Health Technology Research Synopsis
133rd Issue Date 13 JUL 2012
Compiled By Ralph Turchiano
Editors Top Five:
2. Frankincense as a medicine 3. Dangerous caregivers for elderly 4. OxyContin formula change has many abusers switching to heroin 5. Veterinary vaccines found to combine into new viruses, prompting regulatory response
In This Is Issue:
1. Coffee consumption inversely associated with risk of most common form of skin cancersue: 2. Half of Heart Patients Make Serious Medication Errors, Even When Pharmacists Intervene 3. Physical activity needed in order to reap benefits of dietary restriction 4. Uncontrollable anger prevalent among US youth 5. Study: Women infected with common parasite have increased risk of attempting suicide 6. Fast food intake increases risk of diabetes and heart disease in Singapore 7. Some diabetes drugs may increase risk of bladder cancer 8. Feel-good glass for windows 9. Why current strategies for fighting obesity are not working 10. Simple exercises are an easy and cost-effective treatment for persistent dizziness 11. Game, set and match to strawberries 12. How a protein meal tells your brain you’re full 13. Allergy-like symptoms after drinking wine 14. Higher but not lower doses of vitamin D are effective in fracture risk reduction in older adults 15. Child diabetes levels higher in China than in US, study finds 16. Algae extract increases good cholesterol levels, Wayne State research finds 17. Study reveals good news about the GI of rice 18. Cranberry products associated with prevention of urinary tract infections 19. Frankincense as a medicine 20. Millions of diabetics could die of tuberculosis 21. Lower iron levels seen in newborns of obese mothers 22. Iron supplements can reduce fatigue in nonanemic women 23. Drug from Mediterranean weed kills tumor cells in mice 24. Study examines risk of poor birth outcomes following H1N1 vaccination 25. H1N1 vaccine associated with small but significant risk of Guillain-Barre syndrome 26. Metastatic breast cancer: Bevacizumab slows progression, but has no impact on survival 27. Moderate drinking may reduce risk of rheumatoid arthritis 28. Nutrient mixture improves memory in patients with early Alzheimer’s 29. Doctors overlook chemical illnesses, study finds 30. Dangerous caregivers for elderly 31. New study suggests moderate alcohol consumption may help prevent bone loss 32. Hormone-mimicking chemicals cause inter-species mating 33. OxyContin formula change has many abusers switching to heroin 34. Menopausal hormone therapy associated with increased blood pressure 35. Early-life exposure to chemical in drinking water may affect vision, study finds 36. Air in expectant moms' homes contains pesticides, border study finds 37. Toward new drugs for the human and non-human cells in people 38. Veterinary vaccines found to combine into new viruses, prompting regulatory response 39. Chemicals in personal care products may increase risk of diabetes in women
Coffee consumption inversely associated with risk of most common form of skin cancer
PHILADELPHIA — Increasing the number of cups of caffeinated coffee you drink could lower your risk of developing the most common form of skin cancer, basal cell carcinoma, according to a study published in Cancer Research, a journal of the American Association for Cancer Research.
“Our data indicate that the more caffeinated coffee you consume, the lower your risk of developing basal cell carcinoma,” said Jiali Han, Ph.D., associate professor at Brigham and Women’s Hospital, Harvard Medical School in Boston and Harvard School of Public Health.
“I would not recommend increasing your coffee intake based on these data alone,” said Han. “However, our results add basal cell carcinoma to a list of conditions for which risk is decreased with increasing coffee consumption. This list includes conditions with serious negative health consequences such as type 2 diabetes and Parkinson’s disease.”
Basal cell carcinoma is the form of skin cancer most commonly diagnosed in the United States. Even though it is slow-growing, it causes considerable morbidity and places a burden on health care systems.
“Given the large number of newly diagnosed cases, daily dietary changes having any protective effect may have an impact on public health,” said Han.
Han and his colleagues generated their results by conducting a prospective analysis of data from the Nurses’ Health Study, a large and long-running study to aid in the investigation of factors influencing women’s health, and the Health Professionals Follow-up Study, an analogous study for men.
Of the 112,897 participants included in the analyses, 22,786 developed basal cell carcinoma during the more than 20 years of follow-up in the two studies. An inverse association was observed between all coffee consumption and risk of basal cell carcinoma. Similarly, an inverse association was seen between intake of caffeine from all dietary sources (coffee, tea, cola and chocolate) and risk of basal cell carcinoma. However, consumption of decaffeinated coffee was not associated with a decreased risk of basal cell carcinoma.
“These results really suggest that it is the caffeine in coffee that is responsible for the decreased risk of basal cell carcinoma associated with increasing coffee consumption,” said Han. “This would be consistent with published mouse data, which indicate caffeine can block skin tumor formation. However, more studies in different population cohorts and additional mechanistic studies will be needed before we can say this definitively.”
In contrast to the findings for basal cell carcinoma, neither coffee consumption nor caffeine intake were inversely associated with the two other forms of skin cancer, squamous cell carcinoma and melanoma, the most deadly form of the disease.
Only 1,953 cases of squamous cell carcinoma and 741 cases of melanoma were recorded among the 112,897 participants included in Han’s analyses.
“It is possible that these numbers are insufficient for any association with coffee consumption to be seen,” said Han. “As the study participants are followed for a longer time, the number of cases of these conditions is likely to increase. We may be in a position in 10 years’ time to better address this issue.”
Half of Heart Patients Make Serious Medication Errors, Even When Pharmacists Intervene
Many heart patients make mistakes with their medications after hospital discharge that could lead to clinically important adverse outcomes. Patients who are most vulnerable are the elderly, those with impaired cognitive function or low health literacy, or patients who are prescribed numerous or high-risk medications. These outcomes could be prevented, or their severity could be reduced with appropriate interventions. Researchers randomly assigned 831 adults hospitalized for acute coronary syndromes or acute decompensated heart failure to either usual care or usual care plus a pharmacist intervention (check of medication accuracy, in-patient counseling, patient-education materials, telephone follow-up). In the 30 days following hospitalization, one half of the patients had a clinically important medication error, regardless of whether they were in the usual care or pharmacist intervention group. The researchers conclude that more work is needed to help prevent medication errors in cardiac patients.
Physical activity needed in order to reap benefits of dietary restriction
Research in flies highlights fatty acid metabolism in muscle and could have implications for humans using caloric restriction in hopes of living longer
Fruit flies on dietary restriction (DR) need to be physically active in order to get the lifespan extending benefits that come from their Spartan diet. If the same axiom holds true in humans, those practicing caloric restriction in hopes of living longer need to make sure they eat enough to avoid fatigue.
According to research at the Buck Institute, flies on DR shift their metabolism toward increasing fatty acid synthesis and breakdown, specifically in muscle tissue. “Dietary restriction is known to enhance spontaneous movement in a variety of species including primates, however this is the first examination of whether enhanced physical activity is necessary for its beneficial effects,” said Buck faculty Pankaj Kapahi, PhD, who runs the lab where the research took place. “This study establishes a link between DR-mediated metabolic activity in muscle, increased movement and the benefits derived from restricting nutrients,” he said, adding that flies on DR who could not move or had inhibited fat metabolism in their muscle did not exhibit an extended lifespan. “Our work argues that simply restricting nutrients without physical activity may not be beneficial in humans,” said Kapahi. The research is published in the July 3, 2012 edition of Cell Metabolism.
The research also points to a potential target that could yield a drug that mimics the beneficial effects of DR. Lead author, Subhash D. Katewa, PhD, Buck Institute staff scientist, said flies genetically engineered to overexpress the circulating peptide AKH (the fly equivalent of glucagon in mammals) showed increased fat metabolism, spontaneous activity and extended lifespan even though their diet was unrestricted. AKH plays a critical role in glucose and lipid metabolism. “Our data suggests that DR may induce changes in muscle similar to those observed under endurance exercise and that molecules like AKH could serve as potential mimetics for DR that enhance activity and healthspan,” said Katewa.
“A better understanding of the dynamics of fat metabolism is needed in order to clarify its role in aging and disease,” Katewa said. “These current results suggest that enhanced fat metabolism could help slow aging and the onset of age-related disease.”
Uncontrollable anger prevalent among US youth
Intermittent Explosive Disorder affects up to 6 million US adolescents
Nearly two-thirds of U.S. adolescents have experienced an anger attack that involved threatening violence, destroying property or engaging in violence toward others at some point in their lives. These severe attacks of uncontrollable anger are much more common among adolescents than previously recognized, a new study led by researchers from Harvard Medical School finds.
The study, based on the National Comorbidity Survey Replication Adolescent Supplement, a national face-to-face household survey of 10,148 U.S. adolescents, found that nearly two-thirds of adolescents in the U.S. have a history of anger attacks. It also found that one in 12 young people—close to six million adolescents—meet criteria for a diagnosis of Intermittent Explosive Disorder (IED), a syndrome characterized by persistent uncontrollable anger attacks not accounted for by other mental disorders.
The results will be published July 2 in Archives of General Psychiatry.
IED has an average onset in late childhood and tends to be quite persistent through the middle years of life. It is associated with the later onset of numerous other problems, including depression and substance abuse, according to senior author Ronald Kessler, McNeil Family Professor of Health Care Policy at HMS and leader of the team that carried out the study. Yet only 6.5 percent of adolescents with IED received professional treatment for their anger attacks.
Study findings indicate that IED is a severe, chronic, commonly occurring disorder among adolescents, one that begins early in life. Yet the study also shows that IED is under-treated: although 37.8 percent of youths with IED obtained treatment for emotional problems in the 12 months prior to the study interview, only 6.5 percent received treatment specifically for anger. The researchers argue for the importance of identifying and treating IED early, perhaps through school-based violence prevention programs.
“If we can detect IED early and intervene with effective treatment right away, we can prevent a substantial amount of future violence perpetration and associated psychopathology,” Kessler said.
To be diagnosed with IED, an individual must have had three episodes of impulsive aggressiveness “grossly out of proportion to any precipitating psychosocial stressor,” at any time in their life, according to the Diagnostic and Statistical Manual of Mental Disorders. The investigators used an even more stringent definition of IED, requiring that adolescents not meet criteria for other mental disorders associated with aggression, including bipolar disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder and conduct disorder. As a result, researchers found that 1 in 12 adolescents met criteria for IED.
Study: Women infected with common parasite have increased risk of attempting suicide
University of Maryland senior author urges further study of possible link between Toxoplasma gondii and suicidal behavior
BALTIMORE, July 2, 2012 — Women infected with the Toxoplasma gondii (T. gondii) parasite, which is spread through contact with cat feces or eating undercooked meat or unwashed vegetables, are at increased risk of attempting suicide, according to a new study of more than 45,000 women in Denmark. A University of Maryland School of Medicine psychiatrist with expertise in suicide neuroimmunology is the senior author of the study, which is being published online today in the Archives of General Psychiatry.
“We can’t say with certainty that T. gondii caused the women to try to kill themselves, but we did find a predictive association between the infection and suicide attempts later in life that warrants additional studies. We plan to continue our research into this possible connection,” says Teodor T. Postolache, M.D., the senior author and an associate professor of psychiatry and director of the Mood and Anxiety Program at the University of Maryland School of Medicine. He also serves as research faculty at the University of Maryland Child and Adolescent Mental Health Innovations Center and is a senior consultant on suicide prevention for the Baltimore VA Medical Center.
About one-third of the world’s population is infected with the parasite, which hides in cells in the brain and muscles, often without producing symptoms. The infection, which is called toxoplasmosis, has been linked to mental illness, such as schizophrenia, and changes in behavior.
E. Albert Reece, M.D., Ph.D., M.B.A., vice president of medical affairs at the University of Maryland and John Z. and Akiko K. Bowers Distinguished Professor and dean of the University of Maryland School of Medicine, says, “T. gondii infection is a major public health problem around the world, and many people don’t realize they’re infected. Dr. Postolache is a leading expert on suicide neuroimmunology. Suicide is a critically important mental health issue. About 1 million people commit suicide and another 10 million attempt suicide worldwide each year. We hope that this type of research will one day help us find ways to save many lives that now end prematurely in suicide.”
The research is the result of Dr. Postolache’s ongoing collaboration with Preben Mortensen, Dr.Med.Sc., professor and head of the National Centre for Register-based Research at the University of Aarhus in Denmark. Marianne Giortz Pedersen, M.Sc., of the National Centre for Register-based Research, is the study’s lead author. It is the largest study of T. gondii and attempted suicide and the first prospective study to document suicide attempts that occurred after the infection was discovered. Dr. Postolache’s research team at the University of Maryland was the first to report a connection between T. gondii and suicidal behavior in 2009. He is collaborating with researchers in Denmark, Germany and Sweden to confirm and investigate the mechanism leading to this association.
The T. gondii parasite thrives in the intestines of cats, and it is spread through oocysts passed in their feces. All warm-blooded animals can become infected through ingestion of these oocysts. The organism spreads to their brain and muscles, hiding from the immune system within “cysts” inside cells. Humans can become infected by changing their infected cats’ litter boxes, eating unwashed vegetables, drinking water from a contaminated source, or more commonly, by eating undercooked or raw meat that is infested with cysts. Not washing kitchen knives after preparing raw meat before handling another food item also can lead to infection. Pregnant women can pass the parasite directly to their fetuses and are therefore advised not to change cat litter boxes to avoid possible infection.
In this study, researchers analyzed data from 45,788 women in Denmark, who gave birth between May 15, 1992 and Jan. 15, 1995 and whose babies were screened for T. gondii immunoglobulin G (IgG) antibodies. Babies don’t produce antibodies to T. gondii for three months after they are born, so the antibodies present in their blood represented infection in the mothers. The scientists scoured Danish health registries to determine if any of these women later attempted suicide, including cases of violent suicide attempts which may have involved guns, sharp instruments and jumping from high places. The researchers also cross-checked records in the Danish Psychiatric Central Register to determine if the women had been diagnosed previously with mental illness.
The study found that women infected with T. gondii were one and a half times more likely to attempt suicide compared to those who were not infected, and the risk seemed to rise with increasing levels of the T. gondii antibodies. Previous mental illness did not appear to significantly alter these findings. The relative risk was even higher for violent suicide attempts. In contrast to the number of women who attempted suicide using any method (517) or violent methods (78), the number of fatalities through suicides in the cohort (18, with eight in Toxoplasma-positive mothers) was still too small to be conclusively analyzed statistically.
Dr. Postolache stresses that further research is needed to learn more about the connection between T.gondii and suicide. Although studies looking at aggregate data by countries have suggested a link, “there are no studies on individuals confirming the association of T. gondii with suicide fatalities,” he says. “Because suicides and attempts differ based on individual experience and demographics – for example, women attempt suicide more frequently and men have a higher incidence of suicide – the next step is to repeat this study with a sufficient sample aimed at analyzing suicide mortality, the most important target variable in suicide prevention.”
He notes that one of the strengths of this study was that researchers were able to adjust for various factors, such as prior history of mental illness (e.g. mood disorders, schizophrenia, borderline personality disorders) not only in the subjects, but also in their parents. They also had access to a tremendous amount of information as a result of Denmark’s multiple registries and health care system, which provides free medical care for residents. “We had a unique population-based cohort with almost complete follow-up data for up to 14 years. Women were included in the study irrespective of socioeconomic status, and information about T. gondii antibodies was collected prospectively and independently of this study,” Dr. Postolache says.
But, he also notes limitations to the study, such as the inability to determine the cause of the suicidal behavior. “T. gondii infection is likely not a random event and it is conceivable that the results could be alternatively explained by people with psychiatric disturbances having a higher risk of becoming T. gondii infected prior to contact with the health system,” Dr. Postolache says.
The study also did not include men and women who didn’t have children, and did also not capture many episodes of attempted suicide, especially those that were interrupted or aborted and therefore may not have been recorded. It was also not always possible to determine if a self-inflicted injury was an intended suicide, Dr. Postolache says.
“Is the suicide attempt a direct effect of the parasite on the function of the brain or an exaggerated immune response induced by the parasite affecting the brain? We do not know. In fact, we have not excluded reverse causality as there might be risk factors for suicidal behavior that also make people more susceptible to infection with T. gondii,” Dr. Postolache says. “If we can identify a causal relationship, we may be able to predict those at increased risk for attempting suicide and find ways to intervene and offer treatment.” He proposes future research focusing on molecular and behavioral intermediate mechanisms potentially mediating the relationship between T. gondii, suicide risk factors and suicidal behavior.
J. John Mann, M.D., of Columbia University, an international expert on suicide, says that evidence is accumulating on immune factors being associated with suicidal behavior. “Identifying neurotropic latent infections potentially triggering or perpetuating a heightened immune response in patients at risk could lead to new ways of thinking of risk, prevention and risk reduction for suicide, one of the major contributors to premature death worldwide,” he says.
Fast food intake increases risk of diabetes and heart disease in Singapore
MINNEAPOLIS/ST. PAUL (JULY 2, 2012) – The dangers of fast food are well documented; the portions are often larger and the food is generally high in calories and low in nutrients. Now, University of Minnesota School of Public Health researchers have examined the eating habits of residents in Singapore and found new evidence that a diet heavy in fast food increases the risk of developing Type 2 diabetes and coronary heart disease.
The latest research, published online today by the American Heart Association’s journal Circulation, found that people who consume fast food even once a week increase their risk of dying from coronary heart disease by 20 percent in comparison to people who avoid fast food. For people eating fast food two-three times each week, the risk increases by 50 percent, and the risk climbs to nearly 80 percent for people who consume fast food items four or more times each week.
Eating fast food two or more times a week was also found to increase the risk of developing Type 2 diabetes by 27 percent.
According to University of Minnesota researchers, the few existing studies on the association of fast food and metabolic risk have looked almost exclusively at Western-Caucasian populations from the United States.
“We wanted to examine the association of Western-style fast food with cardio-metabolic risk in a Chinese population in Southeast Asia that has become a hotbed for diabetes and heart disease,” said the study’s lead researcher, University of Minnesota post-doctoral researcher Andrew Odegaard, Ph.D., M.P.H. “What we found was a dramatic public health impact by fast food, a product that is primarily a Western import into a completely new market.”
To arrive at their results, School of Public Health researchers worked alongside researchers from the National University of Singapore. Together, they examined results of a study conducted over a period of 16 years beginning in 1993, which looked at the eating habits of 52,000 Chinese residents of Singapore who have experienced a recent and sudden transition from traditional foods to Western-style fast food.
“What’s interesting about the results is that study participants who reported eating fast food most frequently were younger, better educated, smoked less and were more likely to be physically active,” said Odegaard. “This profile is normally associated with lower cardio-metabolic risk.”
According to the study’s senior researcher, Mark Pereira, Ph.D., M.P.H., of the School of Public Health’s Division of Epidemiology and Community Health, the new research provides an important perspective on global health and the nutrition transfer when cultures developing in different parts of the world start moving away from their traditional diet and mode of exercise.
“The big picture is that this [fast food] aspect of globalization and exportation of U.S. and Western culture might not be the best thing to spread to cultures around the world,” he said. “Global public health efforts should focus on maintaining the positive aspects of traditional cultures, while preventing the spread of outside influences thought to be harmful based on the scientific evidence.”
Some diabetes drugs may increase risk of bladder cancer
An increased risk of bladder cancer is linked to the use of pioglitazone, a medication commonly used to treat type 2 diabetes, according to a new study published in CMAJ (Canadian Medical Association Journal) (pre-embargo link only) http://www.cmaj.ca/site/press/cmaj112102.pdf
People with type 2 diabetes are at risk of several types of cancer, including a 40% increased risk of bladder cancer, compared to people without diabetes. Previous studies have shown a higher incidence of bladder cancer in people taking pioglitazone, a type of thiazolidinedione.
To determine whether there is a link between pioglitazone use and bladder cancer, researchers conducted a systematic review and meta-analysis of randomized controlled trials and observational studies involving over 2.6 million patients.
“We observed an increased risk of bladder cancer associated with the use of thiazolidinediones,” writes Dr. Jeffrey Johnson, School of Public Health, University of Alberta, with coauthors. “In particular, use of pioglitazone was associated with an increased risk of bladder cancer based on a pooled estimate from three cohort studies involving more than 1.7 million individuals.”
The researchers also looked at a possible association with rosiglitazone, another type of thiazolidinedione, but did not see an effect.
“Although the absolute risk of bladder cancer associated with pioglitazone was small, other evidence-based treatments for type 2 diabetes may be equally effective and do not carry a risk of cancer,” conclude the authors. “This study quantifies the association between pioglitazone use and bladder cancer and may help inform decisions around safer use of pioglitazone in individuals with type 2 diabetes.”
Feel-good glass for windows
Research News Jul 02, 2012
Daylight acts on our body clock and stimulates the brain. Fraunhofer researchers have made use of this knowledge and worked with industry partners to develop a coating for panes of glass that lets through more light. Above all, it promotes the passage through the glass of those wavelengths of light that govern our hormonal balance.
Most people prefer to live in homes that are airy and flooded with light. Nobody likes to spend much time in a dark and dingy room. That’s no surprise, since daylight gives us energy and has a major impact on our sense of wellbeing. It is a real mood lifter. But not everyone is lucky enough to live in a generously glazed home, and office spaces – where we spend many hours of each day – are often not exactly bright and breezy. Modern heat-insulating, sun-protection glazing for offices and housing doesn’t make things any better, since it isn’t optimized to allow the light that governs our hormonal balance to pass through: instead, a distinctly noticeable percentage of incident sunlight in this effective part of the spectrum is reflected away.
Anti-reflective glass that is more transmissive overall to daylight is reserved for certain special applications, such as in glass covers for photovoltaic modules or in glazing for shop windows. The aim with this kind of glass is to avoid nuisance reflections and to achieve maximum light transmission at the peak emission wavelength of sunlight. This is the wavelength at which the human retina is also most sensitive to light. “However, our biorhythms are not affected by the wavelengths that brighten a room the most, but rather by blue light,” explains graduate engineer Walther Glaubitt, a researcher at the Fraunhofer Institute for Silicate Research ISC in Würzburg. That is why he and his team have developed glass that is designed to be particularly transmissive to light in the blue part of the spectrum. The secret is a special, long-lasting and barely perceptible inorganic coating that is only 0.1 micrometers thick. “Nobody’s ever made glass like this before. It makes you feel as if the window is permanently open,” says Glaubitt. One reason the glass gives this impression is that it exhibits maximum transmission at wavelengths between 450 and 500 nanometers – which is exactly where the effects of blue light are at their strongest.
Lack of light gives rise to sleep disorders
Why is it that the blue part of the light spectrum has such an impact on our sense of wellbeing? “There is a nerve connecting the human retina to the hypothalamus, which is the control center for the autonomic nervous system,” explains Glaubitt’s team colleague Dr. Jörn Probst. Special receptors sit at the end of the nerve connection which are sensitive to blue light, converting it into light-and-dark signals and sending these to the area of the brain that functions as our biological clock. There, one of the things these nerve impulses do is regulate melatonin levels. A lack of light leads to high levels of melatonin, which can result in problems sleeping and concentrating, as well as depression and other psychological impairments. Seasonal affective disorder, also known as winter depression, is one possible outcome of unusually high melatonin levels. “The coating we’ve developed helps people to feel they can perform better and makes it less likely they will fall ill,” says Probst.
Industrial partner Centrosolar Glas GmbH & Co. KG is responsible for applying the coating to the glass while UNIGLAS GmbH & Co. KG, the company that brought the product to market maturity, handles the remaining finishing work as well as sales. It is about to launch a triple-glazing product featuring this innovative glass, for which a patent is pending, under the name UNIGLAS | VITAL® feel-good glass. Fitting triple glazing to a room does not make it seem appreciably darker, but it does affect the light that enters the room in a way that is detrimental to our biorhythms. This is especially true for people who have little opportunity to spend time outdoors and are obliged to spend most of their time in rooms with only small windows. “Thanks to the special ISC coating, this is not the case with our UNIGLAS | VITAL® feel-good glass. Instead, the light quality achieved is very close to that of single glazing,” says Thomas Fiedler, the Technical Director of UNIGLAS. Its transmissivity to light is increased across the entire range from 380 to 580 nanometers, which is to say in the portion of the spectrum that is responsible for promoting wellbeing. At 460 nanometers, the light transmissivity of UNIGLAS | VITAL® is 79 percent. Comparable triple glazing only lets through 66 percent of light at this wavelength. Meanwhile, the coating has no impact on the window’s heat-insulating properties.
But the ISC researchers haven’t quite reached their ultimate goal: “Up to now we’ve only applied our special coating to the side of the glass facing into the cavity between panes,” says Glaubitt. “In future we will also be coating the glazing’s exposed surfaces – in other words, the outside and the inside of the window. That will allow us to achieve around 95 percent light transmissivity at 460 nanometers.”
Ralph’s Note – I want
Why current strategies for fighting obesity are not working
Epidemic of obesity requires a new focus on controlling energy balance and preventing weight gain
DENVER (July 3, 2012) – As the United States confronts the growing epidemic of obesity among children and adults, a team of University of Colorado School of Medicine obesity researchers concludes that what the nation needs is a new battle plan – one that replaces the emphasis on widespread food restriction and weight loss with an emphasis on helping people achieve “energy balance” at a healthy body weight.
In a paper published in the July 3 issue of the journal Circulation, James O. Hill, PhD. and colleagues at the Anschutz Health and Wellness Center take on the debate over whether excessive food intake or insufficient physical activity cause obesity, using the lens of energy balance – which combines food intake, energy expended through physical activity and energy (fat) storage – to advance the concept of a “regulated zone,” where the mechanisms by which the body establishes energy balance are managed to overcome the body’s natural defenses towards preserving existing body weight. This is accomplished by strategies that match food and beverage intake to a higher level of energy expenditure than is typical in America today, enabling the biological system that regulates body weight to work more effectively. Additional support for this concept comes from many studies showing that higher levels of physical activity are associated with low weight gain whereas comparatively low levels of activity are linked to high weight gain over time.
“A healthy body weight is best maintained with a higher level of physical activity than is typical today and with an energy intake that matches,” explained Hill, professor of pediatrics and medicine and executive director of the Anschutz Health and Wellness Center at the University of Colorado Anschutz Medical Campus and the lead author of the paper. “We are not going to reduce obesity by focusing only on reducing food intake. Without increasing physical activity in the population we are simply promoting unsustainable levels of food restriction. This strategy hasn’t worked so far and it is not likely to work in the future.
As Dr. Hill explains, “What we are really talking about is changing the message from ‘Eat Less, Move More” to ‘Move More, Eat Smarter.’ ”
The authors argue that preventing excessive weight gain is a more achievable goal than treating obesity once it is present. Here, the researchers stress that reducing calorie intake by 100 calories a day would prevent weight gain in 90 percent of the adult population and is achievable through small increases in physical activity and small changes in food intake.
People who have a low level of physical activity have trouble achieving energy balance because they must constantly use food restriction to match energy intake to a low level of energy expenditure. Constant food restriction is difficult to maintain long-term and when it cannot be maintained, the result is positive energy balance (when the calories consumed are greater than the calories expended) and an increase in body mass, of which 60 percent to 80 percent is usually body fat. The increasing body mass elevates energy expenditure and helps reestablish energy balance. In fact, the researchers speculate that becoming obese may be the only way to achieve energy balance when living a sedentary lifestyle in a food-abundant environment.
Using an exhaustive review of the energy balance literature as the basis, the researchers also refuted the popular theory that escalating obesity rates can be attributed exclusively to two factors — the change in the American diet and the rise in overall energy intake without a compensatory increase in energy expenditure. Using rough estimates of increases in food intake and decreases in physical activity from 1971 to 2000, the researchers calculated that were it not for the physiological processes that produce energy balance, American adults would have experienced a 30 to 80 fold increase in weight gain during that period, which demonstrates why it is not realistic to attribute obesity solely to caloric intake or physical activity levels. In fact, energy expenditure has dropped dramatically over the past century as our lives now require much less physical activity just to get through the day. The authors argue that this drop in energy expenditure was a necessary prerequisite for the current obesity problem, which necessitates adding a greater level of physical activity back into our modern lives.
“Addressing obesity requires attention to both food intake and physical activity, said co-author John Peters, PhD., assistant director of the Anschutz Health and Wellness Center. “Strategies that focus on either alone will not likely work.”
In addition, the researchers conclude that food restriction alone is not effective in reducing obesity, explaining that although caloric restriction produces weight loss, this process triggers hunger and the body’s natural defense to preserve existing body weight, which leads to a lower resting metabolic rate and notable changes in how the body burns calories. As a result, energy requirements after weight loss can be reduced from 170 to 250 calories for a 10 percent weight loss and from 325 to 480 calories for a 20 percent weight loss. These findings provide insight concerning weight loss plateau and the common occurrence of regaining weight after completing a weight loss regimen.
Recognizing that energy balance is a new concept for to the public, the researchers call for educational efforts and new information tools that will teach Americans about energy balance and how food and physical activity choices affect energy balance
Simple exercises are an easy and cost-effective treatment for persistent dizziness
A professor from the University of Southampton has called on doctors around the world to give patients with persistent dizziness a booklet of simple exercises, after new research has shown that it is a very cost effective treatment for common causes of the condition.
Lucy Yardley, who has been researching dizziness for many years, will urge GPs at the international WONCA conference today (5 July) to ensure that the booklet is translated so that patients of all nationalities can benefit.
Professor Yardley’s urgent appeal comes after her study, funded by the National Institute for Health Research (NIHR) and published in the British Medical Journal, revealed that the exercises, such as turning your head right to left and back again or nodding your head up and down, led to reduced dizziness within a matter of weeks of starting, and the benefits lasted for at least a year.
Dizziness is a common condition, especially among older people, but it can affect any age. It can interfere with people’s daily activities and cause stress. It also increases the risk of falling and fear of falling, which in turn, can result in substantial further limitation of activity, injury, and healthcare costs.
Research has shown that an exercise-based treatment known as “vestibular rehabilitation” or “balance retraining” is the most effective means of treating dizziness related to inner ear problems (a very common cause of dizziness), however currently only about one in ten suitable patients are referred for this treatment.
During the study, which Professor Yardley will present at the WONCA conference today, more than 300 participants were randomly allocated to receive either routine medical care (commonly just reassurance and medication to suppress dizziness symptoms), booklet based vestibular rehabilitation only, or booklet based vestibular rehabilitation with telephone support from a healthcare professional.
The majority of patients within the study, an NIHR Research for Patient Benefit project, suffered from dizziness due to an inner ear problem, however there were many patients who had undiagnosed dizziness.
Nearly twice as many patients who had the booklet and telephone support said they felt much better or totally well at the end of the study, compared with those who had routine care. Even without any support, getting the booklet led to better recovery than routine care. Only 5 per cent of patients receiving the booklet with support reported worse symptoms at the end of the study, compared with 15 per cent of those receiving usual care.
Professor Yardley says: “Dizziness can be a frustrating and sometimes frightening condition. Many people are undiagnosed, have no treatment for it and just learn to live with it. This leads to a low quality of life and can have high healthcare costs. By being given something as a simple as a booklet by their GP, that contains these simple head, neck and eye exercises, many patients will see real benefits in just a few weeks. These easy to understand exercises, which can be carried out at home, have the potential to improve the quality of life for thousands of people.”
The University of Southampton worked with the Ménière’s Society UK during the study. The Society supplied the exercise booklets used in the study and has been giving them to health professionals and members of the public for seven years.
Natasha Harrington-Benton, UK Director of the Society, comments: “Dizziness and balance disorders can be extremely debilitating and affect a person’s quality of life. This study demonstrates the benefits of vestibular rehabilitation in helping people to manage the symptoms of their condition. We are pleased to be able to provide access to the exercise booklets for both patients and health professionals and, to-date, we have distributed over 8,000 copies.”
Game, set and match to strawberries
Strawberries, the traditional summer treat associated with Wimbledon could be serving up some unexpected health benefits.
Scientists at the University of Warwick have been studying the beneficial effects of strawberries on our cardiovascular health, particularly around how they prevent the development of heart disease and diabetes.
Professor Paul Thornalley from Warwick Medical School heads the team that discovered extracts from strawberries positively activate a protein in our bodies called ‘Nrf2’ which is shown to increase antioxidant and other protective activities. This protein works to decrease blood lipids and cholesterol, the very things which can lead to cardiovascular problems.
Eating strawberries has previously been found to counter post-meal blood glucose and low density lipoprotein, or ‘bad’ cholesterol and therefore decrease risk of diabetes and heart disease, but this is the first time that strawberry extracts have been proved to actively stimulate proteins that offer us protection against disease.
Professor Thornalley explained:
We’ve discovered the science behind how strawberries work to increase our in-built defences to keep cells, organs and blood vessels healthy and which can reduce the risk of developing cardiovascular problems such as heart disease and diabetes.
So don’t feel guilty about serving up strawberries and cream … although I’d suggest more strawberries and less or even no cream!
Screening and mathematical modelling techniques developed at the University of Warwick can now take this research further to help identify the best varieties of strawberries, how they are served or processed and how many strawberries should be eaten for optimum health benefit.
The research was funded by the Biotechnology and Biological Sciences Research Council (BBSRC) and is led by Professor Paul Thornalley with Dr Naila Rabbani (Medical School), Dr Guy Barker (Life Sciences) and Professor David Rand (Systems Biology). Professor Thornalley will be presenting the research at the forthcoming 16th biennial meeting for the Society for Free Radical Research International (SFRRI) http://www.sfrrimeeting.org/ at Imperial College London.
How a protein meal tells your brain you’re full
Feeling full involves more than just the uncomfortable sensation that your waistband is getting tight. Investigators reporting online on July 5th in the Cell Press journal Cell have now mapped out the signals that travel between your gut and your brain to generate the feeling of satiety after eating a protein-rich meal. Understanding this back and forth loop between the brain and gut may pave the way for future approaches in the treatment and/or prevention of obesity.
Food intake can be modulated through mu-opioid receptors (MORs, which also bind morphine) on nerves found in the walls of the portal vein, the major blood vessel that drains blood from the gut. Specifically, stimulating the receptors enhances food intake, while blocking them suppresses intake. Investigators have now found that peptides, the products of digested dietary proteins, block MORs, curbing appetite. The peptides send signals to the brain that are then transmitted back to the gut to stimulate the intestine to release glucose, suppressing the desire to eat.
Mice that were genetically engineered to lack MORs did not carry out this release of glucose, nor did they show signs of ‘feeling full’, after eating high-protein foods. Giving them MOR stimulators or inhibitors did not affect their food intake, unlike normal mice.
Because MORs are also present in the neurons lining the walls of the portal vein in humans, the mechanisms uncovered here may also take place in people.
“These findings explain the satiety effect of dietary protein, which is a long-known but unexplained phenomenon,” says senior author Dr. Gilles Mithieux of the Université de Lyon, in France. “They provide a novel understanding of the control of food intake and of hunger sensations, which may offer novel approaches to treat obesity in the future,” he adds.
Allergy-like symptoms after drinking wine
Around seven percent of adults suffer from an intolerance to wine. This is the result of a survey presented by Peter Wigand and co-authors in the current edition of Deutsches Ärzteblatt International (Dtsch Arztelb Int 2012; 109 (25): 437-44).
The authors evaluated 948 questionnaires that were returned from the 4000 sent out to randomly selected people between the ages of 20 and 69 years. They found that women (8.9%) were more often affected by an intolerance to wine than men (5.2%). The most commonly reported reactions included flushed and itchy skin and a runny nose. The symptoms were particularly common after drinking red wine. Additionally, people with a wine intolerance were more likely to report other food intolerances.
The interpretation of Wigand et al. is that these results to not necessarily indicate a true allergy, but rather an intolerance to alcohol, biogenic amines, sulfites, or other ingredients.
Higher but not lower doses of vitamin D are effective in fracture risk reduction in older adults
BOSTON (July 5, 2012) – Based on the results of a pooled analysis of 11 unrelated randomized clinical trials investigating vitamin D supplementation and fracture risk in more than 31,000 older adults, Bess Dawson-Hughes, MD, director of the Bone Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging (USDA HNRCA) at Tufts University, says higher doses of Vitamin D may be the most beneficial in reducing bone fractures in this age group.
As part of the study, published today in The New England Journal of Medicine, Dawson-Hughes and colleagues divided the subjects into quartiles ranging from 0 to 2,000 International Units (IUs) of daily vitamin D intake. In the top quartile, there was a 30% reduction in hip fracture risk and a 14% reduced risk of fracturing other bones, compared to the control groups.
“Taking between 800 IUs and 2,000 IUs of vitamin D per day significantly reduced the risk of most fractures, including hip, wrist and forearm in both men and women age 65 and older,” said Dawson-Hughes, the study’s senior author. “Importantly, we saw there was no benefit to taking Vitamin D supplements in doses below 800 IUs per day for fracture prevention.”
Dawson-Hughes and colleagues analyzed each participant’s vitamin D supplementation within and independent of the study protocol, controlling for age, vitamin D blood levels at baseline, additional calcium supplementation and whether the person lived independently or under medical care.
“Evaluation of individual-level data is the gold-standard of meta-analysis,” said lead author Heike Bischoff-Ferrari, MD, D.Ph., director of the Centre on Aging and Mobility at the University of Zurich and Waid City Hospital and a visiting scientist in the Bone Metabolism Laboratory at the USDA HNRCA. “Our results make a compelling contribution to the existing data on Vitamin D and fracture risk in men and women age 65 and older, whose vulnerability to bone density loss and osteoporosis leave them prone to fractures resulting from thinning bones.”
The current Dietary Reference Intake (DRI) for vitamin D in older adults set by the Institute of Medicine (IOM) is a minimum of 600 IUs per day for adults between 51 and 70 years-old and 800 IUs in adults over 70.
“Vitamin D supplementation is an efficient intervention for a costly injury that affects thousands of older adults each year,” said Dawson-Hughes, who is also a professor at Tufts University School of Medicine. “The average recovery is long and painful and deeply impacts quality of life. After a fracture, older patients may only regain partial mobility, resulting in a loss of independence that is personally demoralizing and that can place added stress on family members and caregivers”
Financially, Vitamin D supplements cost pennies a day, Dawson-Hughes said, whereas the American Academy of Orthopaedic Surgeons estimated the cost of treating a hip fracture was $26,912 in 2007.
Dawson-Hughes adds that older adults, unless they are exposed to bright, year-round sunlight, require supplementation to meet their vitamin D needs. Typically, adults consume 150 IUs per day from food sources such as tuna or salmon or fortified milk. On average, multivitamins contain 400 IUs of vitamin D and there are individual vitamin D supplements with 400, 800 or 1,000 IUs. While vitamin D toxicity is rare, the IOM suggests capping intake at 4,000 IUs per day.
Dawson-Hughes said the results of the current study would be strengthened by large interventional trials investigating the impact of vitamin D supplementation on fracture risk. She and the authors also call for further investigation of the impact of combining calcium supplementation with high doses of vitamin D, as their data was inconclusive.
Child diabetes levels higher in China than in US, study finds
A study led by researchers at the University of North Carolina at Chapel Hill found Chinese teenagers have a rate of diabetes nearly four times greater than their counterparts in the United States. The rise in the incidence of diabetes parallels increases in cardiovascular risk, researchers say, and is the result of a Chinese population that is growing increasingly overweight.
The study led by Barry Popkin, Ph.D., W.R. Kenan Jr. Distinguished Professor of nutrition at UNC’s Gillings School of Global Public Health, and Chinese researchers, used data from the China Health and Nutrition Survey (CHNS), the longest ongoing study of its kind in China. Between 1989 and 2011, the study followed more than 29,000 people in 300 communities throughout China, with surveys conducted in 1989, 1991, 1993, 1997, 2000, 2004, 2006, 2009 and 2011. The CHNS project was a joint undertaking by the University of North Carolina at Chapel Hill and the Chinese Center for Disease Control (CCDC) National Institute of Nutrition and Food Safety.
The findings appear online in Obesity Reviews (www.obesityreviews.net) Early View Section and will be published in the September issue (Obesity Reviews Volume 13, Issue 9, September 2012). Obesity Reviews is an official journal of the International Association for the Study of Obesity (IASO; http://www.iaso.org)
China has experienced unprecedented economic growth in the past two decades, but the study finds that at the same time, China has seen equally dramatic changes in the weight, diets and physical activity levels of its people. UNC-CCDC researchers followed a randomly selected sample representing 56 percent of the Chinese population in 2009 and found large increases in overweight and cardiometabolic risk factors.
“What is unprecedented is the changes in diet, weight and cardiovascular risk for children age 7 and older,” said Popkin. “These estimates highlight the huge burden that China’s health care system is expected to face if nothing changes.”
The UNC-CCDC team observed rates of diabetes of 1.9 percent and pre-diabetes levels of 14.9 percent in Chinese children age 7-17. Researchers noted that high levels of glycosylated hemoglobin (HbA1c) were found in the children’s blood. HbA1c is a measure of the average plasma-glucose concentration over time.
“The findings suggest a very high burden of chronic disease risk starting at a young age, with 1.7 million Chinese children ages 7-18 having diabetes and another 27.7 million considered prediabetic,” Popkin said. “In addition, more than one-third of children under age 18 had high levels of at least one cardiometabolic risk factor.”
Comparing the Chinese data with data from the United States based on National Health and Nutrition Survey (NHANES) results, the authors found that diabetes and inflammation rates were higher in the Chinese pediatric population than in the U.S. pediatric population or in other Asian countries. Researchers found 1.9 percent of Chinese children age 12-18 had diabetes, compared to 0.5 percent of children in the U.S. The study also found great disparity with respect to inflammation, a key cardiovascular risk factor; 12.1 percent of Chinese adolescents showed a high inflammation risk, compared to 8.5 percent of adolescents in the U.S.
“The number of individuals with high levels of at least one cardiovascular risk factor increased to 85 percent in individuals age 40 and older,” said Penny Gordon-Larsen, Ph.D., professor of nutrition in UNC’s Gillings School of Global Public Health. “Of even greater concern is the fact that we see these high levels of risk in individuals living across the entire country – in rural and urban, as well as high and low-income areas. So the impending health care costs and implications are immense.”
These results reinforce earlier research by the authors that found higher levels of obesity emerging in the past decade among the poor and those living in rural areas of China.
Algae extract increases good cholesterol levels, Wayne State research finds
Detroit – A Wayne State University researcher has found that an extract from algae could become a key to regulating cardiovascular disease.
In a study funded by Health Enhancement Products of Bloomfield Hills, Mich., Smiti Gupta, Ph.D., assistant professor in the department of nutrition and food science in the College of Liberal Arts and Sciences, has found that dietary intake of ProAlgaZyme increased the level of high-density lipoprotein (HDL) in an animal model.
While medications for the control of high plasma cholesterol levels such as statins and numerous dietary supplements primarily function by lowering levels of low-density lipoproteins (LDL), or “bad cholesterol,” Gupta’s research explores the effects of raising levels of HDL, or “good cholesterol,” which work in part by carrying cholesterol out of the arterial wall.
Results of her study, titled “ProAlgaZyme and its Sub-fractions Increase Plasma HDL-Cholesterol via Up Regulation of ApoA1, ABCA1 and SRB1 and Inhibition of CETP in Hypercholesterolemic Hamsters,” were published recently in the Journal of Nutrition and Dietary Supplements.
“The cholesterol mechanism is crucial to heart disease,” Gupta said. “Very few agents increase good cholesterol, but we found that this algae extract does. The ratio of total to HDL cholesterol improved significantly. This result, if replicated in humans, would be consistent with a decreased risk of heart disease.”
ProAlgaZyme, a clear liquid, was administered as part of the drinking fluid over four weeks. In addition to increasing HDL levels, the group found that it also changed the expression of genes involved in the reverse cholesterol transport mechanism. And while they don’t know exactly how it will function in humans, Gupta said other research suggests a similar outcome.
“Its biological effect over time and toxic effects, if any, need to be further investigated in a long-term study in an animal model before testing its effects in humans,” she said. “But this is a step in the right direction, since increased HDL is considered an important therapeutic target for improvement of the lipid profile and thus reduction of the risk for cardiovascular disease.”
Study reveals good news about the GI of rice
This finding is good news because it not only means rice can be part of a healthy diet for the average consumer, it also means people with diabetes, or at risk of diabetes, can select the right rice to help maintain a healthy, low GI diet.
The study found that the GI of rice ranges from a low of 48 to a high of 92, with an average of 64, and that the GI of rice depends on the type of rice consumed.
The research team from the International Rice Research Institute (IRRI) and CSIRO’s Food Futures Flagship also identified the key gene that determines the GI of rice, an important achievement that offers rice breeders the opportunity to develop varieties with different GI levels to meet consumer needs. Future development of low GI rice would also enable food manufactures to develop new, low GI food products based on rice.
Dr Tony Bird, CSIRO Food Futures Flagship researcher, said that low GI diets offer a range of health benefits.
Dr Melissa Fitzgerald, who led the IRRI team, said GI is a measure of the relative ability of carbohydrates in foods to raise blood sugar levels after eating.
“Understanding that different types of rice have different GI values allows rice consumers to make informed choices about the sort of rice they want to eat,” she said.
“Rice varieties like India’s most widely grown rice variety, Swarna, have a low GI and varieties like Doongara and Basmati from Australia have a medium GI.”
Dr Tony Bird, CSIRO Food Futures Flagship researcher, said that low GI diets offer a range of health benefits.
“Low GI diets can reduce the likelihood of developing Type 2 diabetes, and are also useful for helping diabetics better manage their condition,” he said.
“This is good news for diabetics and people at risk of diabetes who are trying to control their condition through diet, as it means they can select the right rice to help maintain a healthy, low GI diet.”
Low GI foods are those measured 55 and less, medium GI are those measured between 56 and 69, while high GI measures 70 and above.
When food is measured to have a ’high GI‘, it means it is easily digested and absorbed by the body, which often results in fluctuations in blood sugar levels that can increase chances of getting diabetes, and make management of Type 2 diabetes difficult.
Conversely, foods with low GI are those that have slow digestion and absorption rates in the body, causing a gradual and sustained release of sugar into the blood, which has been proven beneficial to health, including reducing the chances of developing diabetes.
Evidence Reveals Little Difference in Efficacy Between Intensive Insulin Therapies, Glucose Monitoring Approaches
Advances in intensive insulin therapy and glucose monitoring are designed to improve glycemic control and quality of life while limiting adverse effects such as hypoglycemia and weight gain. Currently, there are several therapies being heavily marketed to patients, but there is little objective evidence available to guide decision making about which therapy is best for the individual patient. Researchers reviewed published studies to evaluate how intensive insulin therapy (multiple daily injections versus insulin pump) or mode of blood glucose monitoring (self-monitoring versus real-time monitoring) affects outcomes in children and adults with type 1 or 2 diabetes. The researchers found that insulin pump and multiple-daily injections have similar effects on glycemic control and the incidence of severe hypoglycemia in children and adolescents with type 1 diabetes and in adults with type 2 diabetes. However, insulin pump yielded better satisfaction with diabetes treatment in children with type 1 diabetes, and better diabetes-specific quality-of-life in adults with type 1 diabetes. As for blood-glucose monitoring, real-time monitoring achieved a lower blood glucose level compared to self-monitoring. The researchers also found that real-time glucose monitoring was associated with a lower blood glucose level compared with multiple daily injection in individuals 18 years of age or younger, but the rate of severe hypoglycemia, weight gain, and quality of life did not seem to differ between intervention groups. Patients that used a sensor-augmented pump experienced greater reduction in blood glucose compared to multiple daily injection/self-monitoring use in individuals with type 1 diabetes. The researchers conclude that based on the evidence, physicians can use patient preference to guide treatment decisions for type 1 and type 2 diabetes.
Ralph’s Note: Drugs are worse than just monitoring your sugars on your own. Due to, the side effects of the multiple medications.
Cranberry products associated with prevention of urinary tract infections
EMBARGOED FOR RELEASE: 3 P.M. (CT), MONDAY, JULY 9, 2012
CHICAGO – Use of cranberry-containing products appears to be associated with prevention of urinary tract infections in some individuals, according to a study that reviewed the available medical literature and was published by Archives of Internal Medicine, a JAMA Network publication.
Urinary tract infections (UTIs) are common bacterial infections and adult women are particularly susceptible. Cranberry-containing products have long been used as a “folk remedy” to prevent the condition, according to the study background.
Chih-Hung Wang, M.D., of National Taiwan University Hospital and National Taiwan University College of Medicine, and colleagues reviewed the available medical literature to reevaluate cranberry-containing products for the prevention of UTI.
“Cranberry-containing products tend to be more effective in women with recurrent UTIs, female populations, children, cranberry juice drinkers, and people using cranberry-containing products more than twice daily,” the authors note.
The authors identified 13 trials, including 1,616 individuals, for qualitative analysis and 10 of these trials, including 1,494 individuals, were included in quantitative analysis. The random-effects pooled risk ratio for cranberry users vs. nonusers was 0.62, according to the study results.
“In conclusion, the results of the present meta-analysis support that consumption of cranberry-containing products may protect against UTIs in certain populations. However, because of the substantial heterogeneity across trials, this conclusion should be interpreted with great caution,” the authors conclude
Frankincense as a medicine
Pharmacists of University Jena clarify the anti-inflammatory impact of boswellic acids
|IMAGE:Ph.D. student Olga Scherer from Jena University compares the resin of Boswellia trees from Africa (left) and India.|
Jena (Germany) It was one of the gifts of the Magi – in addition to myrrh and gold they offered frankincense to the newly born baby Jesus. Since the ancient world the aromatic fragrance of burning Boswellia resin has been part of many religious ceremonies and is still used as a means to indicate special festive atmosphere in the church today. But frankincense can do much more: “The resin from the trunk of Boswellia trees contains anti-inflammatory substances,” Professor Dr. Oliver Werz of the Friedrich Schiller University Jena (Germany) says. The chair of Pharmaceutical and Medical Chemistry is convinced that these substances can be very beneficial in therapies against diseases like asthma, rheumatoid arthritis or atopic dermatitis.
However, so far the active substances in frankincense cannot at present be found in drugs in German pharmacies, as the pharmacological impact of frankincense hasn’t been thoroughly investigated. “Although Boswellia resin has been used for thousands of years in the Ayurvedic medicine for instance, the clinical studies we have so far are not suffice for a license in Germany and Europe,” Professor Werz explains.
But that could change. As part of a mutual project with partners of the University Saarbrücken and a start-up company, Professor Werz and his team examined the curative effect of frankincense. In this project the researchers were able to show where exactly the boswellic acids – which are responsible for the impact of the ingredients of the Boswellia resin – actually interfere in the process of inflammation. “Boswellic acids interact with several different proteins that are part of inflammatory reactions, but most of all with an enzyme which is responsible for the synthesis of prostaglandin E2,” Oliver Werz points out. Prostaglandin E2 is one of the mediators of the immune response and plays a decisive role in the process of inflammation, in the development of fever and of pain. “Boswellic acids block this enzyme efficiently and thereby reduce the inflammatory reaction,” the Jena pharmacist explains. With this, not only a targeted use in the therapy of inflammatory diseases is conceivable. It can also be expected that boswellic acids have less side effects than today’s prevalent anti-inflammatory treatments like diclofenac or indometacin. Their impact is less specific, they can increase the risk of stomach ulcers and can negatively affect renal function.
In their latest study the researchers around Professor Werz additionally compared the resin of different kinds of frankincense in its anti-inflammatory impact. There are more than ten Boswellia species in the world. The most well-known and widely-used one is the Boswellia serrata from Northern and central India. “We were able to show that the resin of the Boswellia papyrifera is ten times more potent,” Professor Werz explains a further result of his research. This species mostly occurs in the Northeast of Africa (Ethiopia, Somalia) and on the Arabian Peninsula (Yemen, Oman).
Whether frankincense will become accepted, is indeed not only due to the outcome of the clinical examination which is yet to come. “Boswellic acids exclusively occur in the resin of Boswellia trees and are very difficult to produce synthetically,” Werz points out. Therefore these trees are the only source of these promising active ingredients. However Boswellia trees are already an endangered tree species. In many places they are just being used as heating fuel. “Thereby without sustained protection not only plant species are endangered but at the same time medicine loses promising active ingredients,” Professor Werz warns.
Millions of diabetics could die of tuberculosis
Public Health Risk
A third of the world’s human population is infected with a dormant tuberculosis bacteria, primarily people living in developing countries. The bacteria presents a lifelong TB risk. Recent research out of the University of Copenhagen demonstrates that the risk of tuberculosis breaking out is four times as likely if a person also suffers from diabetes. Meanwhile, as a diabetic, a person is five times as likely to die during tuberculosis treatment. The growing number of diabetics in Asia and Africa increases the likelihood that more people will succumb to and die from tuberculosis in the future.
A research group from the Faculty of Science at the University of Copenhagen has just completed a major research project in Tanzania in which they have documented that diabetes is far more widespread than previously thought.
Diabetes hastily advancing in developing countries
The risk of dying from tuberculosis is increased if a person also has diabetes. In the past, diabetes was most commonly associated with the Western world while tuberculosis was more widespread throughout the developing world.
“Our studies show, firstly, that diabetes is hastily advancing in developing countries, not just in Asia, but in Africa as well. And secondly, that as a diabetic one is four times more at risk of developing tuberculosis and five times as likely to die under tuberculosis treatment,” reports PhD student and physician Daniel Faurholt-Jepsen who has written his doctoral dissertation on the basis of the study.
Need to bolster preventative regimens
With the dramatic increase in the spread of diabetes, even among the poorest, there is a need to strengthen prevention. The results of the study demonstrate that diabetes is a severe threat to the control of tuberculosis:
“Tuberculosis kills more than a million people each year. The figure may be much higher in the future if nothing is done now. We should develop better international guidelines for a combined treatment of diabetes and tuberculosis patients as well as better diagnostic methods, which can cheaply and effectively diagnose diabetes among tuberculosis patients,” emphasises Daniel Faurholt-Jepsen.
The study was conducted in the northern Tanzanian city of Mwanza, home to more than a million people.
Daniel Faurholt-Jepsen defended his PhD dissertation ‘The Double Burden: The role of diabetes for tuberculosis risk, manifestations, treatment outcomes and survival’ on July 6 at the University of Copenhagen’s Faculty of Science
Lower iron levels seen in newborns of obese mothers
Overproduction of the hormone hepcidin appears to impair maternal-fetal iron transfer
BOSTON (July 9, 2012) — A growing number of studies imply that children born to obese mothers face health problems stemming from the womb.
New research from the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and The Mother Infant Research Institute at Tufts Medical Center suggests that low iron status is among these health problems, according to an analysis of maternal hepcidin, a hormone that is key in keeping iron levels balanced.
The study enrolled 15 obese pregnant women with body mass index (BMI) greater than 30 and 15 healthy weight pregnant women with BMIs between 20 and 25 as a control group. Maternal blood draws took place during the second trimester of pregnancy and newborn iron status was measured in cord blood.
The researchers found that being born to an obese mother with elevated hepcidin levels was associated with lower iron status at birth. Obese adults are known to produce higher levels of hepcidin compared to healthy weight adults and the researchers suggest that overproduction of the hormone interferes with the transfer of iron from mother to infant. The results were recently published online by the Journal of Perinatology.
During pregnancy, hepcidin levels are kept at low levels to optimize iron transfer from mother to fetus. “When there is excess hepcidin in a cell, it binds to and inhibits the function of ferroportin, the protein that allows iron to pass through the cell membrane and into the bloodstream,” explained senior author Simin Nikbin Meydani, DVM, PhD, director of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (USDA HNRCA).
“The chronic low-grade inflammation that can result from being obese triggers an abnormal immune response, increasing production of proteins that increase hepcidin levels,” added Maria Carlota Dao, first author and a doctoral student in the Nutritional Immunology Laboratory at the USDA HNRCA. Because iron plays a crucial role in the formation of the central nervous system, children born with iron deficiency are at a greater risk for delays in motor and cognitive development.
“The data on the impact of low maternal iron levels on the fetus comes from undernourished populations,” said first author Sarbattama Sen, MD, a neonatologist at Tufts Medical Center and an assistant professor of pediatrics at Tufts University School of Medicine (TUSM). “To the best of our knowledge, ours is the first study to demonstrate that obesity might hamper iron transfer from mother to child and offers some insight into the mechanism of how it occurs. Future studies, however, are needed to confirm the role of obesity associated with inflammation during pregnancy on hepcidin and iron status of the newborn.”
The authors further stress that more research is needed before any changes to dietary guidelines or recommendations to obese pregnant women should be considered. Most prenatal vitamin supplements contain 27 milligrams of iron, the daily amount currently recommended by The American Congress of Obstetricians and Gynecologists.
“During pregnancy, women should try to eat a varied, healthy diet while taking the standard prenatal vitamins recommended by their doctors,” Sen adds. “Weight gain goals should be based on a woman’s BMI prior to becoming pregnant. In 2009, the Institute of Medicine issued new guidelines on weight gain during pregnancy.”
Iron supplements can reduce fatigue in nonanemic women
Clinical trial shows 50 percent reduction in fatigue from baseline in participants
Iron supplementation reduced fatigue by almost 50% in women who are low in iron but not anemic, according to the results of a clinical trial published July 9 in CMAJ (Canadian Medical Association Journal).
“We found that iron supplementation for 12 weeks decreased fatigue by almost 50% from baseline, a significant difference of 19% compared with placebo, in menstruating iron-deficient nonanemic women with unexplained fatigue and ferritin levels below 50 μg/L,” writes Dr. Bernard Favrat, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland, with coauthors.
The study, a randomized controlled trial involving 198 menstruating women between the ages of 18 and 50 years, included daily oral supplements of 80 mg of prolonged-release ferrous sulfate as well as placebo. The trial was double-blinded, meaning neither the participants nor the health care providers knew which group was receiving the supplement versus placebo.
Fatigue is common in patients in primary care practices, with 14% to 27% suffering from fatigue and 1% to 2% of visits specifically for fatigue. Women are three times more likely than men to report fatigue. Positive effects on hemoglobin, ferritin and other blood levels were evident as early as six weeks after iron supplementation.
The authors note that iron did not affect anxiety or depression scores or quality-of-life indicators such as physical and psychological performance.
“Iron deficiency may be an under-recognized cause of fatigue in women of child-bearing age,” write the authors. “If fatigue is not due to secondary causes, the identification of iron deficiency as a potential cause may prevent inappropriate attribution of symptoms to putative emotional causes or life stressors, thereby reducing the unnecessary use of health care resources, including inappropriate pharmacologic treatments,” conclude the authors.
Drug from Mediterranean weed kills tumor cells in mice
‘Molecular grenade’ now in clinical trials for advanced cancer
Scientists at the Johns Hopkins Kimmel Cancer Center, working with Danish researchers, have developed a novel anticancer drug designed to travel — undetected by normal cells — through the bloodstream until activated by specific cancer proteins. The drug, made from a weedlike plant, has been shown to destroy cancers and their direct blood supplies, acting like a “molecular grenade,” and sparing healthy blood vessels and tissues.
In laboratory studies, researchers said they found that a three-day course of the drug, called G202, reduced the size of human prostate tumors grown in mice by an average of 50 percent within 30 days. In a direct comparison, G202 outperformed the chemotherapy drug docetaxel, reducing seven of nine human prostate tumors in mice by more than 50 percent in 21 days. Docetaxel reduced one of eight human prostate tumors in mice by more than 50 percent in the same time period.
In a report June 27 in the journal Science Translational Medicine, the researchers also reported that G202 produced at least 50 percent regression in models of human breast cancer, kidney cancer and bladder cancer.
Based on these results, Johns Hopkins physicians have performed a phase I clinical trial to assess safety of the drug and have thus far treated 29 patients with advanced cancer. In addition to Johns Hopkins, the University of Wisconsin and the University of Texas-San Antonio are participating in the trial. A phase II trial to test the drug in patients with prostate cancer and liver cancer is planned.
The drug G202 is chemically derived from a weed called Thapsia garganica that grows naturally in the Mediterranean region. The plant makes a product, dubbed thapsigargin, that since the time of ancient Greece has been known to be toxic to animals. In Arab caravans, the plant was known as the “death carrot” because it would kill camels if they ate it, the researchers noted.
“Our goal was to try to re-engineer this very toxic natural plant product into a drug we might use to treat human cancer,” says lead study author Samuel Denmeade, M.D., professor of oncology, urology, pharmacology and molecular sciences. “We achieved this by creating a format that requires modification by cells to release the active drug.”
By disassembling thapsigargin and chemically modifying it, the researchers created a form that Denmeade likens to a hand grenade with an intact pin. The drug can be injected and can travel through the bloodstream until it finds the site of cancer cells and hits a protein called prostate-specific membrane antigen (PSMA). PSMA is released by cells lining tumors of the prostate and other areas, and in effect “pulls the pin” on G202, releasing cell-killing agents into the tumor and the blood vessels that feed it, as well as to other cells in the vicinity. Specifically, G202 blocks the function of a protein called the SERCA pump, a housekeeping protein necessary for cell survival that keeps the level of calcium in the cell at the correct level, the researchers report.
“The exciting thing is that the cancer itself is activating its own demise,” says senior study author John Isaacs, Ph.D., professor of oncology, urology, chemical and biomedical engineering at Johns Hopkins.
Because the drug is targeted to the SERCA pump, which all cells need to stay alive, researchers say it will be difficult for tumor cells to become resistant to the drug, because they cannot stop making the protein.
Study examines risk of poor birth outcomes following H1N1 vaccination
CHICAGO – In studies examining the risk of adverse outcomes after receipt of the influenza A(H1N1) vaccine, infants exposed to the vaccine in utero did not have a significantly increased risk of major birth defects, preterm birth, or fetal growth restriction; while in another, study researchers found a small increased risk in adults of the nervous system disorder, Guillain-Barre syndrome, during the 4 to 8 weeks after vaccination, according to 2 studies in the July 11 issue of JAMA.
In the first study, Björn Pasternak, M.D., Ph.D., of the Statens Serum Institut, Copenhagen, Denmark and colleagues investigated whether exposure to an adjuvanted influenza A(H1N1)pdm09 vaccine during pregnancy was associated with increased risk of major birth defects, preterm birth, and fetal growth restriction. According to background information in the article, the 2009 influenza A(H1N1) pandemic put pregnant women at increased risk of illness, death, and poor pregnancy outcomes. “Pregnant women were among the main target groups prioritized for vaccination against influenza A(H1N1)pdm09, and an estimated 2.4 million women were vaccinated during pregnancy in the United States alone. However, assessment of the fetal safety of H1N1 vaccination in pregnancy has been limited to a few pharmacovigilance reports and descriptive cohort studies.”
The registry-based study included all live-born singleton infants in Denmark delivered between November 2, 2009, and September 30, 2010. The researchers estimated the prevalence odds ratios of adverse fetal outcomes, comparing infants exposed and unexposed to an AS03-adjuvanted influenza A(H1N1)pdm09 vaccine during pregnancy. Following exclusions, a group of 53,432 live-born infants was identified with 6,989 (13.1 percent) exposed to the vaccine during pregnancy.
In a propensity score-matched analysis of 330 infants exposed to the vaccine in the first trimester of pregnancy and 330 unexposed, there were 18 infants (5.5 percent) diagnosed with a major birth defect among those exposed compared with 15 (4.5 percent) among the unexposed. Among infants exposed to the H1N1 vaccine in the first trimester, 31 (9.4 percent) were born preterm compared with 24 (7.3 percent) among the unexposed. Preterm birth occurred in 302 of 6,543 infants (4.6 percent) with second- or third-trimester exposure, compared with 295 of 6,366 unexposed infants (4.6 percent). “Taking gestational age into account, there was no increased risk of small size for gestational age associated with vaccination in the first (25 [7.6 percent] exposed vs. 31 [9.4 percent] unexposed) or the second or third trimester (641 [9.7 percent] exposed vs. 657 [9.9 percent] unexposed),” the researchers write.
“In conclusion, this nationwide cohort study in Denmark found no significant associations between exposure to an AS03-adjuvanted influenza A(H1N1)pdm09 vaccine in pregnancy and risk of adverse fetal outcomes including major birth defects, preterm birth, and growth restriction. Although the data provide robust evidence of safety with respect to outcomes associated with second- or third-trimester exposure, results from analyses of first-trimester exposure should be viewed as preliminary and need confirmation. Further research also needs to address risk of specific birth defects as well as effectiveness of H1N1 vaccination in pregnancy.”
H1N1 vaccine associated with small but significant risk of Guillain-Barre syndrome
Guillain-Barre syndrome (GBS) is usually characterized by rapidly developing motor weakness and areflexia (the absence of reflexes). “The disease is thought to be autoimmune and triggered by a stimulus of external origin. In 1976-1977, an unusually high rate of GBS was identified in the United States following the administration of inactivated ‘swine’ influenza A(H1N1) vaccines. In 2003, the Institute of Medicine (IOM) concluded that the evidence favored acceptance of a causal relationship between the 1976 swine influenza vaccines and GBS in adults. Studies of seasonal influenza vaccines administered in subsequent years have found small or no increased risk,” according to background information in the article. “In a more recent assessment of epidemiologic studies on seasonal influenza vaccines, experimental studies in animals, and case reports in humans, the IOM Committee to Review Adverse Effects of Vaccines concluded that the evidence was inadequate to accept or reject a causal relationship.”
Philippe De Wals, M.D., Ph.D., of Laval University, Quebec City, Canada and colleagues conducted a study to assess the risk of GBS following pandemic influenza vaccine administration. In fall 2009 in Quebec an immunization campaign was launched against the 2009 influenza A(H1N1) pandemic strain. By the end of the year, 4.4 million residents had been vaccinated. The study included follow-up over the 6-month period of October 2009 through March 2010 for suspected and confirmed GBS cases reported by physicians, mostly neurologists, during active surveillance or identified in the provincial hospital summary discharge database. Immunization status was verified.
Over the 6-month period, 83 confirmed GBS cases were identified. Twenty-five confirmed cases had been vaccinated against 2009 influenza A(H1N1) 8 or fewer weeks before disease onset, with most (19/25) vaccinated 4 or fewer weeks before onset. Analysis of data indicated a small but significant risk of GBS following influenza A(H1N1) vaccination. The number of cases attributable to vaccination was approximately 2 per 1 million doses. The excess risk was observed only in persons 50 years of age or older.
“In Quebec, the individual risk of hospitalization following a documented influenza A(H1N1) infection was 1 per 2,500 and the risk of death was 1/73,000. The H1N1 vaccine was very effective in preventing infections and complications. It is likely that the benefits of immunization outweigh the risks,” the authors write.
Metastatic breast cancer: Bevacizumab slows progression, but has no impact on survival
The cancer drug bevacizumab (Avastin®) offers only a modest benefit in delaying disease progression in patients with advanced stage breast cancer, according to a systematic review by Cochrane researchers. The researchers assessed the efficacy of bevacizumab in combination with chemotherapy, an established cancer treatment in this indication, and found no overall survival benefit when adding bevacizumab to chemotherapy.
Breast cancer is the most common cause of cancer death among women. If it spreads to other parts of the body it is referred to as “metastatic” and the cancer becomes much more difficult to treat. One promising approach is drugs that target vascular endothelial growth factor (VEGF), a key molecule mediating growth of blood vessels in tumours. At present, trials of drugs that target VEGF are limited to bevacizumab, which is the first drug of this type to be approved for metastatic breast cancer.
To assess the clinical value of bevacizumab in combination with other established chemotherapy drugs, the researchers gathered evidence from seven trials involving a total of 4,032 patients, most of whom had metastatic breast cancer. They found that adding bevacizumab to established drug regimens increased the time to tumour progression or death by between one and six months, depending on the chemotherapy drugs prescribed. However, the researchers found that adding bevacizumab to first- or second-line treatments did not increase overall survival or quality of life.
“At best, adding bevacizumab to standard chemotherapy appears to offer a modest benefit for those with metastatic breast cancer,” said lead researcher, Anna Dorothea Wagner, of the Fondation du Centre Pluridisciplinaire d’Oncologie, University Hospital Lausanne, Switzerland. “Whether it can truly be of benefit to the patient is debatable, because it only briefly prolongs progression of the disease. No impact on the patient’s overall survival or quality of life has been demonstrated.”
According to the researchers, clinical trials testing new drugs for advanced stage breast cancer should follow patients until death in order to understand the impact of new treatments on survival. “The fact that an increase in progression-free survival does not lead to an increase in overall survival suggests that progression-free survival may not be a reliable surrogate for clinical trials in metastatic cancer,” said Wagner.
In 2011, the US Food and Drug Administration (FDA) removed breast cancer from indications on the label of bevacizumab, due to concerns about serious side effects and doubts about its benefit in terms of overall survival. By contrast, it is approved for first-line treatment of metastatic breast cancer in Europe, in combination with the cancer drug paclitaxel, as well as in combination with capecitabine for patients with metastatic cancer who are not eligible for treatment with taxanes or anthracyclines.
Moderate drinking may reduce risk of rheumatoid arthritis
3 drinks per week can halve the risk of developing the condition
Research: Long term alcohol intake and risk of rheumatoid arthritis in women: a population based cohort study
Moderate consumption of alcohol is associated with a reduced risk of developing rheumatoid arthritis, suggests a study published on bmj.com today.
The results show that women who regularly consume more than three alcoholic drinks a week for at least 10 years have about half the risk of developing rheumatoid arthritis compared with non-drinkers.
After adjusting for factors such as age, smoking and dietary habits, women who reported drinking more than three glasses of alcohol per week in both 1987 and 1997 had a 52% reduced risk of rheumatoid arthritis compared with never drinkers at both assessments.
These findings add to a growing body of evidence that long term moderate alcohol consumption is not harmful and may protect against a chronic disease like rheumatoid arthritis, say the authors. However, they stress that the effect of higher doses of alcohol on the risk of rheumatoid arthritis remains unknown.
Rheumatoid arthritis is a chronic inflammatory joint disorder that usually develops between the ages of 40 and 50. About 1% of the world’s population is affected – women three times more often than men. Some studies have shown that drinking alcohol is associated with a lower risk of rheumatoid arthritis, whereas others have found no association.
The relation between alcohol intake and rheumatoid arthritis remains controversial. So a team of researchers based in Sweden set out to analyse this association among 34,141 Swedish women born between 1914 and 1948.
Detailed information about alcohol consumption, diet, smoking history, physical activity and education level was collected in 1987 and again in 1997.
Participants were followed up for seven years (Jan 2003 to Dec 2009) when they were aged 54-89 years, during which time 197 new cases of rheumatoid arthritis were registered.
The age-standardized rate of rheumatoid arthritis was smaller among women who drank more than four glasses of alcohol a week (7 per 10,000 person years) than among women who drank less than one glass a week (9.1 per 10,000 person years) as reported in 1997.
After adjusting for factors such as age, smoking and dietary habits, women who reported drinking more than three glasses of alcohol per week in both 1987 and 1997 had a 52% reduced risk of rheumatoid arthritis compared with never drinkers at both assessments.
One standard glass of alcohol was defined as approximately 500 ml beer, 150 ml of wine or 50 ml of liquor.
The reduced risk was similar for all three types of alcoholic drink.
Further analyses made little difference to the results, supporting the theory that a moderate amount of alcohol may be a protective factor for rheumatoid arthritis. The authors suggest that this is most likely to be due to alcohol’s ability to lower the body’s immune response.
This is relevant because rheumatoid arthritis is an autoimmune disease – it causes the immune system, which usually fights infection, to attack the cells that line the joints.
Nutrient mixture improves memory in patients with early Alzheimer’s
A graphic depicting a synapse, a connection between brain cells. Photo – Graphic: Christine Daniloff
In clinical trial, mixture developed at MIT appears to help overcome loss of connections between brain cells.
Anne Trafton, MIT News Office
July 9, 2012
A clinical trial of an Alzheimer’s disease treatment developed at MIT has found that the nutrient cocktail can improve memory in patients with early Alzheimer’s. The results confirm and expand the findings of an earlier trial of the nutritional supplement, which is designed to promote new connections between brain cells. Alzheimer’s patients gradually lose those connections, known as synapses, leading to memory loss and other cognitive impairments. The supplement mixture, known as Souvenaid, appears to stimulate growth of new synapses, says Richard Wurtman, the Cecil H. Green Distinguished Professor Emeritus at MIT, who invented the nutrient mixture. “You want to improve the numbers of synapses, not by slowing their degradation — though of course you’d love to do that too — but rather by increasing the formation of the synapses,” Wurtman says. To do that, Wurtman came up with a mixture of three naturally occurring dietary compounds: choline, uridine and the omega-3 fatty acid DHA. Choline can be found in meats, nuts and eggs, and omega-3 fatty acids are found in a variety of sources, including fish, eggs, flaxseed and meat from grass-fed animals. Uridine is produced by the liver and kidney, and is present in some foods as a component of RNA. These nutrients are precursors to the lipid molecules that, along with specific proteins, make up brain-cell membranes, which form synapses. To be effective, all three precursors must be administered together. Results of the clinical trial, conducted in Europe, appear in the July 10 online edition of the Journal of Alzheimer’s Disease. The new findings are encouraging because very few clinical trials have produced consistent improvement in Alzheimer’s patients, says Jeffrey Cummings, director of the Cleveland Clinic’s Lou Ruvo Center for Brain Health. “Memory loss is the central characteristic of Alzheimer’s, so something that improves memory would be of great interest,” says Cummings, who was not part of the research team. Plans for commercial release of the supplement are not finalized, according to Nutricia, the company testing and marketing Souvenaid, but it will likely be available in Europe first. Nutricia is the specialized health care division of the food company Danone, known as Dannon in the United States. Making connections Wurtman first came up with the idea of targeting synapse loss to combat Alzheimer’s about 10 years ago. In animal studies, he showed that his dietary cocktail boosted the number of dendritic spines, or small outcroppings of neural membranes, found in brain cells. These spines are necessary to form new synapses between neurons. Following the successful animal studies, Philip Scheltens, director of the Alzheimer Center at VU University Medical Center in Amsterdam, led a clinical trial in Europe involving 225 patients with mild Alzheimer’s. The patients drank Souvenaid or a control beverage daily for three months. That study, first reported in 2008, found that 40 percent of patients who consumed the drink improved in a test of verbal memory, while 24 percent of patients who received the control drink improved their performance. The new study, performed in several European countries and overseen by Scheltens as principal investigator, followed 259 patients for six months. Patients, whether taking Souvenaid or a placebo, improved their verbal-memory performance for the first three months, but the placebo patients deteriorated during the following three months, while the Souvenaid patients continued to improve. For this trial, the researchers used more comprehensive memory tests taken from the neuropsychological test battery, often used to assess Alzheimer’s patients in clinical research. Patients showed a very high compliance rate: About 97 percent of the patients followed the regimen throughout the study, and no serious side effects were seen. Both clinical trials were sponsored by Nutricia. MIT has patented the mixture of nutrients used in the study, and Nutricia holds the exclusive license on the patent. Brain patterns In the new study, the researchers used electroencephalography (EEG) to measure how patients’ brain-activity patterns changed throughout the study. They found that as the trial went on, the brains of patients receiving the supplements started to shift from patterns typical of dementia to more normal patterns. Because EEG patterns reflect synaptic activity, this suggests that synaptic function increased following treatment, the researchers say. Patients entering this study were in the early stages of Alzheimer’s disease, averaging around 25 on a scale of dementia that ranges from 1 to 30, with 30 being normal. A previous trial found that the supplement cocktail does not work in patients with Alzheimer’s at a more advanced stage. This makes sense, Wurtman says, because patients with more advanced dementia have probably already lost many neurons, so they can’t form new synapses. A two-year trial involving patients who don’t have Alzheimer’s, but who are starting to show mild cognitive impairment, is now underway. If the drink seems to help, it could be used in people who test positive for very early signs of Alzheimer’s, before symptoms appear, Wurtman says. Such tests, which include PET scanning of the hippocampus, are now rarely done because there are no good Alzheimer’s treatments available.
Doctors overlook chemical illnesses, study finds
Sufferers seek out health care more often than others
SAN ANTONIO (July 10, 2012) — Chemical intolerance contributes to the illnesses of 1 in 5 patients but the condition seldom figures in their diagnosis, according to clinical research directed by a UT Medicine San Antonio physician.
Clinical tools are available to identify chemical intolerance but health care practitioners may not be using them, lead author David Katerndahl, M.D., M.A., said. The study is in the July 9 issue of Annals of Family Medicine. UT Medicine is the clinical practice of the School of Medicine at The University of Texas Health Science Center San Antonio.
Avoidance of triggers
The study’s authors said physicians need to know how chemical intolerance affects certain people and understand that conventional therapies can be ineffective. Some patients would improve by avoiding certain chemicals, foods and even medical prescriptions, the authors said.
Patients with chemical intolerance go to the doctor more than others, are prone to having multi-system symptoms and are more apt to have to quit their job due to physical impairment, the authors said.
The study involved 400 patients who gave personal health information while waiting to be seen at primary care clinics in San Antonio, one in UT Medicine and the other in the University Health System. The researchers asked the patients to respond to 90 questions about their illnesses, mental health and ability to function.
In the end, the authors said, 20.3 percent of the patients questioned met the scientific criteria for chemical intolerance.
Researchers surveyed patients with chronic conditions such as allergies, asthma, diabetes and heart disease. They excluded patients who were at the clinics for acute conditions such as earaches, flu or bone fractures.
The origins of chemical intolerance have been the subject of much speculation, the authors acknowledge, but the condition is also understudied. People with chemical intolerance, or “CI,” are highly sensitive to common substances such as cleaning products, tobacco smoke, fragrances, pesticides, new carpet and auto exhaust.
Important consideration in care
“Apart from the debate over causality, the fact that so many patients meet the criteria for chemical intolerance holds particular relevance for primary care providers,” said Dr. Katerndahl, professor of family and community medicine who is supported by the Dr. Mario E. Ramirez Distinguished Professorship.
Chemically intolerant individuals often have symptoms that affect multiple organ systems simultaneously, especially the nervous system. Symptoms commonly include fatigue, changes in mood, difficulty thinking and digestive problems.
Dangerous caregivers for elderly
Agencies place unqualified, possibly criminal caregivers in homes of vulnerable seniors
CHICAGO — If you hire a caregiver from an agency for an elderly family member, you might assume the person had undergone a thorough criminal background check and drug testing, was experienced and trained for the job.
You’d be wrong in many cases, according to new Northwestern Medicine research.
A troubling new national study finds many agencies recruit random strangers off Craigslist and place them in the homes of vulnerable elderly people with dementia, don’t do national criminal background checks or drug testing, lie about testing the qualifications of caregivers and don’t require any experience or provide real training.
“People have a false sense of security when they hire a caregiver from an agency,” said lead study author Lee Lindquist, M.D., an associate professor of medicine at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital. “There are good agencies out there, but there are plenty of bad ones and consumers need to be aware that they may not be getting the safe, qualified caregiver they expect. It’s dangerous for the elderly patient who may be cognitively impaired.”
(See Lindquist’s “10 Questions to Ask Before Hiring a Caregiver” below.)
The study will be published in the July 13 issue of the Journal of American Geriatrics Society.
Lindquist, a geriatrician, personally has seen a number of bad caregivers accompanying patients in her clinic. “Some of the paid caregivers are so unqualified it’s scary and really puts the senior at risk,” she said.
Lindquist had a 103-year-old patient whose illiterate caregiver was mixing up her own medications and the patient’s medications. The caregiver was giving her own medicines to the elderly patient by mistake. Another patient had dropped 10 percent of her weight and developed pressure ulcers because her caregiver was not properly feeding her or getting her out of bed.
“It was easier for the caregiver to sit and watch TV and not to try to feed the patient or move her,” Lindquist said.
Several agencies surveyed in the study actually made up names of screening tests they claimed to give their job applicants.
“We had agencies say they used a ‘National Scantron Test for Inappropriate Behavior’ and an ‘Assessment of Christian Morality Test’,” Lindquist said. “To our knowledge, these tests don’t exist. If you’re not a smart consumer, you won’t recognize which agencies are being deceitful.”
Identifying the good agencies from the bad is difficult because many agencies have slick websites and marketing campaigns, she added.
“It’s a cauldron of potentially serious problems that could really hurt the senior,” Lindquist said. “These agencies are a largely unregulated industry that is growing rapidly with high need as our population ages. This is big business with potentially large profit margins and lots of people are jumping into it.”
For the study, researchers posed as consumers and surveyed 180 agencies around the country about their hiring methods, screening measures, training practices, skill competencies assessments and supervision. They found:
Only 55 percent of the agencies did a federal background check.
“A number of agencies don’t do a federal background check or look at other states besides their own,” Lindquist said. “Someone could move from Wisconsin to Illinois and could have been convicted of abusing an elder adult or theft or rape and the agency would never know.”
Only one-third of agencies interviewed said they did drug testing.
“Considering that seniors often take pain medications, including narcotics, this is risky,” Lindquist said. “Some of the paid caregivers may be illicit drug users and could easily use or steal the seniors’ drugs to support their own habits.”
Few agencies (only one-third) test for caregiver skill competency. A common method of assessing skill competencies was “client feedback,” which was explained as expecting the senior or family member to alert the agency that their caregiver was doing a skill incorrectly.
“How do you expect a senior with dementia to identify what the caregiver is doing wrong?” Lindquist asked.
Many agencies (58.5 percent) use self-reports in which they ask the caregiver to describe their own skills. “In the hunt for a job, some people may report they can do tasks that in reality they have no idea how to do,” Lindquist said. “We found agencies sending caregivers out into the seniors’ home without checking.”
Inconsistent supervision of the caregiver.
Agencies should send a supervisor to do a home visit to check on the caregivers more frequently initially and then at least once a month. But this only occurred with 30 percent of the agencies.
“Amazingly, some agencies considered supervision to be asking the caregiver how things were going over the phone or when the employee stopped in to get their paycheck,” Lindquist said.
With seniors wishing to remain in their own homes, paid caregivers fill an important role.
“The public should demand higher standards, but in the short term, seniors need to be aware what explicitly to look for when hiring a paid caregiver through an agency,” Lindquist said.
Below are Lindquist’s 10 questions to ask an agency prior to hiring a paid caregiver:
10 QUESTIONS TO ASK BEFORE HIRING A CAREGIVER
1. How do you recruit caregivers, and what are your hiring requirements?
2. What types of screenings are performed on caregivers before you hire them? Criminal background check—federal or state? Drug screening? Other?
3. Are they certified in CPR or do they have any health-related training?
4. Are the caregivers insured and bonded through your agency?
5. What competencies are expected of the caregiver you send to the home? (These could include lifting and transfers, homemaking skills, personal care skills such as bathing, dressing, toileting, training in behavioral management and cognitive support.)
6. How do you assess what the caregiver is capable of doing?
7. What is your policy on providing a substitute caregiver if a regular caregiver cannot provide the contracted services?
8. If there is dissatisfaction with a particular caregiver, will a substitute be provided?
9. Does the agency provide a supervisor to evaluate the quality of home care on a regular basis? How frequently?
10. Does supervision occur over the telephone, through progress reports or in-person at the home of the older adult?
New study suggests moderate alcohol consumption may help prevent bone loss
CORVALLIS, Ore. – Drinking a moderate amount of alcohol as part of a healthy lifestyle may benefit women’s bone health, lowering their risk of developing osteoporosis.
A new study assessed the effects of alcohol withdrawal on bone turnover in postmenopausal women who drank one or two drinks per day several times a week. Researchers at Oregon State University measured a significant increase in blood markers of bone turnover in women after they stopped drinking for just two weeks.
Bones are in a constant state of remodeling with old bone being removed and replaced. In people with osteoporosis, more bone is lost than reformed resulting in porous, weak bones. About 80 percent of all people with osteoporosis are women, and postmenopausal women face an even greater risk because estrogen, a hormone that helps keep bone remodeling in balance, decreases after menopause.
Past studies have shown that moderate drinkers have a higher bone density than non-drinkers or heavy drinkers, but these studies have provided no explanation for the differences in bone density. Alcohol appears to behave similarly to estrogen in that it reduces bone turnover, the researchers said.
In the current study, published online July 11 in the journal Menopause, researchers in OSU’s Skeletal Biology Laboratory studied 40 early postmenopausal women who regularly had one or two drinks a day, were not on any hormone replacement therapies, and had no history of osteoporosis-related fractures.
The researchers found evidence for increased bone turnover – a risk factor for osteoporotic fractures – during the two week period when the participants stopped drinking. Even more surprising: the researchers found that less than a day after the women resumed their normal drinking, their bone turnover rates returned to previous levels.
“Drinking moderately as part of a healthy lifestyle that includes a good diet and exercise may be beneficial for bone health, especially in postmenopausal women,” said Urszula Iwaniec, associate professor in the College of Public Health and Human Sciences at OSU and one of the study’s authors. “After less than 24 hours to see such a measurable effect was really unexpected.”
Iwaniec, OSU’s Skeletal Biology Laboratory director Russell Turner, and researcher Gianni Maddalozzo assisted OSU alumna Jill Marrone with the study, which was Marrone’s master’s thesis.
This study is important because it suggests a cellular mechanism for the increased bone density often observed in postmenopausal women who are moderate drinkers, Turner said.
The researchers said many of the medications to help prevent bone loss are not only expensive, but can have unwanted side effects. While excessive drinking has a negative impact on health, drinking a glass of wine or beer regularly as part of a healthy lifestyle may be helpful for postmenopausal women.
“Everyone loses bone as they age, but not everyone develops osteoporosis,” Turner said. “Being able to identify factors, such as moderate alcohol intake, that influence bone health will help people make informed lifestyle choices.”
Hormone-mimicking chemicals cause inter-species mating
BPA in rivers leads to breakdown of fish species barriers
Hormone-mimicking chemicals released into rivers have been found to impact the mating choices of fish, a new study has revealed. The controversial chemical BPA, which emits oestrogen-like properties, was found to alter an individual’s appearance and behavior, leading to inter-species breeding. The study, published in Evolutionary Applications, reveals the threat to biodiversity when the boundaries between species are blurred.
The research, led by Dr Jessica Ward from the University of Minnesota, focused on the impact of Bisphenol A (BPA) on Blacktail Shiner (Cyprinella venusta) and Red Shiner (Cyprinella lutrensis) fish which are found in rivers across the United States. BPA is an organic compound used in the manufacture of polycarbonate and other plastics. It is currently banned from baby bottles and childrens’ cups in 11 U.S. states.
“Chemicals from household products and pharmaceuticals frequently end up in rivers and BPA is known to be present in aquatic ecosystems across the United States,” said Ward. “Until now studies have primarily focused on the impact to individual fish, but our study demonstrates the impact of BPA on a population level.”
The team collected individuals of both species from two streams in the state of Georgia. The species were kept separated for 14 days in tanks, some of which contained BPA. On the 15th day behavioral trials were undertaken as individuals from different tanks were introduced to each other.
The scientists monitored any physiological or signalling differences the individuals displayed, such as colour, as well as any behavioral differences during courtship, such as mate choice.
BPA disrupts an individual’s endocrine system, which controls the release of hormones. This impacts behavior and appearance, which in turn can lead an individual to mistake a newly introduced species as a potential mate.
This process poses long-term ecological consequences, especially in areas threatened by the introduction of invasive species. BPA and other hormone-mimicking chemicals can escalate the loss of native biodiversity by breaking down species barriers and promoting the invader.
“Our research shows how the presence of these manmade chemicals leads to a greater likelihood of hybridization between species,” concluded Ward. “This can have severe ecological and evolutionary consequences, including the potential for the decline of our native species.”
OxyContin formula change has many abusers switching to heroin
A change in the formula of the frequently abused prescription painkiller OxyContin has many abusers switching to a drug that is potentially more dangerous, according to researchers at Washington University School of Medicine in St. Louis.
The formula change makes inhaling or injecting the opioid drug more difficult, so many users are switching to heroin, the scientists report in the July 12 issue of the New England Journal of Medicine.
For nearly three years, the investigators have been collecting information from patients entering treatment for drug abuse. More than 2,500 patients from 150 treatment centers in 39 states have answered survey questions about their drug use with a particular focus on the reformulation of OxyContin.
The widely prescribed pain-killing drug originally was thought to be part of the solution to the abuse of opioid drugs because OxyContin was designed to be released into the system slowly, thus not contributing to an immediate “high.” But drug abusers could evade the slow-release mechanism by crushing the pills and inhaling the powder, or by dissolving the pills in water and injecting the solution, getting an immediate rush as large amounts of oxycodone entered the system all at once.
In addition, because OxyContin was designed to be a slow-release form of the generic oxycodone, the pills contained large amounts of the drug, making it even more attractive to abusers. Standard oxycodone tablets contained smaller amounts of the drug and did not produce as big a rush when inhaled or injected.
Then in 2010, a new formulation of the drug was introduced. The new pills were much more difficult to crush and dissolved more slowly. The idea, according to principal investigator Theodore J. Cicero, PhD, was to make the drug less attractive to illicit users who wanted to experience an immediate high.
“Our data show that OxyContin use by inhalation or intravenous administration has dropped significantly since that abuse-deterrent formulation came onto the market,” says Cicero, a professor of neuropharmacology in psychiatry. “In that sense, the new formulation was very successful.”
The researchers still are analyzing data, but Cicero says they wanted to make their findings public as quickly as possible. The new report appears as a letter to the editor in the journal. Although he found that many users stopped using OxyContin, they didn’t stop using drugs.
“The most unexpected, and probably detrimental, effect of the abuse-deterrent formulation was that it contributed to a huge surge in the use of heroin, which is like OxyContin in that it also is inhaled or injected,” he says. “We’re now seeing reports from across the country of large quantities of heroin appearing in suburbs and rural areas. Unable to use OxyContin easily, which was a very popular drug in suburban and rural areas, drug abusers who prefer snorting or IV drug administration now have shifted either to more potent opioids, if they can find them, or to heroin.”
Since the researchers started gathering data from patients admitted to drug treatment centers, the number of users who selected OxyContin as their primary drug of abuse has decreased from 35.6 percent of respondents before the release of the abuse-deterrent formulation to 12.8 percent now.
When users answered a question about which opioid they used to get high “in the past 30 days at least once,” OxyContin fell from 47.4 percent of respondents to 30 percent. During the same time period, reported use of heroin nearly doubled.
In addition to answering a confidential questionnaire when admitted to a drug treatment program, more than 125 of the study subjects also agreed to longer phone interviews during which they discussed their drug use and the impact of the new OxyContin formulation on their individual choices.
“When we asked if they had stopped using OxyContin, the normal response was ‘yes,'” Cicero says. “And then when we asked about what drug they were using now, most said something like: ‘Because of the decreased availability of OxyContin, I switched to heroin.'”
These findings may explain why so many law enforcement officials around the country are reporting increases in heroin use, Cicero says. He compares attempts to limit illicit drug use to a levee holding back floodwaters. Where the new formulation of OxyContin may have made it harder for abusers to use that particular drug, the “water” of illicit drug use simply has sought out other weak spots in the “levee” of drug policy.
“This trend toward increases in heroin use is important enough that we want to get the word out to physicians, regulatory officials and the public, so they can be aware of what’s happening,” he says. “Heroin is a very dangerous drug, and dealers always ‘cut’ the drug with something, with the result that some users will overdose. As users switch to heroin, overdoses may become more common.”
Menopausal hormone therapy associated with increased blood pressure
Menopausal hormone therapy use is associated with higher odds of high blood pressure, according to research published July 11 in the open access journal PLoS ONE. Longer hormone use was associated with further increased odds of high blood pressure, although this association decreased with subjects’ ages.
The authors of the study, led by Joanne Lind of the University of Western Sydney, included 43,405 postmenopausal women in their study to identify the association.
As Dr. Lind explains, the study shows that “longer use of menopausal hormone therapy is associated with having high blood pressure. It is therefore important that high blood pressure be conveyed as a health risk for women considering using menopausal hormone therapy.”
The results of the study may be taken into account when women are deciding whether, and for how long, menopausal hormone therapy is right for them.
Early-life exposure to chemical in drinking water may affect vision, study finds
(BOSTON) — Prenatal and early childhood exposure to the chemical solvent tetrachloroethylene (PCE) found in drinking water may be associated with long-term visual impairments, particularly in the area of color discrimination, a new study led by Boston University School of Public Health (BUSPH) researchers has found.
The study by epidemiologists and biostatisticians at BUSPH, working with an ophthalmologist from the BU School of Medicine, found that people exposed to higher levels of PCE from gestation through age 5 exhibited poorer color-discrimination abilities than unexposed people. The study, published July 11 in the journal Environmental Health Perspectives, recommends further investigation into the visual impairments associated with PCE exposure.
The research team assessed visual functioning among a group of people born between 1969 and 1983 to parents residing in eight towns in the Cape Cod region of Massachusetts. The towns all had PCE in their drinking water because of pipes outfitted with a vinyl liner that was improperly cured. Previous studies led by Ann Aschengrau, professor of epidemiology at BUSPH, have found associations between PCE exposure and cancer, as well as reproductive and developmental outcomes. Increases in the risks of breast cancer and certain birth defects were seen in the team’s prior studies.
PCE is a known neurotoxin that was used to apply the vinyl liner of some drinking water pipes. Surveys have estimated that more than 600 miles of such pipes were installed in nearly 100 cities and towns in Massachusetts, mainly during the 1970s. Exposure to PCE from drinking water occurs by direct ingestion, dermal exposure during bathing, and by inhalation during showering, bathing and other household uses.
The pipes no longer leach PCE, but the chemical is still widely used in dry cleaning and metal degreasing solutions and is a common drinking water contaminant.
In testing vision, Aschengrau and colleagues found that people exposed to PCE made more major errors in color discrimination than those not exposed. The levels of color confusion were greatest among people with high exposure levels. PCE previously has been implicated in deficiencies in color discrimination, mainly among adults with occupational exposures. The new study is the first to assess “the associations between prenatal and early childhood exposure to PCE and adult vision,” Aschengrau said. The findings suggest that “the effects of early life PCE-exposure on color discrimination may be irreversible.”
Air in expectant moms’ homes contains pesticides, border study finds
Low-cost, less-toxic control methods urged
HARLINGEN, Texas (July 11, 2012) — Air samples from homes of Hispanic mothers-to-be along the Texas-Mexico border contained multiple pesticides in a majority of the houses, according to a study conducted by the School of Medicine at The University of Texas Health Science Center San Antonio.
All the women were in the third trimester of pregnancy, when the fetal brain undergoes a growth spurt. Several studies have reported that pesticide exposure may adversely affect mental and motor development during infancy and childhood. The new report is in the summer issue of the Texas Public Health Journal sent to members this week.
Two-thirds of the families surveyed said they used pest control methods to kill cockroaches, rodents and other pests. Pregnant women and infants often spend 90 percent of their day indoors.
“There is a lack of education in our communities regarding the health hazards of these toxic pest control methods,” said lead author Beatriz Tapia, M.D., M.P.H., lecturer at the UT Health Science Center — Regional Academic Health Center campus in Harlingen, located 10 miles from the border. “We should concentrate on trying to educate families about low-cost methods that prevent infestations and use the least toxic pest control methods first.”
A wise alternative
Integrated pest management (IPM) is a low-cost strategy to replace the use of residential pesticides, Dr. Tapia said. IPM focuses on installing screens and caulking doors and windows to keep out pests, putting away food and placing boric acid, a low-impact alternative, in walls.
“Once we educate our women of childbearing age about how they can safely and in a healthy manner diminish pests in their homes, they will feel empowered that they can make a difference in their family’s life,” Dr. Tapia said. She is a faculty associate in the university’s Department of Family and Community Medicine and serves as environmental medicine training coordinator for the South Texas Environmental Education and Research Center (STEER). She co-coordinates a 30-day Harlingen student elective in environmental and occupational medicine.
Samples show presence
The team sampled air in 25 households, finding at least five pesticides in 60 percent of the dwellings. Nine other pesticides were identified in less than one-third of the homes.
Ninety-two percent of the air samples contained o-phenylphenol, which is used as a fungicide, germicide and household disinfectant, while 80 percent included chlorpyrifos, employed in agriculture to kill mosquitoes and other pests. Propoxur, present in granular baits, pet collars and other products, showed up in 76 percent of samples, along with the insecticide diazinon in 72 percent. The herbicide trifluralin turned up in 60 percent of samples.
The U.S. Environmental Protection Agency (EPA) in June 2000 entered into an agreement to eliminate virtually all homeowner uses of chlorpyrifos, except ant and roach baits in child-resistant packaging. The EPA banned residential use of diazinon as of Dec. 31, 2004.
Pregnancy and pesticides don’t mix
“Increasingly, pesticide exposures are being linked to neurodevelopmental disorders such as autism and attention deficit hyperactivity disorder (ADHD),” said co-author and STEER Director Claudia S. Miller, M.D., M.S., professor in environmental and occupational medicine with the Department of Family and Community Medicine. “Planning for pregnancy today should include not only prenatal vitamins and a good diet, but also avoiding potentially hazardous pesticides. Instead, use non-toxic approaches for pest control and IPM.”
Environmental medicine researchers at the Harlingen campus modeled the pilot project on studies conducted by the Columbia Center for Children’s Environmental Health. These studies, which sampled air in homes of mother/newborn pairs in northern Manhattan or South Bronx, showed that fetal and childhood exposure to pesticides can be measured in indoor air and can adversely affect fetal growth in a minority population.
Young Hispanics recruited
The Harlingen researchers recruited pregnant Hispanic women from two maternity clinics in Hidalgo County. Enrolled women were 18-35 years old, had no serious medical conditions and had reached 30-34 weeks of gestation. The team asked the women questions about pesticide use and exposure, proximity to agricultural fields, and how often they saw spraying operations or detected pesticide or other odors drifting from fields.
Air samples were measured for multiple pesticides used in agriculture, given the close proximity of the fields to participant homes. These pesticides turned up in 12 percent of the homes, not as high a number as expected. “The reality is, when these pesticides are used outdoors, the sun and soil do their part and eliminate them from the environment,” Dr. Tapia said. “Indoors you don’t have nature helping you.”
Outdoor exposures may not be reflected
Outdoor and indoor exposures are measured differently. “Agricultural spraying tends to result in shorter-term bursts, so-called acute exposures that may not be captured in a study like ours,” Dr. Miller said. “This is a limitation of most pesticide exposure studies in agricultural areas.”
Toward new drugs for the human and non-human cells in people
Amid the growing recognition that only a small fraction of the cells and genes in a typical human being are human, scientists are suggesting a revolutionary approach to developing new medicines and treatments to target both the human and non-human components of people. That’s the topic of an article, which reviews work relating to this topic from almost 100 studies, in ACS’ Journal of Proteome Research.
Liping Zhao, Jeremy K. Nicholson and colleagues explain that human beings have been called “superorganisms” because their bodies contain 10 percent human cells and 90 percent microbes that live mainly in the intestines. “Super” in that sense means “above and beyond.” Scientists thus are viewing people as vast ecosystems in which human, bacterial, fungal and other cells interact with each another. Microbes, for instance, release substances that determine whether human genes turn on or off and influence the immune system’s defenses against disease. And populations of microbes in the body change with changes in diet, medications and other factors.
“This superorganism view of the human body provides a complete new systems concept for managing human health at the clinically relevant whole body level,” say the authors. They term it “one of the most significant paradigm shifts in modern medicine.” The article describes how this revolutionary change is fostering emergence of an approach called “functional metagenomics” for developing new medicines. It opens the possibility of sustaining health and treating disease with medicines and other substances that target non-human cells in the body. The article notes that many substances in traditional Chinese medicines may work in that way.
Veterinary vaccines found to combine into new viruses, prompting regulatory response
Research from the University of Melbourne has shown that two different vaccine viruses- used simultaneously to control the same condition in chickens- have combined to produce new infectious viruses, prompting early response from Australia’s veterinary medicines regulator.
The vaccines were used to control infectious laryngotracheitis (ILT), an acute respiratory disease occurring in chickens worldwide. ILT can have up to 20% mortality rate in some flocks and has a significant economic and welfare impact in the poultry industry.
The research found that when two different ILT vaccine strains were used in the same populations, they combined into two new strains (a process known as recombination), resulting in disease outbreaks.
Neither the ILT virus or the new strains can be transmitted to humans or other animals, and do not pose a food safety risk.
The study was led by Dr Joanne Devlin, Professor Glenn Browning and Dr Sang-Won Lee and colleagues at the Asia-Pacific Centre for Animal Health at the University of Melbourne and NICTA’s Victoria Research Laboratory and is published today [13 July, 2012] in the international journal Science.
Dr Devlin said the combining of live vaccine virus strains outside of the laboratory was previously thought to be highly unlikely, but this study shows that it is possible and has led to disease outbreaks in poultry flocks.
“We alerted the Australian Pesticide and Veterinary Medicines Authority (APVMA) to our findings and they are now working closely with our research team, vaccine registrants and the poultry industry to determine both short and long term regulatory actions,” she said.
“Short-term measures include risk assessment of all live virus vaccines currently registered by the APVMA in regard to the risk of recombination and could include changes to product labels, which may result in restrictions on the use of two vaccines of different origins in the one animal population.”
The ILT vaccines are ‘live attenuated vaccines’, which means that the virus has some disease-causing factors removed but the immune system still recognises the virus to defend against a real infection.
“Live vaccines are used throughout the world to control ILT in poultry. For over 40 years the vaccines used in Australia were derived from an Australian virus strain. But following a vaccine shortage another vaccine originating from Europe was registered in 2006 and rapidly became widely used,” Dr Devlin said.
“Shortly after the introduction of the European strain of vaccine, two new strains of ILT virus were found to be responsible for most of the outbreaks of disease in New South Wales and Victoria. So we sought to examine the origin of these two new strains.”
The team sequenced all of the genes (the genome) of the two vaccines used in Australia, and the two new outbreak strains of the virus. Following bioinformatic analysis on the resulting DNA sequence, in conjunction with Dr John Markham at NICTA’s Victoria Research Laboratory, they found that the new disease-causing strains were combinations of the Australian and European origin vaccine strains.
“Comparisons of the vaccine strains and the new recombinant strains have shown that both the recombinant strains cause more severe disease, or replicate to a higher level than the parent vaccine strains that gave rise to them,” Dr Lee said.
Professor Glenn Browning said recombination was a natural process that can occur when two viruses infect the same cell at the same time.
“While recombination has been recognised as a potential risk associated with live virus vaccines for many years, the likelihood of it happening in viruses like this in the field has been thought to be so low that it was considered to be very unlikely to lead to significant problems,” he said.
“Our studies have shown that the risk of recombination between different vaccine strains in the field is significant as two different recombinant viruses arose within a year. We also demonstrated that the consequences of such recombination can be very severe, as the new viruses have been responsible for the deaths of thousands of Australian poultry.”
“The study suggests that regulation of live attenuated vaccines for all species needs to take into account the real potential for vaccine viruses to combine. Measures such as those now being taken for the ILT vaccines will need to be implemented.”
Chemicals in personal care products may increase risk of diabetes in women
Brigham and Women’s Hospital study is the first to examine an association between phthalates and diabetes in a large population of American women
Boston, MA – A study lead by researchers from Brigham and Women’s Hospital (BWH) shows an association between increased concentrations of phthalates in the body and an increased risk of diabetes in women. Phthalates are endocrine disrupting chemicals that are commonly found in personal care products such as moisturizers, nail polishes, soaps, hair sprays and perfumes. They are also used in adhesives, electronics, toys and a variety of other products. This finding is published in the July 13, 2012 online edition of Environmental Health Perspectives
Researchers, lead by Tamarra James-Todd, PhD, a researcher in the Division of Women’s Health at BWH, analyzed urinary concentrations of phthalates in 2,350 women who participated in the National Health and Nutrition Examination Survey. They found that women with higher levels of phthalates in their urine were more likely to have diabetes. Specifically:
- Women who had the highest levels of the chemicals mono-benzyl phthalate and mono-isobutyl phthalate had almost twice the risk of diabetes compared to women with the lowest levels of those chemicals.
- Women with higher than median levels of the chemical mono-(3-carboxypropyl) phthalate had approximately a 60 percent increased risk of diabetes.
- Women with moderately high levels of the chemicals mono-n-butyl phthalate and di-2-ethylhexyl phthalate had approximately a 70 percent increased risk of diabetes.
The study population consisted of a representative sample of American women and was controlled for socio-demographic, dietary and behavioral factors. However, the women self-reported their diabetes and researchers caution against reading too much into the study due to the possibility of reverse causation.
“This is an important first step in exploring the connection between phthalates and diabetes,” said Dr. James-Todd. “We know that in addition to being present in personal care products, phthalates also exist in certain types of medical devices and medication that is used to treat diabetes and this could also explain the higher level of phthalates in diabetic women. So overall, more research is needed.”
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