Pomegranate shows promise for the prevention of postoperative cognitive dysfunction
Tuesday, November 5, 2013. On September 16, 2013, the journal Evidence-Based Complementary and Alternative Medicine published the results of a pilot study which found a protective effect for pomegranate against postoperative cognitive dysfunction in heart surgery patients. The phenomenon of postoperative cognitive dysfunction subsequent to cardiac surgery has been suggested to be the result of global ischemia, which leads to reduced oxygen and glucose levels in the brain, or could be caused by other factors related to general anesthesia, particularly the aggregation of beta amyloid. Both amyloid aggregation and brain ischemia lead to an increase in reactive oxygen species, which in turn increase neuronal cell death and inflammation. Polyphenols such as those occurring in pomegranate have been shown to have a neuroprotective effect in experimental models in addition to being associated with other health benefits.
The study included ten patients scheduled to undergo coronary artery bypass grafting and/or valve repair/replacement. Participants were randomized to receive a placebo or one gram capsules containing a blend of pomegranate-derived polyphenols twice daily, beginning a week before the surgery and continued until six weeks following the event. Neuropsychological tests that evaluated various aspects of learning and memory were administered one week prior to surgery, and were repeated two and six weeks afterward.
Participants who received a placebo exhibited slight impairment of memory at both post-surgery time points; however, those who received pomegranate demonstrated improvements in all aspects of memory in comparison with their status at the beginning of the study. While memory retention was the domain most affected by surgery, supplementation with pomegranate was associated with strong improvement in this area.
Authors Richard E. Hartman of Loma Linda University and his colleagues remark that, in addition to pomegranate's neuroprotective benefit, the fruit has been associated with reductions in low-density lipoprotein aggregation, oxidative stress, serum angiotensin converting enzyme and systolic blood pressure. "In this study, we are the first to show that pomegranate can improve cognitive functions in humans," they announce. "We showed a clear pattern of postsurgical memory improvement in the pomegranate group across all of the memory domains that we tested, with an especially strong and long-lasting protective effect in the memory retention domain."
"Perhaps the most intriguing prospect raised by this study is the possibility that dietary supplementation with pomegranate polyphenols can improve cognition," they write. "If this treatment can improve memory retention performance for individuals who have undergone a surgical treatment shown to cause a decline in performance, perhaps this treatment can improve the cognitive function of healthy individuals."
The results of a trial reported on July 31, 2013 in the Journal of the American College of Cardiology reveal a reduction in postoperative atrial fibrillation in men and women given omega-3 polyunsaturated fatty acids and vitamins C and E. Atrial fibrillation is a type of heart arrhythmia that is a major risk factor for illness and mortality when it occurs following cardiac surgery. Evidence suggests that oxidative stress may play a role in the development of this condition.
Participants included 307 patients scheduled to undergo on-pump heart surgery at the University of Chile Clinical Hospital and the San Juan de Dios Hospital in Santiago. The subjects were randomized to receive a placebo or 2 grams eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) beginning seven days prior to surgery, and 1 gram vitamin C and 400 international units (IU) vitamin E beginning two days before surgery. Supplementation was continued until discharge from the hospital. Continuous electrocardiographic monitoring performed for 24 to 48 hours after the surgery and Holter monitoring until the fourth postoperative day followed by periodic ECG evaluation detected any new onset atrial fibrillation.
Postoperative atrial fibrillation occurred in 32% of subjects who received a placebo and just 9.7% of the supplemented group. Additionally, those who received the supplements experienced atrial fibrillation later than the placebo group. The researchers calculated that the placebo group had a 3.62 times greater risk of postoperative atrial fibrillation on any day in comparison with participants who received the supplements.
"This short-term, safe, low cost treatment containing readily available substances represents a cost effective strategy that could improve the outcome of patients who undergo on-pump cardiac surgery, as well as other surgeries, involving atrial fibrillation risk, thereby reducing major cardiovascular adverse events, the length of hospital stay, and the overall cost," Ramón Rodrigo and coauthors conclude.
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