Health Technology Research Synopsis

127th Issue Date 20APR2012

Compiled By Ralph Turchiano

www.vit.bz

www.youtube.com/vhfilm

 

Editors Top Five:

1.      New study examines risks and benefits of the first line treatment for diabetes

2.      Caffeine use may offer relief for millions of dry eye sufferers

3.      Naturopathic care can improve blood sugar, mood in diabetes

4.      Taking large doses of vitamin C may moderately reduce blood pressure

5.      Omega-3 fatty acids may help to reduce the physical harm caused by smoking

 

In this issue:

1.      Penn Study Cautions Use of Drugs to Block “Niacin Flush” in Heart Patients

2.      New study examines risks and benefits of the first line treatment for diabetes

3.      Antioxidant may disrupt Alzheimer’s disease process

4.      Hate group formation associated with big-box stores

5.      High levels of phthalates can lead to greater risk for type-2 diabetes

6.      Exercise and attitude may be thermostat for hot flashes

7.      Caffeine use may offer relief for millions of dry eye sufferers

8.      Liquorice root found to contain anti-diabetic substance

9.      A common cholesterol medication may impact kidney health

10.  Sunlight plus lime juice makes drinking water safer

11.  Get moving: Daily exercise may reduce Alzheimer’s disease risk at any age

12.  Naturopathic care can improve blood sugar, mood in diabetes

13.  Modest alcohol consumption lowers risk and severity of liver disease

14.  Taking large doses of vitamin C may moderately reduce blood pressure

15.  Omega-3 fatty acids may help to reduce the physical harm caused by smoking

 

Penn Study Cautions Use of Drugs to Block “Niacin Flush” in Heart Patients

PHILADELPHIA — Niacin, or vitamin B3, is the one approved drug that elevates “good” cholesterol (high density lipoprotein, HDL) while depressing “bad” cholesterol (low density lipoprotein , LDL), and has thereby attracted much attention from patients and physicians. Niacin keeps fat from breaking down, and so obstructs the availability of LDL building blocks.

Patients often stop taking niacin because it causes uncomfortable facial flushing, an effect caused by the release of a fat called prostaglandin or (PG)D2. PGD2 is the primary cause of the unwanted vasodilation, the “niacin flush.” The dilation occurs when blood vessels widen from relaxed smooth muscle cells within vessel walls.

PGD2, formed by an enzyme called COX-2 and released by immune and skin cells, acts on a muscle cell-surface receptor called DP1 to cause the flushing. In fact, a combination of a DP1- blocking drug and niacin is being evaluated in a large clinical trial to determine its effectiveness in reducing heart attacks, as opposed to other drugs that reduce LDL cholesterol.

In work published in the Journal of Clinical Investigation this month, first authors Wenliang Song, MD, research assistant professor, and Jane Stubbe, PhD, postdoctoral fellow, in the Perelman School of Medicine, University of Pennsylvania, and their colleagues now question the wisdom of blocking DP1 in patients prone to cardiovascular disease, especially those taking niacin.

Drawing evidence from studies in mice and humans, they show that platelets — complicated cells circulating in the bloodstream that stick together in the first phase of blood clotting — make PGD2, which acts as a brake via DP1 on their own activation. This is surprising as PGD2 is made in platelets by COX-1, the target inhibited by low-dose aspirin.

COX-1 in platelets also makes thromboxane (Tx)A2, another fat that activates platelets. As low-dose aspirin is cardioprotective by thinning blood, the benefit from shutting down platelet TxA2 trumps the potential risk of suppressing platelet PGD2 production.

To gather more information on the potential risks from blocking DP1, the Penn investigators used mice lacking the DP1 receptor. However, unlike humans, mice do not express DP1 in their platelets. “Frankly, because of this, we did not expect to detect any signal of cardiovascular hazard in the mice,” notes senior author Garret FitzGerald, MD, director of the Institute for Translational Medicine and Therapeutics.

However, deletion of DP1 made mice somewhat more susceptible to hardening of the arteries, the formation of aneurysm, thrombosis, and in some cases, high blood pressure. The researchers suggest that these findings are reflective of DP1 expression in vascular and immune cells in mice, just as in humans, despite its absence on mouse platelet cells.

Turning back to humans, the Penn investigators discovered that niacin evoked COX-1- dependent formation of both TxA2 and PGD2 in platelets and that a DP1 blockade enhanced the effect of TxA2 on platelet activation.

Taken together, these interwoven findings suggest that blocking the effects of PGD2 on DP1 is likely to be undesirable in patients with heart disease, and perhaps in particular, those taking niacin. That possibility is not addressed by the design of the large ongoing trial of the niacin/DP1 antagonist combination, say the researchers.

Should such a hazard exist, FitzGerald expects it to be confined to those patients not taking low-dose aspirin, along with niacin. “This potential hazard of blocking one aspect of PGD2 action, the one dependent on DP1, contrasts nicely with our recent report that blocking its other receptor, DP2, may be beneficial in limiting male-pattern baldness” said FitzGerald.

New study examines risks and benefits of the first line treatment for diabetes

Although the drug metformin is considered the gold standard in the management of type 2 diabetes, a study by a group of French researchers published in this week’s PLoS Medicine suggests that the long-term benefits of this drug compared with the risks are not clearly established—an important finding given that currently, thousands of people around the world are regularly taking metformin to help control their blood sugar levels in the belief that it also has long-lasting health benefits.

For the past 14 years, metformin has been recommended as the first-line treatment for type 2 diabetes after a landmark study (the UK Prospective Diabetes Study) reported that when combined with dietary control measures, metformin reduced death from all causes in overweight people with type 2 diabetes. However, an overlooked finding from this study was that in non-overweight people with type 2 diabetes, metformin may actually increase the risk of death.

In this new analysis, the authors led by Catherine Cornu from the Clinical Investigation Centre, in Lyon, France, analysed the data available from all relevant studies to re-evaluate the balance of the benefits versus the risks of taking metformin for type 2 diabetes.

Using information from 13 randomized controlled trials (which included a total of more than 13,000 patients) the authors found that compared to other drugs, metformin had no effect on the risk of death from all causes or on the risk of death from cardiovascular disease. Furthermore, metformin had no significant effect on the risk of developing cardiovascular conditions such as heart attacks, strokes, and heart failure.

The authors conclude: “We cannot exclude beyond any reasonable doubt that metformin use increases or decreases the risk of all-cause mortality or cardiovascular mortality.”

They explain: “The specific efficacy of metformin to prevent death or cardiovascular events has not been proven by current studies. The number and quality of available studies are insufficient.”

The authors recommend: “Further studies are needed to clarify this problematic situation. Metformin may not be the best comparator [drug] for evaluating new hypoglycaemic [blood sugar-lowering] drugs. However, it is not clear which comparator [drug] has the most favourable risk/benefit ratio.”

It is essential that patients taking metformin who have any concerns do not stop the drug without consulting their doctor, especially as the authors conclude that “Compared with other antidiabetic treatments, metformin may be the one with the least disadvantages. It does not induce hypoglycaemia, weight gain, and heart failure. It is also associated with a reduced rate of mortality among patients with atherothrombosis.”

Antioxidant may disrupt Alzheimer’s disease process

According to new study published in the Journal of Alzheimer’s Disease

Amsterdam, NL, April 10, 2012 – Alzheimer’s disease (AD) is now the sixth leading cause of death among Americans, affecting nearly 1 in 8 people over the age of 65. There is currently no treatment that alters the course of this disease. However, an increasing amount of evidence suggests that changes in the way the body handles iron and other metals like copper and zinc may start years before the onset of AD symptoms. A new study shows that reducing iron levels in blood plasma may protect the brain from changes related to AD.

In the current study a group of investigators from led by Dr. Othman Ghribi, PhD, Associate Professor, Department of Pharmacology, Physiology, and Therapeutics, University of North Dakota School of Medicine and Health Sciences, rabbits were fed a high-cholesterol diet which caused them to accumulate plaques of a small protein called beta-amyloid (Aβ). These plaques are toxic to neurons and central to the development of Alzheimer’s disease. The rabbits also developed changes in tau protein, which is part of the skeleton of neurons. When this protein becomes heavily phosphorylated, the ability of neurons to conduct electrical signals is disrupted. Following treatment with a drug called deferiprone (an iron chelator), the iron level in the rabbits’ blood plasma was reduced and the levels of both beta-amyloid and phosphorylated tau in the brain were returned to normal levels.

Another degenerative process in AD involves the production of reactive oxygen species (ROS) that can damage neurons in the brain. Deferiprone is also thought to suppress this reactive oxygen damage caused by free iron in the bloodstream, however in this study there was no difference in reactive oxygen species in the treated group. It appears that iron in the AD brain is located in the wrong places – in particular it accumulates to very high levels in the cores of beta-amyloid plaques and is very reactive in this setting.

According to Dr. Ghribi, “Our data show that treatment with the iron chelator deferiprone opposes several pathological events induced by a cholesterol-enriched diet…Deferiprone reduced the generation of Aβ and lowered levels of tau phosphorylation.” While there was no effect on ROS levels, he comments that “It is possible that a higher dose of deferiprone, or combination therapy of deferiprone together with an antioxidant to prevent ROS generation would more-fully protect against the deleterious effects of cholesterol-enriched diet that are relevant to AD pathology.”

Noted expert on metals metabolism research on AD Ashley Bush, MD, PhD, Mental Health Research Institute, Melbourne, Australia, adds that “this research highlights the role of metal ions as key modulators for the toxic interactions of risk factors for Alzheimer’s disease, in this case cholesterol. Drugs targeting these metal interactions hold promise as disease-modifying agents.”

Hate group formation associated with big-box stores

The presence of big-box retailers, such as Wal-Mart, K-Mart and Target, may alter a community’s social and economic fabric enough to promote the creation of hate groups, according to economists.

The number of Wal-Mart stores in a county is significantly correlated with the number of hate groups in the area, said Stephan Goetz, professor of agricultural economics and regional economics, Penn State, and director of the Northeast Regional Center for Rural Development.

“Wal-Mart has clearly done good things in these communities, especially in terms of lowering prices,” said Goetz. “But there may be indirect costs that are not as obvious as other effects.”

The number of Wal-Mart stores was second only to the designation of a county as a Metropolitan Statistical Area in statistical significance for predicting the number of hate groups in a county, according to the study.

The researchers, who reported their findings in the online version of Social Science Quarterly, said that the number of Wal-Mart stores in a county was more significant statistically than factors commonly regarded as important to hate group participation, such as the unemployment rate, high crime rates and low education.

The researchers suggested several theories for the correlation between the number of large retail stores and hate groups in an area.

Goetz, who worked with Anil Rupasingha, adjunct professor of agricultural economics and agricultural business, New Mexico State University, and Scott Loveridge, professor and director of the Northcentral Regional Center for Rural Development, Michigan State University, said that local merchants may find it difficult to compete against large retailers and be forced out of business.

Local business owners are typically members of community and civic groups, such as the Kiwanis and Rotary clubs. Losing members of these groups, which help establish programs that promote civic engagement and foster community values, may cause a drop in community cohesion, according to Goetz.

“While we like to think of American society as being largely classless, merchants and bankers are part of what we could call a leadership class in a community,” Goetz said.

The large, anonymous nature of big-box retailers may also play a role in fraying social bonds, which are strongest when individuals feel that their actions are being more closely watched. For example, people may be less likely to shoplift at a local hardware store if they know the owner personally, Goetz said.

Religious priming — using certain words or phrases to promote a range of attitudes and behaviors — may also play a role, according to the researchers. In one study of religious priming, after participants reviewed a list of Christian words, such as Bible, gospel and Messiah, they also tended to support racist attitudes against blacks.

The researchers said that because Wal-Mart promotes typical Protestant values, such as savings and thrift, the cues may lead customers to adopt other beliefs, including intolerant attitudes, according to the researchers.

The researchers used data collected by the Southern Poverty Law Center, a group that monitors the activities of hate groups, on hate groups in each U.S. county in 2007. They used the number and location of Wal-Mart stores from 1998. Goetz said the lag time between the data sets provided time for the possible influence of a store to affect a community.

Goetz said that the researchers chose Wal-Mart for the study because of the availability of data on the stores. He added that the presence of Wal-Mart in an area generally indicates the establishment of other types of big-box retailers, such as Home Depot and Target.

“We’re not trying to pick on Wal-Mart,” said Goetz. “In this study, Wal-Mart is really serving as a proxy for any type of large retailer.”

The store chain could use this study to find ways to play a role in supporting local groups that can foster stronger social and economic ties in a community.

“We doubt strongly that Wal-Mart intends to create such effects or that it specifically seeks to locate in places where hate groups form,” the researchers said.

High levels of phthalates can lead to greater risk for type-2 diabetes

There is a connection between phthalates found in cosmetics and plastics and the risk of developing diabetes among seniors. Even at a modest increase in circulating phthalate levels, the risk of diabetes is doubled. This conclusion is drawn by researchers at Uppsala University in a study published in the journal Diabetes Care.

“Although our results need to be confirmed in more studies, they do support the hypothesis that certain environmental chemicals can contribute to the development of diabetes,” says Monica Lind, associate professor of environmental medicine at the Section for Occupational and Environmental Medicine, Uppsala University.

Together with Lars Lind, professor of medicine at Uppsala University, she has analysed new information from the so-called PIVUS study, which covers more than 1 000 70-year-old women and men in Uppsala.

In a physical examination participants were examined for fasting blood sugar and various insulin measures. They submitted blood samples for analysis of various environmental toxins, including several substances formed when the body breaks down so-called phthalates. Most people come into daily contact with phthalates as they are used a softening agents in plastics and as carriers of perfumes in cosmetics and self-care products.

As expected, diabetes was more common among participants who were overweight and had high blood lipids. But the researchers also found a connection between blood levels of some of the phthalates and increased prevalence of diabetes, even after adjusting for obesity, blood lipids, smoking, and exercise habits. Individuals with elevated phthalate levels had roughly twice the risk of developing diabetes compared with those with lower levels. They also found that certain phthalates were associated with disrupted insulin production in the pancreas.

“However, to find out whether phthalates truly are risk factors for diabetes, further studies are needed that show similar associations. Today, besides the present study, there is only one small study of Mexican women. But experimental studies on animals and cells are also needed regarding what biological mechanisms might underlie these connections,” says Monica Lind.

Exercise and attitude may be thermostat for hot flashes

Attitude may play an important role in how exercise affects menopausal women, according to Penn State researchers, who identified two types of women — one experiences more hot flashes after physical activity, while the other experiences fewer.

“The most consistent factor that seemed to differentiate the two groups was perceived control over hot flashes,” said Steriani Elavsky, assistant professor of kinesiology. “These women have ways of dealing with (hot flashes) and they believe they can control or cope with them in an effective way on a daily basis.”

Women who experienced fewer hot flashes the day after participating in vigorous to moderate physical activity were more likely to be part of the group that felt they had control over their hot flashes. Women who had more hot flashes following exercise were likely to be those who felt they had very few ways of coping with their hot flashes, Elavsky and her colleagues report in a recent issue of Maturitas.

Elavsky suggested that cognitive behavioral therapy may help some women feel they have more control over their bodies and reactions to hot flashes.

The participants with fewer hot flashes the day after vigorous exercising were also less likely to experience anxiety and depression. However, women who had fewer hot flashes the day after only light or moderate physical activity had higher levels of pessimism and depression than others.

“The bottom line for research is that people need to look at individual differences,” said Elavsky. “It’s not enough anymore to do a study and look at overall impact of an exercise program on symptoms. It’s very clear that we need to look at the different responses that women might have, and try to understand these individual differences more.”

Elavsky and her colleagues followed 24 menopausal women for the length of one menstrual cycle, or for 30 days if they were no longer menstruating. Each woman used a personal digital assistant to record hot flashes and wore an accelerometer at the hip to track physical activity. The women in the study regularly had hot flashes before the start of the study, experiencing from five to 20 a day.

“The real-time reporting of symptoms and the objective measurement is a strength of the study,” said Elavsky. “There aren’t any studies out there that use both of these approaches. … To ask a woman to report a symptom when she’s experiencing it is the most valid assessment.”

At the beginning of the study, the participants completed evaluations that looked at their depressive symptoms, chronic stress, perceived control over hot flashes, and personality. They had a physical exam where researchers measured levels of reproductive hormones and body composition. Each woman served as her own control, therefore the data was analyzed for each separately.

If a woman experienced a hot flash during the observation period, she entered the event on the PDA, along with the severity and length of the event, where she was, if she had recently consumed a trigger, such as coffee, and included other situational information. At four random times throughout the day, the PDA prompted the woman to assess and record daily stressors and mood. At the end of the day, each completed a fifth assessment and looked retrospectively at how her day went and how well she coped with her hot flashes that day.

“I was surprised by how large the individual differences were,” said Elavsky. “I was also surprised that the association was present in terms of statistically significant association only in a handful of women — and among those, there were two whose physical activity led to more hot flashes the next day and one that had the opposite. Maybe the reason why we don’t see the associations in larger studies is because they cancel each other out.”

Caffeine use may offer relief for millions of dry eye sufferers

Study published in Ophthalmology journal

SAN FRANCISCO – April 17, 2012 – Researchers at the University of Tokyo’s School of Medicine have shown for the first time that caffeine intake can significantly increase the eye’s ability to produce tears, a finding that could improve treatment of dry eye syndrome. This common eye condition affects about four million people age 50 and older in the United States. For many, dry eye syndrome is simply uncomfortable and annoying, but for others it escalates into a vision-threatening disease. All of the 78 participants in the new study produced significantly more tears after consuming caffeine than after taking a placebo. The study is available in Ophthalmology, the journal of the American Academy of Ophthalmology.

Dry eye syndrome involves malfunction of the rate of tear production, the quality of tears, and/or the rate of evaporate from the surface of the eye. Anyone can experience dry eye, though it is more common among women. Symptoms can include gritty, scratchy or burning sensations, excessive tearing, and/or production of stringy mucus.

The research team, by Reiko Arita, MD, PhD, was motivated by an earlier study that had shown a reduced risk for dry eye in caffeine users: 13 percent of users had the syndrome compared with nearly 17 percent of non-users. The team knew that caffeine was likely to stimulate tear glands, since it is known to increase other secretions, such as saliva and digestive juices. They also knew that people respond differently to caffeine, so they analyzed study participants’ DNA samples for two genetic variations that play important roles in caffeine metabolism. Tear production proved to be higher in study subjects who had the two genetic variations.

“If confirmed by other studies, our findings on caffeine should be useful in treating dry eye syndrome,” said Dr. Arita. “At this point, though, we would advise using it selectively for patients who are most sensitive to caffeine’s stimulating effects.”

The study subjects were divided into two groups: one received caffeine tablets in the first session and a placebo in the second session, while the order was reversed for the other group. Tear volume was measured within 45 minutes of consuming the tablets. All sessions took place between 10 a.m. and noon, a time of day when tear production is usually stable. No subjects knew whether they received caffeine or the placebo. All abstained from caffeine use for six days prior to each session and used no drugs during the sessions. To be eligible for the study subjects had to be free of high blood pressure, dry eye syndrome, allergies that affect the eye, glaucoma, and other eye diseases and conditions that can interfere with tear production. The study also found that tear drainage rates were not affected by caffeine.

Dry eye can be very uncomfortable and interfere with vision. It’s important to see an ophthalmologist if symptoms continue, since advanced cases can cause eye damage and permanent vision problems. Current treatment options range from simple warm compresses, eye washes and artificial tears to medications and tear drainage devices.

Liquorice root found to contain anti-diabetic substance

Researchers discover promising anti-diabetic substance in the amorfrutin class of natural substances

It provides the raw material for liquorice candy, calms the stomach and alleviates diseases of the airways: liquorice root. Chosen as the “Medicinal plant 2012”, the root has been treasured in traditional healing since ancient times. Researchers at the Max Planck Institute for Molecular Genetics in Berlin have now discovered that liquorice root also contains substances with an anti-diabetic effect. These amorfrutins not only reduce blood sugar, they are also anti-inflammatory and are very well tolerated. Thus, they may be suitable for use in the treatment of complex metabolic disorders.

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Unexpectedly sweet help in the battle against diabetes: scientists have identified a group of natural substances with… [more]

Unexpectedly sweet help in the battle against diabetes: scientists have identified a group of natural substances with an anti-diabetic effect, the amorfrutins, in the edible roots of the liquorice plant Glycyrrhiza. [less]

© Alexander Vögtli, PharmaWiki

Natural substances have a surprising and often largely unexploited potential in the prevention and treatment of common diseases. For example, liquorice root Glycyrrhiza contains different substances that help to alleviate disorders of the airways and digestive system. It has been used for millennia in traditional healing and is mainly administered in the form of tea. A team of researchers working with Sascha Sauer from the Max Planck Institute for Molecular Genetics in Berlin has now discovered that the plant from the papilionaceae or leguminous family might also be effective in the treatment of adult (type 2) diabetes. The scientists identified a group of natural substances with an anti-diabetic effect, the amorfrutins, in the plant’s edible root.

The substances, which have a simple chemical structure, are not only found in liquorice root, but are also in the fruit of the Amorpha fruticosa bush. The new anti-diabetic agents were named after this plant, which is native to the US, Canada and Mexico. As the researchers demonstrated using diabetic mice, the amorfrutins not only have characteristics that reduce blood sugar, they are also anti-inflammatory in their effect. Moreover, they also prevent fatty liver – a common disease caused by excessively fat-rich nutrition.

“The health-beneficial effects are based on the fact that the amorfrutin molecules dock directly onto a receptor in the nucleus called PPARγ,” explains Sascha Sauer. PPARγ plays an important role in the cell’s fat and glucose metabolism. The binding of the amorfrutin molecules activates various genes that reduce the plasma concentration of certain fatty acids and glucose. The reduced glucose level prevents the development of insulin resistance – the main cause of adult diabetes.

“Although there are already drugs on the market that affect the PPARγ receptor, they are not selective enough in their effect and cause side effects like weight gain and cardio-vascular problems,” says Sascha Sauer. In contrast, as demonstrated by the studies carried out to date, the amorfrutins are very well tolerated. “However, drinking liquorice tea or eating liquorice will not help to treat diabetes,” explains the scientist. “The concentration of the substances in the tea and liquorice is far too low to be effective.” The researchers therefore developed special extraction processes to obtain the amorfrutins from the plant in sufficient concentrations. This could be used to produce amorfrutin extracts on an industrial scale.

The newly discovered active substances not only seem to hold great promise for the treatment of complex metabolic disorders, they may also be suitable for prophylactic use. “The amorfrutins can be used as functional nutritional supplements or as mild remedies that are individually tailored to the patient,” says Sascha Sauer. “In view of the rapid spread of metabolic diseases like diabetes, it is intended to develop these substances further so that they can be used on humans in the future.” To do this, the researchers must now test the effect of the substances and the plant amorfrutin extracts in clinical studies on diabetes patients.

A common cholesterol medication may impact kidney health

New study by Lawson Research cautions further research is needed

LONDON, ON, – Older patients taking a common cholesterol medication should be cautious of the impact on their kidney health. In a new study by Dr. Amit Garg, Scientist at the Lawson Health Research Institute and the Institute for Clinical Evaluative Sciences (ICES), and colleagues, one in 10 new older fibrate users experienced a 50 per cent increase in their serum creatinine.

Fibrates are a group of medications commonly used to treat high cholesterol. Recent evidence from clinical trials and case reports suggests fibrates can cause an increase to serum creatinine, an indicator of kidney health measured by a blood test, which indicates a loss of kidney health. After a number of similar experiences in their renal clinics, Dr. Garg and his colleagues felt these events merited further examination.

In a large, “real practice” study, the team examined more than 20,000 older Ontario residents with new prescriptions for fibrates. Throughout the first 90 days of their prescription, they monitored the renal outcomes in this population, and compared them to patients taking ezetimide, another cholesterol agent not known to have any renal effects.

Results show new fibrate users were more likely to experience an increase in serum creatinine; one in 10 users experienced a 50 per cent increase in the first 90 days of their prescription. As a result, these users were also more likely to consult a kidney specialist or to be hospitalized during this time.

The exact mechanism by which fibrates influence kidney function remains unclear and requires further research. This study proves that fibrates have important acute effects on kidney function and/or its measurement, to a greater extent than described in existing clinical trials data.

“At the end of the day, we want to prescribe medication with the highest benefit and the least amount of adverse events,” Dr. Garg says. “When a physician decides to start a fibrate in a new patient, especially an older patient, given the information we have today they should start the patient on a dose that’s appropriate, closely monitor their kidney function, and, if the kidney function goes off, either lower the dose or discontinue the drug.”

The full study is published in the Annals of Internal Medicine, available here: http://www.annals.org/content/156/8/560.abstract.

Sunlight plus lime juice makes drinking water safer

Looking for an inexpensive and effective way to quickly improve the quality of your drinking water? According to a team of researchers from the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins School of Medicine, sunlight and a twist of lime might do the trick. Researchers found that adding lime juice to water that is treated with a solar disinfection method removed detectable levels of harmful bacteria such as Escherichia coli (E. coli) significantly faster than solar disinfection alone. The results are featured in the April 2012 issue of American Journal of Tropical Medicine and Hygiene.

“For many countries, access to clean drinking water is still a major concern. Previous studies estimate that globally, half of all hospital beds are occupied by people suffering from a water-related illness,” said Kellogg Schwab, PhD, MS, senior author of the study, director of the Johns Hopkins University Global Water Program and a professor with the Bloomberg School’s Department of Environmental Health Sciences. “The preliminary results of this study show solar disinfection of water combined with citrus could be effective at greatly reducing E. coli levels in just 30 minutes, a treatment time on par with boiling and other household water treatment methods. In addition, the 30 milliliters of juice per 2 liters of water amounts to about one-half Persian lime per bottle, a quantity that will likely not be prohibitively expensive or create an unpleasant flavor.”

In low-income regions, solar disinfection of water is one of several household water treatment methods to effectively reduce the incidence of diarrheal illness. One method of using sunlight to disinfect water that is recommended by the United Nations Children’s Fund (UNICEF) is known as SODIS (Solar water Disinfection). The SODIS method requires filling 1 or 2 L polyethylene terephthalate (PET plastic) bottles with water and then exposing them to sunlight for at least 6 hours. In cloudy weather, longer exposure times of up to 48 hours may be necessary to achieve adequate disinfection. To determine if one of the active constituents in limes known as psoralenes could enhance solar disinfection of water, Schwab and Alexander Harding, lead author of the study and a medical student at the Johns Hopkins School of Medicine, looked at microbial reductions after exposure to both sunlight and simulated sunlight. The researchers filled PET plastic bottles with dechlorinated tap water and then added lime juice, lime slurry, or synthetic psoralen and either E. coli, MS2 bacteriophage or murine norovirus. Researchers found that lower levels of both E. coli and MS2 bacteriophage were statistically significant following solar disinfection when either lime juice or lime slurry was added to the water compared to solar disinfection alone. They did find however, that noroviruses were not dramatically reduced using this technique, indicating it is not a perfect solution.

“Many cultures already practice treatment with citrus juice, perhaps indicating that this treatment method will be more appealing to potential SODIS users than other additives such as TiO2 [titanium dioxide] or H2O2[hydrogen peroxide],” suggest the authors of the study. However, they caution, “additional research should be done to evaluate the use of lemon or other acidic fruits, as Persian limes may be difficult to obtain in certain regions.”

Get moving: Daily exercise may reduce Alzheimer’s disease risk at any age

ST. PAUL, Minn. – Daily physical exercise may reduce the risk of Alzheimer’s disease, even in people over the age of 80, according to a study published in the April 18, 2012, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“The study showed that not only exercise but also activities such as cooking, washing the dishes and cleaning are associated with a reduced risk of Alzheimer’s disease,” said study author Aron S. Buchman, MD, with Rush University Medical Center in Chicago and a member of the American Academy of Neurology. “These results provide support for efforts to encourage physical activity in even very old people who might not be able to participate in formal exercise but can still benefit from a more active lifestyle.”

For the study, a group of 716 people with an average age of 82 wore an actigraph, a device that monitors activity, on their non-dominant wrist continuously for 10 days. All exercise and non-exercise was recorded. They also were given annual tests during the four-year study that measured memory and thinking abilities. During the study, 71 people developed Alzheimer’s disease.

Participants also self-reported their physical and social activity. Buchman said this is the first study to use an objective measurement of physical activity in addition to self-reporting. “This is important because people may not be able to remember the details correctly,” he said.

The research found that people in the bottom 10 percent of daily physical activity were more than twice as likely to develop Alzheimer’s disease as people in the top 10 percent of daily activity.

The study also showed that those people in the bottom 10 percent of intensity of physical activity were almost three times as likely to develop Alzheimer’s disease as people in the top 10 percent of intensity of physical activity.

“Since the actigraph was attached to the wrist, activities like cooking, washing the dishes, playing cards and even moving a wheelchair with a person’s arms were associated with a lower Alzheimer’s risk,” said Michal Schnaider-Beeri, PhD, of Mount Sinai School of Medicine in New York in an accompanying editorial. “These are low-cost, easily accessible and side-effect free activities people can do at any age, including very old age, to possibly prevent Alzheimer’s disease.”

Naturopathic care can improve blood sugar, mood in diabetes

Holistic approach added to benefits of usual care in joint Group Health–Bastyr University study

Seattle, WA—A new joint study by Group Health Research Institute and Bastyr University Research Institute found that type 2 diabetes patients who received naturopathic care (as an adjunct to conventional care) had lower blood-sugar levels, better eating and exercise habits, improved moods, and a stronger sense of control over their condition than did patients receiving only conventional care.

The findings, published today in BMC Complementary and Alternative Medicine, show that complementary and alternative medicine (CAM) may have several positive effects on people with type 2 diabetes, which affects nearly 26 million Americans.

“The news is encouraging for those fighting the disease,” said Ryan Bradley, ND, MPH, director of the Center for Diabetes and Cardiovascular Wellness at Bastyr University and its clinic, the Bastyr Center for Natural Health. “Patients involved in the study cited the benefits of trying different approaches to find the best ways to minimize the effects of type 2 diabetes. In many ways, that strategy mirrors our partnership with Group Health in this research study—working together to discover the best possible solutions.”

Forty study participants received counseling on diet, exercise, and glucose monitoring from four naturopathic physicians (NDs) in addition to conventional diabetes care from their medical doctors, including prescription medications. Many of the participants also received stress-management care and dietary supplements. Researchers then compared these 40 participants with 329 patients receiving only conventional diabetes care.

In six months and about four naturopathic treatment visits, participants demonstrated improved self-care, more consistent monitoring of glucose, and improved moods. Hemoglobin A1c rates (a measure of blood-sugar control) were nearly a full percentage point lower for those patients. This compares with a drop of only 0.5 percent over the same time period for 329 clinically similar patients receiving only conventional diabetes care. The encouraging findings from this small observational study will need to be confirmed by a randomized trial with larger numbers of participants, according to Dr. Bradley.

Finding more effective ways of treating type 2 diabetes is important because it is one of the top-10 causes of death in Americans and is costly to treat: $1 out of every $10 spent on health care in the United States is used to fight type 2 diabetes, at a cost of $178 billion every year.

Modest alcohol consumption lowers risk and severity of liver disease

IMAGE:Two forms of nonalcoholic fatty liver disease (NAFLD) are depicted in these images of liver biopsies from adults, taken from this study. The first shows nonalcoholic fatty liver only.

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People with nonalcoholic fatty liver disease (NALFD) who consume alcohol in modest amounts – no more than one or two servings per day – are half as likely to develop hepatitis as non-drinkers with the same condition, reports a national team of scientists led by researchers at the University of California, San Diego School of Medicine.

The findings are published in the April 19, 2012 online issue of The Journal of Hepatology.

NALFD is the most common liver disease in the United States, affecting up to one third of American adults. It’s characterized by abnormal fat accumulation in the liver. The specific cause or causes is not known, though obesity and diabetes are risk factors. Most patients with NAFLD have few or no symptoms, but in its most progressive form, known as nonalcoholic steatohepatitis or NASH, there is a significantly heightened risk of cirrhosis, liver cancer and liver-related death.

NALFD is also a known risk factor for cardiovascular disease (CVD). Patients with NAFLD are approximately two times more likely to die from coronary heart disease than from liver disease. The study’s authors wanted to know if the well-documented heart-healthy benefits of modest alcohol consumption outweighed alcohol’s negative effects.

IMAGE:The second shows nonalcoholic steatohepatitis (NASH), a more serious condition with potential to progress to cirrhosis.

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“We know a 50-year-old patient with NAFLD has a higher risk of CVD,” said Jeffrey Schwimmer, MD, associate professor of clinical pediatrics at UC San Diego, director of the Fatty Liver Clinic at Rady Children’s Hospital-San Diego and senior author. “Data would suggest modest alcohol consumption would be beneficial (in reducing the patient’s CVD risk) if you don’t take liver disease into account. When you do take liver disease into account, however, the usual medical recommendation is no alcohol whatsoever.”

Schwimmer and colleagues discovered that the benefits of modest alcohol consumption were compelling, at least in terms of reducing the odds of patients with NAFLD from developing more severe forms of the disease. Patients with NASH are 10 times more likely to progress to cirrhosis, the final phase of chronic liver disease. Cirrhosis is the 12th leading cause of death in the U.S., killing an estimated 27,000 Americans annually.

“Our study showed that those people with modest alcohol intake – two drinks or less daily – had half the odds of developing NASH than people who drank no alcohol,” said Schwimmer. “The reasons aren’t entirely clear. It’s known that alcohol can have beneficial effects on lipid levels, that it increases ‘good’ cholesterol, which tends to be low in NAFLD patients. Alcohol may improve insulin sensitivity, which has a role in NAFLD. And depending upon the type of alcohol, it may have anti-inflammatory effects.”

The study also found that in patients with NAFLD, modest drinkers experienced less severe liver scarring than did lifelong non-drinkers.

The study did not evaluate the effects of different types of alcohol, such as beer or spirits. Schwimmer said to do so would require a much larger study. Also, the study’s findings do not apply to children. All of the participants in the study were age 21 and older.

The current paper is based on analyses of 600 liver biopsies of patient’s with NAFLD by a national panel of pathologists who had no identifying clinical information about the samples. The study excluded anyone who averaged more than two alcoholic drinks per day or who reported consuming five or more drinks in a day (binge-drinking) at least once a month. All of the patients were at least 21 years of age.

Schwimmer said the findings indicate patients with liver disease should be treated individually, with nuance.

“For a patient with cirrhosis or viral hepatitis, the data says even small amounts of alcohol can be bad. But that may not be applicable to all forms of liver disease. Forty million Americans have NAFLD. Physicians need to look at their patient’s overall health, their CVD risk, their liver status, whether they’re already drinking modestly or not. They need to put all of these things into a framework to determine risk. I suspect modest alcohol consumption will be an appropriate recommendation for many patients, but clearly not all.”

 

Taking large doses of vitamin C may moderately reduce blood pressure

Taking large doses of vitamin C may moderately reduce blood pressure, according to an analysis of years of research by Johns Hopkins scientists. But the researchers stopped short of suggesting people load up on supplements.

“Our research suggests a modest blood pressure lowering effect with vitamin C supplementation, but before we can recommend supplements as a treatment for high blood pressure, we really need more research to understand the implications of taking them,” says Edgar “Pete” R. Miller III, M.D., Ph.D., an associate professor in the division of general internal medicine at the Johns Hopkins University School of Medicine and leader of the study published in the American Journal of Clinical Nutrition.

Roughly 30 percent of adults in the United States have high blood pressure, or hypertension, an important risk factor for heart disease and stroke. Successful treatment may include drugs, exercise, weight loss, and dietary changes such as reducing salt intake. Some experts believe that large amounts of vitamin C, an essential micronutrient found primarily in fruits and vegetables, could lower pressure as well, but randomized, controlled dietary intervention studies — the gold standard of nutrition research — have produced mixed results.

Miller and his colleagues reviewed and analyzed data from 29 randomized, controlled, previously published clinical trials that reported systolic and/or diastolic blood pressure values and also compared vitamin C intake to a placebo. What they found is that taking an average of 500 milligrams of vitamin C daily — about five times the recommended daily requirement — reduced blood pressure by 3.84 millimeters of mercury in the short term. Among those diagnosed with hypertension, the drop was nearly 5 millimeters of mercury.

By comparison, Miller says, patients who take blood pressure medication such as ACE inhibitors or diuretics (so-called “water pills”) can expect a roughly 10 millimeter of mercury reduction in blood pressure.

Five hundred milligrams of vitamin C is the amount in about six cups of orange juice. The recommended daily intake of vitamin C for adults is 90 milligrams.

“Although our review found only a moderate impact on blood pressure, if the entire U.S. population lowered blood pressure by 3 milliliters of mercury, there would be a lot fewer strokes,” Miller says. Miller cautions, however, that none of the studies his team reviewed show that vitamin C directly prevents or reduces rates of cardiovascular disease, including stroke.

Scientists have focused on vitamin C’s potential role in blood pressure reduction because of the nutrient’s biological and physiological effects. For example, vitamin C may act as a diuretic, causing the kidneys to remove more sodium and water from the body, which helps to relax the blood vessel walls, thereby lowering blood pressure.

Nutritional supplements are a $28 billion-a-year industry, and marketing claims, newspaper stories and testimonials often make them hard to resist, Miller says. People often view supplements as a “natural alternative” and preferable to drugs for high blood pressure or other ailments, he adds, despite mounting evidence that many supplements don’t work and in some cases may cause harm.

“People love to take vitamins regardless of the evidence or lack of it,” Miller says. “We’re trying to raise the bar and provide evidence-based guidance about whether supplements help or actually do harm.” With respect to vitamin C, he says, the jury is still out.

Other study authors from Johns Hopkins include Stephen P. Juraschek, an M.D., Ph.D. candidate; Eliseo Guallar, M.D., Dr.Ph.; and Lawrence J. Appel, M.D., M.P.H.

Omega-3 fatty acids may help to reduce the physical harm caused by smoking

New study presented at the World Congress of Cardiology organized by the World Heart Federation

Dubai (20 April 2012): Omega-3 fatty acids may help to reduce the physical harm caused by smoking, according to a new study presented today at the World Congress of Cardiology.

The study, carried out in Greece, assessed the effect of four-week oral treatment with 2 g/day of omega-3 fatty acids on the arterial wall properties of cigarette smokers. The results showed that short-term treatment with omega-3 fatty acids improves arterial stiffness and moderates the acute smoking-induced impairment of vascular elastic properties in smokers.

“These findings suggest that omega-3 fatty acids inhibit the detrimental effects of smoking on arterial function, which is an independent prognostic marker of cardiovascular risk,” said Dr. Gerasimos Siasos, University of Athens Medical School, 1st Department of Cardiology, “Hippokration” Hospital. “The cardioprotective effects of omega-3 fatty acids appear to be due to a synergism between multiple, intricate mechanisms involving anti-inflammatory and anti-atherosclerotic effects. Furthermore, AHA recommends that people without documented history of coronary heart disease should consume a variety of fish (preferably oily – rich in omega-3 fatty acids) at least twice per week.”

“The World Heart Federation strongly encourages all smokers to quit,” said Dr Kathryn Taubert, Chief Science Officer at the World Heart Federation. “The only way to protect your body from the harmful effects of tobacco is to stop smoking. We encourage all people, both smokers and non-smokers, to eat healthy diets, which includes foods rich in omega-3 fatty acids.”




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