This study investigated if behavioral therapy improves fatigue in rheumatoid arthritis (RA). They found that behavioral therapy reduced fatigue in patients with RA.

This study determined whether treating breast cancer that has spread (metastatic) with olaparib (Lynparza) resulted in better outcomes and fewer side effects compared to chemotherapy. The study found that treatment with olaparib led to similar survival outcomes compared to chemotherapy. 

This study investigated if a treat-to-target (TTT) approach reduces cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA). They found that TTT reduced CVD risk in patients with RA over 5 years. 

This study wanted to find out if the risk of patients with breast cancer developing a blood clot was higher if they were treated with aromatase inhibitors, or tamoxifen (Nolvadex). The study found that the patients treated with tamoxifen had a higher risk of developing blood clots compared to those treated with aromatase inhibitors. 

This study wanted to find out if performing radiation therapy on patients with breast cancer who have had surgery results in a lesser quality of life. The study found that the patients who had radiotherapy had a higher chance of having pain, swelling, skin problems and sensitivity in the area of the breast.

This study investigated disease activity in patients with rheumatoid arthritis (RA) by season. They found that disease activity was lowest in fall and highest in spring.

In 1908, the presence of cholesterol crystals was noted “in the proliferating areas of cancers,” suggesting that perhaps cholesterol, in some way, was “associated with the regulation of [cancer] proliferation.” A century later, we now recognize “the accumulation of cholesterol [as] a general feature of cancer tissue, and recent evidence suggests that cholesterol [may indeed play] critical roles in the progression of cancers, including breast, prostate, and colorectal cancers.”

Perhaps that could explain why “egg consumption was associated with increased breast cancer risk.” And, indeed, a systematic review of the evidence suggests that “dietary cholesterol intake increases risk of breast cancer,” and the more cholesterol you eat, the higher the risk appears to go. But, why?

One thought is that the “[p]rolonged ingestion of a cholesterol-enriched diet induces chronic, auto-inflammatory responses,” and we know that “chronic…inflammation can lead to the initiation, promotion, and progression of tumor development.” It’s true that sprinkling some cholesterol on white blood cells in a test tube can trigger the release of inflammatory compounds, and LDL cholesterol can induce breast cancer proliferation and invasion. But again, that’s in vitro, where you can show that like breast cancer cells can migrate nearly twice as far within a day in a petri dish in the presence of LDL cholesterol. But what about in people?

Well, the level of LDL cholesterol in the blood of women diagnosed with breast cancer does appear to be “a predictive factor of breast tumor progression.” About two years after surgery/chemo/radiation, not one of the women in the lowest third of LDL cholesterol levels had a cancer recurrence. The same could not be said for women with higher cholesterol. We know cholesterol can cause inflammation in our artery walls; maybe it’s also playing an effect on breast cancer initiation and progression? They speculate that the high cholesterol levels may have a “cancer-fueling effect.” And indeed, women with breast cancer who happen to be taking cholesterol-lowering statin drugs appear to live about 40 percent longer before the cancer comes back. But the data isn’t good enough to ensure the drug benefits outweigh the risks, though lowering cholesterol with diet, one may be able to get the best of both worlds. But what does this have to do with dietary cholesterol?

Sure, animal studies show that if you feed mice cholesterol, you can accelerate their cancers, “but extrapolation to humans is difficult as dietary cholesterol has limited effects on blood cholesterol levels in humans.” Thus, “dietary cholesterol might [just] be indicative of a lifestyle prone to health-related problems, including cancer.” Maybe people are just more likely to chase bacon and eggs down with a cigarette, compared to oatmeal? It’s hard to imagine how dietary cholesterol alone could promote cancer development. But that all changed recently, with the discovery that 27-Hydroxycholesterol, a metabolite of cholesterol, “can function as an estrogen and increase the proliferation” of most breast cancer cells.

Ah, so it’s not the cholesterol itself, but what it turns into in the body. “Scientists have long struggled to understand why women with heart disease risk factors are more likely to develop breast cancer.” Now, perhaps we know. “The discovery that the most abundant oxidized cholesterol metabolite” in our bloodstream can have estrogenic effects may explain the link between high cholesterol and the development and progression of breast cancer and prostate cancer. Yes, 27-Hydroxycholesterol also stimulates the proliferation of prostate cancer cells, boosting growth by about 50 percent.

I’ve explored before the role oxycholesterols may play in mediating pro-oxidative and pro-inflammatory processes in degenerative diseases, such as Alzheimer’s and heart disease, but now it looks like oxidized cholesterol can play a role in all three stages of tumor development as well: initiation, promotion, and then the progression of cancer. Not just promoting the growth of breast cancer cells, but also inducing their invasion and migration—potentially facilitating breast cancer metastasis through suppressing anti-cancer immunity, and then inducing angiogenesis, helping breast tumors hook up their blood supply.

This is all supported by “several lines of evidence [that point to] a pathologic role” for this cholesterol metabolite. Yeah, you can feed mice cholesterol; their oxysterol levels go up and their tumors accelerate. It “also appears to dramatically hasten the spread, or metastasis, of breast tumors to other organs.” But turning to human breast tissue samples, they found that more aggressive tumors have higher levels of the enzyme that converts cholesterol into 27-HC. In breast cancer patients with estrogen receptor-positive tumors, the 27 Hydroxycholesterol content in their breast tissue is increased overall, and especially within the tumor itself—so much so that circulating oxysterol levels in the blood may one day be used as a prognostic factor. And “breast cancer patients with low tumor levels of [the enzyme] that breaks down 27-HC did not live as long” as women who can detoxify it better. “The bottom line…is that some estrogen-driven breast tumors may rely on 27-HC to grow when estrogen isn’t available.” And that may explain a second breast cancer mystery.

Over 80 percent of breast cancers start out responding to estrogen, and so what we do is use hormone blockers—either aromatase inhibitors to stop the formation of estrogen in the first place, or tamoxifen to block its action. Despite the efficacy of these drugs, many patients relapse with resistant tumors. And that’s where oxidized cholesterol can come in. 27-HC can fuel breast cancer growth without estrogen, which could explain why sometimes these estrogen blockers don’t work.

And finally, 27-HC may explain why breast cancer patients with higher vitamin D levels appear to live longer. Vitamin D supplementation decreases 27-HC levels in the blood. The best way, though, may be to just lower overall cholesterol. Lower cholesterol, and you lower oxidized cholesterol. So, discovering this role of cholesterol is actually really good news, since “cholesterol is a highly amenable risk factor, either by lifestyle, dietary, or pharmacologic interventions.” The implications of these findings, according to the principal investigator, is that “lowering cholesterol with dietary changes or [drugs] could reduce a women’s breast cancer risk or slow tumor growth.”

“Hippocrates, the father of western medicine, believed that all disease begins in the gut.” Of course, he also thought women were hysterical because of their “wandering uterus.” So much for ancient medical wisdom.

But something like constipation can have a “major [negative] impact on physical, mental and social well-being.” Yet it’s “often overlooked in health care.” This may be because poop-talk is taboo, but it can have “a severe influence on…everyday living,” both psychologically and physically. Constipation can hurt, causing “abdominal discomfort and pain, straining, hard stool, infrequent bowel movements, bloating and nausea.”

No wonder “[l]axatives are among the most commonly used drugs. Most are safe when used judiciously [and] intermittently,” but because of the frequency of their use, they end up being one of the most common causes of adverse drug reactions. Perhaps “treatment should [instead] address the underlying problem,” such as lack of dietary fiber. You probably don’t need a meta-analysis to demonstrate that “dietary fiber can obviously increase stool frequency.”

“Populations in most Western countries must be considered by world standards to be almost universally constipated.” Here, it’s an epidemic among the elderly, but it’s simply not a problem among those centering their diets around fiber-rich foods. Where is fiber found? This patient summary in the AMA’s journal sums it up with an illustration: whole unrefined plant foods. Now for those of us smug in our intake of fruits and vegetables, we need to realize that “fruits and leafy vegetables are the poorest whole food sources of fiber.” Why? Because they’re 90 percent water. Root vegetables have more, but the fiber superstars are legumes, which means beans, split peas, chickpeas, and lentils, as well as whole grains. And gram for gram, fruit fiber doesn’t seem to have the same effect. It may take 25 grams of fruit fiber to double stool output, something just 10 grams of whole grain fiber or vegetable fiber can do.

And that’s not all fiber can do. If you eat some whole grain barley for supper, by the next morning your good gut bacteria are having it for breakfast, releasing butyrate into our bloodstream—a compound that seems to exert broad anti-inflammatory activities, which could help explain why significant decreases in the prevalence of inflammation are associated with increasing dietary fiber intakes. Check it out. And the highest group here was just getting the minimum recommended daily intake of fiber. So, what, if you have knee pain or something, you should eat more fiber-rich foods? We didn’t know…until now. “Dietary Fiber Intake in Relation to Knee Pain Trajectory.” Thousands of patients were followed and…”a high intake of dietary fiber,” which is to say just the minimum recommended intake, was “associated with a lower risk of developing moderate or severe knee pain over time.” And two Framingham studies found that higher fiber intake was related to a lower risk of having symptomatic osteoarthritis in the first place.

But wait; don’t a variety of diseases have an inflammatory component? How about fiber consumption and all-cause, cardiovascular, and cancer mortality? They found that, compared with those who consumed the least fiber, those who consumed the most had 23 percent less cardiovascular disease mortality, 17 percent lower risk of dying from cancer, and 23 percent lower mortality from all causes put together. “Unfortunately, most persons in the United States consume less than half the recommended intake of dietary fiber daily.”

These researchers suggest all sorts of potential mechanisms for which fiber could be life-saving, from improving cholesterol, immune function, and blood sugar control, but there also may be more of a direct cause. If you ask people to bear down as if they’re straining on stool, you can get a rapid increase in intracranial pressure, pressure inside your skull, and indeed, if you look at trigger factors for the rupture of intracranial aneurysms, if you ask hundreds of people who had strokes—bleeds within their brains—one of the biggest trigger factors noted was straining for defecation, multiplying risk seven-fold.

This study wanted to find out if joint pain is associated with falling down in patients with breast cancer who were treated with aromatase inhibitors. The study found that the patients who reported having joint pain were more likely to have a fall than those who had no joint pain.

This study investigated intensive treatment to achieve remission in rheumatoid arthritis (RA). They found that intensive treatment was effective at achieving remission.