Recent Longevity News for the seven days ending 6/23/10.  You should consult your doctor if you are taking any medications.

Coffee cuts risk of head, neck cancers - MSNBC, 6/22/10 - "Overall, the risk of developing head and neck cancers was 12 percent lower in people who drank coffee compared with those who didn't ... And the more coffee consumed, the lower the cancer risk. In those who gulped more than four cups a day, for instance, the risk was reduced by more than a third ... Besides caffeine, coffee contains more than a thousand chemicals ... the compounds cafestol and kahweol may be protective against carcinogens that would normally damage our genes"

Compound found in red wine neutralizes toxicity of proteins related to Alzheimer's - Science Daily, 6/22/10 - "An organic compound found in red wine -- resveratrol -- has the ability to neutralize the toxic effects of proteins linked to Alzheimer's disease ... this molecule can target some of these packing arrangements that are toxic and rearrange them into packing arrangements that are not toxic. For those forms that are non-toxic, it doesn't change them" - See resveratrol products at Amazon.com.

Gut bacteria could be key indicator of colon cancer risk - "a shift in the balance between the "good" bacteria and the "bad" bacteria that populate our gut could be a harbinger of colon cancer ... We think something happens to tip the balance away from the beneficial bacteria and in favor of microbes that make toxic metabolites and are detrimental to our health ... By pinpointing these bacterial culprits, we can not only identify people at risk, but also suggest that they include the good bacteria in their diet .. And what a great way to address colon cancer -- you could know your risk and lower it by eating your yogurt every day" - Note:  Dannon claims that only their Activia brand reaches the gut.  see:

• Activia by Dannon - "Specialists at Dannon® selected Bifidus Regularis™ for Activia® because it survives passage through the digestive tract, arriving in the colon as a living culture. Once there, it plays a beneficial role in your intestinal ecosystem"

Lemurs lose weight with 'life-extending' supplement resveratrol - Science Daily, 6/22/10 - "The anti-obesity properties of resveratrol have been demonstrated for the first time in a primate ... lemurs eating a diet supplemented with the compound decreased their energy intake by 13% and increased their resting metabolic rate by 29% ... a four-week resveratrol supplementation was associated with a decrease in food intake and a reduction in seasonal body-mass gain. The response to resveratrol supplementation also involved significant changes in the animals' body temperatures" - [Nutra USA] - See resveratrol products at Amazon.com.

Progesterone is effective for hot flash treatment and provides an alternative to estrogen, study finds - Science Daily, 6/21/10 - "Progesterone, in a 300-milligram dose, was more effective than placebo at decreasing the intensity and number of symptoms [hot flashes], the authors reported, and the difference was both statistically significant and clinically important. The 68 women taking progesterone showed a 56% improvement from baseline in VMSScore, and a 48% reduction in the number of VMS; the 46 women taking placebo had 28% lower VMSScores and a 22% reduction in number"

Well-defined quantity of antioxidants in diet can improve insulin resistance, study finds - Science Daily, 6/21/10 - "For groups C and D, the researchers prescribed a diet enriched in antioxidant, with a calculated intake, 800 to 1,000 milligrams a day, coming from fruits and vegetables, but group D also took metformin ... Despite similar weight loss in all the groups, only the two groups receiving the antioxidant diet (groups C and D) had a significant decrease in insulin resistance ... Group D had the best improvement in insulin resistance on some measures of insulin response to an oral glucose tolerance test ... We think that a total antioxidant level of 800 to 1,000 milligrams a day is safe and probably not close to the maximum tolerable level"

Fructose sugar makes maturing human fat cells fatter, less insulin-sensitive, study finds - Science Daily, 6/21/10 - "high levels of fructose, which may result from eating a diet high in fructose, throughout childhood may lead to an increase in visceral [abdominal] obesity, which is associated with increased cardiometabolic risk ... For both types of fat cells, maturation in fructose decreased the cells' insulin sensitivity, which is the ability to successfully take up glucose from the bloodstream into fat and muscles. Decreased insulin sensitivity is a characteristic of Type 2 diabetes"

Poor control of diabetes may be linked to low vitamin D - Science Daily, 6/21/10 - "Despite receiving regular primary care visits before referral to the endocrine clinic, 91 percent of patients had either vitamin D deficiency (defined as a level below 15 nanograms per deciliter, or ng/dL) or insufficiency (15 to 31 ng/dL) ... Additionally, the investigators found an inverse relationship between the patients' blood levels of vitamin D and their hemoglobin A1c value, a measure of blood sugar control over the past several months. Lower vitamin D levels were discovered in patients with higher average blood sugars as measured by HbA1c" - See vitamin D at Amazon.com.

Early-life exposure to BPA may affect testis function in adulthood - Science Daily, 6/21/10 - "Exposure to environmental levels of the industrial chemical bisphenol A, or BPA, in the womb and early life may cause long-lasting harm to testicular function"

Women with polycystic ovary syndrome have higher BPA blood levels, study finds - Science Daily, 6/21/10 - "Excessive secretion of androgens -- masculinization-promoting hormones -- occurs in PCOS. The syndrome raises the risk of infertility, obesity, Type 2 diabetes and heart disease ... Blood levels of BPA, compared with those of controls, were nearly 60 percent higher in lean women with PCOS and more than 30 percent higher in obese women with the syndrome ... Additionally, as the BPA blood level increased, so did the concentrations of the male sex hormone testosterone and androstenedione, a steroid hormone that converts to testosterone"

Treating depression with Omega-3: Encouraging results from largest clinical study - Science Daily, 6/21/10 - "Initial analyses failed to clearly demonstrate the effectiveness of Omega-3 for all patients taking part in the study. Other analyses, however, revealed that Omega-3 improved depression symptoms in patients diagnosed with depression unaccompanied by an anxiety disorder. Efficacy for these patients was comparable to that generally observed with conventional antidepressant treatment" - See Mega Twin EPA at Amazon.com and Jarrow Max DHA at Amazon.com.

Is Exercise the Best Drug for Depression - Time Magazine, 6/19/10 - "depressed adults who participated in an aerobic exercise plan improved as much as those treated with sertraline, the drug that was marketed as Zoloft ... Subsequent trials have repeated these results, showing again and again that patients who undergo aerobic exercise regimens see comparable improvement in their depression as those treated with medication, and that both groups do better than patients given only a placebo ... exercise may alter brain chemistry in much the same way that antidepressant drugs do — regulating the key neurotransmitters serotonin and norepinephrine"

FDA Approves Dutasteride/Tamsulosin Combo Pill for BPH - Medscape, 6/18/10 - "daily use of the drug combination yielded significantly greater relief of BPH symptoms compared with either 0.5 mg dutasteride or 0.4 mg tamsulosin alone, as measured by point changes on the International Prostate Symptom scale from baseline (mean Δ, −6.2 vs −4.9 and −4.3; P < .001 for both). The difference was observed by month 9 and continued through month 24" - See dutasteride at OffshoreRx1.com.

Drinking Moderate Amounts of Coffee, Tea, Is Protective Against CHD - Medscape, 6/18/10 - "the relationship between CHD morbidity and coffee was U-shaped: "We saw a significant protective effect with around two to four cups of coffee a day," whereas for tea, it was a linear and inverse association, with the lowest hazard ratio seen for more than six cups a day. But three to six cups of tea a day was associated with an almost 50% reduction in CHD deaths, although the number of events was small"

Vitamin D deficiency confirmed as common across a range of rheumatic conditions - Science Daily, 6/18/10 - "Two separate studies have shown that vitamin D deficiency is common in patients with a range of rheumatic diseases, with over half of all patients having below the 'normal' healthy levels of vitamin D (48-145 nmol/L) in their bodies. A further study assessing response to vitamin D supplementation found that taking the recommended daily dose did not normalise vitamin D levels in rheumatic disease patients" - See vitamin D at Amazon.com.

Note:  I haven't been doing specific research of probiotics.  The reason is been in my newsletters so much lately is because it's what's been in the news.

Oral bacteria may offer probiotic potential against upper respiratory infections - Science Daily, 6/18/10 - "So far, the benefits of probiotics have been predominantly explored in the intestinal tract, however, other initial studies suggest probiotics may contribute to wellness in the stomach, vaginal tract, skin and mouth ... A probiotic strategy effective in the prophylaxis of pharyngitis, therefore, could provide a significant social benefit"

Low calcium intake linked with increased risk of osteoporosis and hypertension in postmenopausal women - Science Daily, 6/18/10 - "a significantly increased proportion of women (35.4%) who consumed a lower amount of calcium through intake from dairy sources, had a concurrent diagnosis of both hypertension and osteoporosis, compared with women who consumed a higher amount of calcium (19.3% p<0.001) ... Further statistical analyses revealed that a lower calcium intake was associated with an increased risk of developing hypertension or osteoporosis over time when compared with controls (Odds Ratio (OR) hypertension: 1.43; 95%CI: 1.12-1.82, osteoporosis: OR 1.46; CI: 1.15-1.85). Women who consumed a lower amount of calcium were shown to be most likely to develop both conditions over time compared with women consuming a higher amount of calcium (OR 1.60; CI: 1.09-2.34)"

Probiotic therapy cuts risk of ventilator-associated pneumonia in half for some in ICU, study finds - Science Daily, 6/17/10 - "daily use of probiotics not only decreased VAP infections by about 50 percent compared to placebo, but also reduced the amount of antibiotics needed in comparison to placebo-treated patients. This reduction in antibiotic consumption led to significantly fewer Clostridium difficile infections in patients given probiotics. No side effects attributable to the probiotics were observed"

Probiotic Reduces Crying Time in Infants With Colic - Medscape, 6/17/10 - "One week of supplementation with the probiotic Lactobacillus reuteri Protectis reduced crying time in colicky babies by 74%, compared with 38% with placebo" - See Lactobacillus products at iHerb.

Gut-residing bacteria trigger arthritis in genetically susceptible individuals - Science Daily, 6/17/10 - "A single species of bacteria that lives in the gut is able to trigger a cascade of immune responses that can ultimately result in the development of arthritis ... In the absence of all bacteria, these mice didn't develop arthritis, but the introduction of a single bacterium was enough to jump-start the immune process that leads to development of the disease ... bacteria in the gut could influence the development of an autoimmune disease affecting tissues distant from the gut. Diseases such as irritable bowel syndrome have been linked to gut-residing bacteria" - See Garden of Life, Primal Defense at Amazon.com.  Also see my section in last week's newsletter on making you own Activa.

• Activia by Dannon - "Specialists at Dannon® selected Bifidus Regularis™ for Activia® because it survives passage through the digestive tract, arriving in the colon as a living culture. Once there, it plays a beneficial role in your intestinal ecosystem"

Blueberry ameliorates hepatic fibrosis, study finds - Science Daily, 6/17/10 - "An increasing number of natural substances have been studied to explore if they have protective effects on the liver. Blueberries have unique effects on human retinal, brain and tumor cells, but reports about the effects of blueberries on liver diseases are lacking ... The authors suggest that blueberry consumption is beneficial for hepatic diseases (including fibrosis)" - See blueberry extract at Amazon.com.

Alcohol consumption lowers risk of developing several arthritic conditions, study finds - Science Daily, 6/16/10 - "Alcohol consumption is associated with a significantly reduced risk of developing several arthritic conditions including Rheumatoid Arthritis (RA), Osteoarthritis (OA), reactive arthritis, psoriatic arthritis and spondylarthropathy ... alcohol consumption was associated with a significantly lower risk of developing RA (Odds Ratio (OR) 0.27 (0.22-0.34), Osteoarthritis (OR 0.31, (0.16-0.62), spondylarthropathy (OR 0.34, 0.17-0.67), psoriatic arthritis (OR 0.38, 0.23-0.62), and reactive arthritis (OR 0.27, 0.14-0.52)"

Vitamin D May Cut Risk of Flu - WebMD, 6/16/10 - "people who maintain vitamin D blood levels of 38 nanograms per milliliter or more are less likely to get viral infections such as flu than people with less in their blood ... Of 18 people who maintained that level during the study period, only three developed viral infect ... But of the 180 other participants with less vitamin D in their blood, 81(45%), did get sick with viral infections ... And those with higher levels of vitamin D also experienced a marked reduction in the number of days they were ill" - See vitamin D at Amazon.com.

Experts explore emerging evidence linking diabetes and cancer - Science Daily, 6/16/10 - "Possible mechanisms for a direct link between diabetes and cancer include hyperinsulinemia, hyperglycemia, and inflammation"

Women who choose boiled coffee run lower risk of breast cancer, Swedish study finds - Science Daily, 6/16/10 - "A major difference between boiled and filtered coffee is that the boiled version contains up to 80 times as much coffee-specific fatty acids ... Among women who drank boiled coffee more than four times a day there was a lowered risk of breast cancer compared with women who drank coffee less than once a day. Among women who drank filtered coffee there was an increased risk for early breast cancer (under 49 years old) and a decreased risk for late breast cancer (over 55 years old). Boiled-coffee drinkers, but not filtered-coffee drinkers, also had an increased risk of pancreatic cancer and lung cancer among men"

Mediterranean-style diet improves heart function, twin study shows - Science Daily, 6/15/10 - "heart rate variability (HRV) ... Eating a Mediterranean-style diet -- one characterized by low saturated fats and high in fish, fruits, vegetables, legumes, nuts, olive oil, cereals and moderate alcohol consumption -- reduces a person's heart disease risk ... the higher a person's diet score, the more variable the heart beat-to-beat time interval -- 10 percent to 58 percent (depending on the HRV measure considered) for men in the top Mediterranean diet score quarter compared to those in the lowest quarter; this equates to a 9 percent to 14 percent reduction in heart-related death"

New combination effective against pancreatic cancer: Substance in broccoli supports cancer therapy, study finds - Science Daily, 6/15/10 - "Sorafenib is used for advanced liver and kidney cancer and also appears to be effective against cancer stem cells in pancreatic cancer ... It inhibits resistant tumor stem cells and is also especially effective in combination with sulforaphane, an organic compound found in broccoli ... vegetables from the cruciferous family such as broccoli and cauliflower possess a high content of sulforaphane, an anti-cancer compound. The experiments show that sulforaphane prevents the activation of the NF-kB pathway by sorafenib. The combination treatment reinforces the effect of sorafenib without causing additional side effects" - See sulforaphane at Amazon.com.

Higher levels of vitamin B6, common amino acid associated with lower risk of lung cancer - Science Daily, 6/15/10 - "Our results suggest that above-median se­rum measures of both B6 and methionine, assessed on average 5 years prior to disease onset, are associated with a reduction of at least 50 percent on the risk of developing lung cancer. An additional association for se­rum levels of folate was present, that when combined with B6 and methionine, was associated with a two-thirds lower risk of lung cancer"

Obesity may harm your sexual health, study suggests - Science Daily, 6/15/10 - "obese women were 30% less likely to have had a sexual partner in the last 12 months. Obese men were 70% less likely to have had more than one sexual partner in the same period and were two and half times more likely to experience erectile dysfunction"

Abstracts from this week's Doctor's Guide Nutrition/Dietetics plus abstracts from my RSS feeds (Click here for the journals, the PubMed ones at the top):

Clinical evidence of skin benefits of a dietary supplement containing probiotic and carotenoids on UV- induced damage - Br J Dermatol. 2010 Jun 9 - "Lactobacillus johnsonii (La1) ... dietary supplement (DS) combining La1 and nutritional doses of carotenoids ... A 10 week DS intake prevented the UV-DL induced decrease in Langerhans cell density and the increase in Factor XIIIa+ type I dermal dendrocytes while it reduced dermal inflammatory cells. Clinical and instrumental MED rose by 20% and 19% respectively, and skin colour was intensified, as shown by the increase in DeltaE parameter. The efficacy of DS was confirmed by dermatologists and subjects in real conditions of use. Conclusion: Nutritional supplementation combining a specific probiotic (la1) and nutritional doses of carotenoids reduced early UV-induced skin damage caused by simulated or natural sun exposure in a large panel of subjects (n=139). Altogether, these results support the use of this nutritional supplement for a global approach in photoprotection, in combination with a sunscreen" - See probiotics at Amazon.comand Jarrow Formulas, CarotenALL, Mixed Carotenoid Complex at Amazon.com.

Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study - J Allergy Clin Immunol. 2010 Jun 8 - "insufficient vitamin D status was associated with a higher odds of any hospitalization or emergency department visit (odds ratio, 1.5; 95% CI, 1.1-1.9; P = .01)" - See vitamin D at Amazon.com.

Effect of Long-Term L-Arginine Supplementation on Arterial Compliance and Metabolic Parameters in Patients with Multiple Cardiovascular risk Factors: Randomized, Placebo-Controlled Study - J Cardiovasc Pharmacol. 2010 Jun 7 - "large artery elasticity index (LAEI) ... Although large artery elasticity index (LAEI) did not differ significantly between the groups at baseline (10.64.3 vs.11.64.5 ml/mm HgX100, p=0.346), at the end of the study LAEI was significantly greater in patients treated with L-arginine than in the placebo group (12.73.4 vs. 8.02.8 ml/mm HgX10, p<0.0001). Systemic vascular resistance was significantly lower in patients treated with L-arginine than in the placebo group after 6 months. Small artery elasticity index (SAEI) did not differ significantly between the groups at baseline or at the end of the study. Serum aldosterone decreased significantly in Group 1 from 10.76.3 to 8.45.0 ng/ml (p=0.008), but did not change in the placebo group. CONCLUSION:: L-arginine supplementation improves LAEI in patients with multiple cardiovascular risk factors. This improvement was associated with a decrease in systolic blood pressure, peripheral vascular resistance as well as a decrease in aldosterone levels. The results suggest that long term L-arginine supplementation has beneficial vascular effects in pathologic disease states associated with endothelial dysfunction" - See L-arginine products at Amazon.com.

Role of androgens in women's sexual dysfunction - Menopause. 2010 Jun 8 - "Significantly lower levels of two precursor hormones, dehydroepiandrosterone sulfate and androstene-3beta,17beta-diol, were found in women with sexual dysfunction ... Although the significance of the former awaits further study, androgen deficiency in women with HSDD was not confirmed. Given the unknown long-term effects of testosterone supplementation, women receiving testosterone therapy should be informed that a deficit of testosterone activity in women with HSDD has not been identified" - See DHEA at Amazon.com.

Neat Tech Stuff and "How To's: (backing up Blu-Ray Movies):

• What you'll need:
  • A Blu-Ray reader burner such as LG Electronics 8X External Blu-ray ReWrite Drive BE08LU20
  • Software such as AnyDVD HD.
  • Software such at CyberLink Power2Go.  Note, I think the Power2Go software comes bundled with the above LG drive.  I bought the Media Suite 8 Ultra upgrade which was $70 when you register the bundled software so I'm not sure.
  • For Blu-Ray movies less than 25 GB, blank single layer Blu-Ray such as Verbatim 97090 25 GB 2x Blu-ray Single-Layer Recordable Disc BD-R LTH (Low to High), 20-Disc Spindle.
  • For Blu-Ray moves greater than 25 GB (which seem to be most movies), Blu-Ray dual layer discs such as TDK Blu-ray Disc 10 Pack - 50GB 4X BD-R DL.
• With the source disc in the Blu-Ray drive, right click the AnyDVD HD icon and select "Rip to Image ...", uncheck ""Keep Protection" and  save it on your hard drive as a .iso file.
• When that's done, remove the source disc and put the blank disc in. In Windows Explorer, click on the .iso file and it should bring it up the Power2Go software.  Follow the menu to burn the unprotected .iso file to the blank Blu-Ray disc.
• Another option that I like better is to right click AnyDVD HD and rip to the hard drive.  Then, on the hard drive, go to the BDMV/STREAM directory and find the .m2ts file that huge (usually 18 to 48 GB).  Drag that file into Nero Vision (Part of Nero 10 Suite) and burn it.  Nero will also compress it onto the cheaper single layer discs but I don't know what the limits are.
• To take advantage of the 1080 Blu-Ray resolution you need to use the HDMI jack.  Many systems are already maxed out.  Here's a good fix from monoprice.com:  4X4 True Matrix HDMI 1.3a Powered Switch w/ Remote Controller

Health Focus (Combining ACEI's and ARBs, Pros and Cons):

• ARB Plus ACE Not for Heart Failure - Medscape, 9/10/09
• Combining ACE Inhibitors With Angiotensin Receptor Blockers May Not Be Optimal for Treating Hypertension - Doctor's Guide, 5/11/09
• Beneficial Effects of Combination Therapy with Angiotensin II Receptor Blocker and Angiotensin-Converting Enzyme Inhibitor on Vascular Endothelial Function - Hypertens Res. 2008 Aug;31(8):1603-10 - "these results suggest that the angiotensin I-converting enzyme inhibitor perindopril is superior to the calcium channel blocker amlodipine for reducing vascular endothelial dysfunction when co-administered with angiotensin receptor blockers in patients with essential hypertension"
• Use of Combination ACE Inhibitors and ARB Therapy in Patients With CKD - Medscape, 9/29/08
• Effects of Angiotensin Converting Enzyme Inhibitor and Angiotensin II Receptor Antagonist Combination on Nitric Oxide Bioavailability and Atherosclerotic Change in Watanabe Heritable Hyperlipidemic Rabbits - Hypertens Res. 2008 Mar;31(3):575-84 - "1) vehicle (control), 2) the ACEI enalapril (E: 3 mg/kg/day), 3) the ARB losartan (L: 30 mg/kg/day) and 4) enalapril (1.5 mg/kg/day) + losartan (15 mg/kg/day) (E+L). Intra-aortic infusion of ACh produced an increase in plasma NO concentration, which was significantly greater with all the drug treatments than with the control. E increased ACh-induced NO significantly more than L (by 6.9 nmol/L, and 4.7 nmol/L, respectively). E+L increased ACh-induced NO by 9.5 nmol/L, significantly more than either E or L ... the combined treatment with an ACEI and an ARB may have additive protective effects on endothelial function as well as atherosclerotic change"
• Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, or Both for Patients With Proteinuria? A Best Evidence Review - Medscape, 5/20/08 - "Most significantly, the addition of ACEIs to ARBs reduced proteinuria to a greater degree than ARBs alone (ratio of means 0.76 at 1 to 4 months and 0.75 at 5 to 12 months). Combination therapy was also superior to treatment with ACEIs alone ... The 2 important conclusions that can be drawn from this meta-analysis are that ARBs are not superior to ACEIs in improving proteinuria, and that the combination of these 2 treatments appears superior in this outcome compared with either treatment alone ... Two of the biggest safety concerns regarding the combination therapy include the risks for hyperkalemia and acute worsening of renal function. A review of the literature, however, suggests that these risks may not be significantly worse with combination treatment vs monotherapy"
• ACE Inhibitors Plus ARBs Reduce Proteinuria But Increase Kidney Damage - Doctor's Guide, 8/15/08 - "in people at high vascular risk, telmisartan's effects on major renal outcomes are similar to [those of] ramipril. Although combination therapy reduces proteinuria to a greater extent than monotherapy, overall it worsens major renal outcomes"
• Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events - N Engl J Med. 2008 Mar 31 - "Telmisartan was equivalent to ramipril in patients with vascular disease or high-risk diabetes and was associated with less angioedema. The combination of the two drugs was associated with more adverse events without an increase in benefit" - Yeah but if you have to go with two drugs it sure seems like it's the least of all the evils regarding side effects.
• ACE Inhibitors May Protect Diabetics From Cancer, Peptic Ulcer - Medscape, 12/19/08 - "There was a significant association between ACE inhibitor use and the risk for cancer, with an adjusted odds ratio of 0.59 ... The rate of cancer among users of ACE inhibitors was 10% vs 15% for nonusers ... There was also a significant association between ACE inhibitor use and peptic ulcer disease, with an odds ratio of 0.68 ... The rate of peptic ulcer disease among ACE inhibitor users was 12% vs 16% among nonusers"
• Establishing A New Option for Target-organ Protection: Rationale for ARB Plus ACE Inhibitor Combination Therapy - Am J Hypertens. 2008 Jan 24 - "Combination therapy targeting RAS activation may reduce target-organ damage and provide superior blood pressure (BP) control; combining angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) represents one possible approach"
• Rationale for double renin-angiotensin-aldosterone system blockade - Am J Cardiol. 2007 Aug 6;100(3A):25J-31J - "The clinical benefits of both angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) extend beyond blood pressure reduction to encompass tissue-protective effects in target organs, such as the heart, vasculature, and kidneys, that underlie the reductions in cardiovascular mortality and morbidity seen in large outcome trials. However, these effects are achieved by different mechanisms. ACE inhibitors reduce circulating and tissue angiotensin II levels and potentiate the beneficial effects of bradykinin, including generation of nitric oxide (NO). By contrast, the protective effects of ARBs are owing to the blockade of the angiotensin II type 1 (AT(1)) receptors and possibly also to the stimulation of angiotensin II type 2 (AT(2)) receptors, again resulting in NO release. In addition, some ARBs, such as telmisartan, are selective activators of peroxisome proliferator-activated receptor-gamma (PPAR-gamma), thereby increasing insulin sensitivity. In contrast to other PPAR-gamma ligands, such as the thiazolidinediones, activation of this receptor by telmisartan does not result in weight gain. The complementary mechanisms of action of ACE inhibitors and ARBs create a rationale for combination therapy in high-risk patients"
• New opportunities in cardiovascular patient management: a survey of clinical data on the combination of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers - Am J Cardiol. 2007 Aug 6;100(3A):45J-52J - "Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) differ in their actions on the renin-angiotensin-aldosterone system (RAAS). ACE inhibitors prevent the formation of angiotensin II, although angiotensin II may still be generated by alternative pathways. However, ACE inhibitors interrupt bradykinin breakdown, which in turn potentially enhances nitric oxide and prostacyclin mechanisms. In contrast, ARBs selectively prevent the binding of angiotensin II to the angiotensin type 1 (AT(1)) receptor while leaving the potentially beneficial effects of the AT(2) receptor unaffected. The supposition is that dual blockade of the RAAS effectively overcomes the harmful effects of angiotensin II mediated by the AT(1) receptor while offering the additional effects of the ACE inhibitor"
• Do we use an ACE, an ARB, or both? What clinical trials tell us - Patient Care, 4/1/05 - "Combining ACEs and ARBs can improve outcomes, particularly for patients with heart failure and those who have hypertension with diabetes"
• Impact of Telmisartan Versus Ramipril on Renal Endothelial Function in Patients with Hypertension and Type 2 Diabetes - Diabetes Care. 2007 Mar 2 - "In patients with type 2 diabetes telmisartan and ramipril both increased NO activity of the renal endothelium significantly that in turn may support the preservation of cardiovascular and renal function"
• Addition of an angiotensin receptor blocker to full-dose ACE-inhibition: controversial or common sense? - Eur Heart J. 2005 Nov;26(22):2361-7 - "combination of a full-dose ACE-inhibitor and an ARB can be a rational choice in selected patients" - [full article]
• Combination ACE inhibitor and angiotensin receptor blocker therapy - future considerations - J Clin Hypertens (Greenwich). 2007 Jan;9(1):78-86. - "The individual gains seen with each of these drug classes have led to speculation that their combination might offer additive if not synergistic outcome benefits. The foundation of this hypothesis, although biologically possible, has thus far not been sufficiently well proven to support the everyday use of these 2 drug classes in combination. Additional outcomes trials, which are currently proceeding to their conclusion, may provide the necessary proof to support an expanded use of these 2 drug classes in combination"
• Do ACE inhibitors and ARBs mix well? Analysis urges caution - theheart.org, 10/10/07 - "patients receiving both an ACE inhibitor and an ARB were more likely not to comply with therapy due to side effects, which included hypotension, cough, angioedema, worsening renal function as defined by a change in serum creatinine >0.5 mg/dL, hyperkalemia as defined by serum potassium level changes >5.5 mEq/L, and symptomatic hypotension"
• See telmisartan and ramipril at OffshoreRx1.com

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