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The impact of financial incentives on participants' food purchasing patterns in a supermarket-based randomized controlled trial.
Olstad, DL, Crawford, DA, Abbott, G, McNaughton, SA, Le, HN, Ni Mhurchu, C, Pollard, C, Ball, K
The international journal of behavioral nutrition and physical activity. 2017;14(1):115
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Food prices are a key driver of food purchasing behaviours, and The Supermarket Healthy Eating for Life (SHELf) study has shown that price discounts on healthier foods can increase their purchase. The aim of this study was to quantify whether participants in the SHELf study switched to study supermarkets for purchasing their FV during the intervention because of the discounted price. 642 participants completed self-reported surveys on the proportion of FV purchased at the study supermarket at baseline, 3 months and 6 months post intervention. This study found that it is likely that participants switched supermarket choice during the intervention to purchase their FV from the study supermarkets. The authors conclude that unless food-purchasing data are available from all sources, differential changes in purchasing patterns can make it difficult to discern the effectiveness of nutrition interventions.
Abstract
BACKGROUND The impacts of supermarket-based nutrition promotion interventions might be overestimated if participants shift their proportionate food purchasing away from their usual stores. This study quantified whether participants who received price discounts on fruits and vegetables (FV) in the Supermarket Healthy Eating for Life (SHELf) randomized controlled trial (RCT) shifted their FV purchasing into study supermarkets during the intervention period. METHODS Participants were 642 females randomly assigned to a 1) skill-building (n = 160), 2) price reduction (n = 161), 3) combined skill-building and price reduction (n = 160), or 4) control (n = 161) group. Participants self-reported the proportion of FV purchased in study supermarkets at baseline, 3- and 6-months post-intervention. Fisher's exact and χ2 tests assessed differences among groups in the proportion of FV purchased in study supermarkets at each time point. Multinomial logistic regression assessed differences among groups in the change in proportionate FV purchasing over time. RESULTS Post-intervention, 49% of participants purchased ≥50% of their FV in study supermarkets. Compared to all other groups, the price reduction group was approximately twice as likely (RRR: 1.8-2.2) to have increased proportionate purchasing of FV in study supermarkets from baseline to post-intervention (p< 0.05). CONCLUSIONS Participants who received price reductions on FV were approximately twice as likely to shift their FV purchasing from other stores into study supermarkets during the intervention period. Unless food purchasing data are available for all sources, differential changes in purchasing patterns can make it difficult to discern the true impacts of nutrition interventions. TRIAL REGISTRATION The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901, Registered 30 June 2010, Retrospectively registered ( http://www.isrctn.com/ISRCTN39432901 ).
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Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study.
Kang, DW, Adams, JB, Gregory, AC, Borody, T, Chittick, L, Fasano, A, Khoruts, A, Geis, E, Maldonado, J, McDonough-Means, S, et al
Microbiome. 2017;5(1):10
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Children with autism spectrum disorders (ASD) often suffer gastrointestinal problems, such as constipation or diarrhea, the severity of which often correlate with ASD severity. This open-label clinical trial evaluated the impact of Microbiota Transfer Therapy (MTT) on GI and ASD symptoms of 18 ASD-diagnosed children. Treatment involved 2 weeks of antibiotic treatment and a bowel cleanse, followed by extended fecal microbiota transplant using a high initial dose and lower maintenance doses for 7-8 weeks. Results showed significant improvements in GI symptoms, which persisted 8 weeks after treatment ended. Bacterial diversity also increased. Behavioural ASD symptoms also improved significantly and lasted 8 weeks after treatment finished. This exploratory study suggests a promising approach to alter the gut microbiome in ASD subjects, improving GI and behavioural symptoms of ASD. Further clinical research is required.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Fecal Microbiota Transfer Therapy demonstrates an effective clinical intervention in pediatric patients suffering with autistic spectrum disorder and associated gastrointestinal symptoms.
- Benefits of the therapy in this trail persisted even 2 months after treatment cessation.
- Future research on autistic spectrum disorder should address microbiota-gut-brain axis.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
The article describes an original clinical protocol in which microbiota transfer was used to ameliorate gastrointestinal (GI) and autism symptoms in pediatric patients. Common occurrence of GI pathology in patients affected by autistic spectrum disorder (ASD), poses a clinical challenge, since there is no standardised specific therapy. In light of recent insights on the importance of microbiota-gut-brain axis in health and disease, microbiota emerges as a salient treatment target in the aforementioned population.
Clinical practice applications:
Fecal microbiota transfer therapy (MTT) applied by the protocol described in the article demonstrates a longer-term effective clinical intervention in pediatric patients suffering from ASD and concomitant GI symptoms. Benefits of the therapy persisted even two months after actual treatment cessation, a highly important feature considering ASD.
Considerations for future research:
This modality could complement current treatments used for ASD-related symptomatology, but requires further validation through additional clinical experiments. The procedure also supports the efforts to focus more research on the role of microbiota in ASD pathophysiology. Further basic and clinical investigations on ASD should include addressing microbiota-gut-brain axis whenever possible, if not always.
Abstract
BACKGROUND Autism spectrum disorders (ASD) are complex neurobiological disorders that impair social interactions and communication and lead to restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. The causes of these disorders remain poorly understood, but gut microbiota, the 1013 bacteria in the human intestines, have been implicated because children with ASD often suffer gastrointestinal (GI) problems that correlate with ASD severity. Several previous studies have reported abnormal gut bacteria in children with ASD. The gut microbiome-ASD connection has been tested in a mouse model of ASD, where the microbiome was mechanistically linked to abnormal metabolites and behavior. Similarly, a study of children with ASD found that oral non-absorbable antibiotic treatment improved GI and ASD symptoms, albeit temporarily. Here, a small open-label clinical trial evaluated the impact of Microbiota Transfer Therapy (MTT) on gut microbiota composition and GI and ASD symptoms of 18 ASD-diagnosed children. RESULTS MTT involved a 2-week antibiotic treatment, a bowel cleanse, and then an extended fecal microbiota transplant (FMT) using a high initial dose followed by daily and lower maintenance doses for 7-8 weeks. The Gastrointestinal Symptom Rating Scale revealed an approximately 80% reduction of GI symptoms at the end of treatment, including significant improvements in symptoms of constipation, diarrhea, indigestion, and abdominal pain. Improvements persisted 8 weeks after treatment. Similarly, clinical assessments showed that behavioral ASD symptoms improved significantly and remained improved 8 weeks after treatment ended. Bacterial and phagedeep sequencing analyses revealed successful partial engraftment of donor microbiota and beneficial changes in the gut environment. Specifically, overall bacterial diversity and the abundance of Bifidobacterium, Prevotella, and Desulfovibrio among other taxa increased following MTT, and these changes persisted after treatment stopped (followed for 8 weeks). CONCLUSIONS This exploratory, extended-duration treatment protocol thus appears to be a promising approach to alter the gut microbiome and virome and improve GI and behavioral symptoms of ASD. Improvements in GI symptoms, ASD symptoms, and the microbiome all persisted for at least 8 weeks after treatment ended, suggesting a long-term impact. TRIAL REGISTRATION This trial was registered on the ClinicalTrials.gov, with the registration number NCT02504554.
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Inhalational Alzheimer's disease: an unrecognized - and treatable - epidemic.
Bredesen, DE
Aging. 2016;8(2):304-13
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Alzheimer’s disease (AD) is the third leading cause of death in the USA, with around 5.2 million Americans diagnosed with AD. Effective treatment with medications has yet to be found. A recent multiple therapy programme (originally known as MEND, now called ReCODE) proposed by Professor Bredesen and team, has shown some promising anecdotal results. Identifying sub-types of AD has been proposed as a means to develop targeted protocols for treatment. Recently, 3 sub-types of AD have been described: Type 1 (inflammatory), Type 2 (non-inflammatory or decreasing brain size) and Type 3 (damage to the outer layer of the cerebrum). This report describes 7 patients with Type 3 AD. Type 3 AD is characterised by exposure to specific toxins (usually inhaled) and is often associated with Chronic Inflammatory Response Syndrome (CIRS). The report provides the symptoms, signs and laboratory values representative of Type 3 AD and could be used by Nutrition Practitioners to help with implementation of appropriate nutrition protocols when working with clients with AD.
Abstract
Alzheimer's disease is one of the most significant healthcare problems today, with a dire need for effective treatment. Identifying subtypes of Alzheimer's disease may aid in the development of therapeutics, and recently three different subtypes have been described: type 1 (inflammatory), type 2 (non-inflammatory or atrophic), and type 3 (cortical). Here I report that type 3 Alzheimer's disease is the result of exposure to specific toxins, and is most commonly inhalational (IAD), a phenotypic manifestation of chronic inflammatory response syndrome (CIRS), due to biotoxins such as mycotoxins. The appropriate recognition of IAD as a potentially important pathogenetic condition in patients with cognitive decline offers the opportunity for successful treatment of a large number of patients whose current prognoses, in the absence of accurate diagnosis, are grave.