Thursday, January 30, 2014
You may have seen one of the many advertisements geared toward men asking if they suffer from "low T" — low testosterone levels that, according to the ads, can result in lost sex drive, diminished energy and moodiness. The answer, they suggest, may be as simple as applying testosterone through a gel or patch.
So successful has the marketing for this testosterone therapy been that, according to Drugs.com, an independent medicine website, sales of the testosterone gel Androgel in 2013 exceeded sales of Viagra.
Now, a new joint study by UCLA, the National Institutes of Health and Consolidated Research Inc., has shown there is a twofold increase in the risk of a heart attack shortly after beginning testosterone therapy among men under 65 who have a history of heart disease. Further, the study confirmed earlier studies that found a twofold increase in heart attack risk shortly after treatment began in men older than 65.
The study, the largest to date examining heart disease in men using testosterone supplements, appears in the Jan. 29 online edition of the journal PLOS ONE.
The research was prompted by three small, earlier studies that raised concerns about possible adverse cardiovascular outcomes associated with testosterone therapy. These included a randomized clinical trialofmen older than 65, which was reported in the New England Journal of Medicine and was stopped in 2010 due to a variety of cardiovascular events.
"We decided to investigate cardiovascular risks of this therapy in a large health care database since these previous studies were modest in size and only focused on men 65 and older," said the study's senior author, Sander Greenland, a professor of epidemiology at the UCLA Fielding School of Public Health and a professor of statistics in the UCLA College of Letters and Science. "Our study allowed us to examine cardiovascular risk in men under the age of 65 and to replicate the findings in men over 65."
Greenland and his colleagues used data from Truven Health Analytics, which aggregates information on patient care. They examined the health care records of 55,593 men who had been prescribed testosterone therapy — 48,539 under the age of 65 and 7,054 who were 65 or older. Their research led to the finding of a twofold increase in men under 65 with heart disease and confirmed the earlier findings of a twofold increase in men over 65 with or without heart disease.
"The extensive and rapidly increasing use of testosterone treatment and the evidence of risk of heart attack underscore the urgency of further large studies of the risks and the benefits of this treatment," Greenland said. "Patients and their physicians should discuss the risk of heart attacks when considering testosterone therapy."
Previous studies have shown that breast cancer survivors who meet the current exercise recommendations (2.5 hours of moderate intensity physical activity per week) are at 25 percent lower risk for dying from breast cancer. New research suggests that exceeding the recommendations may provide greater protection, and that running may be better than walking.
Previous studies have shown that breast cancer survivors who meet the current exercise recommendations (2.5 hours of moderate intensity physical activity per week) are at 25% lower risk for dying from breast cancer. New research from the U.S. Department of Energy's Lawrence Berkeley National Laboratory (Berkeley Lab) and reported in the International Journal of Cancer suggests that exceeding the recommendations may provide greater protection, and that running may be better than walking.
The study, by Berkeley Lab's Paul Williams of the lab's Life Sciences Division, followed 986 breast cancer survivors as part of the National Runners' and Walkers' Health Study. Thirty-three of the 714 walkers and 13 of the 272 runners died from breast cancer over 9 years. When analyzed together, their risk for breast cancer mortality decreased an average of 24% per metabolic equivalent (MET) hours per day of exercise, where one MET hour equals a little less than a mile of brisk walking or about two-thirds of a mile of running.
However, when the runners and walkers were looked at separately, there was significantly less mortality in those who ran than walked. The runners' risk for breast cancer mortality decreased over 40% per MET hour per day. Runners that averaged over 2 and a quarter miles per day were at 95% lower risk for breast cancer mortality than those that did not meet the current exercise recommendations. In contrast, the walkers' risk for breast cancer mortality decreased a non-significant 5% per MET hour per day.
Williams cautions, however, that this study doesn't disprove the benefits of walking because the number of subjects was small compared to previous research showing a benefit. However, he does believe that the research shows that exceeding the current exercise recommendations is probably better than simply meeting them, and that running may be better than walking.
"If I were a breast cancer survivor, I would certainly consider running or some other vigorous exercise over walking, and I wouldn't just be doing the minimum, with the consequences and potential benefit being so great," he adds
Running and walking appear to give the same benefits for prevention
Previous research from the national study showed that running was more effective than walking for weight loss. For many health benefits, however, running and walking appear to give the same benefits for the same amount of energy expenditure. These include lower risk for coronary heart disease, diabetes, hip replacements, as well as brain cancer. Running and walking also seem to be equally beneficial in the primary prevention of breast cancer.
The pain reliever Aleve may be safer for the heart than Advil and Motrin, other nonsteroidal anti-inflammatory drugs (NSAIDs), according to the U.S. Food and Drug Administration.
On Tuesday, the agency posted a review online that said naproxen -- the main ingredient in Aleve and a number of generic pain killers -- may pose a lower risk of heart attack and stroke than ibuprofen, which is used in Advil and Motrin.
The review -- which suggested that products with naproxen should be relabeled to highlight their heart safety -- was prompted by the release last year of an analysis that looked at 350,000 people taking different types of pain relievers. It concluded that naproxen does not carry the same heart risks as other NSAIDs.
The FDA review was released ahead of next week's meeting of a panel of outside experts who will discuss the new data and recommend whether naproxen should be relabeled. The FDA typically follows the advice of its expert panels.
Smokers and other people at high risk for lung cancer could make matters worse if they take antioxidant supplements, a new study of rodents suggests.
Antioxidants appear to accelerate cancer progression by short-circuiting one of the body's key immune responses to malignant cells, researchers from Sweden report.
Normal doses of vitamin E and smaller doses of the antioxidant supplement acetylcysteine increased the growth of tumors in mice with early lung cancer, the researchers reported in the Jan. 29 issue of Science Translational Medicine.
"We found that antioxidants caused a threefold increase in the number of tumors, and caused tumors to become more aggressive," senior author Dr. Martin Bergo said during a Tuesday news conference. "Antioxidants caused the mice to die twice as fast, and the effect was dose-dependent. If we gave a small dose, tumors grew a little. If we gave a high dose, tumors grew a lot."
Bergo, co-director of the Sahlgrenska Cancer Center at the University of Gothenburg, said the findings are particularly concerning because acetylcysteine is used to improve breathing in patients with chronic obstructive pulmonary disease, or COPD. Most people who have COPD are current or former smokers.
Antioxidants are supposed to protect the body from disease by preventing cell damage caused by molecules called free radicals. "These radicals can damage almost anything inside the cell, including DNA, and DNA damage can lead to cancer," Bergo said.
But this protection backfires in people who already have cancerous or precancerous cells, the researchers said.
When the body detects cellular DNA damage that can lead to cancer, it releases a key tumor-suppressing protein called p53.
In laboratory tests with mouse and human cancer cells, researchers found that antioxidants suppress the release of p53 by halting DNA damage done to cancer cells by free radicals.
"By reducing the DNA damage, the antioxidant actually helps the cancer cells escape detection," co-author Per Lindahl, a professor of biochemistry and cell biology at the University of Gothenburg, said in the news conference.
The findings suggest that people carrying small undiagnosed tumors in their lungs should avoid taking extra antioxidants, the study concludes.
"If you have lung cancer, or if you have an increased risk of developing lung cancer, then taking extra antioxidants may be harmful and it could speed up the growth of a tumor," Bergo said.
While studies involving animals can be useful, they may fail to produce similar results in humans.
However, this isn't the first study to indicate that antioxidants are bad for cancer patients, said Peter Campbell, director of the Tumor Repository at the American Cancer Society.
Human trials conducted in the 1980s and 1990s found that the antioxidants beta-carotene, vitamin A and vitamin E substantially increased the incidence of lung cancer in smokers, he said.
"This study doesn't stick out like a sore thumb," Campbell said. "We've known for some time that some of these agents tend to backfire. It's nice to have laboratory evidence to corroborate what we've seen in human populations."
The human body creates its own antioxidants, and is built to use additional antioxidants gained from the food a person eats, Campbell said. By taking antioxidant supplements, people could be defeating the body's ability to fight cancer and disease.
"There is a food supplement industry that has done a really good job marketing itself, suggesting that if we take these molecules normally found in food we will have better health and, well, a little is good so a whole lot would be better," Campbell said. "There are very intricate, complicated pathways that are supposed to sense and signal and destroy these precancerous cells. When our body doesn't turn that system on, these cancerous cells can proliferate."
However, the Swedish researchers stopped short of saying that no one should take antioxidants.
"If I had a patient with lung cancer, I would probably recommend they do not take extra antioxidants," Bergo said. "Would I make that recommendation with healthy people? Absolutely not."
Tuesday, January 28, 2014
"I'm a zombie without my morning coffee." "My blood type is Diet Coke." "Caffeine isn't a drug, it's a vitamin." Most people make jokes like these about needing a daily boost from their favorite caffeinated beverage—whether first thing in the morning or to prevent the after-lunch slump.
But a recent study coauthored by American University psychology professor Laura Juliano indicates that more people are dependent on caffeine to the point that they suffer withdrawal symptoms and are unable to reduce caffeine consumption even if they have another condition that may be impacted by caffeine—such as a pregnancy, a heart condition, or a bleeding disorder.
These symptoms combined are a condition called "Caffeine Use Disorder." And according to the study Juliano coauthored, even though caffeine is the most commonly used drug in the world—and is found in everything from coffee, tea, and soda, to OTC pain relievers, chocolate, and now a whole host of food and beverage products branded with some form of the word "energy"—health professionals have been slow to characterize problematic caffeine use and acknowledge that some cases may call for treatment.
"The negative effects of caffeine are often not recognized as such because it is a socially acceptable and widely consumed drug that is well integrated into our customs and routines," Juliano said. "And while many people can consume caffeine without harm, for some it produces negative effects, physical dependence, interferes with daily functioning, and can be difficult to give up, which are signs of problematic use."
"Caffeine Use Disorder: A Comprehensive Review and Research Agenda," which Juliano coauthored with Steven Meredith and Roland Griffiths of the Johns Hopkins University School of Medicine and John Hughes from the University of Vermont, published last fall in the Journal of Caffeine Research.
Grounds for More Research
The study summarizes the results of previously published caffeine research to present the biological evidence for caffeine dependence, data that shows how widespread dependence is, and the significant physical and psychological symptoms experienced by habitual caffeine users. Juliano and her coauthors also address the diagnostic criteria for Caffeine Use Disorder and outline an agenda to help direct future caffeine dependence research.
In so far as heeding the call for more research, the scientific community is beginning to wake up and smell the coffee. Last spring, the American Psychiatric Association officially recognized Caffeine Use Disorder as a health concern in need of additional research in the Diagnostic and Statistical Manual of Mental Health Disorders—the standard classification of mental disorders, now in its fifth edition (DSM-5), used by mental health professionals in the United States.
"There is misconception among professionals and lay people alike that caffeine is not difficult to give up. However, in population-based studies, more than 50 percent of regular caffeine consumers report that they have had difficulty quitting or reducing caffeine use," said Juliano, who served as an appointed advisor to the DSM-5 Substance Use Disorders work group and helped outline the symptoms for the Caffeine Use Disorder inclusion.
"Furthermore, genetics research may help us to better understand the effects of caffeine on health and pregnancy as well as individual differences in caffeine consumption and sensitivity," she added.
A Lack of Labelling
Based on current research, Juliano advises that healthy adults should limit caffeine consumption to no more than 400 mg per day—the equivalent of about two to three 8-oz cups of coffee. Pregnant women should consume less than 200 mg per day and people who regularly experience anxiety or insomnia—as well as those with high blood pressure, heart problems, or urinary incontinence—should also limit caffeine.
But limiting one's caffeine intake is often easier said than done as most people don't know how much caffeine they consume daily.
"At this time, manufacturers are not required to label caffeine amounts and some products such as energy drinks do not have regulated limits on caffeine," Juliano said, adding that if this changed, people could perhaps better limit their consumption and ideally, avoid caffeine's possible negative effects.
But in a nation where a stop at Starbucks is a daily ritual for many people, is there really a market for caffeine cessation? Juliano says yes.
"Through our research, we have observed that people who have been unable to quit or cut back on caffeine on their own would be interested in receiving formal treatment—similar to the outside assistance people can turn to if they want to quit smoking or tobacco use."
Monday, January 27, 2014
Handwashing, zinc may be best prevention
How do you prevent and treat the common cold? Handwashing and zinc may be best for prevention whereas acetaminophen, ibuprofen and perhaps antihistamine–decongestant combinations are the recommended treatments, according to a review in CMAJ (Canadian Medical Association Journal).
The common cold is well, common, affecting adults approximately 2-3 times a year and children under age 2 approximately 6 times a year. Symptoms such as sore throat, stuffy or runny nose, cough and malaise are usually worse in days 1-3 and can last 7-10 days, sometimes as long as 3 weeks.
"Although self-limiting, the common cold is highly prevalent and may be debilitating. It causes declines in function and productivity at work and may affect other activities such as driving," write Drs. Michael Allan, Department of Family Medicine, University of Alberta, Edmonton, and Bruce Arroll, Department of General Practice and Primary Health Care, University of Auckland, New Zealand.
Colds are also costly. It is estimated that direct medical costs in the United States, including physician visits, secondary infections and medications for colds, were an estimated $17 billion a year in 1997. Indirect costs from missed work for illness or to look after a sick child were an estimated $25 billion per year.
Most colds are caused by viruses, with only about 5% of clinically diagnosed colds having a bacterial infection, yet antibiotics are sometimes used inappropriately for viral infections.
The review, aimed at physicians and patients, looked at available evidence for both traditional and nontraditional approaches for preventing and alleviating colds.
• Clean hands: a review of 67 randomized controlled trials (RCTs) indicated that handwashing, a traditional public health approach, as well as alcohol disinfectants and gloves, is likely effective.
• Zinc may work for children (and possibly adults) — at least 2 RCTs indicated that children who took 10 or 15 mg of zinc sulfate daily had lower rates of colds and fewer absences from school due to colds. The authors suggest that zinc may also work for adults.
• Probiotics: there is some evidence that probiotics may help prevent colds, although the types and combinations of organisms varied in the studies as did the formulations (pills, liquids, etc.), making comparison difficult.
• Antihistamines combined with decongestants and/or pain medications appear to be somewhat or moderately effective in treating colds in older children — but not in children under age 5 — and adults.
• Pain relievers: ibuprofen and acetaminophen help with pain and fever. Ibuprofen appears better for fever in children.
• Nasal sprays: ipratropium, a drug used to treat allergies and chronic obstructive pulmonary disorder, may alleviate runny nose when used in a nasal spray but has no effect on congestion.
Other approaches and treatments
According to the evidence, the benefits of frequently used remedies such as ginseng, (found in ColdFX), gargling, vapour rubs and homeopathy are unclear. Cough medicines show no benefit in children but may offer slight benefit in adults. Honey has a slight effect in relieving cough symptoms in children over age 1. Vitamin C and antibiotics show no benefit, and misused antibiotics can have associated harms.
The authors note that the evidence for preventing and treating colds is often of poor quality and has inconsistent results.
"Much more evidence now exists in this area, but many uncertainties remain regarding interventions to prevent and treat the common cold," write the authors. "We focused on RCTs and systematic reviews and meta-analyses of RCTs for therapy, but few of the studies had a low risk of bias. However, many of the results were inconsistent and had small effects (e.g., vitamin C), which arouses suspicion that any noted benefit may represent bias rather than a true effect."
Thursday, January 23, 2014
Reduces mortality by up to 48 percent
Physical activity significantly extends the lives of male cancer survivors, a new study of 1,021 men has found.
During the period while the men were followed, those who expended more than 12,600 calories per week in physical activity were 48 percent less likely to die than those who burned fewer than 2,100 calories per week.
Kathleen Y. Wolin, PhD, of Loyola University Chicago Stritch School of Medicine, is co-author of the study, published in the Journal of Physical Activity & Health, the official journal of the International Society for Physical Activity and Health.
Many cancer survivors are living longer, due to earlier diagnosis and better treatment, and their numbers are increasing rapidly. "Thus physical activity should be actively promoted to such individuals to enhance longevity," researchers concluded.
There has been extensive research showing that among generally healthy, cancer-free populations, physical activity extends longevity. But there has been relatively little such research on physical activity among cancer survivors.
Researchers examined data from the Harvard Alumni Health Study, an ongoing study of men who entered Harvard as undergraduates between 1916 and 1950. Researchers looked at 1,021 men (average age 71) who previously had been diagnosed with cancer. In questionnaires conducted in 1988, men reported their physical activities, including walking, stair-climbing and participation in sports and recreational activities. Their physical activities were updated in 1993, and the men were followed until 2008.
Compared with men who expended fewer than 2,100 calories per week in physical activity, men who expended more than 12,600 calories per week were 48 percent less likely to die of any cause during the follow-up period. This finding was adjusted for age, smoking, body mass index, early parental mortality and dietary variables. (By comparison, a 176-pound man who walks briskly for 30 minutes a day, five days a week burns 4,200 calories.)
There were similar findings for mortality from cancer and cardiovascular disease: the most physically active cancer survivors were 38 percent less likely to die of cancer and 49 percent less likely to die of cardiovascular disease during the follow-up period.
The study this story is based on is available online: http://bit.ly/1dDuf7i
A study of the metabolic effects of omega-3 fatty acids, especially DHA, concludes that these compounds may have an even wider range of biological impacts than previously considered, and suggests they could be of significant value in the prevention of fatty liver disease.
The research, done by scientists at Oregon State University and several other institutions, was one of the first of its type to use “metabolomics,” an analysis of metabolites that reflect the many biological effects of omega-3 fatty acids on the liver. It also explored the challenges this organ faces from the “Western diet” that increasingly is linked to liver inflammation, fibrosis, cirrhosis and sometimes liver failure.
The results were surprising, researchers say.
Supplements of DHA, used at levels that are sometimes prescribed to reduce blood triglycerides, appeared to have many unanticipated effects. There were observable changes in vitamin and carbohydrate metabolism, protein and amino acid function, as well as lipid metabolism.
Supplementation with DHA partially or totally prevented metabolic damage through those pathways often linked to the Western diet – excessive consumption of red meat, sugar, saturated fat and processed grains.
The findings were published last month in PLOS One, an online professional journal.
“We were shocked to find so many biological pathways being affected by omega-3 fatty acids,” said Donald Jump, a professor in the OSU College of Public Health and Human Sciences. “Most studies on these nutrients find effects on lipid metabolism and inflammation.
“Our metabolomics analysis indicates that the effects of omega-3 fatty acids extend beyond that, and include carbohydrate, amino acid and vitamin metabolism,” he added.
Omega-3 fatty acids have been the subject of much recent research, often with conflicting results and claims. Possible reasons for contradictory findings, OSU researchers say, are the amount of supplements used and the relative abundance of two common omega-3s – DHA and EPA. Studies at OSU have concluded that DHA has far more ability than EPA to prevent the formation of harmful metabolites. In one study, it was found that DHA supplementation reduced the proteins involved in liver fibrosis by more than 65 percent.
These research efforts, done with laboratory animals, used a level of DHA supplementation that would equate to about 2-4 grams per day for an average person. In the diet, the most common source of DHA is fatty fish, such as salmon, mackerel or sardines.
The most recent research is beginning to break down the specific processes by which these metabolic changes take place. If anything, the results suggest that DHA may have even more health value than previously thought.
“A lot of work has been done on fatty liver disease, and we are just beginning to explore the potential for DHA in preventing or slowing disease progression,” said Jump, who is also a principal investigator in OSU’s Linus Pauling Institute.
“Fish oils, a common supplement used to provide omega-3, are also not prescribed to regulate blood glucose levels in diabetic patients,” he said. “But our studies suggest that DHA may reduce the formation of harmful glucose metabolites linked to diabetic complications.”
Both diabetes and liver disease are increasing steadily in the United States.
The American Liver Foundation has estimated that about 25 percent of the nation’s population, and 75 percent of those who are obese, have nonalcoholic fatty liver disease. This can progress to nonalcoholic steatohepatitis, cirrhosis and cancer.
This study established that the main target of DHA in the liver is the control of inflammation, oxidative stress and fibrosis, which are the characteristics of more progressively serious liver problems. Omega-3 fatty acids appear to keep cells from responding to and being damaged by whatever is causing inflammation.
The more you consume the omega-3 fatty acids found in fish oils, the less likely you are to lose as many precious brain cells as you age, a new study suggests.
More research is needed, however, to understand both why this happens and how much of the nutrient brings about the most benefit, the researchers said.
"Our findings support the idea that a higher omega-3 status from fish or supplements is good for brain health," said study author James Pottala, an assistant professor in the department of internal medicine at the University of South Dakota's Sanford School of Medicine.
According to the study, which was published online Jan. 22 in the journal Neurology, the researchers tested levels of omega-3 fatty acids in the red blood cells of more than 1,000 older women. Eight years later, the women had MRI scans that measured their brain volumes. At the time of the scans, the women were an average of 78 years old.
Participants whose omega-3 levels were twice as high had a 0.7 percent higher brain volume. "The results suggest that the effect on brain volume is the equivalent of delaying the normal loss of brain cells that comes with aging by one to two years," Pottala said.
Higher omega-3 levels also were associated with greater volume in the hippocampus, the region of the brain in which the memory-robbing disease Alzheimer's first attacks.
The study offers valuable information, said Dr. Gregory Cole, associate director of the Mary S. Easton Center for Alzheimer's Disease Research at the University of Southern California.
"[The study] has a large number of subjects with an objective measure -- the measure of brain volume," Cole said. "Studies that measure things like [memory and thinking] are not as concrete. People have good days and bad days, but when you measure brain volume you get a pretty repeatable measure."
It's also a plus that the participants are all the same gender, so there is no gender variation in brain size to factor in, Cole said.
The study's findings are intriguing, said Dr. JoAnn Manson, chief of the division of preventive medicine at Brigham and Women's Hospital in Boston. "[But] the results should be interpreted cautiously because it's an observational study and not a randomized clinical trial looking at the relationship between omega-3 intake and changes in brain volume," she said.
Although the study showed an association between omega-3 intake and improved brain health, it didn't necessarily prove a cause-and-effect link.
Manson is the principal investigator in a study involving more than 20,000 adults across the United States looking at whether taking daily dietary supplements of vitamin D or omega-3 fatty acids reduces the risk for certain diseases.
The study involves memory testing as well, Manson said. "We'll have some more information in another two to three years, and I think that will be important to see if increasing supplementation with omega-3s is having a clinical impact on [brain] function," she said.
Cole said clinical trials are the only way to find out if high omega-3 consumption really increases brain volume and reduces the risk for dementia.
"This is pretty believable. This is a solid finding," he said. "The question is: How can you translate this into [effectiveness] in people? Will it really work to protect peoples' brains?"
In the meantime, people who want to boost their omega-3 intake can eat nonfried 'oily' fish such as salmon, herring, tuna and sardines. The American Heart Association recommends eating at least two servings of fish a week.
Wednesday, January 22, 2014
Men who reported being sedentary with low levels of physical activity were at a significantly higher risk for heart failure than those who were more active, according to a Kaiser Permanente study published today in the journal Circulation: Heart Failure. The study shows the increased risk of heart failure with prolonged sedentary behavior.
Researchers examined the electronic health records of more than 82,000 men aged 45 years and older who were part of the California Men's Health Study. The study participants did not have prevalent heart failure and were enrolled in Kaiser Permanente health plans in the Northern and Southern California regions. The researchers followed these men for more than 10 years and found that those who reported high levels of sedentary time and low levels of physical activity had 2.2 times the risk of developing heart failure as compared with men who reported high physical activity and low sedentary time.
"Though traditionally we know quite a bit about the positive impact that physical activity has on cardiovascular disease, we know significantly less about the relationship between physical activity and heart failure," said Deborah Rohm Young, PhD, study lead author and researcher at the Kaiser Permanente Southern California Department of Research & Evaluation. "The results of this large study of a racially and ethnically diverse population reinforce the importance of a physically active and, importantly, a nonsedentary lifestyle for reducing the risk of heart failure."
Heart failure occurs when the heart is unable to maintain a proper blood flow. It is a serious and major cardiovascular disease that affected about 5.7 million Americans in 2012, according to the American Heart Association. Though the condition does not necessarily mean that the heart has stopped beating, about half of the people who develop heart failure will die within five years of diagnosis. Primary risk factors for the condition include coronary heart disease, high blood pressure, diabetes, obesity and a lack of physical activity.
"Kaiser Permanente considers physical activity an important part of a comprehensive approach to patient wellness and has included exercise as one of the patient's vital signs for several years now," said Young. "Hopefully, this study will provide even more evidence that moving more and sitting less can be prescribed for better health."
Kaiser Permanente is one of the first health care organizations to implement Exercise as a Vital Sign in a patient's electronic health record. The measure was launched in Kaiser Permanente Southern California in 2009 and has since been applied across the organization. As part of these efforts, patients are asked during routine outpatient visits how many minutes per week they exercise. Patients' responses are included in their electronic medical record, along with other traditional vital signs such as blood pressure, pulse and temperature.
An October 2012 study, published in the journal Medicine & Science in Sports & Exercise, found that among nearly 1.8 million Kaiser Permanente Southern California patients, 86 percent had an exercise vital sign in their record and that one third of the patients met national guidelines for physical activity. And last month, a study published in the Journal of General Internal Medicine found that asking patients about their exercise habits was associated with weight loss in overweight patients and improved glucose control for patients with diabetes.
Regular exposure to mild cold may be a healthy and sustainable way to help people lose weight, according to researchers writing in the Cell Press publication Trends in Endocrinology & Metabolism on January 22nd. On the flip side, that means our warm and cozy homes and offices might be partly responsible for our expanding waistlines.
"Since most of us are exposed to indoor conditions 90 percent of the time, it is worth exploring health aspects of ambient temperatures," said first author of the article Wouter van Marken Lichtenbelt of Maastricht University Medical Center in The Netherlands. "What would it mean if we let our bodies work again to control body temperature? We hypothesize that the thermal environment affects human health and more specifically that frequent mild cold exposure can significantly affect our energy expenditure over sustained time periods."
Marken Lichtenbelt and his colleagues started studying the effects of mild cold about 10 years ago, mostly because it had received so little attention. Earlier studies of temperature primarily focused on the extreme for application to the military, firefighters, and others. But studies began to show big differences amongst people in their response to mild cold conditions. That led researchers to an important discovery: heat-generating, calorie-burning brown fat isn't just for babies. Adults have it too and some more than others.
Marken Lichtenbelt says they now have evidence to suggest that a more variable indoor temperature – one that is allowed to drift along with temperatures outside – might be beneficial, although long-term effects still await further investigation. A research group from Japan found a decrease in body fat after people spent 2 hours per day at 17 degrees Celsius (62.6 degrees F) for six weeks. The Netherlands team also found that people get used to the cold over time. After six hours a day in the cold for a period of 10 days, people in their study increased brown fat, felt more comfortable and shivered less at 15 degree Celsius (59 degrees F).
In young and middle-aged people at least, non-shivering heat production can account for a few percent up to 30 percent of the body's energy budget, they say. That means lower temperatures can significantly affect the amount of energy a person expends overall.
So perhaps, in addition to our exercise training, we need to train ourselves to spend more time in the cold. Managing that in practice might take some convincing, however.
"Indoor temperature in most buildings is regulated to minimize the percentage of people dissatisfied," the researchers write. "This results in relatively high indoor temperatures in wintertime. This is evident in offices, in dwellings and is most pronounced in care centers and hospitals. By lack of exposure to a varied ambient temperature, whole populations may be prone to develop diseases like obesity. In addition, people become vulnerable to sudden changes in ambient temperature."
Tuesday, January 21, 2014
What happens to our cognitive abilities as we age? Traditionally it is thought that age leads to a steady deterioration of brain function, but new research in Topics in Cognitive Science argues that older brains may take longer to process ever increasing amounts of knowledge, and this has often been misidentified as declining capacity.
The study, led by Dr. Michael Ramscar of the University of Tuebingen, takes a critical look at the measures that are usually thought to show that our cognitive abilities decline across adulthood. Instead of finding evidence of decline, the team discovered that most standard cognitive measures are flawed, confusing increased knowledge for declining capacity.
Dr. Ramscar's team used computers, programmed to act as though they were humans, to read a certain amount each day, learning new things along the way. When the researchers let a computer 'read' a limited amount, its performance on cognitive tests resembled that of a young adult.
However, if the same computer was exposed data which represented a lifetime of experiences its performance looked like that of an older adult. Often it was slower, not because its processing capacity had declined, but because increased "experience" had caused the computer's database to grow, giving it more data to process, and that processing takes time.
"What does this finding mean for our understanding of our ageing minds, for example older adults' increased difficulties with word recall? These are traditionally thought to reveal how our memory for words deteriorates with age, but Big Data adds a twist to this idea," said Dr. Ramscar. "Technology now allows researchers to make quantitative estimates about the number of words an adult can be expected to learn across a lifetime, enabling the team to separate the challenge that increasing knowledge poses to memory from the actual performance of memory itself."
"Imagine someone who knows two people's birthdays and can recall them almost perfectly. Would you really want to say that person has a better memory than a person who knows the birthdays of 2000 people, but can 'only' match the right person to the right birthday nine times out of ten?" asks Ramscar.
"It is time we rethink what we mean by the aging mind before our false assumptions result in decisions and policies that marginalize the old or waste precious public resources to remediate problems that do not exist," said Topics in Cognitive Science, Editors Wayne Gray and Thomas Hills.
Monday, January 20, 2014
Higher levels of melatonin, a hormone involved in the sleep-wake cycle, may suggest decreased risk for developing advanced prostate cancer, according to results presented here at the AACR-Prostate Cancer Foundation Conference on Advances in Prostate Cancer Research, held Jan. 18-21.
Melatonin is a hormone that is produced exclusively at night in the dark and is an important output of the circadian rhythm, or the body's inherent 24-hour clock. Many biological processes are regulated by the circadian rhythm, including the sleep-wake cycle. Melatonin may play a role in regulating a range of other hormones that influence certain cancers, including breast and prostate cancers.
"Sleep loss and other factors can influence the amount of melatonin secretion or block it altogether, and health problems associated with low melatonin, disrupted sleep, and/or disruption of the circadian rhythm are broad, including a potential risk factor for cancer," said Sarah C. Markt, M.P.H., doctoral candidate in the Department of Epidemiology at Harvard School of Public Health in Boston. "We found that men who had higher levels of melatonin had a 75 percent reduced risk for developing advanced prostate cancer compared with men who had lower levels of melatonin.
"Our results require replication, but support the public health implication of the importance of maintaining a stable light-dark and sleep-wake cycle," added Markt. "Because melatonin levels are potentially modifiable, further studies of melatonin and prostate cancer risk and progression are warranted."
To investigate the association between urine levels of the main breakdown product of melatonin, 6-sulfatoxymelatonin, and risk of prostate cancer, Markt and colleagues conducted a case-cohort study of 928 Icelandic men from the AGES-Reykjavik cohort between 2002 and 2009. They collected first morning void urine samples at recruitment, and asked the participants to answer a questionnaire about sleep patterns.
The researchers found that one in seven men reported problems falling asleep, one in five men reported problems staying asleep, and almost one in three reported taking sleeping medications.
The median value of 6-sulfatoxymelatonin in the study participants was 17.14 nanograms per milliliter of urine. Men who reported taking medications for sleep, problems falling asleep, and problems staying asleep had significantly lower 6-sulfatoxymelatonin levels compared with men without sleep problems, according to Markt.
Of the study participants, 111 men were diagnosed with prostate cancer, including 24 with advanced disease. The researchers found that men whose 6-sulfatoxymelatonin levels were higher than the median value had a 75 percent decreased risk for advanced prostate cancer. A 31 percent decreased risk for prostate cancer overall was observed as well, but this finding was not statistically significant.
"Further prospective studies to investigate the interplay between sleep duration, sleep disturbance, and melatonin levels on risk for prostate cancer are needed," said Markt.
Men who walked at a fast pace prior to a prostate cancer diagnosis had more regularly shaped blood vessels in their prostate tumors compared with men who walked slowly, providing a potential explanation for why exercise is linked to improved outcomes for men with prostate cancer, according to results presented here at the AACR-Prostate Cancer Foundation Conference on Advances in Prostate Cancer Research, held Jan. 18-21.
Men who engage in higher levels of physical activity have been reported to have a lower risk of prostate cancer recurrence and mortality compared with men who participate in little or no physical activity. The biological mechanisms underlying this association are not known.
"Prior research has shown that men with prostate tumors containing more regularly shaped blood vessels have a more favorable prognosis compared with men with prostate tumors containing mostly irregularly shaped blood vessels," said Erin Van Blarigan, Sc.D., assistant professor in the Department of Epidemiology and Biostatistics at the University of California, San Francisco. "In this study, we found that men who reported walking at a brisk pace had more regularly shaped blood vessels in their prostate tumors compared with men who reported walking at a less brisk pace.
"Our findings suggest a possible mechanism by which exercise may improve outcomes in men with prostate cancer," continued Van Blarigan. "Although data from randomized, controlled trials are needed before we can conclude that exercise causes a change in vessel regularity or clinical outcomes in men with prostate cancer, our study supports the growing evidence of the benefits of exercise, such as brisk walking, for men with prostate cancer."
The Health Professionals Follow-up Study, which was initiated in 1986, enables researchers to examine how nutritional and lifestyle factors affect the incidence of serious illnesses, such as cancer and heart disease. Every two years, participants receive questionnaires that ask about diseases and health-related topics like smoking, physical activity, and medications taken. Questionnaires that ask detailed dietary information are administered every four years.
Van Blarigan and colleagues investigated whether prediagnostic physical activity was associated with prostate tumor blood vessel regularity among 572 men enrolled in the Health Professionals Follow-up Study. Prediagnostic physical activity was determined through analysis of questionnaire answers. Blood vessel regularity was established by semiautomated image analysis of the tumor samples. Blood vessels that are perfect circles are considered the ideal shape and given a score of 1. Higher values indicate less regular blood vessels.
The researchers found that men with the fastest walking pace (3.3-.5 miles per hour) prior to diagnosis had 8 percent more regularly shaped blood vessels compared with men with the slowest walking pace (1.5-.5 miles per hour).
"Our study, which provides a potential explanation by which exercise may improve outcomes in men with prostate cancer, highlights the value of multidisciplinary collaborations between laboratory, clinical, and population scientists to explore new pathways by which lifestyle factors or other exposures may affect disease," said Van Blarigan. "It is reasonable to hypothesize that the same explanation could exist for the beneficial effects of exercise in other cancers, and it would be interesting to examine this in future studies."
Eating high levels of flavonoids including anthocyanins and other compounds (found in berries, tea, and chocolate) could offer protection from type 2 diabetes - according to research from the University of East Anglia (UEA) and King's College London.
Findings published today in the Journal of Nutrition reveal that high intakes of these dietary compounds are associated with lower insulin resistance and better blood glucose regulation.
A study of almost 2,000 people also found that these food groups lower inflammation which, when chronic, is associated with diabetes, obesity, cardiovascular disease, and cancer.
Prof Aedin Cassidy from UEA's Norwich Medical School led the research. She said: "Our research looked at the benefits of eating certain sub-groups of flavanoids. We focused on flavones, which are found in herbs and vegetables such as parsley, thyme, and celery, and anthocyanins, found in berries, red grapes, wine and other red or blue-coloured fruits and vegetables.
"This is one of the first large-scale human studies to look at how these powerful bioactive compounds might reduce the risk of diabetes. Laboratory studies have shown these types of foods might modulate blood glucose regulation – affecting the risk of type 2 diabetes. But until now little has been know about how habitual intakes might affect insulin resistance, blood glucose regulation and inflammation in humans."
Researchers studied almost 2,000 healthy women volunteers from TwinsUK who had completed a food questionnaire designed to estimate total dietary flavonoid intake as well as intakes from six flavonoid subclasses. Blood samples were analysed for evidence of both glucose regulation and inflammation. Insulin resistance, a hallmark of type 2 diabetes, was assessed using an equation that considered both fasting insulin and glucose levels.
"We found that those who consumed plenty of anthocyanins and flavones had lower insulin resistance. High insulin resistance is associated with Type 2 diabetes, so what we are seeing is that people who eat foods rich in these two compounds – such as berries, herbs, red grapes, wine– are less likely to develop the disease.
"We also found that those who ate the most anthocyanins were least likely to suffer chronic inflammation – which is associated with many of today's most pressing health concerns including diabetes, obesity, cardiovascular disease, and cancer.
"And those who consumed the most flavone compounds had improved levels of a protein (adiponectin) which helps regulate a number of metabolic processes including glucose levels.
"What we don't yet know is exactly how much of these compounds are necessary to potentially reduce the risk of type 2 diabetes," she added.
Prof Tim Spector, research collaborator and director of the TwinsUK study from King's College London, said: "This is an exciting finding that shows that some components of foods that we consider unhealthy like chocolate or wine may contain some beneficial substances. If we can start to identify and separate these substances we can potentially improve healthy eating. There are many reasons including genetics why people prefer certain foods so we should be cautious until we test them properly in randomised trials and in people developing early diabetes."
People who enjoy life maintain better physical function in daily activities and keep up faster walking speeds as they age, compared with people who enjoy life less, according to a new study in CMAJ (Canadian Medical Association Journal).
A study of 3199 men and women aged 60 years or over living in England looked at the link between positive well-being and physical well-being, following participants over 8 years. Participants were divided into three age categories: 60–69, 70–79 and 80 years or over. Researchers from University College London (UCL), United Kingdom, assessed participants' enjoyment of life with a four-point scale, rating the following questions: "I enjoy the things that I do," "I enjoy being in the company of others," "On balance, I look back on my life with a sense of happiness" and "I feel full of energy these days." Researchers used personal interviews to determine whether participants had impairments in daily activities such as getting out of bed, getting dressed, bathing or showering. They gauged walking speed with a gait test.
"The study shows that older people who are happier and enjoy life more show slower declines in physical function as they age," states Dr. Andrew Steptoe, UCL. "They are less likely to develop impairments in activities of daily living such as dressing or getting in or out of bed, and their walking speed declines at a slower rate than those who enjoy life less."
Participants in the 60–69-year bracket had higher levels of well-being as did those with higher socioeconomic status and education and those who were married and working. Not surprisingly, people with chronic illnesses such as heart disease, diabetes, arthritis, stroke and depression had lower levels of enjoyment of life.
People with low well-being were more than three times as likely as their positive counterparts to develop problems in their daily physical activities.
"This is not because the happier people are in better health, or younger, or richer, or have more healthy lifestyles at the outset, since even when we take these factors into account, the relationship persists," Steptoe says. "Our previous work has shown that older people with greater enjoyment of life are more likely to survive over the next 8 years; what this study shows is that they also keep up better physical function."
"Our results provide further evidence that enjoyment of life is relevant to the future disability and mobility of older people," Steptoe and coauthors conclude. "Efforts to enhance well-being at older ages may have benefits to society and health care systems."
Exposing skin to sunlight may help to reduce blood pressure and thus cut the risk of heart attack and stroke, a study published in the Journal of Investigative Dermatology suggests.
Research carried out at the Universities of Southampton and Edinburgh shows that sunlight alters levels of the small messenger molecule, nitric oxide (NO) in the skin and blood, reducing blood pressure.
Martin Feelisch, Professor of Experimental Medicine and Integrative Biology at the University of Southampton, comments: "NO along with its breakdown products, known to be abundant in skin, is involved in the regulation of blood pressure. When exposed to sunlight, small amounts of NO are transferred from the skin to the circulation, lowering blood vessel tone; as blood pressure drops, so does the risk of heart attack and stroke."
While limiting sunlight exposure is important to prevent skin cancer, the authors of the study, including Dr Richard Weller of the University of Edinburgh, suggest that minimising exposure may be disadvantageous by increasing the risk of prevalent conditions related to cardiovascular disease.
Cardiovascular disease, often associated with high blood pressure, accounts for 30 per cent of deaths globally each year. Blood pressure and cardiovascular disease are known to vary according to season and latitude, with higher levels observed in winter and in countries further from the equator, where ultraviolet radiation from the sun is lower.
During the study, the skin of 24 healthy individuals was exposed to ultraviolet (UVA) light from tanning lamps for two sessions of 20 minutes each. In one session, the volunteers were exposed to both the UVA rays and the heat of the lamps. In another, the UV rays were blocked so that only the heat of the lamps affected the skin.
The results suggest that UVA exposure dilates blood vessels, significantly lowers blood pressure, and alters NO metabolite levels in the circulation, without changing vitamin D levels. Further experiments indicate that pre-formed stores of NO in the upper skin layers are involved in mediating these effects. The data are consistent with the seasonal variation of blood pressure and cardiovascular risk at temperate latitudes.
Professor Feelisch adds: "These results are significant to the ongoing debate about potential health benefits of sunlight and the role of Vitamin D in this process. It may be an opportune time to reassess the risks and benefits of sunlight for human health and to take a fresh look at current public health advice. Avoiding excess sunlight exposure is critical to prevent skin cancer, but not being exposed to it at all, out of fear or as a result of a certain lifestyle, could increase the risk of cardiovascular disease. Perhaps with the exception of bone health, the effects of oral vitamin D supplementation have been disappointing.
"We believe that NO from the skin is an important, so far overlooked contributor to cardiovascular health. In future studies we intend to test whether the effects hold true in a more chronic setting and identify new nutritional strategies targeted at maximizing the skin's ability to store NO and deliver it to the circulation more efficiently."
Cholesterol-lowering drugs known as statins also help to lower blood pressure. A new study reports that:
Mortality risk was 34% lower among high blood pressure individuals treated with statins compared with those not on statins. Fitness also limited mortatlity risk by approximayely the same measure. However, the combination of statin therapy and higher fitness lowered mortality risk in hypertensive individuals more effectively than either alone. The risk reduction associated with moderate increases in fitness was similar to that achieved by statin therapy. Higher fitness was associated with 52% lower mortality risk when compared with the least fit subjects on statin therapy.
Saturday, January 18, 2014
I really should get this vaccination (and a flu shot)
Shingles Vaccination Among Baby Boomers
While people over the age of 60 account for more than half of all shingles cases, less than 15% get the vaccination that helps prevent the blistering skin rash, which can cause lingering nerve pain. The vaccine can reduce the chances of catching shingles by 51% or reduce the severity of an outbreak.
I really need to get up from the computer and the couch more often:
People who decrease sitting time and increase physical activity have a lower risk of chronic disease
Even standing throughout the day -- instead of sitting for hours at a time -- can improve health and quality of life while reducing the risk for chronic diseases such as cardiovascular disease, diabetes, heart disease, stroke, breast cancer and colon cancer, among others.
Prolonged sitting linked to early mortality in women
Women with more than 11 hours of daily sedentary time faced a 12 percent increase in all-cause premature mortality compared with the most energetic group – those with four hours or less of inactivity. The former group also upped their odds for death due to cardiovascular disease, coronary heart disease and cancer by 13, 27 and 21 percent, respectively.
Women begin to lose muscle mass at age 35, a change that accelerates with menopause. Regular exercise, especially lifting weights and other muscular strength-building exercises, helps to counteract these declines, but research finds that more everyday movement on top of working out is also important for maintaining health.
I'm pretty good on fiber and omega 3:
Fiber prevents diabetes and obesity
A high-fiber diet reduces the risk of colon problems
Omega-3 fatty acids help reduce the risk of type 2 diabetes
The study sheds new light on the association between fish consumption and the risk of type 2 diabetes. A well-balanced diet should include at least two fish meals per week, preferably fatty fish. Fish rich in long-chain omega-3 fatty acids include salmon, rainbow trout, herring, anchovy, sardine and mackerel
I took this test: the Self-Administered Gerocognitive Examination (SAGE test), and passed with flying colors.
Study: Self-administered test helps spot early Alzheimer's
Four out of five people (80 percent) with mild thinking and memory (cognitive) issues will be detected by this test, and 95 percent of people without issues will have normal SAGE scores.
So I guess I don’t need to worry about this:
Cognitive training shows staying power
Training to improve cognitive abilities in older people lasted to some degree 10 years after the training program was completed, according to results of a randomized clinical trial supported by the National Institutes of Health.
But I’m glad for this help:
Caffeine Enhances Memory
Caffeine enhances certain memories at least up to 24 hours after it is consumed.
People still question me about this when I drink coffee before soccer:
Researchers dispel the myth that coffee consumption can cause dehydration
I'm glad I take a statin:
High Good, Low Bad Cholesterol Levels Are Healthy for Brain, Too/
High levels of "good" cholesterol and low levels of "bad" cholesterol are correlated with lower levels of the amyloid plaque deposition in the brain that is a hallmark of Alzheimer's disease, in a pattern that mirrors the relationship between good and bad cholesterol in cardiovascular disease, UC Davis researchers have found. The relationship between elevated cholesterol and increased risk of Alzheimer's disease has been known for some time, but the current study is the first to specifically link cholesterol to amyloid deposits in living human study participants.
In the United States, cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. For HDL cholesterol, a level of 60 mg/dl or higher is best. For LDL cholesterol, a level of 70 mg/dL or lower is recommended for people at very high risk of heart disease.
More interesting research:
Alcohol consumption reduces odds of getting multiple sclerosis
Some 30 minutes of meditation daily may improve symptoms of anxiety and depression
High blood pressure potentially more dangerous for women than men
Friday, January 17, 2014
While people over the age of 60 account for more than half of all shingles cases, less than 15% get the vaccination that helps prevent the blistering skin rash, which can cause lingering nerve pain.
"I awoke with such pain in my head and neck area I thought someone must have taken a lead pipe to me during the night," recalls Rose Hallarn, who was 57 at the time. "After watching what I went through, my husband made a point of getting vaccinated -- both because of what he had seen me go through and also on advice of his physician -- but it wasn't something that was necessarily top of mind for him before that."
Now, a new study from researchers at The Ohio State University is reporting that older patients who receive written information on shingles were almost three times more likely to get vaccinated than those that didn't receive a similar communication. The study is also one of the first to show that using a patient's electronic medical record (EMR) coupled with pharmacist intervention markedly improves preventative care of shingles over the current standard.
The research team, led by Stuart Beatty, a pharmacist with Ohio State's College of Pharmacy, says that the low vaccination rate is due to a combination of factors including lack of awareness, cost, access to clinics able to store the fragile vaccine and the fact that face-to-face appointments don't offer enough time to discuss shingles, also known as herpes zoster.
"With older patients, there are usually more pressing health issues to discuss during routine appointments, so herpes zoster falls off the list," said Beatty. "Plus, as a live vaccine, it's not appropriate for people with certain illnesses. There usually isn't time to figure all that out in a regular office visit."
For the six-month study, which was supported by the Ohio State Center for Clinical and Translational Science (CCTS), Beatty and his team used electronic medical record (EMR) data to identify more than 2,500 patients over the age of 60 without a documented herpes zoster vaccination. Some were randomized to receive information about shingles via a secure email linked to their online personal health record (PHR) or a mailed postcard, while others received no information outside what they may have gotten in a routine doctor visit.
Pharmacists reviewed the EMRs of patients who had received emails or mailed information to identify eligible vaccine candidates, and then sent them a vaccination prescription via standard mail, along with a list of local pharmacies that offered the vaccine. Vaccine fulfillment was tracked by reports submitted to the team by local pharmacists.
Patients with an active PHR that received email information on shingles had the highest vaccination rate of 13.2% compared to a rate of 5.0% for patients with an active PHR that did not receive the email information. For patients that did not have an active PHR but did receive mailed information, the vaccination rate was 5.2% compared to a rate of 1.8% for patients without an active PHR and received no information.
Neeraj Tayal, MD, an Ohio State Wexner Medical Center general internist on the research team, noted that while the numbers of patients vaccinated may seem small, the study was conducted in 2010-2011, a time when the national vaccination average was actually 6%, far lower than today's average of 15%. Tayal also suggests that despite the overall low vaccination rate, the results challenge the notion that there are too many logistical barriers to this type of effort.
"It took pharmacists a matter of minutes to review the chart and mail out a prescription. This saved the physician time, the patient time, and improved the overall health of our patients," said Tayal, who is also an expert on how EMR and PHR can improve clinical practice. "By utilizing pharmacists as members of a care team, many perceived logistical barriers were managed and overcome."
Hallarn, who did not participate in the study, recovered fully from her bout with shingles, and got vaccinated to help prevent a recurrence. An active user of her online health record, Hallarn says she requested a prescription for the shingles vaccine online through her chart, but then had to manually update her file to reflect that she had gotten the vaccine, something that study authors acknowledge is an ongoing issue.
"We found a few patients that said they had already been vaccinated, but there was no record of it in their EMR, which isn't surprising given that the current information exchange between a physician's office and a community pharmacy is extremely limited," said Beatty. "As EMR use and a team approach to patient care increases, this health information exchange will be critical for success."
As an example, the authors reported that during the EMR review, pharmacists were able to identify a few patients who shouldn't get the vaccine. These patients had their chart updated so the contraindication will appear for any provider trying to order the vaccine in the future. According to Tayal, this offers a peek at the potential of EMRs.
"Between 40 and 60% of office-based providers and hospitals in the US have adopted an EMR system. While it's too early to tell whether EMRs will save money, our intervention model shows there are opportunities to manage chronic and preventable illnesses, prevent medication interactions, and integrate team-based care in ways that would result in better care and cost savings," said Tayal.
Winter and spring are the most common times of the year for shingles outbreaks. According to Tayal, shingles generally causes a blistering rash on the face, chest, belly or legs, and is accompanied by intense pain lasting between 2-4 weeks. Some patients are stricken with a prolonged pain syndrome called "post herpetic neuralgia" that can last months, or in rare cases, years. The rash can lead to complications ranging from blindness to urinary problems. The pain often develops before a rash is noticed so patients often seek medical attention for pain that is misdiagnosed until the rash develops. The vaccine can reduce the chances of catching shingles by 51% or reduce the severity of an outbreak.
The study was published in The American Journal of Medicine.
Thursday, January 16, 2014
A woman’s body at rest will remain at rest – and that means health woes for older women.
Led by Cornell University nutritional scientist Rebecca Seguin, a new study of 93,000 postmenopausal American women found those with the highest amounts of sedentary time – defined as sitting and resting, excluding sleeping – died earlier than their most active peers. The association remained even when controlling for physical mobility and function, chronic disease status, demographic factors and overall fitness – meaning that even habitual exercisers are at risk if they have high amounts of idle time.
Seguin and co-authors found that women with more than 11 hours of daily sedentary time faced a 12 percent increase in all-cause premature mortality compared with the most energetic group – those with four hours or less of inactivity. The former group also upped their odds for death due to cardiovascular disease, coronary heart disease and cancer by 13, 27 and 21 percent, respectively.
“The assumption has been that if you’re fit and physically active, that will protect you, even if you spend a huge amount of time sitting each day,” said Seguin, assistant professor of nutritional sciences in Cornell’s College of Human Ecology. “In fact, in doing so you are far less protected from negative health effects of being sedentary than you realize.”
Worse still, Seguin said, excess sedentary time tends to make it harder to regain physical strength and function. Women begin to lose muscle mass at age 35, a change that accelerates with menopause. Regular exercise, especially lifting weights and other muscular strength-building exercises, helps to counteract these declines, but her research finds that more everyday movement on top of working out is also important for maintaining health.
“In general, a use it or lose it philosophy applies,” Seguin said. “We have a lot of modern conveniences and technologies that, while making us more efficient, also lead to decreased activity and diminished ability to do things. Women need to find ways to remain active.”
Starting in middle age and even younger, Seguin said, women can adopt “small changes that make a big difference.”
“If you’re in an office, get up and move around frequently,” she said. “If you’re retired and have more idle time, find ways to move around inside and outside the house. Get up between TV programs, take breaks in computer and reading time and be conscious of interrupting prolonged sedentary time.”
Though previous research has linked prolonged sedentary time with poor health outcomes, the study by Seguin is one of the largest and most ethnically diverse of its type. The women, ages 50-79 at the study’s outset as part of the national Women’s Health Initiative Study, were followed over 12 or more years.
The paper, “Sedentary Behavior and Mortality in Older Women,” was published online Jan. 7 in the American Journal of Preventive Medicine.
People who decrease sitting time and increase physical activity have a lower risk of chronic disease, according to Kansas State University research.
Even standing throughout the day -- instead of sitting for hours at a time -- can improve health and quality of life while reducing the risk for chronic diseases such as cardiovascular disease, diabetes, heart disease, stroke, breast cancer and colon cancer, among others.
The researchers -- Sara Rosenkranz and Richard Rosenkranz, both assistant professors of human nutrition -- studied a sample of 194,545 men and women ages 45 to 106. The data was from the 45 and Up Study, which is a large Australian study of health and aging.
"Not only do people need to be more physically active by walking or doing moderate-to-vigorous physical activity, but they should also be looking at ways to reduce their sitting time," Richard Rosenkranz said.
The twofold approach -- sitting less and moving more -- is key to improving health, the researchers said. People often spend the majority of the day being sedentary and might devote 30 to 60 minutes a day to exercise or physical activity, Sara Rosenkranz said. Taking breaks to stand up or move around can make a difference during long periods of sitting.
Sitting for prolonged periods of time -- with little muscular contraction occurring -- shuts off a molecule called lipoprotein lipase, or LPL, Sara Rosenkranz said. Lipoprotein lipase helps to take in fat or triglycerides and use it for energy.
"We're basically telling our bodies to shut down the processes that help to stimulate metabolism throughout the day and that is not good," Sara Rosenkranz said. "Just by breaking up your sedentary time, we can actually upregulate that process in the body."
In a previous study published in the International Journal of Behavioral Nutrition and Physical Activity, the researchers found that the more people sit, the greater their chances of obesity, diabetes, cardiovascular disease and overall mortality.
For the more recent study, the researchers wanted to take a positive approach and see if increasing physical activity helped to increase health and quality of life. The researchers want to motivate people -- especially younger people -- to sit less and move more so they can age easier with less chronic disease.
"There is only so far that messages about avoiding diseases can go, especially when talking about chronic disease because it is so far removed and in the future," Richard Rosenkranz said. "For young people, being motivated by avoiding diseases is probably not the most pressing matter in their lives. We wanted to look at excellent health and excellent quality of life as things to aspire to in health."
To help office workers and employees who often sit for long periods of time, the researchers suggest trying a sit/stand desk as way to decrease sedentary time and add physical activity into the day. A sit/stand desk or workstation can adjust up and down so employees can add more standing time to their days. There are even sit/stand desks for children to stand and do homework or projects.
The research appears in the journal BMC Public Health. Collaborators included Gregory Kolt of the School of Science and Health at the University of Western Sydney in Sydney, Australia, and Mitch Duncan of the Institute for Health and Social Science Research with the Centre for Physical Activity Studies at Central Queensland University in Rockhampton, Australia.
While the researchers have used existing data for this latest study, the Rosenkranzes are now conducting experiments to manipulate sitting time in already active people. They want to understand how increased sitting time affects physiological risk factors such as blood pressure, body composition, triglyceride and cholesterol levels, inflammation and oxidative stress.
Most sweet fruit and many vegetables such as salsify, cabbage or beans, as well as
berries and other fresh fruit, vegetables, whole grains, seeds and nuts are rich in so-called fermentable fibers. Such fibers cannot be digested directly by the intestine but are instead fermented by intestinal bacteria into short-chain fatty acids such as propionate and butyrate, which can in fact be assimilated by our bodies. The protective effect of these fibers is well known to researchers: animals fed a fiber-rich diet become less fat and are less likely to develop diabetes than animals fed a fiber-free diet.
Whilw scientists have known for the past twenty years that a fiber-rich diet protects the organism against obesity and diabetes but the mechanisms involved have so far eluded them. A French-Swedish team including researchers from CNRS, Inserm and the Université Claude Bernard Lyon 1 (Unité Inserm 855 “Nutrition et Cerveau”) has succeeded in elucidating this mechanism, which involves the intestinal flora and the ability of the intestine to produce glucose between meals. These results, published in the journal Cell on 9 January 2014, also clarify the role of the intestine and its associated microorganisms in maintaining glycaemia. They will give rise to new dietary recommendations to prevent diabetes and obesity.
Scientists have more reasons for you to eat fiber and not abuse antibiotics.
They've shown that a receptor doctors already activate with mega-doses of niacin to protect patients' cardiovascular systems also plays a key role in preventing colon inflammation and cancer, according to a study featured on the cover of the journal Immunity.
The finding helps explain why a high-fiber diet reduces the risk of colon problems and indicates that when fiber is lacking, niacin, or vitamin B3, just may help keep the colon healthy as well, said Dr. Vadivel Ganapathy, Chairman of the Department of Biochemistry and Molecular Biology at the Medical College of Georgia at Georgia Regents University and a corresponding study author.
The study found that mice lacking the receptor, Gpr109a, were prone to inflammation and cancer of the colon, said Dr. Nagendra Singh, MCG immunologist, member of the Cancer Immunology, Inflammation and Tolerance Program at the GRU Cancer Center, and a corresponding study author.
And, when they gave niacin to mice whose healthy colonic bacteria had been wiped out by antibiotics – a frequent occurrence in chronic antibiotic use – it helped steer immune cells in the colon into a safe, anti-inflammatory mode.
Good bacteria in the colon thrive on fiber and its digestion produces butyrate, a short-chain fatty acid, which Ganapathy discovered years before naturally activates Gpr109a. However this relationship appears limited to the colon, where butyrate levels can soar in the face of a high-fiber diet.
Research teams at GlaxoSmithKline and the University of Heidelberg, Germany showed in 2003 that Gpr109a receptors on the surface of fat cells mediate the protective cardiovascular effect of niacin, including increasing good cholesterol, or HDL, while decreasing levels of disease-producing LDL. Their search for other activators identified butyrate, which led Ganapathy to find that not only is the Gpr109a receptor expressed on the surface of colon cells, but that with sufficient fiber intake, butyrate levels in the colon can activate it.
Now, he and Singh have shown activation of Gpr109a in the colon by butyrate prompts immune cells, which are in ample supply in that region, to suppress rather than promote inflammation, a factor in a number of painful conditions such as ulcerative colitis, Crohn's disease, and colorectal cancer.
Once butyrate activates the Gpr109a receptor on dendritic cells and macrophages in the colon, these immune cells start producing anti-inflammatory molecules and sending messages to the T cells, key orchestrators of immunity, to do the same, Singh said. Butyrate also prompts epithelial cells that line the colon to produce cytokines, which aid wound-healing, a critical step for resolving the intestinal inflammation that occurs in ulcerative colitis and Crohn's.
"To protect your colon, you need this receptor, as well as the fiber and butyrate which activate it," Ganapathy said. For people who won't or can't eat high-fiber diets, mega-doses of niacin, may help protect the colon, the way it's already protecting hearts, the scientists suggest.
"We think mega-doses of niacin may be useful in the treatment and/or prevention of ulcerative colitis, Crohn's disease, and colorectal cancer as well as familial adenomatous polyposis, or FAP, a genetic condition that causes polyps to develop throughout the gastrointestinal tract," Singh said. In fact, they've already shown that fiber depletion increases and mega-niacin doses decrease development of polyps in mice with FAP.
The colon and intestines are constantly exposed to foreign bacteria that enter the body primarily through the mouth. The good bacteria, which are essential to digestion and colon health, regularly communicate to immune cells that they are not the enemy and butyrate appears to be a key signal there as well, said Ganapathy, who also leads the Signaling and Angiogenesis Program at the GRU Cancer Center.
Next steps include pursuing clinical trials of niacin supplements in colon health and, potentially, epidemiological studies that examine intestinal inflammation and colon cancer rates in patients already taking niacin for cardiovascular health. The research was funded by the National Institutes of Health.
Tuesday, January 14, 2014
High concentrations of serum long-chain omega-3 fatty acids may help reduce the risk of type 2 diabetes, according to a University of Eastern Finland study published recently in Diabetes Care. The sources of these fatty acids are fish and fish oils.
Type 2 diabetes is becoming increasingly widespread throughout the world, including Finland. Overweight is the most significant risk factor, which means that diet and other lifestyle factors play important roles in the development of type 2 diabetes. Earlier research has established that weight management, exercise and high serum linoleic acid concentrations, among other things, are associated with reduced risk of diabetes. However, findings on how fish consumption or long-chain omega-3 fatty acids affect the risk of diabetes have been highly contradictory. A protective link has mainly been observed in Asian populations, whereas a similar link has not been observed in European or US studies – and some studies have even linked a high consumption of fish to increased diabetes risk.
Ongoing at the University of Eastern Finland, the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) determined the serum omega-3 fatty acid concentrations of 2,212 men between 42 and 60 years of age at the onset of the study, in 1984–1989.
During a follow-up of 19.3 years, 422 men were diagnosed with type 2 diabetes.
Serum long-chain omega-3 fatty acid concentrations were used to divide the subjects into four categories. The risk of men in the highest serum omega-3 fatty acid concentration quarter to develop type 2 diabetes was 33% lower than the risk of men in the lowest quarter.
The study sheds new light on the association between fish consumption and the risk of type 2 diabetes. A well-balanced diet should include at least two fish meals per week, preferably fatty fish. Fish rich in long-chain omega-3 fatty acids include salmon, rainbow trout, vendace, bream, herring, anchovy, sardine and mackerel, whereas for example saithe and Atlantic cod are not so good alternatives. Weight management, increased exercise and a well-rounded diet built around dietary recommendations constitute the cornerstones of diabetes prevention.
Monday, January 13, 2014
The Self-Administered Gerocognitive Examination (SAGE test), which takes less than 15 minutes to complete, is a reliable tool for evaluating cognitive abilities. Findings by researchers at The Ohio State University Wexner Medical Center confirming the feasibility and efficiency of the tool for community screening large numbers of people are published in the January issue of The Journal of Neuropsychiatry and Clinical Neurosciences.
Memory disorders researchers visited 45 community events where they asked people to take a simple, self-administered test to screen for early cognitive loss or dementia. Of the 1047 people who took the simple pen-and-paper test, 28 percent were identified with cognitive impairment, said Dr. Douglas Scharre, who developed the test with his team at Ohio State.
The SAGE test can also be taken at home by patients, who can then share the results with their physicians to help spot early symptoms of cognitive issues such as early dementia or Alzheimer's disease, said Scharre, who is director of the Division of Cognitive Neurology and heads the Memory Disorders Research Center at Ohio State's Wexner Medical Center. Often physicians may not recognize subtle cognitive deficits during routine office visits, he said.
"What we found was that this SAGE self-administered test correlated very well with detailed cognitive testing," Scharre said. "If we catch this cognitive change really early, then we can start potential treatments much earlier than without having this test."
While the test does not diagnose problems like Alzheimer's, it does allow doctors to get a baseline of cognitive function in their patients, so they can follow them for these problems over time. "We can give them the test periodically and, the moment we notice any changes in their cognitive abilities, we can intervene much more rapidly," Scharre said.
The SAGE test could also provide health care providers and caregivers an earlier indication of life-changing events that could lie ahead. Earlier research by Scharre found that four out of five people (80 percent) with mild thinking and memory (cognitive) issues will be detected by this test, and 95 percent of people without issues will have normal SAGE scores.
In this study, researchers found that SAGE's self-administered feature, pen-and-paper format, and four equivalent interchangeable forms allows it to be given in almost any setting, doesn't require any staff time to administer or to set up a computer, and makes it practical to rapidly screen large numbers of individuals in the community at the same time.
Study participants were ages 50 or older who had been recruited from a wide variety of community locations and events, including senior centers, health fairs, educational talks to lay public, independent and assisted-living facilities, and free memory screens through newspaper advertisement. The study excluded individuals who indicated that they had taken SAGE previously.
Participants are tested on orientation (month + date + year); language (verbal fluency + picture naming); reasoning/computation (abstraction + calculation); visuospatial (three-dimensional construction + clock drawing); executive (problem solving) and memory abilities.
Participants were provided their score and written information about SAGE, and were advised to show it to their physician for interpretation and potential further screening or evaluation based on their health history. All were told that this test represented their baseline to be compared to future re-screening by their physician. Missing six or more points on the 22-point SAGE test usually warrants additional follow-up by the physician.
Scharre, who specializes in treating Alzheimer's disease, said treatments for Alzheimer's and dementia are more effective when started in the earliest stage of the disease. Unfortunately, patients with Alzheimer's disease often wait three to four years after their symptoms first appear to seek treatment.
Some 5 million Americans have Alzheimer's disease, and those numbers are expected to almost triple by 2050. An additional 3 percent to 22 percent of those over 60 years of age are thought to currently meet criteria for Mild Cognitive Impairment as well, Scharre said.
"Hopefully, this test will help change those situations," Scharre said. "We are finding better treatments, and we know that patients do much better if they start the treatments sooner than later."
Training to improve cognitive abilities in older people lasted to some degree 10 years after the training program was completed, according to results of a randomized clinical trial supported by the National Institutes of Health.
The findings showed training gains for aspects of cognition involved in the ability to think and learn, but researchers said memory training did not have an effect after 10 years.
The report, from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, appears in the January 2014 issue of the Journal of the American Geriatrics Society. The project was funded by the National Institute on Aging (NIA) and the National Institute of Nursing Research (NINR), components of the NIH.
“Previous data from this clinical trial demonstrated that the effects of the training lasted for five years,” said NIA Director Richard J. Hodes, M.D. “Now, these longer term results indicate that particular types of cognitive training can provide a lasting benefit a decade later. They suggest that we should continue to pursue cognitive training as an intervention that might help maintain the mental abilities of older people so that they may remain independent and in the community.”
“ACTIVE is an important example of intervention research aimed at enabling older people to maintain their cognitive abilities as they age,” said NINR Director Patricia Grady, Ph.D. “The average age of the individuals who have been followed over the last 10 years is now 82. Given our nation’s aging population, this type of research is an increasingly high priority.”
The original 2,832 volunteers for the ACTIVE study were divided into three training groups — memory, reasoning and speed-of-processing — and a control group. The training groups participated in 10 60- to 70-minute sessions over five to six weeks, with some randomly selected for later booster sessions. The study measured effects for each specific cognitive ability trained immediately following the sessions and at one, two, three, five and 10 years after the training.
The investigators were also interested in whether the training had an effect on the participants’ abilities to undertake some everyday and complex tasks of daily living. They assessed these using standardized measures of time and efficiency in performing daily activities, as well as asking the participants to report on their ability to carry out everyday tasks ranging from preparing meals, housework, finances, health care, using the telephone, shopping, travel and needing assistance in dressing, personal hygiene and bathing.
At the end of the trial, all groups showed declines from their baseline tests in memory, reasoning and speed of processing. However, the participants who had training in reasoning and speed of processing experienced less decline than those in the memory and control groups. Results of the cognitive tests after 10 years show that 73.6 percent of reasoning-trained participants were still performing reasoning tasks above their pre-trial baseline level compared to 61.7 percent of control participants, who received no training and were only benefiting from practice on the test. This same pattern was seen in speed training: 70.7 percent of speed-trained participants were performing at or above their baseline level compared to 48.8 percent of controls. There was no difference in memory performance between the memory group and the control group after 10 years.
Participants in all training groups said they had less difficulty performing the everyday tasks compared with those in the control group. However, standard tests of function conducted by the researchers showed no difference in functional abilities among the groups.
“The speed-of-processing results are very encouraging,” said Jonathan W. King, Ph.D., program director for cognitive aging in the Division of Behavioral and Social Research at NIA and co-author. “The self-reported improvements in daily function are interesting, but we do not yet know whether they would truly allow older people to live independently longer; if they did, even a small effect would be important, not only for the older adults, but also for family members and others providing care.”
The ACTIVE study followed healthy, community-dwelling older adults from six cities — Baltimore; Birmingham, Ala.; Boston; Detroit; State College, Pa.; and Indianapolis. The participants averaged 74 years of age at the beginning of the study and 14 years of education, 76 percent were female, 74 percent were white and 26 percent were African-American. The 10-year follow-up was conducted with 44 percent of the original sample between April 1998 and October 2010.
The consumption of caffeine is the energy boost of choice for millions to wake up or stay up. Now, however, researchers at the Johns Hopkins University have found another use for the stimulant: memory enhancer.
Michael Yassa, assistant professor of psychological and brain sciences in the Krieger School of Arts and Sciences at Johns Hopkins, and his team of scientists found that caffeine has a positive effect on long-term memory in humans. Their research, published by the journal Nature Neuroscience, shows that caffeine enhances certain memories at least up to 24 hours after it is consumed.
"We've always known that caffeine has cognitive-enhancing effects, but its particular effects on strengthening memories and making them resistant to forgetting has never been examined in detail in humans," said Yassa, senior author of the paper. "We report for the first time a specific effect of caffeine on reducing forgetting over 24 hours."
The Johns Hopkins researchers conducted a double-blind trial; which participants who did not regularly eat or drink caffeinated products received either a placebo or a 200-milligram caffeine tablet five minutes after studying a series of images. Salivary samples were taken from the participants before they took the tablets to measure their caffeine levels. Samples were taken again one, three and 24 hours afterwards.
The next day, both groups were tested on their ability to recognize images from the previous day's study session. On the test, some of the visuals were the same as from the day before, some were new additions and some were similar but not the same as the items previously viewed. More members of the caffeine group were able to correctly identify the new images as "similar" to previously viewed images versus erroneously citing them as the same.
The brain's ability to recognize the difference between two similar but not identical items, called pattern separation, reflects a deeper level of memory retention, the researchers said.
"If we used a standard recognition memory task without these tricky similar items, we would have found no effect of caffeine," Yassa said. "However, using these items requires the brain to make a more difficult discrimination -- what we call pattern separation, which seems to be the process that is enhanced by caffeine in our case."
The memory center in the human brain is the hippocampus, a seahorse-shaped area in the medial temporal lobe of the brain. The hippocampus is the switchbox for all short-term and long-term memories. Most research done on memory -- the effects of concussions in athletics to war-related head injuries to dementia in the aging population -- are focused on this area of the brain.
Until now, caffeine's effects on long-term memory had not been examined in detail. Of the few studies done, the general consensus was that caffeine has little or no effect on long-term memory retention.
The research is different from prior experiments because the subjects took the caffeine tablets only after they had viewed and attempted to memorize the images.
"Almost all prior studies administered caffeine before the study session, so if there is an enhancement, it's not clear if it's due to caffeine's effects on attention, vigilance, focus or other factors. By administering caffeine after the experiment, we rule out all of these effects and make sure that if there is an enhancement, it's due to memory and nothing else," said Yassa.
According to the U.S. Food and Drug Administration, 90 percent of people worldwide consume caffeine in one form or another. In the United States, 80 percent of adults consume caffeine every day. The average adult has an intake of about 200 milligrams -- the same amount used in the Yassa study -- or roughly one strong cup of coffee or two small cups of coffee per day.
Yassa's team completed the research at Johns Hopkins before his lab moved to the University of California-Irvine at the start of this year.
"The next step for us is to figure out the brain mechanisms underlying this enhancement," he said. "We can use brain-imaging techniques to address these questions. We also know that caffeine is associated with healthy longevity and may have some protective effects from cognitive decline like Alzheimer's disease. These are certainly important questions for the future."
Thursday, January 9, 2014
Researchers dispel the myth that coffee consumption can cause dehydration
New research(1), published today in the PLOS ONE, has found no evidence for a link between moderate coffee consumption and dehydration. The research, conducted by researchers at the University of Birmingham School of Sport and Exercise Sciences, UK, found that drinking moderate amounts of coffee does not result in dehydration and contributes to daily fluid requirements in regular coffee drinkers just as other fluids do.
Due to early research showing the acute effects of caffeine as a mild diuretic, there appears to be a common assumption that caffeinated beverages, such as coffee also have this effect(2). However, the effect of coffee consumption on fluid balance cannot be directly compared with that of pure caffeine. Interestingly, prior to publication of this new study only two studies had specifically investigated the effects of caffeine in the form of coffee on hydration status(3,4) with mixed and inconclusive results.
This is the first study to directly assess the effects of a moderate consumption of coffee compared to equal volumes of water. Sophie Killer a Doctoral researcher and lead author of the study commented: "Despite a lack of scientific evidence, it is a common belief that coffee consumption can lead to dehydration and should be avoided, or reduced, in order to maintain a healthy fluid balance. Our research aimed to establish if regular coffee consumption, under normal living conditions, is detrimental to the drinker's hydration status."
In a sample of regular coffee drinkers, Killer and colleagues measured the effects of moderate consumption of black coffee compared to the consumption of equal volumes of water on fluid balance and hydration status. Fifty male participants were tested in two phases, where they were required to drink four mugs (200ml) of either black coffee or water per day for three days. In the second phase, those who had initially drunk coffee switched to water and vice versa. The two phases were separated by a ten day 'wash out' period. Females were excluded from the trial to control against possible fluctuations in fluid balance resulting from menstrual cycles.
To assess hydration status, the researchers used a variety of well-established hydration measures including body mass and total body water, as well as blood and urine analyses. The researchers found no significant differences in total body water or any of the blood measures of hydration status between those who drank coffee and those who drank water. Furthermore, no differences in 24-hour urine volume or urine concentration were observed between the two groups.
"We found that consumption of a moderate intake of coffee, four cups per day, in regular coffee drinking males, caused no significant differences across a wide range of hydration indicators compared to the consumption of equal amounts of water," said Sophie Killer. "We conclude that advice provided in the public health domain, regarding coffee and dehydration, should be updated to reflect these findings."