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DATE: June 26, 2009
Doctors are testing a new kind of obesity surgery without any cuts through the abdomen, snaking a tube as thick as a garden hose down the throat to snap staples into the stomach. The experimental, scar-free procedure creates a narrow passage that slows the food as it moves from the upper stomach into the lower stomach, helping patients feel full more quickly and eat less. Doctors say preliminary results from about 200 U.S. patients and 100 in Europe look promising.
CBS News medical correspondent Dr. Jennifer Ashton agreed. She said on CBS's Early Show that the procedure sounds hopeful for people suffering with obesity. After about 18 months, obese European patients have lost an average of about 45 percent of their body weight, said Dr. Gregg Nishi, a surgeon at Cedars-Sinai Medical Center in Los Angeles. He discussed the European and U.S. studies during a Chicago conference this week for digestive disease specialists. The procedure is only being done in the studies, which recently ended enrollment. Makers of the device used in the operation plan to seek federal approval if the research continues to go as planned. Ashton, who performed a year of clinical bariatric surgery research in Pittsburgh, Pa., with surgeons who did more than 1000 obesity procedures, said the procedure has significant advantages, including no skin incisions and no surgical pain. Ashton added that patients will benefit from the short recovery time. "They can be back to work the next day," she said. But, she said the absence of long-term data on the surgery, such as long-term weight loss for patients or reduced cases of diabetes, is a drawback.
While the two studies are still under way and only brief details are being released, Nishi said results so far are slightly better than typical results from with conventional stomach stapling. In the experimental study, risks include perforating the esophagus, as Nishi said happened to a patient at another center, but otherwise, he said, there have been no major complications. But in Ashton's opinion, the risks are similar to stomach stapling. She explained to Early Show co-anchor Harry Smith that there is the possibility of gastric bypass-leaks in the staple line, general anesthesia risks, staple-line failure due to over-eating, and perforation of the stomach. Some study patients have lost weight after unknowingly undergoing fake procedures - sedation and the tube, but no stapling. Results comparing them with the real thing aren't yet available.
Liliana Gomez, an administrative coordinator at Cedars-Sinai, was among the first Americans to have the scarless obesity surgery last year, as a test case for the U.S. study. She had planned on more invasive conventional surgery until learning that doctors at her hospital were studying the scarless stapling technique. "When I found out it was going to be oral, through your mouth, I was like, 'Wow, that's kind of different,"' she said. Since her operation in August, Gomez has lost about 40 pounds and dropped from size 22 to size 16. The 35-year-old mother of three has a long way to go - she's still obese according to body mass index standards. But Gomez says she has cut her meal portions by more than half and still feels full, and is optimistic she'll continue to lose weight. The new method is part of a medical movement to perform surgery through body openings such as the nose, mouth and vagina instead of making cuts. The idea is to reduce chances of infection and pain, and speed recovery. With no scars, there are cosmetic advantages, too. Gomez had considered a gastric bypass operation, a more complex kind of stomach stapling, but worried about risks from that surgery. It reduces the stomach to the size of a golf ball and reroutes the digestive tract. Whether done through one large abdominal incision or several tiny ones, gastric bypass is far more invasive and increases chances for malnutrition because it repositions how the stomach attaches to the intestines to restrict calorie absorption.
Another popular weight-loss surgery option involves putting an adjustable band around the top part of the stomach to create a small pouch. The experimental method Gomez had is the oral version of a different kind of stomach surgery, which reduces the size of the stomach with staples but doesn't reroute the digestive system. Surgery is generally considered a last-resort treatment for obesity, which affects more than 15 million Americans. Still, demand is high. More than 200,000 Americans are expected to have conventional forms of obesity surgery this year, according to the American Society for Metabolic & Bariatric Surgery. Dr. Scott Shikora, the society's president, called the oral procedure exciting and innovative, but said, "It is too early for us to say this is going to be a breakthrough." Shikora said many U.S. obesity surgeons prefer the rerouting surgery or flexible bands, and that it remains to be seen whether the oral method has the same drawbacks as more outmoded stapling procedures.
The U.S. study is taking place at 10 centers. Patients will be followed for at least one year, with final results expected in 2010. They are randomly selected to undergo either the operation or a sham procedure. Nishi said of 25 patients enrolled at his hospital, 17 got the real treatment, with no complications. "I'm very impressed with it," Nishi said. So far, it looks like "a viable alternative," he said. Satiety Inc., a California company that created the medical devices used in the technique, is paying for the research. Nishi said he has no financial ties to the company. At Washington University School of Medicine in St. Louis, where the first U.S. procedure was done last summer, about 30 patients have undergone the treatment. Side effects have been minimal, including sore throats, nausea and some abdominal pain lasting less than a week, said Dr. J. Christopher Eagon. He said weight loss results from his center aren't yet available.
Diabetes Risk Cut by Cholesterol Lowering Drug
DATE: June 19, 2009
London -Doctors who gave diabetics a drug originally intended to lower patients' cholesterol found it reduced their risk of so-called minor amputation by 36 percent, a new analysis of research says. Researchers in Australia, Finland and New Zealand studied almost 10,000 patients ages 50 to 75 with type 2 diabetes, the kind linked to obesity. About half of the patients were given fenofibrate, a drug available generically and sold as Antara, Fenoglide, Lipofen and others. The other half got fake pills. After five years, 115 patients had at least one lower limb amputation because of diabetes.
Diabetes can damage nerves and blood vessels. In severe cases, this leads to amputation. About one diabetes patient in 10 loses part of a leg. The study, first published in 2005, aimed to see if fenofibrate prevented heart disease. It didn't. But in this new analysis, experts found patients on fenofibrate had a 36 percent lower risk of a first amputation than those on placebo. Patients who lost part of their legs were more likely to have heart disease, skin ulcers or previous amputations. Amputations were labeled minor if they were below the ankle and major if they were above the ankle. The risk of minor amputations in patients without large vessel disease, the narrowing of blood vessels, was nearly 50 percent lower in the group taking fenofibrates. The risk of a major amputation was not substantially different between the two groups. Taller people were also more likely to suffer amputations. The results were published Friday in the medical journal Lancet. The study was paid for by Laboratoires Fournier SA, now part of Solvay Pharmaceuticals, which makes fenofibrates, and the National Health and Medical Research Council of Australia. After the study's first results, many doctors switched to statins to cut their patients' heart disease risks and dropped fenofibrates. Fenofibrates may be re-entering the game," said Sergio Fazio of Vanderbilt University Medical Center, who co-authored an accompanying commentary in the Lancet. "Fenofibrates cannot possibly take the place of statins, but they may earn a place next to them in diabetes treatment." The study's authors said their findings could change the standard treatment for avoiding amputations. "(Fenofibrates) is the first therapy that has been shown to reduce these amputations," said Anthony Keech of the Royal Melbourne Hospital in Australia and one of the paper's authors. Victoria King of the charity Diabetes UK said the study could help doctors find more ways of reducing diabetes-related amputations. Fenofibrates can cause side effects including abdominal pain, nausea, pancreas and lung problems.
The Hydrangea Shrub Might Hold Key to a Cure
DATE: June 12, 2009
The hydrangea could be used to treat a raft of common diseases including diabetes, researchers say. The colourful shrub - a staple of Chinese medicine - has the power to 'revolutionise' the treatment of multiple sclerosis, psoriasis and some forms of diabetes and arthritis, they claimed. These diseases occur when the immune system turns on and attacks the body.
Existing treatments are expensive and do not address the cause of the problem. Now it appears that a drug derived from the hydrangea's root could offer an alternative. A series of experiments found that it blocked the formation of white blood cells involved in autoimmune disease. Crucially, the drug does not seem to affect other kinds of cell vital to the body's defences. Mice with a multiple sclerosis-like disease were far less severely affected when given low doses of the drug, which is called halofuginone, the journal Science reported. Researcher Dr Mark Sundrud said: 'This is really the first description of a small molecule that interferes with autoimmune pathology but is not a general immune suppressant.' Hydrangea root has traditionally been used in Chinese and Native American medicine to relieve inflammation and cleanse the joints. It is one of the 50 staple herbs of Chinese medicine and is also a traditional medicine of north American Cherokee Indians. Leaf extract of hydrangea is also said to have anti-malarial properties. In some species, the colour of the flowers varies with the type of soil. Acidic ground produces blue buds, a neutral pH pale cream petals, and alkaline soils, pink or purple flowers. Halofuginone is already used to treat a rare autoimmune disease that affects the skin and internal organs. But much more research would be needed for it to be given the green light to treat other conditions such as rheumatoid arthritis and type 2 diabetes.
Diabetes Drug May Help Defend Against Cancer
DATE: June 05, 2009
A common anti-diabetes drug may boost the potency of vaccines against cancer, research suggests. Tests on mice found metformin, used for Type 2 diabetes, helps the body's T-cells work more effectively. These cells, the body's key defenders against disease, "remember" former infections or vaccinations, enabling them to fight subsequent illness.
Writing in the journal Nature, a US team said metformin appeared to improve this important memory of disease. This ability to remember disease has been the subject of much research, but there has been little understanding of the cellular mechanisms behind it. The team from McGill University and the University of Pennsylvania used an experimental cancer vaccine and found that when administered in mice, the diabetes drug appeared to improve the strength of the inoculation.
Several studies in recent years have shown that people with diabetes may be more likely to develop certain cancers, although the exact nature of the relationship is unclear. Type 2 diabetes is associated with extra weight for instance, as are certain types of cancer. But there also appear to be similarities between the basic chemical reactions which happen in the cells when affected by either of these diseases. "Many genes involved in diabetes regulation also play a role in cancer progression," said Dr Russell Jones of McGill's Goodman Cancer Centre, one of the report's author. "There is also a significant body of data suggesting that diabetics are more prone to certain cancers. However, our study is the first to suggest that by targeting the same metabolic pathways that play a role in diabetes, you can alter how well your immune system functions." This is turn could help the body fight cancer more effectively with a vaccine. Cancer vaccines are still at an early stage, but ideally could help both stop the disease developing in the first place or treat it when it arises. Dr Kat Arney, Cancer Research UK's senior science information officer, said: "This is a fascinating piece of research, which sheds light on the complex links between the immune system, cell metabolism and cancer. "At the moment, this research has only been done in mice and there is a long way to go before it can be applied to cancer patients, but it certainly holds promise for the future."
Depression Linked With Belly Fat
DATE: May 29, 2009
Researchers at Rush University Medical Center have shown that depression is linked with the accumulation of visceral fat, the kind of fat packed between internal organs at the waistline. This type of fat has long been known to increase the risk of cardiovascular disease and diabetes. The finding may clarify the association between the diseases. The study was published in the May issue of Psychosomatic Medicine.
"Our results suggest that central adiposity – which is commonly called belly fat – is an important pathway by which depression contributes to the risk for cardiovascular disease and diabetes," said Lynda Powell, PhD, chairperson of the Department of Preventive Medicine at Rush and the study’s principal investigator. “In our study, depressive symptoms were clearly related to deposits of visceral fat, which is the type of fat involved in disease.” The study included 409 middle-aged women, about half African-American and half Caucasian, who were participating in the Women in the South Side Health Project (WISH) in Chicago, a longitudinal study of the menopausal transition.
Depressive symptoms were assessed using a common screening test, and visceral fat measured with a CT scan. Although waist size is often used as a proxy for the amount of visceral fat, it is an inaccurate measure because it includes subcutaneous fat, or fat deposited just beneath the skin. The researchers found a strong correlation between depression and visceral fat, particularly among overweight and obese women. The results were the same even when the analysis adjusted for other variables that might explain the accumulation of visceral fat, such as the level of physical activity. The study found no association between depressive symptoms and subcutaneous fat. The findings were the same for both black and white women. Powell speculated that depression triggers the accumulation of visceral fat by means of certain chemical changes in the body – like the production of cortisol and inflammatory compounds – but said that more research is needed to pinpoint the exact mechanism.
Gene Therapy Improves Diabetic Neuropathy in Study
DATE: May 22, 2009
Gene therapy shows promise in treating diabetic polyneuropathy, a disorder that commonly affects diabetics who've had the disease for many years, a new study finds. Injections appear to be safe, but more research is needed.
Researchers in Boston found that intramuscular injections of vascular endothelial growth factor (VEGF) gene may help patients with diabetic polyneuropathy. The study included 39 patients who received three sets of injections of VEGF gene in one leg and 11 patients who received a placebo. Six months after treatment, the patients who received the VEGF gene injections showed greater improvements in sensory symptoms and pain than those who received the placebo. Loss of sensation and pain in the legs and feet, weakness, and balance problems are among the symptoms associated with diabetic neuropathy. The loss of sensation means that ulcerations on the feet may go undetected, which can lead to amputation. "Most patients had fairly severe neuropathy, and the expectation for improvement was therefore not high," Dr. Allan Ropper, executive vice chair of the neurology department at Brigham and Women's Hospital in Boston, said in a hospital news release. The VEGF gene used in the study is active without packaging it in a virus, which is a major safety advantage, according to the researchers. "The study shows that this form of gene transfer therapy can be performed relatively safely, but further investigation using a larger study group is needed before it can be introduced as a mainstream therapy," Ropper said. The study was presented in Seattle at the annual meeting of the American Academy of Neurology.
Sleeping Too Little Increases Your Risk of Diabetes
DATE: May 15, 2009
People who get too little sleep, or too much, are far more likely to develop diabetes, say scientists. A study has found that those who did not enjoy the optimum level of seven to eight hours sleep a night were two and a half times more likely to develop a blood sugar abnormality linked to type 2 diabetes. Researchers who studied the habits of 276 volunteers over a six-year period said they did not know the cause.
The findings, published in the journal Sleep Medicine, suggest seven to eight hours' sleep a night seems to be the ideal amount for adults to protect against common diseases and premature death. Scientists say they do not know the cause, but previous studies have shown a link between sleep patterns and obesity, cardiovascular disease and overall mortality. Obesity is known to be linked to diabetes, but the greater risk of diabetes due to sleeping habits remained even when obesity was taken into account. Previous research suggests sleep loss could disturb the production of hormones that control the desire for calorie-rich foods, hunger and energy expenditure.
Researcher Angelo Tremblay said 'This study is a continuation of our recent investigations having focused on the relationship between sleep duration and the risk of obesity. 'The greater risk towards diabetes that we document in our most recent paper remains significant even after a statistical adjustment for body mass index and waist circumference. 'With respect to clinical implications, it is clear that the recommendation to seek an optimal sleep duration seems to be appropriate but for some individuals, it is easier to say than to do.' Other surveys have revealed fewer and fewer people are getting the right amount of sleep. Around one third of the adult population regularly sleep five hours or fewer a night. The average night's sleep is seven hours which research suggests is the 'healthiest' amount. It is possible the increased risk for long sleepers might be a symptom of impending health problems
Scientists closer to diabetes vaccine
DATE: May 08, 2009
Australian scientists are a major step closer to developing a vaccine which could stop people at risk of Type 1 diabetes from developing the condition. Dr Shane Grey and his colleagues have found a way to stop the genetic condition from occurring in mice bred to spontaneously develop it and, he says, it appeared the protection was life-long.
The technique also had a 100 per cent success rate for the mice involved in the study, undertaken at Sydney's The Garvan Institute. 'It does sound too good to be true,' Dr Grey told AAP. 'We helped the immune system to re-educate itself, and it was tolerant again of the (mice's) insulin producing cells. 'That then gives very strong support to the idea that our drug treatment would give life-long protection.'
More than 140,000 Australians have Type 1 diabetes, a condition which causes their immune system to kill off their ability to make insulin. The genetic fault is present from birth but the condition may not strike until adulthood, and without daily insulin injections these people would lapse into a potentially fatal coma. The study found a chemical compound (BCMA-Fc), known to have potential benefits in combating a range of auto-immune disease, was effective in this case at stopping the onset of Type 1 diabetes. A clinical trial to see if the results could be replicated in humans could take place in around two years, he said. If successful, it could lead to the creation of a vaccine to inoculate people in families with a history of the disease. 'All immune cells talk to each other with various hormones ... and we've found this drug is an inhibitor of one of those hormones,' Dr Grey says. 'We've hit the nerve centre of the emerging clinical disease (diabetes Type 1).' The study was undertaken with support from the Juvenile Diabetes Research Foundation, and the Garvan's Diabetes Vaccine Development Centre. The results are to be published in the journal Diabetes
Diabetes in Older Adults Preventable With a Healthier Lifestyle
DATE: May 01, 2009
Even as science searches for more clues about the causes of diabetes and medications to prevent it, the vast majority of new cases of the disease in older adults could be prevented by following a modestly healthier lifestyle, according to research led by scientists at the Harvard School of Public Health (HSPH).
Researchers have found that a combination of five lifestyle factors could account for nine in 10 new cases of type 2 diabetes in men and women age 65 and older. The lifestyle factors that were examined included physical activity, diet, smoking habits, alcohol use, and amount of body fat (as determined by body mass index and waist circumference). The findings highlight that diabetes really is a lifestyle disease and is largely preventable, said lead author Dariush Mozaffarian, assistant professor of epidemiology at HSPH and assistant professor of medicine in the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School. Although previous studies had linked these lifestyle factors separately to diabetes or in sum to risk of diabetes in specific socioeconomic populations, this study quantifies the overall impact of several lifestyle factors associated with diabetes risk in a general population of older men and women.
Type 2 diabetes is the most common form of the disease and occurs when the body fails to properly respond to and produce insulin, resulting in a build-up of sugar in the blood and other biologic abnormalities. Incidence of diabetes has jumped in the past decade and is now estimated to affect 24 million Americans, or nearly eight percent of the population, according to the Centers for Disease Control and Prevention. The disease disproportionately affects older Americans. In this study, researchers tracked 4,883 men and women age 65 or older over a period of 10 years as part of the Cardiovascular Health Study, a multicenter study sponsored by the National Heart, Lung and Blood Institute to evaluate risk factors for cardiovascular disease in older adults. Data was collected through annual questionnaires and physical exams. Participants were asked about their physical activity level, diet, smoking habits, and alcohol use. Their body mass index and waist circumference were measured. Participants were grouped into a low-risk or high-risk group for each factor. During the study period, more than 300 subjects were diagnosed with diabetes. After making statistical adjustments for age, sex, race, educational level, and annual income, researchers found that each of the five lifestyle factors they measured was independently associated with the onset of diabetes. Overall, the rate of incident diabetes was 35 percent lower for each one additional lifestyle factor in the low-risk group.
Subjects in the low-risk group for diet consumed slightly better-than-average levels of dietary fiber and polyunsaturated fat and less trans fat and starchy and sugary foods. Other low-risk characteristics included whether participants had never smoked; consumed up to two alcoholic drinks per day (modest alcohol consumption has been shown to be a protective factor against diabetes); and were not overweight (defined by having a body mass index below 25 or a waist circumference of less than 88 cm for women or 92 cm for men). The study results underscore that people can lower their diabetes risk considerably, even if they are unable to follow a perfect ideal of healthy behavior. Very modest differences in lifestyle can have a tremendous impact on diabetes risk, Mozaffarian said. Even two or three or four of the five factors, in any combination, were associated with substantially lower risk. For instance, he pointed out that diabetes prevention often focuses on weight loss, something that is difficult for many people to achieve. But this study found that independent of any differences in weight, individuals in the low-risk category for only physical activity level and dietary habits had a 46 percent lower incidence of diabetes. Combining low-risk groups for physical activity level, dietary habits, smoking habits and alcohol use produced an 82 percent lower risk of diabetes, and four in five new cases of diabetes appeared to be attributable to not having these low-risk lifestyle factors. Adding either not being overweight or not having large waist circumference was associated with an 89 percent lower risk of diabetes. Mozaffarian pointed out that the differences in lifestyle between the low-risk and high-risk categories were not extreme. For instance, because participants were divided only into two groups, anyone who participated in physical activity above the average was included in the lower-risk group for that category. These physical activity levels included walking regularly and engaging in leisure activities. Mozaffarian said that prior work in the Nurses' Health Study showed similarly large associations between lifestyle risk factors and diabetes risk in married U.S. nurses. The new research includes older adults, both sexes, and is drawn from community-based populations, suggesting that these significant benefits of lifestyle are likely to extend to the general population. Whereas considerable ongoing research is investigating possible genetic causes of type 2 diabetes and the underlying biology of the disease, Mozaffarian said that this study and other studies emphasize that much is already known about how to prevent the majority of cases. "We are entering a public health emergency in obesity and diabetes," he said. "We know how to prevent nearly all cases of type 2 diabetes. We need real and sustained policy, research, and public health focus on this emergency so that we can fix the clear societal and individual causes of this epidemic."
Other study authors are based at the University of Washington and Northwestern University. The study was supported by grants from the National Heart, Lung and Blood Institute, NIH. One author was supported by an unrestricted educational grant from Amgen, Inc., to the Cardiovascular Health Study Coordinating Center.
Radio Waves Offer Hope For Treating High Blood Pressure
DATE: April 24, 2009
A breakthrough in the treatment of high blood pressure could improve the life expectancy for a million Australians whose condition does not normalise with drugs. The procedure uses radio waves to silence or destroy nerves in arteries supplying the kidneys. Initial results show a significant reduction in blood pressure for most of the patients taking part in the study.
Gael Lander, 65, has suffered from high blood pressure for most of her adult life and lived with the constant fear of heart attack or stroke. "I really felt as if something or someone had pushed the fast forward button," she said. "Everything raced - for example, my heart - and I didn't quite know what a feeling of calmness was, or just being in a state of relaxation." But she says her life changed because of the radical new procedure; her blood pressure went from as high as 210 over 70, down to 140 over 70. "Obviously my blood pressure has dropped a lot, which has taken away that feeling of anything might happen at any time," she said. "It's given me a new peace of mind and you can't believe the feelings of relief I'm experiencing. "I'm also a diabetic and my blood sugars have dropped some 20 to 30 per cent over a period of nearly two years, so that's a bonus in itself." It's long been known that the sympathetic nervous system plays a role in controlling blood pressure and sugar levels.
Associate Professor Markus Schlaich co-authored the research at the Baker IDI Heart and Diabetes Institute in Melbourne , and he says this is the first treatment targeting those nerves that has proven both safe and effective "Together with an American company we've developed a device, a catheter-based device, that actually enables us to target these renal sympathetic nerves quite specifically," Professor Schlaich said. "These nerves run along the renal arteries, the blood vessels that supply the kidneys. "With this catheter-based device we can target these nerves coming from the inner side of the blood vessels, emitting energy into the tissue which kind of silences or destroys the nerves in the vessel wall, which then leads to a substantial reduction in blood pressure." And there was a significant reduction in blood pressure for the majority of the 50 patients who took part in the study. But Professor Schlaich says the procedure is not a cure. "All of these patients were on quite a few drugs which didn't really work, and we did this procedure but we did not necessarily reach normal blood pressure in all of these patients," he said. "So we still want them to be on their drugs in order to get the blood pressure as low as possible; the reason for that is that we know in general the lower the blood pressure, the lower the risk for cardio-vascular events. "And of course we want to protect them as much as possible." Further trials are now being planned and if successful, researchers say the procedure could be widely available within three years.
New Low-Sugar Health Juice For Diabetics
DATE: April 17, 2009
Chinese scientists have developed a nutritious low calorie, low sugar, vegetable juice for patients with diabetes. The research team led by Dr Heqin Xing and Xiuqi Liu of Jilin University in Changchun, China have come up with a cost-effective method of preparing a special type of vegetable drink using lactic acid-producing bacteria (LAB) to remove carbohydrates while retaining good taste, vitamins and other nutrients.
"This is an exciting development. The process significantly removes sugar but retains the nutritional content of the juice's raw materials," Liu said. The juice was made from pumpkin, balsam pear, onion and carrots. People have long cultured food including everyday eats such as yogurt, cheeses and sausage by using the same LAB. The LAB microbes produce a compound commonly found in sour milk products called lactic acid. Because of LAB's healthy link to food production, this class of bacteria is also referred to as probiotics. During the study, LAB reduced sugar content of the vegetable juice by transforming carbohydrates into lactic acid by a routine conversion process called fermentation. As this process increases the juice's acidity, it extends its shelf life as it inhibits growth of other bacteria. LAB is known for its ability to withstand acidic environments. In addition to the lactic acid's protection against contamination, the acidity from fermentation could enhance flavours in the beverage. The researchers’ use of Lactobacillus acidophilus and L. plantarum in the vegetable juice increased its acidity by about 10-fold after 12 hours of fermentation. With the addition of sugar, and a diabetic-friendly sugar substitute called xylitol, Xing the juice had a good mix of sweet and sour taste. "It has a good taste with reduced calories due to lower carbohydrates," Xing said. The findings were presented at the 237th National Meeting of the American Chemical Society.
Single Pill Combining Five Heart Drugs Appears Safe
DATE: April 10, 2009
Imagine if people at risk of heart disease could take a single pill that would contain all the medications they need to reduce their heart risk. Such a pill is already a reality and now new research suggests it's safe and effective. It's called a polypill and could soon become a cheap, simple way to prevent both heart disease and stroke. The formulation studied in this latest research is called Polycap and contains five medications:
Researchers led by Dr. Salim Yusuf of the Population Health Research Institute at Hamilton Health Sciences and McMaster University conducted a short-term study in India to see if combining these five medications into one pill was as effective as each medication alone. They recruited 2,053 people across India who were between the ages of 45 and 80 who had no heart disease but had one risk factor for it, such as type 2 diabetes, smoking, or abnormal cholesterol levels. They divided the volunteers into nine groups: one received the polypill marketed as Polycap; the rest received either the medications alone or in different combinations. The researchers found the Polycap effectively reduced blood pressure, LDL cholesterol, and heart rate. What's more, the researchers found no additional side effects from combining all five medications into one pill compared to those who took the meds separately. The results of the study will be published in an upcoming edition of The Lancet and are also being announced at the American College of Cardiology meeting in Florida. The researchers believe the pill could massively reduce future incidence of heart attack and stroke in otherwise healthy people at risk of heart disease. They say the combined effects of all the medications in the Polycap could potentially reduce the rate "cardiovascular events", such as heart attacks and strokes, in these people by half. The pill is not meant to replace the healthy eating, exercise and other lifestyle factors needed to lower the risk of heart attack. But it should help patients who have trouble taking four to five medications a day or who sometimes forget some of the medications. Research suggests that many patients on multiple medications skip doses, believing that since they feel well, they don't need so many pills. Others regularly forget one or two of the meds in their regimens, putting themselves health at risk or a heart attack of stroke. The study authors stress that their findings are preliminary and that longer and larger studies are needed to evaluate the longer-term effects of the medications. As well, more research is needed on combining different strengths of each of the medications.
LOW-CAL DIETS PROMOTE WEIGHT LOSS REGARDLESS OF FAT, PROTEIN OR CARD CONTENT
DATE: April 03, 2009
Stem Cells Show Promise For Treating Type 2 Diabetes
A University of Miami clinical trial recently announced that 25 patients achieved better insulin production, lower blood-sugar levels and a reduced need for insulin injections.
In the trial, still in its pilot stage, doctors extracted immature adult stem cells from the patients' own bone marrow, purified and concentrated them, and injected them into arteries near the pancreas. They then put the patients into hyperbaric oxygen chambers like those used for divers with decompression sickness - also called the "bends" - and subjected them to 10 hours of pure oxygen at 2.4 times the atmospheric pressure at ground level. Researchers believe the high-pressure oxygen pulled extra stem cells from the patients' bone marrow, adding to the stem cells injected near the pancreas. They say the immature stem cells developed into pancreatic cells, regenerating the pancreas's ability to produce natural insulin.
"This could be very important," says Dr. Camillo Ricordi, director of the Cell Transplant Center and the Diabetes Research Institute at University of Miami. "It could be an improved treatment for diabetes, substantially ameliorating type 2 and preventing the complications of the disease." Nearly 24 million people in the U.S., or 8 percent of the population, have diabetes, which can cause problems for the eyes, kidneys, nerves and heart, according to the Centers for Disease Control and Prevention. Ricordi cautioned that the optimistic findings come from small pilot studies involving only dozens of patients, and three to four more years of research are needed before practical treatments might start. "We always have to avoid hype and be careful not to put too much hope in pilot trials," Ricordi said. "But the first results are really promising." Two more successful trials over three or four years would be needed before the FDA might approve the treatment for the public. The studies, coordinated by University of Miami's Diabetes Research Institute, will also take place at the Karolinska Institutet in Stockholm, Stem Cell Argentina in Buenos Aires and other institutions.
LOW-CAL DIETS PROMOTE WEIGHT LOSS REGARDLESS OF FAT, PROTEIN OR CARD CONTENT
DATE: MARCH 27, 2009
Heart-healthy diets that reduce calorie intake—regardless of differing proportions of fat, protein, or carbohydrate—can help overweight and obese adults achieve and maintain weight loss, according to a study funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.
Researchers from the Preventing Overweight Using Novel Dietary Strategies (POUNDS LOST) study found similar weight loss after six months and two years among participants assigned to four diets that differed in their proportions of these three major nutrients. The diets were low or high in total fat (20 or 40 percent of calories) with average or high protein (15 or 25 percent of calories). Carbohydrate content ranged from 35 to 65 percent of calories. The diets all used the same calorie reduction goals and were heart-healthy—low in saturated fat and cholesterol while high in dietary fiber. On average, participants lost 13 pounds at six months and maintained a 9 pound loss at two years. Participants also reduced their waistlines by 1 to 3 inches by the end of the study. Craving, fullness, hunger, and diet satisfaction were all similar across the four diets. "These results show that, as long as people follow a heart-healthy, reduced-calorie diet, there is more than one nutritional approach to achieving and maintaining a healthy weight," said Elizabeth G. Nabel, M.D., director, NHLBI. "This provides people who need to lose weight with the flexibility to choose an approach that they're most likely to sustain—one that is most suited to their personal preferences and health needs."
In the POUNDS LOST study, 811 overweight and obese adults aged 30 to 70 were assigned to one of four diets, and asked to record their food intake in a diary or an online tool that showed how intake compared with goals. Group diet counseling sessions were held at least twice per month throughout the two years of the study, and individual sessions were held every eight weeks. Participants were given personalized calorie goals, ranging from 1,200 to 2,400 calories per day, which reduced their overall caloric intake as compared with their daily energy requirement. All participants were asked to do moderate-intensity physical activity, such as brisk walking, for at least 90 minutes per week. Study participants were diverse in gender and ethnicity, with 38 percent men and 22 percent representing minorities. Participants did not have diabetes or severe heart disease but could have had other risk factors, such as high blood pressure or high cholesterol. Overweight is defined by having a body mass index (BMI)—a calculation of the relationship between weight and height—greater than 25 and less than 30. Those with a BMI of 30 or higher are considered to be obese. Sixty-six percent of American adults are overweight and of those, 32 percent are obese, according to the Centers for Disease Control and Prevention.
Research was conducted in Boston at Harvard University School of Public Health and at the Pennington Biomedical Research Center of Louisiana State University in Baton Rouge, La. Diets were adapted during sessions to the diverse cuisines from these two regions of the country. "We were encouraged that, in addition to achieving and maintaining weight loss, study participants experienced other positive health changes as well," said Catherine M. Loria, Ph.D., a nutritional epidemiologist at NHLBI and co-author of the study. "The findings emphasize the importance of weight loss in reducing heart disease risk." All diets improved risk factors for cardiovascular disease at both six months and two years in ways consistent with previous studies. Improved risk factors include reduced levels of triglycerides, LDL (bad) cholesterol, lowered blood pressure, and increased HDL (good) cholesterol. All diets decreased the presence of metabolic syndrome, a cluster of related conditions, overweight, high triglycerides, high blood sugar, high blood pressure, and low HDL cholesterol, which increases heart disease risk. Previous studies have shown that a loss of 5 to10 percent of body weight will help reduce risk factors for heart disease and other medical conditions. In this study, 15 percent of patients achieved a 10 percent weight loss after two years.
"This new information should focus weight loss approaches on reducing calorie intake rather than any particular proportions of fat, protein or carbohydrate. This is important information for health professionals who prescribe weight loss for their patients, and for adults who are seeking ways to sustain a healthful eating pattern," said Frank M. Sacks, M.D., principal investigator of POUNDS LOST and Professor of Cardiovascular Disease Prevention in the Nutrition Department at the Harvard School of Public Health.
The target nutrient compositions of the four diets were:
While the design of the POUNDS LOST study called for physical activity targets to be set at 90 minutes per week, many people need more physical activity in order to achieve their weight loss goals.
RECOMMENDED D LEVELS NOT ENOUGH
DATE: MARCH 20, 2009
Evidence continues to pile up that the sunshine vitamin protects against much more than bone-softening rickets. Vitamin D, also found in milk and oily fish, is becoming king, from fighting colds to preventing cancer. But here's the kicker. New research suggests we're not getting nearly enough, and recommended levels may be woefully inadequate.
Investigators at the Medical University of South Carolina shut down part of a National Institutes of Health study that left nursing mothers and infants deficient, even though the mothers received the maximum safe amount of vitamin D allowed by the Institute of Medicine. Bruce Hollis, primary investigator and MUSC professor of pediatrics, said the recommended 200 international units a day for babies, children and adults is grossly deficient. Further, the 2,000-unit-a-day upper limit ? the highest safe dose ? established a decade ago by the Institute of Medicine is "totally false."
In the trial, half of mothers given 2,000 units a day did not receive enough vitamin D to pass to their babies. For years, the medical community has pondered the perfection of human milk for babies except its one shortcoming: deficient levels of vitamin D. The answer may be simple, Hollis said. "It's deficient in vitamin D because mothers are." The five-year trial studying nursing mothers began two years ago with a $5-million NIH grant to determine how much vitamin D nursing mothers needed to supply their infants with enough. Dr. Robert Heaney, a vitamin D and calcium expert at Creighton University in Omaha, Neb., was on the panel that set the vitamin D levels in the mid-1990s. "Most of what we've learned about vitamin D has been in the last decade," Heaney said in a phone interview. "It does jillions of other things than prevent rickets."
Vitamin D is essential for absorbing calcium and enabling normal bone growth. The supplement is critical in preventing rickets and osteoporosis. Data also suggest that vitamin D could help prevent colon, prostate and breast cancers. The supplement also may play a role in preventing diabetes, hypertension and multiple sclerosis. Sources of vitamin D are fortified milk, eggs and fatty fish and brief sun exposure ? about 15 minutes ? twice a week to the face, arms, hands or back without sunscreen. Vitamin D is necessary for the blood to maintain healthy levels of calcium and phosphorus. The supplement lowers risk for breast, prostate and colon cancers, Heaney said. It also reduces risk for Type 1 diabetes, hypertension and multiple sclerosis, and improves resistance to infections. The average person needs about 4,000 units of vitamin D to maintain a healthy level in their bodies, Heaney said. The usual sources of Vitamin D include brief exposures to the sun, such as walking to your car, multivitamins, milk and oily fish. Even with all those sources, many people don't get enough, he said. Unless you work or spend a lot of time outdoors, Heaney recommended 1,000 to 2,000 units in addition to other sources of vitamin D.
But whether or not to seek that extra vitamin D in the sun is a point much debated among experts. No one would argue for browning oneself on the beach for hours, but some researchers suggest between five and 30 minutes twice a week without sunscreen. In light of the growing body of research, the American Academy of Pediatrics doubled its recommended dose to 400 units for newborns. "Regulations do not change rapidly," Heaney said. "That's why the work in South Carolina is so important." The MUSC study formed three groups of nursing mothers with participants in the Lowcountry and a secondary site in Rochester, N.Y. In one group, mothers and babies received 400 units each, as per the academy's recommendation. Mothers in that group ended up grossly deficient, Hollis said, but most of the babies, who are smaller, received enough of the supplement. A second group of mothers was given 6,000 units a day, three times the maximum dosage, and the babies did not receive supplements. Mothers and infants in this group were largely OK, Hollis said. In the third group, mothers were given 2,000 units, and babies were not given extra vitamin D. Half of the babies in this group failed to receive enough vitamin D, leading Hollis and co-primary investigator, Dr. Carol Wagner, to close that study group. By comparison, only 5 percent of babies from the two other groups did not receive enough vitamin D, a rate likely due to participants not following directions, he said. The decision to halt the trial group was based on the babies', not the mothers' levels, he said. Moms in the 2,000-unit-a-day group were borderline deficient. "When you stop an arm of an NIH study, that's a big deal," he said. The remaining groups will continue three more years.
SIX REASONS TO EAT FIBER
DATE: MARCH 13, 2009
By Barbara Quinn
It's not in meat. Or milk. Or fish. It is only found in things that grow in the ground,
such as vegetables, grains, fruit and nuts. We're talking about "dietary fiber," various
components in our food that benefit our health. Basically, according to the newest
definition by the Institute of Medicine and described in a recent position paper by
the American Dietetic Association, dietary fiber includes the carbohydrate
components of plants that are not digested and absorbed into the human small
intestine. Fiber is just . . . on its way through. So why is it important in our diet?
Let me count the reasons:
How much do we need? About 14 grams of dietary fiber for every 1,000 calories
that we eat. That's about 25 grams for most women and 38 grams for adult men.
No recommendations have been made for children under the age of 2.
Most fruits, vegetables and whole grains contain about 2 to 3 grams of dietary
fiber per serving. Cooked dried beans and legumes contain 10 to 15 grams
dietary fiber per cup.
Barbara Quinn is a registered dietitian and certified diabetes educator at the
Community Hospital of the Monterey Peninsula.
ARTHRITIS CAN BE A BARRIER FOR DIABETES MANAGEMENT
DATE: MARCH 06, 2009
More than half of adults with diagnosed diabetes also have arthritis, a painful condition that can be a barrier to physical activity, according to a study released by the Centers for Disease Control and Prevention in today's Morbidity and Mortality Weekly Report.
Nationwide, 46.4 million adults have arthritis and 20.6 million adults have diabetes, with nearly 7 in 10 having had diabetes diagnosed by a health professional. Research shows that engaging in joint-friendly activities such as walking, swimming, biking can help manage both conditions. The study, “Arthritis as a Potential Barrier to Physical Activity among Adults with Diabetes: United States, 2005 and 2007,” analyzed data on the prevalence of physical inactivity among adults with arthritis and diabetes in all 50 states, the District of Columbia, and U.S. territories. The study suggests that the presence of arthritis acts as an additional barrier to physical activity among those with diabetes. The study found that 29.8 percent of adults with arthritis and diabetes were inactive, compared with 21.0 percent of people with diabetes alone, 17.3 percent of those with arthritis alone, and 10.9 percent of adults with neither condition.
The study also found that the percentage of adults with diabetes and arthritis who are physically inactive varied among states, ranging from 20.2 percent in California to 46.4 percent in Tennessee. “People who have arthritis, diabetes or both benefit from being physically active,” said Janet Collins, Ph.D., director, CDC's National Center for Chronic Disease Prevention and Health Promotion. “We know it can be difficult, but regular physical activity helps in many ways. For people with diabetes, physical activity helps control blood glucose and risk factors for complications. For people with arthritis, physical activity reduces pain, and improves function.” Adults with arthritis and diabetes have unique barriers to being physically active such as concerns about pain, aggravating or worsening joint damage, and not knowing how much or what types of physical activity are safe for them. These concerns must be addressed for adults with both conditions to become more physically active. “These findings suggest more needs to be done to help people with diabetes and arthritis get physically active to improve their health,” said Chad Helmick, M.D., a CDC medical epidemiologist and co-author on the study. “Engaging in regular physical activity and maintaining a healthy weight can help alleviate the pain and disability that often accompany arthritis.”
CURING DIABETES WITH ANIMAL TRANSPLANTS
DATE: FEBRUARY 27, 2009
The descendents of Abraham are ready. They were born inside a cinderblock bubble in an anonymous building surrounded by fields in western Wisconsin. Raised on sterilized food and filtered air, they have never seen the sun, felt the rain, or been exposed to the germs known to make swine or people sick. This dynasty of pigs, which began with a boar named Abraham, has the same little eyes and floppy ears as those that become bacon and pork chops. But these are destined for a different service to humanity — to provide insulin-producing cells for people who have diabetes. All they need are the humans.
After decades of research and debate about the ethics and safety of putting living animal tissue into people, the first of such clinical research trials are within sight. Researchers at the Mayo Clinic and at the University of Minnesota have been studying the problem for a decade or more, and say now they will be among the first to propose transplanting living pig tissue into humans. Minnesota, as a result, has become the global epicenter for a unique type of medical-grade pig — animals raised in biosecure environments that insulate them from the infectious agents that have thwarted such transplants in the past. “We have a lot of pig wisdom and expertise” in Minnesota, said Bernhard Hering, a university diabetes researcher who has been studying animal-to-human transplantation for a decade. “You don’t find that at Rockefeller Univer-sity.”
In Rochester, the FIOS company, owned by the Mayo Clinic, houses genetically modified pigs that promise to pro-vide a future supply of hearts and perhaps other organs for people. In New Richmond Wis., the nonprofit Spring Point Project facility houses pigs bred to generate an unusually large number of insulin-producing “islet” cells that Hering hopes to use to treat diabetics. The first pig-to-human heart transplant could be just three to five years away, said Dr. Christopher McGregor, a transplant researcher at Mayo. The first pig-to-human islet cell transplant could happen within one to three years, Hering said. In December he accepted a $40 million gift from the family of Best Buy founder Richard Schulze that he said will greatly accelerate the diabetes research. If successful, islet cells and new hearts would be just the beginning. “The market is huge,” said Dr. Steven Miles, a professor and bioethicist at the university who studies the issues surrounding animal-to-human transplantation, called xenotransplantation. “Everybody would love to find a way to use xenotransplantation for blood,” he said. The 120 pigs at Spring Point’s facility in New Richmond have no idea how special they are. When visitors call, a few of them stare back intently at the faces peering through a thick glass window. They squeal and jostle for feed just like any other herd of pigs. But what extraordinary feed they are served. Without any animal fat or proteins, it’s a vegetarian’s dream. It’s been irradiated to sterilize it. The water used to power wash the concrete pens everyday has been exposed to ultraviolet light to kill any germs before it comes out of the sprayer. Humans are not allowed inside, except the handful of workers who must shower with microbial soap each time they enter what they call “the barrier” — the seven rooms that house the pigs. They don not one but two layers of sanitized suits. When they clean the floor of pig feces, they wear the same kind of caps and face masks used in hospi-tal operating rooms.
Two or more times a month, one of the pigs is killed and tested for 40 or 50 of the infectious agents that could be transmitted to humans and other pigs. So far, after two years and two generations of pigs born and raised entirely within the barrier, none has been found. “These are not your everyday ‘other white meat’ type of product,” said Miles. The extreme precautions are required to convince the Food and Drug Administration that transplanting tissue from pigs will be safe for humans. Surgeons have used treated porcine heart valves to repair human hearts for years, but islet cells and entire hearts are different — they constitute living tissue from pigs and cannot be purified before transplant. The potential for disease is terrifying. Regulators aren’t just worried about the known infections or pathogens that pigs and humans share — swine flu and toxoplasmosis among them. They also fear the epidemic that could occur if a virus or bacteria exclusive to pigs jumped to humans and evolved into something altogether new and lethal. Think bird flu, and all the global efforts to prevent its spread. The reward, however, could be enormous, the researchers say. People with diabetes, for example, often face a life of insulin injections, to say nothing of the many health risks that result from their disease. Their islet cells can be replaced by transplants from deceased human donors — either more islet cells or entire pancreases. But there aren’t nearly enough donated organs to go around, considering that 18 million people in the United States have been diagnosed with Type 1 and Type 2 diabetes. The same kind of hopeless ratios exist for patients needing transplanted hearts, livers and kidneys. The pathogen-free descendents of Abraham could solve the problem of supply. Pig products, including insulin, have been used in humans before, but transplanting the very islet cells could give human patients an almost limit-less supply. Yet significant barriers remain.
In 1996, researchers discovered that viruses called retroviruses, which live inside of cells, could be transmitted from pig cells to human cells. Though all animals and humans carry retroviruses, the discovery “created a shiver in the community,” McGregor said. It nearly brought the field of xenotransplantation to a halt. AIDS, which originated with monkeys, is a retrovirus. There is no way to eliminate those viruses because they are embedded in cells, and the risk of retrovirus transfer remains today. But the danger is not as great as was feared in 1996, McGregor said. Additional studies have shown that the pig retroviruses cannot live in as many human cells as researchers once feared. As a result, “people are becoming much more interested” in xenotransplantation, he said. That leaves the biggest problem of all: the human body’s own defense mechanism, the immune system. Most tissue transplanted into a human from another species would be rejected in minutes, McGregor said. Anti-rejection drugs that have been developed for human-to-human transplants could not stop it. To solve this problem, McGregor and his colleagues at Mayo have turned to genetic engineering. Their pigs at the FIOS facility have been genetically altered to eliminate the molecule on cell surfaces that triggers the human im-mune system to recognize transplanted tissue as foreign and to attack. They’ve also added genes to the pig that help minimize the immune response after transplantation. So far, monkeys receiving genetically altered pig hearts have survived for two months. “That’s huge,” McGregor said.
Hering, too, must overcome the immune challenge. But pig islet cells may be much easier to transplant into hu-mans because they trigger a much milder immune response, he said. That’s why he thinks his first human clinical trials might happen within a year or two. He has already successfully treated diabetic monkeys, which lived for six months after pig islet cells were implanted in their livers. Hering’s ultimate goal, however, is the holy grail of diabetes research: a limitless supply of insulin-producing cells that require no anti-rejection drugs at all. To accomplish that goal, Hering is attempting a kind of biological camouflage: a bioengineered scaffolding that can be seeded with pig islet cells and transplanted into a human patient’s abdomen. The combination of technologies would mask the foreign tissue from the human immune system in what he describes as biological “sanctuaries.” Hering is years away from that yet. But the promise is immense: a whole new field of medicine that could replace the failed organs of humans and cure diseases that have no cure today. If and when that time comes, the pigs in their biosecure bunker in New Richmond will be ready and waiting — a whole new twist on pig farming.
DIABETES DRUG OFFERS ALZHEIMER'S HOPE
DATE: FEBRUARY 20, 2009
Hopes were raised that diabetes drugs could be developed as treatments for Alzheimer’s disease after scientists demonstrated the beneficial effect of insulin on the brain. A US-led research team found the hormone, released by the pancreas to help control levels of sugar in the blood, protected memory-forming parts of the brain. The study, published in the Proceedings of the National Academy of Sciences, concluded that insulin may slow or prevent the memory loss caused by toxic proteins which attack the brains of Alzheimer’s sufferers. It boosts theories the disease — characterised by progressively catastrophic dementia — could be due to a type of brain diabetes.
People with diabetes either fail to produce insulin, do not produce enough or fail to use what is produced effectively. Researchers from Northwestern University in Illinois and the Federal University of Rio de Janeiro in Brazil carried out a study that involved treating neurons taken from one of the brain’s memory centres — the hippocampus — with insulin and diabetes drug rosiglitazone. Cells in the hippocampus are susceptible to damage caused by ADDLs, toxic proteins that build up in people with Alzheimer’s disease. ADDLs (amyloid beta-derived diffusible ligands) are known to attack memory-forming synapses, according to the scientists. After the proteins have attached, the synapses lose their capacity to respond to incoming information, resulting in memory loss. The researchers discovered damage to neurons exposed to ADDLs was blocked by insulin, which stopped the proteins from attaching to the cells. The insulin-sensitising drug rosiglitazone enhanced protection by low levels of insulin, the study found.
MICE SUCCESSFULLY CURED OF TYPE-I DIABETES
DATE: FEBRUARY 13, 2009
Our eyes are our windows to the world and they are now emerging as a window of hope for diabetics. A team of scientists, led by Dr Per-Olof Berggren, has successfully cured Type-I diabetes in mice by tranplanting healthy islets of langerhans, that contain insulin-producing beta cells, from the pancreas into the eyes. Dr Berggren is head of Cell Biology and Signal Tranduction at the Diabetes Research Institute, University of Miami, as well as professor and head of experimental endocrinology at Karolinksa Institute in Stockholm, Sweden.
The revolutionary technique, which allows scientists to study the pancreatic islet function through a microscope, cured Type-I diabetes in mice in just a month. These studies have been on for the last three years and Ahmedabad may well help take it to the next stage. “It’s very difficult to study islets in the pancreas or in isolation in a test tube. Eyes have a normal blood flow and we can also look in through them,” said Dr Berggren, who is in Ahmedabad to attend a symposium organised by Zydus Cadila group. Studies have now progressed to transplants in one monkey in Miami and the results have been encouraging. Ahmedabad could soon play a critical role in this pathbreaking research as Dr Berggren is in talks with Zydus Research Centre for collaborative research. The huge monkey population in the city too could swing it our way. “We could be ready to test it on human patients blinded by diabetes in two years,” Dr Berggren said, adding that this technique may help study Type-II diabetes as well.
Egg Intake Linked to Diabetes Risk
DATE: FEBRUARY 06, 2009
People who sit down to a daily breakfast of eggs may have an increased risk of developing type 2 diabetes, new research suggests. In a long-term study of 57,000 U.S. adults, researchers found that those who ate an egg a day were 58 percent to 77 percent more likely than non-egg-eaters to develop type 2 diabetes. The findings, published in the journal Diabetes Care, do not necessarily mean that eggs themselves put people on a path to diabetes, according to the researchers. But they do suggest it is wise to limit your egg intake.
"Based on the current data, our recommendations would be to consume eggs in moderation and not to exceed six eggs per week," lead researcher Dr. Luc Djousse, of Harvard Medical School in Boston, told Reuters Health. The study does not explain exactly why eggs are linked to diabetes, but cholesterol may play a role. The study participants' daily cholesterol intake was also related to diabetes risk, and when the researchers factored this in, the relationship between egg intake and diabetes weakened. In animal studies, high-fat diets have been shown to raise levels of blood sugar and the sugar-regulating hormone insulin -- suggesting a way that a cholesterol-heavy diet might promote diabetes. According to Djousse, it's important for people at risk of type 2 diabetes -- due to factors like family history and obesity -- to pay attention to their overall cholesterol intake, and not just cholesterol from eggs. Even more important, he noted, is a focus on overall health -- maintaining a normal weight, exercising regularly and eating a well-balanced diet -- rather than any one food or nutrient. He pointed out that eggs also contain important nutrients like protein, vitamins and minerals, and "good" unsaturated fats.
SOURCE: Diabetes Care, February 2009.
STRENGTH TRAINING IS KEY TO HEALTH
DATE: JANUARY 30, 2009
Muscle strength peaks in your 20s and then starts to decline. About five to seven pounds of muscle are lost each decade after about age 40 in both men and women. Aerobic exercises such as biking or running are great for cardiovascular fitness but aren't enough to prevent muscle loss. What's the secret to maintaining strong muscles and a healthy body into your later years?
It's strength training -- preferably started when you're young and continued during your 40s, 50s and beyond. In a recent study at Tufts University, arthritis pain was reduced by 43 percent after a group of older men and women completed a 16-week strength-training program. The researchers found that strength training was just as effective, or more so, than medications in relieving the pain of moderate to severe knee osteoarthritis. Similar effects have been found in patients with rheumatoid arthritis. Poor balance: Strengthening exercises can improve balance and flexibility, helping to prevent falls and broken bones. A New Zealand study of women aged 80 years and older showed a 40 percent reduction in falls with simple strength and balance training.
Weak bones: The pull of muscle on bone increases bone density and lessens the risk of osteoporosis developing in postmenopausal women and older men. A Tufts University study of women aged 50 to 70 found that strength training not only builds bone density but also lowers the incidence of fractures.
Overweight: People who have more muscles have a faster metabolism. Even at rest, your muscles consume more calories than other body tissues. With regular strength training, your average metabolic rate may increase up to 15 percent -- an enormous boon for weight loss and weight control.
Diabetes: Wider use of strength training programs could help prevent and control the skyrocketing prediabetes and diabetes epidemics in America. In a recent study of Hispanic men and women, 16 weeks of strength training produced dramatic improvements in glucose control that are comparable to taking diabetes mediation.
Mental health: Weight training can lift depression in a fashion similar to antidepressant medications, according to the Centers for Disease Control and Prevention. It's not known whether the improvements come from biochemical changes in the brain or from better self-confidence and esteem with participation in weight lifting.
Insomnia: People who do strength work regularly have better quality of sleep. They fall asleep more quickly, sleep more deeply, awaken less often and sleep longer. The sleep benefits obtained as a result of strength training are comparable to treatment with medication, the Centers for Disease Control reports, but without the side effects or expense.
Research has shown that people with chronic but stable medical conditions can benefit from resistance exercises. Before you start, discuss your health conditions and strength-training goals with your doctor. Make changes in your exercise routine slowly and gradually. The general recommendation is to do strength-training exercises on two or three days a week; allow at least one day of rest from those exercises between sessions. For each strength-training exercise, one set of 8 to 12 repetitions, performed to fatigue, is effective. Once you've had a chance to work up to it, two or three sets may even be better, according to the latest national guidelines. Lastly, don't believe the "no pain, no gain" mantra. Exercise performed properly should feel good. Consider working with a qualified fitness trainer for personalized advice.
By Dr. Elizabeth Smoots
Contact: doctor@practicalprevention.com.
REVIVING THE PROMISE OF LEPTIN IN TREATING OBESITY
DATE: JANUARY 23, 2009
The discovery more than a decade ago of leptin, an appetite-suppressing hormone secreted by fat tissue, generated headlines and great hopes for an effective treatment for obesity. But hopes dimmed when it was found that obese people are unresponsive to leptin due to development of leptin resistance in the brain. Now, researchers at Children's Hospital Boston report the first agents demonstrated to sensitize the brain to leptin: oral drugs that are already FDA-approved and known to be safe. Findings were published January 7 by the journal Cell Metabolism.
In 1995, researchers reported in Science that they had isolated a protein that is present in normal mice, but not in an obese strain of mice called ob/ob, which lacked a gene also called ob. When either obese or normal mice were directly injected with the protein now called leptin they ate less and lost weight. "Everyone in the field thought they would get the Nobel," says Umut Ozcan, MD, of Children's Division of Endocrinology. Unfortunately, when obese humans took the hormone, they lost weight only temporarily then rebounded back. "Most humans who are obese have leptin resistance," says Ozcan. "Leptin goes to the brain and knocks on the door, but inside, the person is deaf." For years, industry and academic laboratories have been searching for a drug to make peoples' brains sensitive to leptin again, without success.
In the new study, Ozcan's group first showed that the brain cells of obese mice have increased stress in the endoplasmic reticulum (ER) a structure within the cell where proteins are assembled, folded into their appropriate configurations, and dispatched to do jobs for the cell. In the presence of obesity, the ER is overwhelmed and can't function properly. This stress triggers a signaling cascade (the "unfolded protein response") that tries to relieve the stress by increasing the level of molecular "chaperones," which assist in protein folding, and by blocking more proteins from coming in. Ozcan and colleagues then showed that ER stress, and the resulting activation of this signaling cascade, blocks leptin action in the brain. Most intriguingly, they showed that using chemical chaperones to reduce ER stress can re-sensitize the brain to leptin, and lead to weight loss when used in conjunction with leptin. "I think our study will bring new hope for the treatment for obesity," says Ozcan.
Working first with mice made obese through a high-fat diet, they demonstrated that the animals developed ER stress in the hypothalamus, the main area of the brain where leptin signals. This in turn initiated the unfolded-protein response, rendering the mice extremely leptin-resistant. The team also created a strain of mice whose ER was weakened in the brain through deletion of a gene called XPB1 specifically in the neurons. These mice also developed ER stress and leptin resistance, and also became obese, despite having some of the highest leptin levels ever reported. As expected, the mice also ate more and gained more weight. But when Ozcan and colleagues pretreated either group of mice with a chemical chaperone (either 4-PBA or TUDCA) leptin sensitivity increased as much as 10-fold, and the mice had significant weight loss with leptin treatment even when fed a high-fat diet. Children's researchers hope to eventually move the discovery to human trials. Both 4-PBA and TUDCA are safe in humans and already FDA-approved for clinical use. 4-PBA (Buphenyl) used in urea cycle disorders and in cystic fibrosis; TUDCA (tauroursodeoxycholic acid), used for centuries in traditional Chinese medicine, is currently used in some liver diseases. Both agents are under study for use in neurologic disorders such as Alzheimer's disease and Huntington's disease.
In related work in 2006, Ozcan and colleagues reported in Science that chemical chaperones reduce ER stress in a mouse model of type 2 diabetes, normalizing blood sugar and restoring insulin sensitivity. In 1995, Amgen, Inc. (Thousand Oaks, CA) paid $20 million for commercial rights to recombinant human leptin, a record amount for a deal with an academic institution. In 2006, Amgen sold the rights to Amylin Pharmaceuticals (San Diego, CA). Amylin is testing leptin in combination with its diabetes drug, pramlintide. The current study was supported by the Timothy Murphy Fund, Junior Faculty Start-Up Funds provided to Ozcan from Children's Hospital Boston, and a Translational Research Award from Children's Hospital Boston.
EAT LESS AS YOU AGE - IT PAYS OFF
DATE: JANUARY 16, 2009
Eat less, weigh less.
While it may sound painfully obvious, nutrition experts have been divided over whether cutting calories leads to long-term weight loss, because the practice can sometimes boomerang, triggering binge eating and weight gain. But, new research suggests that eating less can pay big dividends, particularly as you age. Publishing in the current issue of the American Journal of Health Promotion, researchers from Brigham Young University reported that the middle-aged women they studied had more than twice the risk of significant weight gain if they didn't cut back on food consumption.
"Some suggest that restrained eating is not a good practice," BYU professor Larry Tucker, the study's lead author, said in a university news release. "Given the environmental forces in America's food industry, not practicing restraint is essentially a guarantee of failure." The researchers followed 192 middle-aged women for three years and compiled information on their lifestyles, health and eating habits. The analysis revealed that women who didn't practice more restraint while eating were 138 percent more likely to put on 6.6 pounds or more, the news release said. Columbia University researcher Lance Davidson, who was not involved with the study, said the findings underscore a key principle of weight control. "Because the body's energy requirements progressively decline with age, energy intake must mirror that decrease or weight gain occurs," Davidson said. "Dr. Tucker's observation that women who practice eating restraint avoid the significant weight gain commonly observed in middle age is an important health message." Tucker said the benefits of cutting back on what you eat aren't limited to your reflection in a mirror. Healthful eating equals better health, he said. "Weight gain and obesity bring a greater risk of diabetes and a number of other chronic diseases," he said. "Eating properly is a skill that needs to be practiced."
Tucker offers these tips for better eating:
TREATING GUM DISEASE LINKED TO LOWER MEDICAL COSTS FOR PATIENTS WITH DIABETES
DATE: JANUARY 09, 2009
A new report suggests that treating gum disease in patients who have diabetes with procedures such as cleanings and periodontal scaling is linked to 10 to 12 percent lower medical costs per month. The findings are encouraging but the study was not designed to firmly establish cause and effect, said George Taylor, University of Michigan associate professor of dentistry, who also has an appointment in epidemiology in the U-M School of Public Health. Taylor led the research project to investigate whether routine, non-surgical treatment for gum disease is linked to lower medical care costs for people with diabetes.
In periodontal disease, the body reacts to the bacteria causing the gum infection by producing proteins or chemicals called inflammatory mediators. Ulcers and open sores in the gums become passageways for these proteins and for the bacteria themselves to enter the body's blood circulation. These inflammatory mediators, as well as some parts of the bacteria, prevent the body from effectively removing glucose, or sugar, from the blood. The higher level of blood sugar is known as poor diabetes control. Poor diabetes control leads to serious diabetes complications such as vision disorders, cardiovascular and kidney disease and amputations, among others.
"Cleanings and other non-surgical periodontal treatment remove the harmful bacteria," Taylor said. "We believe this helps prevent the body from producing those harmful chemicals that can enter the systemic circulation and contribute to poorer diabetes control." Blue Care Network provided U-M researchers data from 2,674 patients aged 18-64 who were enrolled in BCN between 2001 and 2005 and had at least 12 consecutive months of medical, dental, and pharmaceutical coverage. "We found insured adults with diabetes in Michigan who received routine periodontal treatment, such as dental cleanings and scaling, have significantly lower medical care costs than those who do not," Taylor said. "These results could be meaningful to individuals, employers, health care providers and insurers."
The study showed that medical care costs decreased by an average of 11 percent per month for patients who received one or two periodontal treatment procedures annually compared to those who received none. For patients receiving three or four annual treatments, costs decreased nearly 12 percent. The study also showed that combined medical and pharmaceutical monthly costs were 10 percent lower for patients who received one or two periodontal procedures annually.
"The results of our analyses provide additional evidence supporting a beneficial role for periodontal treatment in improving overall health for people with diabetes," Taylor said. The findings could fuel changes in policies and practices for diabetes patients and their insurers. The research was supported by a grant from the Blue Cross Blue Shield of Michigan Foundation. Taylor's team includes: Wenche Borgnakke, senior research associate in health sciences; Michael Manz, senior research associate in health sciences; and Tammie Nahra, assistant research scientist.
STUDY SUGGESTS TAKING NAPS MAY BE GOOD FOR MEMORY
DATE: JANUARY 02, 2009
As the holidays wrap up, some medical advice most people will like: Take a nap. Interrupting sleep seriously disrupts memory-making, compelling new research suggests. But on the flip side, taking a nap may boost a sophisticated kind of memory that helps us see the big picture and get creative. "Not only do we need to remember to sleep, but most certainly we sleep to remember," is how Dr. William Fishbein, a cognitive neuroscientist at the City University of New York, put it at a meeting of the Society for Neuroscience last week. Good sleep is a casualty of our 24/7 world. Surveys suggest few adults attain the recommended seven to eight hours a night. Way too little clearly is dangerous: Sleep deprivation causes not just car crashes but all sorts of other accidents. Over time, a chronic lack of sleep can erode the body in ways that leave us more vulnerable to heart disease, diabetes and other illnesses.
But perhaps more common than insomnia is fragmented sleep - the easy awakening that comes with aging, or, worse, the sleep apnea that afflicts millions, who quit breathing for 30 seconds or so over and over throughout the night. Indeed, scientists increasingly are focusing less on sleep duration and more on the quality of sleep, what's called sleep intensity, in studying how sleep helps the brain process memories so they stick. Particularly important is "slow-wave sleep," a period of very deep sleep that comes earlier than better-known REM sleep, or dreaming time. Fishbein suspected a more active role for the slow-wave sleep that can emerge even in a power nap. Maybe our brains keep working during that time to solve problems and come up with new ideas. So he and graduate student Hiuyan Lau devised a simple test: documenting relational memory, where the brain puts together separately learned facts in new ways. First, they taught 20 English-speaking college students lists of Chinese words spelled with two characters - such as sister, mother, maid. Then half the students took a nap, being monitored to be sure they didn't move from slow-wave sleep into the REM stage. Upon awakening, they took a multiple-choice test of Chinese words they'd never seen before. The nappers did much better at automatically learning that the first of the two-pair characters in the words they'd memorized earlier always meant the same thing - female, for example. So they also were more likely than non-nappers to choose that a new word containing that character meant "princess" and not "ape." "The nap group has essentially teased out what's going on," Fishbein concludes. These students took a 90-minute nap, quite a luxury for most adults. But even a 12-minute nap can boost some forms of memory, adds Dr. Robert Stickgold of Harvard Medical School. Conversely, Wisconsin researchers briefly interrupted nighttime slow-wave sleep by playing a beep - just loudly enough to disturb sleep but not awaken - and found those people couldn't remember a task they'd learned the day before as well as people whose slow-wave sleep wasn't disrupted. None of the new work is enough, yet, to pinpoint the minimum sleep needed for optimal memory. What's needed may vary considerably from person to person. "A short sleeper may have a very efficient deep sleep even if they sleep only four hours," notes Dr. Chiara Cirellia of the University of Wisconsin, Madison. But altogether, the findings do suggest some practical advice: Get apnea treated. Avoid what Harvard's Stickgold calls "sleep bulimia," super-late nights followed by sleep-in weekends. And don't feel guilty for napping.