Diet and Arthritis. Foods to include, foods to exclude...

Food to include: Fish Curry:omega 3 turmeric and ginger'

eat pineapple for dessert....

Diet and Arthritis

There is no doubt that certain compounds in food modify both the onset and severity of a variety of forms of arthritis as will be discussed later in this article. Turmeric, ginger pineapple, herbs, vitamin D and omega 3 oils all seem to be profoundly beneficial. The good news is that even moderate changes in diet can lead to significant beneficial changes in onset, severity and progression of symptoms of arthritic disease.[i] [ii] As well increasing intake of certain food stuffs it is clear that exclusion diets may be of considerable benefit. In one double blind randomised controlled study 36% of patients showed improvement in their clinical condition after removing certain foods from their diets. The foods most likely to be contributing to the arthritic conditions are shown in the table [iii]

Fasting also seemed to bring about an improvement, but return to normal dietary practise caused a return of symptoms . Hover if subsequently a vegan/vegetarian or Mediterranean diet was adopted, then the improvement was much more likely to be maintained.[iv]

It is known that the adverse effect of obesity on osteoarthritis is not simply due to increase load bearing by the joints but the association of high level inflammatory mediators which seem to be associated with particularly visceral fat. Weight loss by have a direct and significant anti-inflammatory effects. Studies suggest that supplementation of Omega 3 oils at 1000mg to 3500mg per day are likely to help both rheumatoid and osteoarthritis. (approx six servings of oily fish per week), thus supplementation is likely to be the best way of obtaining this quantity of omega 3 oils.

It is also suggested that one should reduce consumption of sunflower and corn oil and increase try instead olive oil and rape seed oil in attempt to increase the antinflammatory omega 3 component in the diet compared to pro-inflammatory omega 6.

Low levels of anti oxidants and vitamins in the diet seem to be associated with increased symptoms of arthritis and supplementation seem to help reduce symptoms, though mega doses of standard viatmins are not recommended[v]. The supplements that have been shown to be helpful include Vitamin C, caretenoids(present in a wide range of fruit and vegetables) vitamin E (in nuts, seeds,and whole grain cereals ), and particularly selenium ( in brazil nuts liver/kdney and fish), low levels of which has been shown to be associated with both inflammatory and osteo arthritis and seems to be particularly deficient in western diets. The role of copper and zinc deficiency is also being recognized and these present in meat and fish in particular . see table [vi]

Vitamin D deficiency has been shown to contribute to disease on set and severity in inflammatory arthritis and more controversially osetoarthrits. It has been recommended that because there are so so few dietary source and due to the high incidence of vitamin D deficiency in the population (and lack of exposure to sunlight ) (see later) that dietary supplementation between 400iu per day generally and possibly upto 2000iu per day in inflammatory arthritis (until blood levels reach at least 75nmol/l). [vii]

Foods found to exacerbate rheumatoid arthritis

Food	patients affected (%)	Food	patients affected (%)
Corn	57	Malt	27
Wheat	54	Cheese	24
Bacon/pork	39	Grapefruit	24
Oranges	39	Tomato	22
Milk	37	Peanuts	20
Oats	37	Sugar	20
Rye	34	Butter	17
Eggs	32	Lamb	17
Beef	32	Lemons	17
Coffee	32	Soya	17

Full-size table

N.B. Dietary intolerances varied between patients

Food that may help rheumatoid arthritis/osteoarthritis.

Vitamin C	Vitamin E	Carotenoids	Selenium	Copper	Zinc
Blackcurrants, kiwi fruit, strawberries	Vegetable oils	Carrots, mange tout peas, curly kale, sweet potato	Brazil nuts	Crab, prawns, lobster, mussels	Red meat
Citrus fruits	Margarine	Red/green capsicums	Liver/kidney	Liver/kidney	Liver/kidney
Fruit juice	Wholegrain cereals	Tomato products	Fish shellfish	Plain chocolate	Fish and shellfish
Vegetables: especially curly kale, spring greens, Brussels sprouts, green	Nuts and seeds	Melon (orange), apricots, pumpkin	Lentils and pulses	Beans and lentils	Milk and milk products

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[i] McKellar G, Morrison E, McEntegart A, et al. A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow. Ann Rheum Dis. 2007 Sep;66(9):1239-43.

[ii] Dietary Manipulation in Musculoskeletal conditions by Rayman and Pattison. In Best Practice & Research Clinical Rheumatology. 2008;22 no 3 :535-561 . This is a brilliant current state of the art review and I am indebeted to the authors .

[iii] Lancet. 1986 Feb 1;1(8475):236-8. Placebo-controlled, blind study of dietary manipulation therapy in rheumatoid arthritis. Darlington LG, Ramsey NW, Mansfield JR and Br J Rheumatol. 1993 Jun;32(6):507-14 Review of dietary therapy for rheumatoid arthritis. Darlington LG, Ramsey NW. G. McKellar, E. Morrison and A. McEntegart et al., A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow, Annals of the Rheumatic Diseases 66 (2007), pp. 1239–1243.

[iv] H. Müller, F.W. de Toledo and K.L. Resch, Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review, Scandinavian Journal of Rheumatology 30 (2001), pp. 1–1012 L. Sköldstam, L. Hagfors and G. Johansson, An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis, Annals of the Rheumatic Diseases 62 (2003), pp. 208–214

[v] M. Reijman, H.A. Pols and A.P. Bergink et al., Body mass index associated with onset and progression of osteoarthritis of the knee but not of the hip: the Rotterdam Study, Annals of the Rheumatic Diseases 66 (2007), pp. 158–162 P. Creamer and M.C. Hochberg, Osteoarthritis, Lancet 350 (1997), pp. 503–508. H. Hauner and Z. Hochberg, Endocrinology of adipose tissue, Hormone and Metabolic Research 34 (2002), pp. 605–606. H. Hauner, Secretory factors from human adipose tissue and their functional role, The Proceedings of the Nutrition Society 64 (2005), pp. 163–169. L. Fontana, J.C. Eagon and M.E. Trujillo et al., Visceral fat adipokine secretion is associated with systemic inflammation in obese humans, Diabetes 56 (2007), pp. 1010–1013. Y. Toda, T. Toda and S. Takemura et al., Change in body fat, but not body weight or metabolic correlates of obesity, is related to symptomatic relief of obese patients with knee osteoarthritis after a weight control program, The Journal of Rheumatology 25 (1998), pp. 2181–2186. Y. Wang, A.E. Wluka and D.R. English et al., Body composition and knee cartilage properties in healthy, community-based adults, Annals of the Rheumatic Diseases 66 (2007), pp. 1244–1248. O. Adam, Anti-inflammatory diet in rheumatic diseases, European Journal of Clinical Nutrition 49 (1995), pp. 703–717. P.C. Calder and R.B. Zurier, Polyunsaturated fatty acids and rheumatoid arthritis, Current Opinion in Clinical Nutrition and Metabolic Care 4 (2001), pp. 115–121. C.H. MacLean, W.A. Mojica and S.C. Morton et al., Effects of omega-3 fatty acids on lipids and glycemic control in Type II diabetes and the metabolic syndrome and on inflammatory bowel disease, rheumatoid arthritis, renal disease, systemic lupus erythematosus, and osteoporosis Summary, Evidence Report/Technology Assessment No. 89. (prepared by the Southern California/RAND Evidence-based Practice Center, Los Angeles, CA.) AHRQ Publication No. 04-E012, Agency for Healthcare Research and Quality, Rockville, MD (March 2004). M.J. James, S.M. Proudmann and L.G. Cleland, Dietary n-3 fats as adjunctive therapy in a prototypic inflammatory disease: issues and obstacles for use in rheumatoid arthritis, Prostaglandins, Leukotrienes, and Essential Fatty Acids 68 (2003), pp. 399–405. P.C. Calder, N-3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases, The American Journal of Clinical Nutrition 83 (Suppl.) (2006), pp. 1505S–1519S. R.J. Goldberg and J. Katz, A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain, Pain 129 (2007), pp. 210–223.L.J. Leventhal, E.G. Boyce and R.B. Zurier, Treatment of rheumatoid arthritis with gamma-linolenic acid, Annals of Internal Medicine 119 (1993), pp. 867–873. C. Little and T. Parsons, Herbal therapy for treating rheumatoid arthritis, Cochrane Database of Systematic Reviews (Online) 1 (2001) R. Ariza-Ariza, M. Mestanza-Peralta and M.H. Cardiel, Omega-3 fatty acids in rheumatoid arthritis: an overview, Seminars in Arthritis and Rheumatism 27 (1998), pp. 366–370 L.G. Darlington and T.W. Stone, Antioxidants and fatty acids in the amelioration of rheumatoid arthritis and related disorders, The British Journal of Nutrition 85 (2001), pp. 251–269.J.M. Kremer, n-3 fatty acid supplements in rheumatoid arthritis, The American Journal of Clinical Nutrition 71 (2000), pp. 349S–351S. P.R. Fortin, R.A. Lew and M.H. Liang et al., Validation of a Meta-Analysis: the effects of fish oil in rheumatoid arthritis, Journal of Clinical Epidemiology 48 (1995), pp. 1379–1390. D. Volker, P. Fitzgerald and G. Major et al., Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis, The Journal of Rheumatology 27 (2000), pp. 2343–2346. O. Adam, C. Beringer and T. Kless et al., Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis, Rheumatology International 23 (2003), pp. 27–36.

[vi] Modified from Dietary Manipulation in Musculoskeletal conditions by Rayman and Pattison. In Best Practice & Research Clinical Rheumatology. 2008;22 no 3 :535-561 . This is a brilliant current state of the art review and I am indebeted to the authors .

[vii] S. Patel, T. Farragher and J. Berry et al., Association between serum vitamin D metabolite levels and disease activity in patients with early inflammatory polyarthritis, Arthritis and Rheumatism 56 (2007), pp. 2143–2149 H.F. DeLuca and M.T. Cantorna, Vitamin D: its role and uses in immunology, The FASEB Journal 15 (2001), pp. 2579–2585. J. Brohult and B. Jonson, Effects of large doses of calciferol on patients with rheumatoid arthritis. A double-blind clinical trial, Scandinavian Journal of Rheumatology 2 (1973), pp. 173–176. L. Dottori, D. D'Ottavio and B. Brundisini, Calcifediol and calcitonin in the therapy of rheumatoid arthritis. A short-term controlled study, Minerva Medica 73 (1982), pp. 3033–3040. Z. Andjelkovic, J. Vojinovic and N. Pejnovic et al., Disease modifying and immunomodulatory effects of high dose 1 alpha (OH) D3 in rheumatoid arthritis patients, Clinical and Experimental Rheumatology 17 (1999), pp. 453–456. E. Hypponen and C. Power, Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors, The American Journal of Clinical Nutrition 85 (2007), pp. 860–868. M.F. Holick, Vitamin D deficiency, The New England Journal of Medicine 357 (2007), pp. 266–281. T. McAlindon and D.T. Felson, Nutrition: risk factors for osteoarthritis, Annals of the Rheumatic Diseases 56 (1997), pp. 397–402. T.E. McAlindon, D.T. Felson and Y. Zhang et al., Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study, Annals of Internal Medicine 125 (1996), pp. 353–359. N.E. Lane, L.R. Gore and S.R. Cummings et al., Serum vitamin D levels and incident changes of radiographic hip osteoarthritis: a longitudinal study. Study of Osteoporotic Fractures Research Group, Arthritis and Rheumatism 42 (1999), pp. 854–860. D.T. Felson, J. Niu and M. Clancy et al., Low levels of vitamin D and worsening of knee osteoarthritis: results of two longitudinal studies, Arthritis and Rheumatism 56 (2007), pp. 129–136. M.T. Cantorna and B.D. Mahon, D-hormone and the immune system, The Journal of Rheumatology 76 (Suppl.) (2005), pp. 11–20. H.A. Bischoff-Ferrari, Y. Zhang, D.P. Kiel and D.T. Felson, Positive association between serum 25-hydroxyvitamin D level and bone density in osteoarthritis, Arthritis and Rheumatism 53 (2005), pp. 821–826.

Turmeric , another reason to enjoy curries!

This food has been shown in various studies to help musculoskeletal symptoms and inflammation in general. The yellow pigment in Turmeric (curcumin) has been shown to have a potent anti-inflammatory effect comparable to prescription anti inflammatory drugs and consumption has been shown to be inversely related to the incidence of Alzheimer’s (a disease which is also thought to have an inflammatory basis.

· Tumeric may be helpful in many conditions where inflammation is mediating the disease pathology such as Inflammatory Bowel Disease,

· Turmeric may help Cystic Fibrosis in experimental models, It has also been shown to prevent cancer in animal models of breast cancer and Non-Hodgkins lymphoma.

· Significantly turmeric seems to prevent precancerous colonic polyps from developing in clinical studies. Quercetin, an anti-oxidant flavonoid found in onions, green tea and red wine, was also shown a similar effect. Studies combining curcumin with phenethyl isothiocyanates, a phytochemical abundant in cruciferous vegetables including cauliflower, cabbage, broccoli, Brussels sprouts, kale, kohlrabi and turnips significantly reduced both prostatic tumour cell growth and spread in animal studies.

· Population studies suggest inverse correlation between child hood leukaemia and turmeric consumption

· Turmeric may help to improve liver function in animal models, in humans turmeric consumptions dropped cholesterol levels in blood and improved overall lipid profile

· Turmeric may protect against neurodegenerative diseases. and this supported by population studies which show that Alzheimer's are very low in aging Indian and other Asian populations . Mechanisms of action include production of antioxidant proteins inhibition of amyloid  aggregation and boost Amyloid Plaque Clearance

Key Referances Aggarwal B. October 5, 2005,. reported in NUTRAingredients.com/Europe "Turmeric slows breast cancer spread in mice.". Balasubramanian K. Molecular Orbital Basis for Yellow Curry Spice Curcumin's Prevention of Alzheimer's Disease. J. Agric. Food Chem., 54 (10), 3512 -3520, 2006. 10.1021/jf0603533 S0021-8561(06)00353-0, Web Release Date: April 20, 2006. Calabrese V, et al Nutritional antioxidants and the heme oxygenase pathway of stress tolerance: novel targets for neuroprotection in Alzheimer's disease. Ital J Biochem. 2003 Dec;52(4):177-81. Calabrese V, et. al. Paper on curcumin's induction of hemeoxygenase-1. American Physiological Society, April 17-21, 2004, Washington, D.C. Cruz-Correa M, et al Combination treatment with curcumin and quercetin of adenomas in familial adenomatous polyposis. Clin Gastroenterol Hepatol. 2006 Aug;4(8):1035-8. Deshpande UR, al. Protective effect of turmeric (Curcuma longa L.) extract on carbon tetrachloride-induced liver damage in rats. Indian J Exp Biol 1998 Jun;36(6):573-7. Dorai T et al. Therapeutic potential of curcumin in human prostate cancer. Curcumin inhibits proliferation, induces apoptosis, and inhibits angiogenesis of LNCaP prostate cancer cells in vivo. Prostate 2001 Jun 1;47(4):293-303. Egan ME, et al Curcumin, a major constituent of turmeric, corrects cystic fibrosis defects. Science. 2004 23;304(5670):600-2. Lim GP,et al. The curry spice curcumin reduces oxidative damage and amyloid pathology in an Alzheimer transgenic mouse. J Neurosci 2001;21:8370-7. Nagabhushan et al. In vitro antimutagenicity of curcumin against environmental mutagens. Food Chem Toxicol. 1987 25(7):545-7. Nagabhushan et al . Curcumin as an inhibitor of cancer. J Am Coll Nutr. 1992;11:192-8. Park et al Discovery of natural products from Curcuma longa that protects cells from beta-amyloid insult: a drug discovery effort against Alzherimer's disease. J Nat Prod 2002;65(9):1227-31. Shishodia S, et al Curcumin (diferuloylmethane) inhibits constitutive NF-kappaB activation, induces G1/S arrest, suppresses proliferation, and induces apoptosis in mantle cell lymphoma. Biochem Pharmacol. 2005 ;70:700-13. Soni KB, at al Effect of oral curcumin administration on serum peroxides and cholesterol levels in human volunteers. Indian J Physiol Pharmacol. 1992 Oct;36(4):273-5. Zhang L, et al Curcuminoids enhance amyloid-beta uptake by macrophages of Alzheimer's disease patients. J Alzheimer’s Dis. 2006 Sep;10(1):1-7.

The remarkable properties of Green Tea

Green tea[i]

Green tea drinkers appear to have lower risk of many diseases including chronic degenerative conditions such as cardiovascular disease, cancer, stroke, oral disease, osteoporosis and infections.

Green tea is rich in flavonoids (30% by dry weight, in contrast black tea may contain only 3-10%) These include polyphenols including (epigallocatechin gallate (EGCG), which is a potent free radical scavenger. Three cups per day provide up to 320mg of polyphenols including 100 mg of EGCG.

i. Green Tea reduces death from all causes, especially Cardiovascular Disease

In one study, women who drink 5 cups or more of green tea showed 20% lower risk of dying from any cause 33% lower risk of dying from heart disease and 66% lower risk of dying from stroke, Men showed 10% lower risk of dying from any cause 20% lower risk of dying from CVD and 40% lower risk of dying from stroke. This relationship was not seen for black or oolong (fermented) teas.

A further study showed a 16% reduction in coronary artery disease and it has been suggested green tea inhibits atherosclerosis formation by lowering harmful fats in the blood. In one animal study the equivalent of 5 cups of green tea a day inhibited atherosclerosis by approximately 33% and 10 cups inhibited atherosclerosis by 50% . Green tea catechin inhibits the pro-inflammatory effects of meats , omega 6 oils (e.g. corn oil) and inhibiting blood cell clumping. Blood pressure is 50% lower in those who drank regular green tea. It has also been shown to be helpful in situation of acute heart attacks, by inhibiting heart cell damage and accelerating recovery. Similar findings have been shown in stroke situations.

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ii.Green Tea and Cancer

Women who consume the most green tea were approx 1/5^th less likely to develop breast cancer independent of any other life style changes. Catechins are thought to be responsible and inhibiting formation of atherosclerosis and cancer. Catechins inhibit angiogenesis (new blood vessel formation which is essential for cancer cells to survive), but more intriguingly, Catechins cause cancerous but not normal cells to commit suicide (apoptose. Green tea has been shown to inhibit PSA (a marker for prostate cancer) rise in a dose dependent manner

The consumption of green tea plus Lycopene containing foods (e.g tomatoes, apricots, pink grapefruit, watermelon, papaya, and guava) is synergistic leading to was found to have an 80-90% reduced risk of prostate cancer. A further study showed an approx 50% reduction in advanced prostate cancer in regular green tea drinkers

Tea drinking prevents onset of ovarian cancer, by up to ¼ for one cup or so per day and up to a ½ for 2 cups. Each further cup of tea per day reduced risk of ovarian cancer by a further 20%. Even in women with established ovarian cancer drinking green tea lowered death rates by 50% over 3 years.

The combination of green tea and soy bean extract was shown to inhibit both breast cancer and prostate cancer.[ii] Combining green tea with other flavanoids (kaempferol) in broccoli and onions led to a 40% lower risk of ovarian cancer. Women consuming the flavonoid luteolin, in e.g. celery, parsley spinach. had a 34% reduced risk of ovarian cancer, compared those with the lowest luteolin intake.

Further studies suggest inhibition of Colorectal Cancer by 50% , Gallstones and Biliary Tract Cancers by a approximately a third and may offer some protection against lung cancer in smokers and inhibits spread in bladder cancers.

iii.Green Tea and Diabetes, Bone Density, Fat loss Viral infection and Exercise.

Green tea improves Insulin Sensitivity in Type 2. Green tea also protects against organ dysfunction after kidney transplant In addition it may prevent liver damage[iii] and has been shown to inhibit flu virus replication.

Green tea may significantly increase bone mineral density in Women who drank green tea 5 or more days per week even allowing for all other factors and the effects of green tea are similar to that of exercise on bone density. Loss of bone density per year was 1.6% per year in green tea drinkers compared to 4% per year in non tea drinker. Green tea seems to inhibit gum disease and protect the liver from the effects of alcohol and other toxins.

Green tea promotes fat loss. Green tea as catechins inhibits fat absorption from the blood by inhibiting some of the pancreatic and gastric enzymes involved. Long term consumption of green tea also promotes exercise endurance in animal models, in human beings this would equate to 4 cups per day

iv.Green Tea and Neural Function

EGCH in green tea protects against Cognitive Decline in a dose dependant fashion , with those consuming 2 cups per day showing ½ as much cognitive decline, Alzheimer's Disease and Parkinson's. The postulated mechanisms include scavenging of free radicals and activation of survival genes as well reduced formation of Beta amyloid protein which is seen in plaques Sin Alzheimer's disease. [iv]

One set of authors wrote

“The potential effect of tea drinking in protecting against the cognitive decline of advanced age thus has great significance, given the rapid aging of the population and the rising prevalence of vascular and Alzheimer-type dementia….,"

the study authors conclude…

"Because tea is cheap, nontoxic, and widely consumed, it has a huge potential effect in promoting cognitive health and perhaps delaying the onset of dementia. Further studies should investigate whether tea consumption lessens the risk of vascular and Alzheimer-type dementia”."[v]

One of the green teas that has been shown to have the highest levels of EGCG is “Long Jing” or otherwise known as “Dragon Well”.

See www.HealingThePerson.com for details.

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[i] Much of the information was adapted from the excellent article at http://www.whfoods.com/genpage.php?tname=foodspice&dbid=146#healthbenefits

References quoted Adhami et al H. Oral consumption of green tea polyphenols inhibits insulin-like growth factor-I-induced signaling in an autochthonous mouse model of prostate cancer. Cancer Res. 2004 Dec 1;64(23):8715-22. Aneja R, et al Epigallocatechin, a green tea polyphenol, attenuates myocardial ischemia reperfusion injury in rats. Mol Med. 2004 Jan-Jun;10(1-6):55-62. Azam Prooxidant property of green tea polyphenols epicatechin and epigallocatechin-3-gallate: implications for anticancer properties. Toxicol In Vitro. 2004 Oct;18(5):555-61. Baek Epicatechin gallate-induced expression of NAG-1 is associated with growth inhibition and apoptosis in colon cancer cells. Carcinogenesis. 2004 Aug 12 Bastianetto S, Neuroprotective effects of green and black teas and their catechin gallate esters against beta-amyloid-induced toxicity. Eur J Neurosci. 2006 Jan;23(1):55-64. BBC Health News. Green tea 'may protect the heart. 2005/02/28, http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/4298403.stm. Chen D Green tea and tea polyphenols in cancer prevention. Front Biosci. 2004 Sep 01;9:2618-31. PMID:15358585. Chen JH, Green tea polyphenols prevent toxin-induced hepatotoxicity in mice by down-regulating inducible nitric oxide-derived prooxidants. Am J Clin Nutr. 2004 Sep;80(3):742-51. Choi YB, Protective effect of epigallocatechin gallate on brain damage after transient middle cerebral artery occlusion in rats. Brain Res. 2004 Sep 3;1019(1-2):47-54. Chow Modulation of human glutathione s-transferases by polyphenon e intervention. Cancer Epidemiol Biomarkers Prev. 2007 Aug;16(8):1662-6. Coimbra The effect of green tea in oxidative stress. Clin Nutr. 2006 Oct;25(5):790-6. Epub 2006 May 15. Coimbra . Nutr Res. 2006 Nov;26(11):604-7. Devine Tea drinking is associated with benefits on bone density in older women. Am J Clin Nutr. 2007 Oct;86(4):1243-7.Donovan JL, Chavin. Green tea (Camellia sinensis) extract does not alter cytochrome p450 3A4 or 2D6 activity in healthy volunteers. Drug Metab Dispos. 2004 Sep;32(9):906-8. Eckert RL, Antioxidants regulate normal human keratinocyte differentiation. Biochem Pharmacol. 2004 Sep 15;68(6):1125-31. Ensminger. Foods & Nutriton Encyclopedia. Pegus Press, Clovis, California 1983 Fassina G. et al Mechanisms of inhibition of tumor angiogenesis and vascular tumor growth by epigallocatechin-3-gallate. Clin Cancer Res. 2004 Jul 15;10(14):4865-73.Gardner EJ, Black tea - helpful or harmful? A review of the evidence. Eur J Clin Nutr. 2006 Jul 19; Gates et al A prospective study of dietary flavonoid intake and incidence of epithelial ovarian cancer. Int J Cancer. 2007 Apr 30;Geetha et al . Delineation of antimutagenic activity of catechin, epicatechin and green tea extract. Mutat Res. 2004 Nov 22;556(1-2):65-74. PMID:15491633. Ghosh et al . Green tea polyphenols as inhibitors of ribonuclease A. Biochem Biophys Res Commun. 2004 Dec 17;325(3):807-11. Gouni-Berthold et al Molecular mechanisms explaining the preventive effects of catechins on the development of proliferative diseases. Curr Pharm Des. 2004;10(11):1261-71. Hakim et al. Effect of a 4-month tea intervention on oxidative DNA damage among heavy smokers: role of glutathione S-transferase genotypes. Cancer Epidemiol Biomarkers Prev. 2004 Feb;13(2):242-9.Han et al . Specific plasma membrane binding sites for polyphenols, including resveratrol, in the rat brain. J Pharmacol Exp Ther. 2006 Mar 30. Haque et al . Long-term administration of green tea catechins improves spatial cognition learning ability in rats. J Nutr. 2006 Apr;136(4):1043-7. Huh et al . Anticancer effects of (-)-epigallocatechin-3-gallate on ovarian carcinoma cell lines. Gynecol Oncol. 2004 Sep;94(3):760-8. Hussain et al. Green tea constituent epigallocatechin-3-gallate selectively inhibits COX-2 without affecting COX-1 expression in human prostate carcinoma cells. Int J Cancer. 2004 Sep 28; Irwin K. Green tea extract has potential as an anti-cancer agent, according to a study by UCLA researchers. UCLA News, February 15, 2005. Jian et al . Tea and lycopene protect against prostate cancer. Asia Pac J Clin Nutr. 2007;16 Suppl 1:453-7 Juhel C, Armand M, Pafumi Y, Rosier C, Vandermander J, Lairon D. Green tea extract (AR25(R)) inhibits lipolysis of triglycerides in gastric and duodenal medium in vitro. J Nutr Biochem. 2000 Jan;11(1):45-51. PMID:15539342.. Koo et al. Pharmacological effects of green tea on the gastrointestinal system. Eur J Pharmacol. 2004 Oct 1;500(1-3):177-85. Kurahashi et al for the JPHC Study Group. Green Tea Consumption and Prostate Cancer Risk in Japanese Men: A Prospective Study. Am J Epidemiol. 2007 Sep 29; . Kuriyama et al . Green tea consumption and cognitive function: a cross-sectional study from the Tsurugaya Project 1. Am J Clin Nutr. 2006 Feb;83(2):355-61. Kuriyama et al . Green tea consumption and mortality due to cardiovascular disease, cancer, and all causes in Japan: the Ohsaki study. JAMA. 2006 Sep 13;296(10):1255-65. Larsson SC, Wolk A. Tea consumption and ovarian cancer risk in a population-based cohort. Arch Intern Med. 2005 Dec 12-26;165(22):2683-6. Mandel S, Youdim MB. Catechin polyphenols: neurodegeneration and neuroprotection in neurodegenerative diseases. Free Radic Biol Med. 2004 Aug 1;37(3):304-17. Mei Yet al . Reversal of cancer multidrug resistance by green tea polyphenols. J Pharm Pharmacol. 2004 Oct;56(10):1307-14. Muraki et al . Green tea drinking is associated with increased bone mineral density in elderly women. Study P187SA, presented at the International Osteoporosis Foundation World Congress on Osteoporosis, Toronto, Canada, June 5, 2006. Nagao et al . Ingestion of a tea rich in catechins leads to a reduction in body fat and malondialdehyde-modified LDL in men. Am J Clin Nutr. 2005 Jan;81(1):122-9. Negishi et al . Black and green tea polyphenols attenuate blood pressure increases in stroke-prone spontaneously hypertensive rats. J Nutr. 2004 Jan;134(1):38-42. Niwattisaiwong et al. Effects of Chinese, Japanese and Western tea on hepatic P450 enzyme activities in rats. Drug Metabol Drug Interact. 2004;20(1-2):43-56. Ostrowska Jet al. Green tea protects against ethanol-induced lipid peroxidation in rat organs. Alcohol. 2004 Jan;32(1):25-32. Park HJ, et al Epigallocatechin gallate reduces hypoxia-induced apoptosis in human hepatoma cells. Life Sci. 2006 Jan 26. Pezzato Eet al Prostate carcinoma and green tea: PSA-triggered basement membrane degradation and MMP-2 activation are inhibited by (-)epigallocatechin-3-gallate. Int J Cancer. 2004 Dec 10;112(5):787-92. Sakanaka S, Okada Y. Inhibitory effects of green tea polyphenols on the production of a virulence factor of the periodontal-disease-causing anaerobic bacterium Porphyromonas gingivalis. J Agric Food Chem. 2004 Mar 24;52(6):1688-92. PMID:15030231.Saleem et al . Tea beverage in chemoprevention of prostate cancer: a mini-review. Nutr Cancer. 2003;47(1):13-2. Sano et al Effects of green tea intake on the development of coronary artery disease. Circ J. 2004 Jul;68(7):665-70. Sasazuki al. Relation between green tea consumption and the severity of coronary atherosclerosis among Japanese men and women. Ann Epidemiol 2000 Aug;10(6):401-8 2000. Schwartz et al . Molecular and cellular effects of green tea on oral cells of smokers: A pilot study. Mol Nutr Food Res. 2004 Nov 11; Siddiqui et al Antioxidants of the beverage tea in promotion of human health. Antioxid Redox Signal. 2004 Jun;6(3):571-82. Song et al . Antiviral effect of catechins in green tea on influenza virus. Antiviral Res. 2005 Nov;68(2):66-74. Vinson et al. Green and black teas inhibit atherosclerosis by lipid, antioxidant, and fibrinolytic mechanisms. J Agric Food Chem. 2004 Jun 2;52(11):3661-5. Weinreb et al . Neurological mechanisms of green tea polyphenols in Alzheimer's and Parkinson's diseases. J Nutr Biochem. 2004 Sep;15(9):506-16. Wu et al . Effect of green tea supplementation on insulin sensitivity in Sprague-Dawley rats. J Agric Food Chem. 2004 Feb 11;52(3):643-8. Yang et al . Prospective cohort study of green tea consumption and colorectal cancer risk in women. Cancer Epidemiol Biomarkers Prev. 2007 Jun;16(6):1219-23. Yang et al . The protective effect of habitual tea consumption on hypertension. Arch Intern Med. 2004 Jul 26;164(14):1534-40. Zhang et al . Green tea consumption enhances survival of epithelial ovarian cancer. Int J Cancer. 2004 Nov 10;112(3):465-9. Zhang et al . Tea drinking and the risk of biliary tract cancers and biliary stones: a population-based case-control study in Shanghai, China. Int J Cancer. 2006 Jun 15;118(12):3089-94.

[ii] Zhou et al. Combined inhibition of estrogen sensitive dependant human breast carcinoma by soy and tea bioactive components in mice. And Zhou et al. Soy phytochemical and tea bioactive components synergistically inhibit androgen sensitive human prostate cancers Journal of Nutrition. 2003;133:516-21

[iii] American Society for Nutrition J. Nutr. 138:323-331, February 2008 Green Tea Extract Protects Leptin-Deficient, Spontaneously Obese Mice from Hepatic Steatosis and Injury Bruno et al

[iv] Am J Clin Nutr. 2008;88:224-231.

[v] http://www.medscape.com/viewarticle/577461?src=mp&spon=17&uac=83420PY