Health Research Report
153rd Issue Date 19 Apr 2013
Compiled By Ralph Turchiano
In this Issue:
1. Lift weights to lower blood sugar? White muscle helps keep blood glucose levels under control
2. New evidence that natural substances in green coffee beans help control blood sugar levels
3. New evidence that egg white protein may help high blood pressure
4. Omega-3 fatty acids more effective at inhibiting growth of triple-negative breast cancer
5. The adult generations of today are less healthy than their counterparts of previous generations
6. Co-Q10 deficiency may relate to statin drugs, diabetes risk
7. Naturally-occurring substance proves effective against deadly skin cancer in laboratory tests
8. Drinking cup of beetroot juice daily may help lower blood pressure
9. Vitamin D may reduce risk of uterine fibroids, according to NIH study
10. Excess vitamin E intake not a health concern
11. US hospitals make more money when surgery goes wrong
Lift weights to lower blood sugar? White muscle helps keep blood glucose levels under control
ANN ARBOR—Researchers in the Life Sciences Institute at the University of Michigan have challenged a long-held belief that whitening of skeletal muscle in diabetes is harmful.
In fact, the white muscle that increases with resistance training, age and diabetes helps keep blood sugar in check, the researchers showed.
In addition, the insights from the molecular pathways involved in this phenomenon and identified in the study may point the way to potential drug targets for obesity and metabolic disease.
“We wanted to figure out the relationship between muscle types and body metabolism, how the muscles were made, and also what kind of influence they have on diseases like type 2 diabetes,” said Jiandie Lin, Life Sciences Institute faculty member and associate professor at the U-M Medical School.
Lin’s findings are scheduled to be published online April 7 in Nature Medicine.
Much like poultry has light and dark meat, mammals have a range of muscles: red, white and those in between. Red muscle, which gets its color in part from mitochondria, prevails in people who engage in endurance training, such as marathon runners. White muscle dominates in the bodies of weightlifters and sprinters—people who require short, intense bursts of energy.
“Most people are in the middle and have a mix of red and white,” Lin said.
When you exercise, nerves signal your muscles to contract, and the muscle needs energy. In response to a signal to lift a heavy weight, white muscles use glycogen to generate adenosine triphosphate (ATP)—energy the cells can use to complete the task. While this process, called glycolysis, can produce a lot of power for a short time, the glycogen fuel soon depletes.
However, if the brain tells the muscle to run a slow and steady long-distance race, the mitochondria in red muscles primarily use fat oxidation instead of glycogen breakdown to generate ATP. The supply of energy lasts much longer but doesn’t provide the burst of strength that comes from glycolysis.
People with diabetes see whitening of the mix of muscle.
“For a long time, the red-to-white shift was thought to make muscle less responsive to insulin, a hormone that lowers blood sugar,” Lin said. “But this idea is far from proven. You lose red muscle when you age or develop diabetes, but is that really the culprit?”
To find out, the team set out to find a protein that drives the formation of white muscle. They sifted through microarray data sets from public databases and identified a list of candidate proteins that were prevalent in white muscle but not in red.
Further studies led the team to focus on a protein called BAF60c, a sort of “zip code” mechanism that tells the cells when and how to express certain genes. The Lin team made a transgenic mouse model to increase BAF60c only in the skeletal muscle. One of the first things they noticed was that mice with more BAF60c had muscles that looked paler.
“That was a good hint that we were going in the white-muscle direction,” said lead author Zhuo-xian Meng, a research fellow in Lin’s lab.
They used electron microscopy to see the abundance of mitochondria within the muscle, and confirmed that muscle from BAF60c transgenic mice had less mitochondria than the normal controls.
“We saw predicted changes in molecular markers, but the ultimate test would be seeing how the mouse could run,” Lin said.
If the BAF60c mice could run powerfully for short distances but tired quickly, the scientists would be able to confirm that the BAF60c pathway was a key part of the creation of white muscle.
Using mouse treadmills, they compared the endurance of BAF60c mice to a control group of normal mice, and found that the BAF60c transgenic mice could only run about 60 percent of the time that the control group could before tiring.
“White muscle uses glycogen, and the transgenic mice depleted their muscles’ supplies of glycogen very quickly,” Lin said.
After some follow-up experiments to figure out exactly which molecules were controlled by BAF60c, Lin and his team were confident that they had identified major players responsible for promoting white muscle formation. Now that they knew how to make more white muscle in animals, they wanted to determine whether white muscle was a deleterious or an adaptive characteristic of diabetes.
The team induced obesity in mice by feeding them the “Super Size Me” diet, Lin said. On a high-fat diet, a mouse will double its body weight in two to three months. They found that obese mice with BAF60c transgene were much better at controlling blood glucose.
“The results are a bit of a surprise to many people,” Lin said. “It really points to the complexity in thinking about muscle metabolism and diabetes.”
In humans, resistance training promotes the growth of white muscle and helps in lowering blood glucose. If future studies in humans determine that the BAF60c pathway is indeed the way in which cells form white muscle and in turn optimize metabolic function, the finding could lead to researching the pathway as a drug target.
“We know that this molecular pathway also works in human cells. The real challenge is to find a w
ay to target these factors,” Lin said.
New evidence that natural substances in green coffee beans help control blood sugar levels
NEW ORLEANS, April 9, 2013 — Scientists today described evidence that natural substances extracted from unroasted coffee beans can help control the elevated blood sugar levels and body weight that underpin type 2 diabetes. Their presentation on chlorogenic acids — widely available as a dietary supplement — was part of the 245th National Meeting & Exposition of the American Chemical Society (ACS), the world’s largest scientific society, being held here this week.
Joe Vinson, Ph.D., who led the research, pointed out that type 2 diabetes, the most common form of diabetes, is an increasing global health problem. In the United States alone, almost 26 million have the disease, in which the pancreas does not produce enough of the insulin that enables the body to use sugar, or cells resist the effects of that insulin. Blood sugar levels rise, increasing the risk of heart attacks, stroke and other health problems. Current treatments focus on oral medications that stimulate insulin secretions and/or reduce insulin resistance, dietary changes that control blood sugar levels and weight loss that reduces insulin resistance.
“A simple natural pill or capsule that would both help control blood sugar and foster weight loss at the same time would be a major advance in the treatment of type 2 diabetes,” Vinson said. “Our own research and studies published by other scientists suggest that such a treatment may, indeed, exist. There is significant epidemiological and other evidence that coffee consumption reduces the risk of type 2 diabetes.
“One large study indicated a 50 percent risk reduction for people who drank seven cups of coffee a day compared to those who drank only two cups a day. I am trying to make the coffee and diabetes story as clear as possible for the public. The evidence points to chlorogenic acids as the active ingredients in coffee that both prevent diabetes and improve glucose control in normal, pre-diabetic and diabetic people.”
Chlorogenic acids are a family of substances that occur naturally in apples, cherries, plums, dried plums and other fruits and vegetables. Vinson, who is with the University of Scranton in Pennsylvania, pointed out that coffee ― due to its popularity as a beverage ― is a major dietary source of these substances. Large amounts of chlorogenic acids exist in green, or unroasted, coffee beans. However, the high temperatures used to roast coffee beans to make them suitable for use in coffee breaks down much of the chlorogenic acids. Thus, the focus has been on using concentrated extracts of green coffee beans, which contain higher amounts of chlorogenic acids.
In a previous study, Vinson found that overweight or obese people who took such an extract lost about 10 percent of their body weight in 22 weeks. The new study sought to document the effects of various doses of a commercial green coffee extract on the blood sugar levels of 56 men and women with normal blood sugar levels. They got a glucose tolerance test to see how their bodies responded to the sugar. Then over a period of time, they took 100, 200, 300 or 400 milligrams (mg) of the extract in a capsule with water. Follow-up glucose tolerance tests showed how the green coffee extract affected their responses.
“There was a significant dose-response effect of the green coffee extract and no apparent gastrointestinal side effects,” Vinson said. “All doses of green coffee extract produced a significant reduction in blood sugar relative to the original blank glucose challenge. The maximum blood glucose occurred at 30 minutes and was 24 percent lower than the original with the 400 mg of green coffee extract and the blood glucose at 120 minutes was 31 percent lower.”
Vinson acknowledged funding from Applied Food Sciences, Inc., which markets a green coffee antioxidant product.
New evidence that egg white protein may help high blood pressure
NEW ORLEANS, April 9, 2013 — Scientists reported new evidence today that a component of egg whites — already popular as a substitute for whole eggs among health-conscious consumers concerned about cholesterol in the yolk — may have another beneficial effect in reducing blood pressure. Their study was part of the 245th National Meeting & Exposition of the American Chemical Society (ACS), the world’s largest scientific society, which continues here through Thursday.
“Our research suggests that there may be another reason to call it ‘the incredible, edible egg,'” said study leader Zhipeng Yu, Ph.D., of Jilin University. “We have evidence from the laboratory that a substance in egg white — it’s a peptide, one of the building blocks of proteins — reduces blood pressure about as much as a low dose of Captopril, a high-blood-pressure drug.”
Yu and colleagues, who are with Clemson University, used a peptide called RVPSL. Scientists previously discovered that the substance, like the family of medications that includes Captopril, Vasotec and Monopril, was an angiotensin-converting-enzyme (ACE) inhibitor. It has a powerful ability to inhibit or block the action of ACE, a substance produced in the body that raises blood pressure.
They set out to further document RVPSL’s effects, using laboratory rats that develop high blood pressure and are stand-ins for humans in such early research on hypertension. The results of feeding the substance were positive, showing that RVPSL did not have apparent toxic effects and lowered blood pressure by amounts comparable to low doses of Captopril.
“Our results support and enhance previous findings on this topic,” Yu said. “They were promising enough to move ahead with further research on the effects of the egg white peptide on human health.”
Yu noted that the research was done with a version of the peptide that was heated to almost 200 degrees Fahrenheit during preparation — less than the temperatures typically used to cook eggs. He cited evidence from other research, however, that egg whites may retain their beneficial effects on blood pressure after cooking.
One, for instance, published in the ACS’ Journal of Agricultural and Food Chemistry, showed that fried egg protein, cooked at high temperatures, actually showed greater ability to reduce blood pressure than eggs boiled at 212 degrees F.
Yu believes that egg white peptides, either in eggs or as a supplement, could become useful as an adjunct to high-blood-pressure medication. For now, he said people with high blood pressure should consult their health care provider before making any changes.
And he noted that findings about egg white and high blood pressure add to the emerging nutritional image of eggs. Once regarded as a food to avoid in a healthy diet, studies in recent years have concluded that many people can eat eggs without raising their blood cholesterol levels, benefiting from an inexpensive food low in calories and rich in protein, vitamins and other nutrients.
Omega-3 fatty acids more effective at inhibiting growth of triple-negative breast cancer
WASHINGTON, DC (April 9, 2013)—Researchers from Fox Chase Cancer Center have found that omega-3 fatty acids and their metabolite products slow or stop the proliferation, or growth in the number of cells, of triple-negative breast cancer cells more effectively than cells from luminal types of the disease. The omega-3s worked against all types of cancerous cells, but the effect was observed to be stronger in triple-negative cell lines, reducing proliferation by as much as 90 percent. The findings will be presented at the AACR Annual Meeting 2013 on Tuesday, April 9.
Omega-3 fatty acids are found in oily fish like sardines and salmon, and also in oils derived from plants like hemp and flax. Previous studies suggest these compounds can negatively affect critical mechanisms in cancer cells, namely those responsible for proliferation and for apoptosis, or programmed cell death. Lead author
on the study Thomas J. Pogash, a scientific technician in the Fox Chase Cancer Center lab of Jose Russo, MD, says the new work underscores the important role common compounds found in food may play in keeping cancer at bay.
“Diet can play a critical role in breast cancer prevention,” says Pogash. “When you compare a western diet to a mediterranean diet, which has more omega-3s, you see less cancer in the mediterranean diet. They eat much more fish.”
Breast cancer is a heterogeneous group of cancers comprising diseases that differ on the molecular level. Patients with different types of breast cancer respond differently to treatments. Four distinct categories of the disease are generally recognized. Two of those, luminal A and luminal B, grow in the luminal cells that line milk ducts in the breast and have receptors for estrogen and progesterone (prognosis is generally better for patients with luminal A than with luminal B). A third category includes tumors that test positive for the HER2 receptor.
Tumors in the fourth category, triple-negative, lack receptors for progesterone, estrogen, and a protein called HER2/neu. As a result, this type of disease is insensitive to treatments like trastuzumab, which disrupts the HER2 receptor, and tamoxifen, which targets the estrogen receptor.
Russo notes that no targeted therapies are currently available for patients diagnosed with triple-negative breast cancer. Combination chemotherapies are the standard of care for early-stage disease.
“This type of cancer, which is found more frequently in Latina and African-American women, is highly aggressive and has a low survival rate,” says Russo. “There is not any specific treatment for it.”
When a cancer cell digests omega-3s, the fatty acid is broken down into smaller molecules called metabolites. Russo, Pogash, and their colleagues tested the effect of large omega-3 parent molecules, as well as their smaller metabolic derivatives, on three luminal cell lines and seven lines that included basal-type triple-negative cells.
Omega-3 and its metabolites were observed to inhibit proliferation in all cell lines, but the effect was dramatically more pronounced in the triple-negative cell lines. In addition, the metabolites of omega-3 reduced the motility, or ability to move, by 20-60 percent in the triple-negative basal cell lines.
This study is part of a consortium between Fox Chase Cancer Center and Pennsylvania State University under a five-year grant awarded by the Komen Foundation. Russo is the principal investigator of the project at Fox Chase. Andrea Manni, MD, leader of the Pennsylvania State University team, has extended this work to animal models, studying the anticancer effects of omega-3s and its metabolites on mouse models of triple-negative breast cancer.
Russo and his colleagues are working on two related projects, one on the role of epigenetic events in the mechanism of cell transformation and another on the potential action of peptides of the hormone human chorionic gonadotropin (hCG) on breast cancer prevention.
The adult generations of today are less healthy than their counterparts of previous generations
Results from a large cohort study suggest that exposure to metabolic risks of cardiovascular disease is increasing
Sophia Antipolis, 10 April 2013. Despite their greater life expectancy, the adults of today are less “metabolically” healthy than their counterparts of previous generations. That’s the conclusion of a large cohort study from the Netherlands which compared generational shifts in a range of well established metabolic risk factors for cardiovascular disease. Assessing the trends, the investigators concluded that “the more recently born generations are doing worse”, and warn “that the prevalence of metabolic risk factors and the lifelong exposure to them have increased and probably will continue to increase”.
The study, reported today in the European Journal of Preventive Cardiology, analysed data on more than 6,000 individuals in the Doetinchem Cohort Study, which began in 1987 with follow-up examinations after six, 11, and 16 years.(1,2) The principal risk factors measured were body weight, blood pressure, total cholesterol levels (for hypercholesterolaemia) and levels of high-density lipoprotein (HDL) cholesterol, which is considered “protective”.
The subjects were stratified by sex and generation at baseline into ten-year age groups (20, 30, 40, and 50 years); the follow-up analyses aimed to determine whether one generation had a different risk profile from a generation born ten years earlier – what the investigators called a “generation shift”.
Results showed that the prevalence of overweight, obesity, and hypertension increased with age in all generations, but in general the more recently born generations had a higher prevalence of these risk factors than generations born ten years earlier. For example, 40% of the males who were in their 30s at baseline were classified as overweight; 11 years later the prevalence of overweight among the second generation of men in their 30s had increased to 52% (a statistically significant generational shift). In women these unfavourable changes in weight were only evident between the most recently born generations, in which the prevalence of obesity doubled in just 10 years.
Other findings from the study included:
Unfavourable (and statistically significant) generation shifts in hypertension in both sexes between every consecutive generation (except for the two most recently born generations of men).
Unfavourable generation shifts in diabetes between three of the four generations of men, but not of women.
No generation shifts for hypercholesterolaemia, although favourable shifts in HDL cholesterol were only observed between the oldest two generations.
As for the overall picture, and based on the evidence of a “clear” shift in the prevalence of overweight and hypertension, the investigators emphasise that “the more recently born adult generations are doing worse than their predecessors”. Evidence to explain the changes is not clear, they add, but note studies reporting an increase in physical inactivity.
What do the findings mean for public health? First author Gerben Hulsegge from the Dutch National Institute for Public Health and the Environment emphasises the impact of obesity at a younger age. “For example,” he explains, “the prevalence of obesity in our youngest generation of men and women at the mean age of 40 is similar to that of our oldest generation at the mean age of 55. This means that this younger generation is ’15 years ahead’ of the older generation and will be exposed to their obesity for a longer time. So our study firstly highlights the need for a healthy body weight – by encouraging increased physical activity and balanced diet, particularly among the younger generations.
“The findings also mean that, because the prevalence of smoking in high-income countries is decreasing, we are likely to see a shift in non-communicable disease from smoking-related diseases such as lung cancer to obesity-related diseases such as diabetes. This decrease in smoking prevalence and improved quality of health care are now important driving forces behind the greater life expectancy of younger generations, and it’s likely that in the near future life expectancy will continue to rise – but it’s also possible that in the more distant future, as a result of our current trends in obesity, the rate of increase in life expectancy may well slow down, although it’s difficult to speculate about that.”
Co-Q10 deficiency may relate to statin drugs, diabetes risk
CORVALLIS, Ore. – A laboratory study has shown for the first time that coenzyme Q10 offsets cellular changes that may be linked to a side-effect of some statin drugs – an increased risk of adult-onset diabetes.
Statins are some of the most widely prescribed drugs in the world, able to reduce LDL, or “bad” cholesterol le
vels, and the risk of heart attacks or other cardiovascular events. However, their role in raising the risk of diabetes has only been observed and studied in recent years.
The possibility of thousands of statin-induced diabetics is a growing concern, and led last year to new labeling and warnings by the Food and Drug Administration about the drugs, especially when taken at higher dosage levels.
The findings of the new research were published as a rapid communication in Metabolic Syndrome and Related Disorders, and offer another clue to a possible causative mechanism of this problem.
Pharmacy researchers at Oregon State University who authored the study said the findings were made only in laboratory analysis of cells, and more work needs to be done with animal and ultimately human studies before recommending the use of coenzyme Q10 to help address this concern.
“A number of large, randomized clinical trials have now shown that use of statins can increase the risk of developing type-2 diabetes by about 9 percent,” said Matthew K. Ito, an OSU professor of pharmacy and president-elect of the National Lipid Association.
“This is fairly serious, especially if you are in the large group of patients who have not yet had a cardiovascular event, but just take statin drugs to lower your risks of heart disease,” Ito said.
A suspect in this issue has been altered levels of a protein called GLUT4, which is part of the cellular response mechanism, along with insulin, that helps to control blood sugar levels. A reduced expression of GLUT4 contributes to insulin resistance and the onset of type-2 diabetes, and can be caused by the use of some statin drugs.
The statins that reduce cholesterol production also reduce levels of coenzyme Q10, research has shown. Coenzyme Q10 is needed in cells to help create energy and perform other important functions. And this study showed in laboratory analysis that if coenzyme Q10 is supplemented to cells, it prevents the reduction in GLUT4 induced by the statins.
Not all statin drugs, however, appear to cause a reduction in GLUT4.
The problems were found with one statin, simvastatin, that is “lipophilic,” which means it can more easily move through the cell membrane. Some of the most commonly used statins are lipophilic, including simvastatin, atorvastatin, and lovastatin. All of these statins are now available as generic drugs, and high dosage levels have been most often linked with the increase in diabetes.
Tests in the new study done with a “hydrophilic” statin, in this case pravastatin, did not cause reduced levels of GLUT4. Pravastatin is also available as a generic drug.
“The concern about increasing levels of diabetes is important,” Ito said. “We need to better understand why this is happening. There’s no doubt that statins can reduce cardiovascular events, from 25-45 percent, and are very valuable drugs in the battle against heart disease. It would be significant if it turns out that use of coenzyme Q10 can help offset the concerns about statin use and diabetes.”
Before that conclusion can be reached, the researchers said, additional studies are needed on coenzyme Q10 supplementation and the pathogenesis of statin-induced diabetes.
Naturally-occurring substance proves effective against deadly skin cancer in laboratory tests
For the first time, scientists have demonstrated the mechanism of action of gossypin, a naturally-occurring substance found in fruits and vegetables, as a treatment for melanoma, which causes the majority of deaths from skin cancer.
“We identified gossypin as a novel agent with dual inhibitory activity towards two common mutations that are the ideal targets for melanoma treatment,” said Texas Biomed’s Hareesh Nair, Ph.D.
At the moment, there is no single therapeutic agent or combination regimen available to treat all melanomas, of which about 76,000 new cases are diagnosed annually, according to the American Cancer Society.
“Our results indicate that gossypin may have great therapeutic potential as a dual inhibitor of mutations called BRAFV600E kinase and CDK4, which occur in the vast majority of melanoma patients. They open a new avenue for the generation of a novel class of compounds for the treatment of melanoma,” Nair added.
His report, appearing in the March 29, 2013 issue of the journal Molecular Cancer Therapeutics, was funded by the Texas Biomedical Forum and the Robert J. Kleberg, Jr. and Helen C. Kleberg Foundation.
Nair and his colleagues found that gossypin inhibited human melanoma cell proliferation, in vitro, in melanoma cell lines that harbor the two mutations. Gossypin stunted activities of the mutated genes, possibly through direct binding with them. It also inhibited the growth of various human melanoma cells. In addition, gossypin treatment for 10 days of human melanoma cell tumors with the mutations transplanted into mice reduced tumor volume and increased survival rate.
Further studies are planned by Nair’s team to understand how the body absorbs gossypin and how it is metabolized. This idea has been discussed with the Cancer Therapy & Research Center at the UT Health Science Center San Antonio’s Deva Mahalingam, M.D, Ph.D., who is interested in testing gossypin in melanoma patients.
Drinking cup of beetroot juice daily may help lower blood pressure
A cup of beetroot juice a day may help reduce your blood pressure, according to a small study in the American Heart Association journal Hypertension.
People with high blood pressure who drank about 8 ounces of beetroot juice experienced a decrease in blood pressure of about 10 mm Hg. But the preliminary findings don’t yet suggest that supplementing your diet with beetroot juice benefits your health, researchers said.
“Our hope is that increasing one’s intake of vegetables with a high dietary nitrate content, such as green leafy vegetables or beetroot, might be a lifestyle approach that one could easily employ to improve cardiovascular health,” said Amrita Ahluwalia, Ph.D., lead author of the study and a professor of vascular pharmacology at The Barts and The London Medical School in London.
The beetroot juice contained about 0.2g of dietary nitrate, levels one might find in a large bowl of lettuce or perhaps two beetroots. In the body the nitrate is converted to a chemical called nitrite and then to nitric oxide in the blood. Nitric oxide is a gas that widens blood vessels and aids blood flow.
“We were surprised by how little nitrate was needed to see such a large effect,” Ahluwalia said. “This study shows that compared to individuals with healthy blood pressure much less nitrate is needed to produce the kinds of decreases in blood pressure that might provide clinical benefits in people who need to lower their blood pressure. However, we are still uncertain as to whether this effect is maintained in the long term.”
The study involved eight women and seven men who had a systolic blood pressure between 140 to 159 millimeters of mercury (mm Hg), did not have other medical complications and were not taking blood pressure medication. The study participants drank 250 mL of beetroot juice or water containing a low amount of nitrate, and had their blood pressure monitored over the next 24 hours.
Blood pressure is typically recorded as two numbers. Systolic blood pressure, which is the top number and the highest, measures the pressure in the arteries when the heart beats. Diastolic blood pressure, the bottom and lower number, measures blood pressure in the arteries between heart beats.
Compared with the placebo group, participants drinking beetroot juice had reduced systolic and diastolic blood pressure — even after nitrite circulating in the blood had returned to their previous levels prior to drinking beetroot. The effect was most pronounced three to six hours after drinking the juice but still present even 24 hours later.
In the United States, more than 77 million adults have dia
gnosed high blood pressure, a major risk factor for heart diseases and stroke. Eating vegetables rich in dietary nitrate and other critical nutrients may be an accessible and inexpensive way to manage blood pressure, Ahluwalia said.
Getting people to eat more fruits and vegetables is challenging, but results of the study offer hope, she said. “In the U.K., the general public is told that they should be eating five portions of fruit or vegetables a day but this can be hard to do. Perhaps we should have a different approach to dietary advice. If one could eat just one (fruit or vegetable) a day, this is one more than nothing and should be viewed as positive.”
The USDA recommends filling half your plate with fruits and vegetables, and the American Heart Association recommends eating eight or more fruit and vegetable servings every day.
Vitamin D may reduce risk of uterine fibroids, according to NIH study
Women who had sufficient amounts of vitamin D were 32 percent less likely to develop fibroids than women with insufficient vitamin D, according to a study from researchers at the National Institutes of Health.
Fibroids, also known as uterine leiomyomata, are noncancerous tumors of the uterus. Fibroids often result in pain and bleeding in premenopausal women, and are the leading cause of hysterectomy in the United States.
The study of 1,036 women, aged 35-49, living in the Washington, D.C., area from 1996 to 1999, was led by Donna Baird, Ph.D., a researcher at the National Institute of Environmental Health Sciences (NIEHS), part of NIH. Baird and her collaborators at The George Washington University and the Medical University of South Carolina screened participants for fibroids using ultrasound. They used blood samples to measure the primary circulating form of vitamin D, known as 25-hydroxy D. Those with more than 20 nanograms per milliliter of 25-hydroxy D were categorized as sufficient, though some experts think even higher levels may be required for good health. The body can make vitamin D when the skin is exposed to the sun, or vitamin D can come from food and supplements.
Study participants also completed a questionnaire on sun exposure. Those who reported spending more than one hour outside per day also had a decreased risk of fibroids. The estimated reduction was 40 percent. Although fewer black than white participants had sufficient 25-hydroxy D levels, the estimated reduction in prevalence of fibroids was about the same for both ethnic groups.
“It would be wonderful if something as simple and inexpensive as getting some natural sunshine on their skin each day could help women reduce their chance of getting fibroids,” said Baird.
Baird also noted that, though the findings are consistent with laboratory studies, more studies in women are needed. Baird is currently conducting a study in Detroit to see if the findings from the Washington, D.C., study can be replicated. Other NIEHS in-house researchers, led by Darlene Dixon, D.V.M., Ph.D., are learning more about fibroid development, by examining tissue samples from study participants who had surgery for fibroids.
“This study adds to a growing body of literature showing the benefits of vitamin D,” said Linda Birnbaum, Ph.D., director of NIEHS and the National Toxicology Program.
Excess vitamin E intake not a health concern
CORVALLIS, Ore. – Despite concerns that have been expressed about possible health risks from high intake of vitamin E, a new review concludes that biological mechanisms exist to routinely eliminate excess levels of the vitamin, and they make it almost impossible to take a harmful amount.
No level of vitamin E in the diet or from any normal use of supplements should be a concern, according to an expert from the Linus Pauling Institute at Oregon State University. The review was just published in the Journal of Lipid Research.
“I believe that past studies which have alleged adverse consequences from vitamin E have misinterpreted the data,” said Maret Traber, an internationally recognized expert on this micronutrient and professor in the OSU College of Public Health and Human Sciences.
“Taking too much vitamin E is not the real concern,” Traber said. “A much more important issue is that more than 90 percent of people in the U.S. have inadequate levels of vitamin E in their diet.”
Vitamin E is an antioxidant and a very important nutrient for proper function of many organs, nerves and muscles, and is also an anticoagulant that can reduce blood clotting. It can be found in oils, meat and some other foods, but is often consumed at inadequate dietary levels, especially with increasing emphasis on low-fat diets.
In the review of how vitamin E is metabolized, researchers have found that two major systems in the liver work to control the level of vitamin E in the body, and they routinely excrete excessive amounts. Very high intakes achieved with supplementation only succeed in doubling the tissue levels of vitamin E, which is not harmful.
“Toxic levels of vitamin E in the body simply do not occur,” Traber said. “Unlike some other fat-soluble vitamins such as vitamins A and D, it’s not possible for toxic levels of vitamin E to accumulate in the liver or other tissues.”
Vitamin E, because of its interaction with vitamin K, can cause some increase in bleeding, research has shown. But no research has found this poses a health risk.
On the other hand, vitamin E performs many critical roles in optimum health. It protects polyunsaturated fatty acids from oxidizing, may help protect other essential lipids, and has been studied for possible value in many degenerative diseases. Higher than normal intake levels may be needed for some people who have certain health problems, and smoking has also been shown to deplete vitamin E levels.
Traber said she recommends taking a daily multivitamin that has the full RDA of vitamin E, along with consuming a healthy and balanced diet.
US hospitals make more money when surgery goes wrong
17 Apr 2013
US hospitals face a disincentive to improve care because they make drastically more money when surgery goes wrong than when a patient is discharged with no complications, a study published Tuesday found.
“We found clear evidence that reducing harm and improving quality is perversely penalized in our current health care system,” said study author Sunil Eappen, chief medical officer of Massachusetts Eye and Ear Infirmary.
An estimated $400 billion is spent on surgery in the United States every year.
Privately insured patients with complications provide hospitals with a 330 percent higher profit margin than those whose surgeries went smoothly, the study published in the Journal of the American Medical Association found.
Patients whose bills are paid by Medicare — a government insurance plan for the elderly and disabled — produced a 190 percent higher profit margin when complications arose following surgery.
“It’s been known that hospitals are not rewarded for quality,” said study author Atul Gawande, a professor at the Harvard School of Public Health and director of Ariadne Labs.
“But it hadn’t been recognized exactly how much more money they make when harm is done.”
While effective methods to reduce complications have been identified by researchers, the authors said that hospitals have been slow to implement them.
“This is clear indication that health care payment reform is necessary,” Gawande added. “Hospitals should gain, not lose, financially from reducing harm.”
The researchers analyzed data from 34,256 surgical inpatients discharged in 2010 from a non-profit, 12-hospital system in the southern United States. A total of 1,820 procedures were identified with at least one complication.
They found that complications were associated with a $39,017 higher profit margin per patient ($55,953 vs. $16,936) for privately insured patients. For Medicare patients, the profit margin per pa
tient was higher by $1,749 ($3,687 vs. $1,880).
Conversely, profit margins were significantly lower when complications arouse with patients who paid out of pocket or through the government-funded Medicaid program to assist low-income children and adults.
That means that while so-called “safety-net” hospitals which primarily treat patients who are either uninsured or covered by Medicaid, reducing complications could improve financial performance.
But most hospitals would see their financial performance hurt if they reduced complications.
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