively) and the Houston VA Health Services Research and Development Center of Excellence (HFP90-020).