Saturday, July 22, 2017

Some dangers of antidepressants and certain antibiotics during pregnancy



Children exposed to antidepressants during pregnancy seem to be at a slightly higher risk of autism than children of mothers with psychiatric disorders who were not treated with antidepressants during pregnancy, finds a study published in The BMJ, although the absolute risk of autism was small.

 A new study published in the British Journal of Clinical Pharmacology has found links between certain antibiotics during pregnancy and major congenital malformations in newborns. Clindamycin, doxycycline, quinolones, macrolides, and phenoxymethylpenicillin were linked to organ-specific malformations, although the absolute risks for birth defects were small. Amoxicillin, cephalosporins, and nitrofurantoin were not associated with birth defects.


Friday, July 21, 2017

Gaining a few pounds may increase long-term heart failure risk


Gaining even a little weight over time may alter the structure and function of heart muscle, affecting long-term risk of heart failure, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

Researchers followed 1,262 adults (average age 44, 57 percent women, 44 percent black, 36 percent obese) who were free from heart disease and other conditions that put them at high risk for heart disease for seven years. Participants had MRIs scans of their hearts and multiple body fat measurements at the start of the study and then seven years later.

Researchers found those who gained weight:

  • even as little as 5 percent, were more likely to have thickening and enlargement of the left ventricle, well-established indicators of future heart failure;
  • were more likely to exhibit subtle decreases in their hearts' pumping ability; and
  • were more likely to exhibit changes in heart muscle appearance and function that persisted even after the researchers eliminated other factors that could affect heart muscle performance and appearance, including high blood pressure, diabetes, smoking and alcohol use.
Conversely, people who lost weight were more likely to exhibit decreases in heart muscle thickness.

Notably, how much a person weighed at the beginning of the study didn't impact the changes, suggesting that even those of normal weight could experience adverse heart effects if they gain weight over time, researchers said.

"Any weight gain may lead to detrimental changes in the heart above and beyond the effects of baseline weight so that prevention should focus on weight loss or if meaningful weight loss cannot be achieved - the focus should be on weight stability," said Ian Neeland, M.D., study senior author and a cardiologist and assistant professor of medicine at University of Texas Southwestern Medical Center in Dallas, Texas. "Counseling to maintain weight stability, even in the absence of weight loss, may be an important preventive strategy among high-risk individuals."

The researchers caution that their study was relatively small and their findings do not mean that every person with weight gain will necessarily develop heart failure. The results do suggest that changes in weight may affect heart muscle in ways that can change the organ's function.

Healthy eating and exercise in pregnancy limits weight gain and lowers odds of caesarean


Encouraging healthy eating and physical activity during pregnancy limits excess weight gain and lowers the odds of having a caesarean section, finds a study published by The BMJ today.

The benefits are consistent, regardless of a woman's age, ethnicity, body mass index (BMI) and underlying medical conditions, suggesting that all women should be given advice on diet and lifestyle as part of routine antenatal care.

Both maternal obesity and excessive weight gain in pregnancy (gestational weight gain) put mother and infant at risk, both in pregnancy and in later life, with considerable costs to the health service and society.

Interventions based on diet or physical activity, or both, in pregnancy minimise gestational weight gain, and therefore may have a role in preventing adverse pregnancy outcomes.

So researchers from the International Weight Management in Pregnancy (i-WIP) Collaborative Group set out to assess the effects of diet and physical activity based interventions in pregnancy on weight gain and outcomes such as caesarean section, stillbirth and admission to a newborn intensive care unit.

Interventions included access to a dietician, specific antenatal classes for advice on diet and lifestyle, or structured exercise of moderate intensity (eg, aerobic classes or stationary cycling).

The research team analysed individual participant data from 36 randomised trials involving over 12,500 women, grouped according to age, pregnancy history, ethnicity, body mass index (BMI), and underlying medical conditions. Overall, the trials had a low risk of bias.

Diet and physical activity based interventions consistently reduced gestational weight gain, regardless of age, pregnancy history, ethnicity, BMI, and existing medical conditions, and remained when studies at high risk of bias were excluded.

Interventions also lowered the odds of caesarean section, but had no effect on offspring outcomes, such as stillbirth or admission to an intensive care unit.

When they included additional study-level data, they found additional benefit for gestational diabetes.

The authors outline some study limitations, including the fact that participants were mostly white and of medium to high education status, a factor favouring compliance with interventions. Nevertheless, they say their analysis "confirms that diet and physical activity based interventions in pregnancy reduce gestational weight gain."

And they say discussions about diet and physical activity in pregnancy, which are delivered as part of antenatal care, "should incorporate specific estimates of benefit for caesarean section and gestational weight gain, and the likelihood of preventing gestational diabetes."

Importantly, such interventions in pregnancy "could be considered in global efforts to reduce caesarean section in relevant populations," they conclude.

A linked editorial says this study provides reassuring information for women and healthcare practitioners that lifestyle interventions are safe in pregnancy, and help control weight gain.


1 in 3 cases of dementia preventable, nonmedical therapies ideal for dementia



Managing lifestyle factors such as hearing loss, smoking, hypertension and depression could prevent one-third of the world's dementia cases, according to a report by the first Lancet Commission on Dementia Prevention and Care. Presented at the Alzheimer's Association International Conference (AAIC) 2017 and published in The Lancet, the report also highlights the beneficial effects of nonpharmacologic interventions such as social contact and exercise for people with dementia.

"There's been a great deal of focus on developing medicines to prevent dementia, including Alzheimer's disease," says commission member and AAIC presenter Lon Schneider, MD, professor of psychiatry and the behavioral sciences at the Keck School of Medicine of USC. "But we can't lose sight of the real major advances we've already made in treating dementia, including preventive approaches."

The commission brought together 24 international experts to systematically review existing research and provide evidence-based recommendations for treating and preventing dementia. About 47 million people have dementia worldwide and that number is expected to climb as high as 66 million by 2030 and 115 million by 2050.

Reducing dementia risk, beginning in childhood

The commission's report identifies nine risk factors in early, mid- and late life that increase the likelihood of developing dementia. About 35 percent of dementia -- one in three cases -- is attributable to these risk factors, the report says.

By increasing education in early life and addressing hearing loss, hypertension and obesity in midlife, the incidence of dementia could be reduced by as much as 20 percent, combined.

In late life, stopping smoking, treating depression, increasing physical activity, increasing social contact and managing diabetes could reduce the incidence of dementia by another 15 percent.

"The potential magnitude of the effect on dementia of reducing these risk factors is larger than we could ever imagine the effect that current, experimental medications could have," Schneider says. "Mitigating risk factors provides us a powerful way to reduce the global burden of dementia."

A nonpharmacologic approach to treating dementia

The commission also examined the effect of nonpharmacologic interventions for people with dementia and concluded that they had an important role in treatment, especially when trying to address agitation and aggression.

"Antipsychotic drugs are commonly used to treat agitation and aggression, but there is substantial concern about these drugs because of an increased risk of death, cardiovascular adverse events and infections, not to mention excessive sedation," Schneider says.

The evidence showed that psychological, social and environmental interventions such as social contact and activities were superior to antipsychotic medications for treating dementia-related agitation and aggression.

The commission also found that nonpharmacologic interventions like group cognitive stimulation therapy and exercise conferred some benefit in cognition as well.

The commission's full report provides detailed recommendations in the areas of prevention, treating cognitive symptoms, individualizing dementia care, caring for caregivers, planning for the future following a dementia diagnosis, managing neuropsychiatric symptoms and considering the end of life.

Why sugary drinks and protein-rich meals don't go well together


Having a sugar-sweetened drink with a high-protein meal may negatively affect energy balance, alter food preferences and cause the body to store more fat, according to a study published in the open access journal BMC Nutrition.

Dr Shanon Casperson, lead author of the study from USDA-Agricultural Research Service Grand Forks Human Nutrition Research Center, USA said: "We found that about a third of the additional calories provided by the sugar-sweetened drinks were not expended, fat metabolism was reduced, and it took less energy to metabolize the meals. This decreased metabolic efficiency may 'prime' the body to store more fat."

The researchers found that the inclusion of a sugar-sweetened drink decreased fat oxidation, which kick-starts the breakdown of fat molecules, after a meal by 8%. If a sugar-sweetened drink was consumed with a 15% protein meal, fat oxidation decreased by 7.2g on average. If a sugar-sweetened drink was consumed with a 30% protein meal, fat oxidation decreased by 12.6g on average. While having a sugar-sweetened drink increased the amount of energy used to metabolise the meal, the increased expenditure did not even out the consumption of additional calories from the drink.

Dr. Casperson said: "We were surprised by the impact that the sugar-sweetened drinks had on metabolism when they were paired with higher-protein meals. This combination also increased study subjects' desire to eat savory and salty foods for four hours after eating."

The researchers recruited 27 healthy-weight adults (13 male, 14 female), who were on average 23 years old. Participants made two 24-hour study visits, receiving two 15% protein meals (breakfast and lunch) after an overnight fast on one visit and two 30% protein meals after an overnight fast on the other visit. The increase in protein was counterbalanced by a decrease in carbohydrates. All meals were composed of the same foods and they provided 17g of fat and 500 kcals. Participants consumed a sugar-sweetened drink with one of the meals and a non-sugar sweetened drink with the other meal.

The researchers used a room calorimeter, a 25m3 furnished chamber that measures movement, oxygen, carbon dioxide, temperature and pressure, to assess how dietary changes affected energy expenditure and the way nutrients were processed by the body. By having study participants stay in a room calorimeter, researchers can determine how many grams of carbohydrate, protein and fat they are using and how many calories they are burning every minute. Study participants stayed inside the room for the duration of each study visit.

Dr. Casperson said: "Our findings suggest that having a sugar-sweetened drink with a meal impacts both sides of the energy balance equation. On the intake side, the additional energy from the drink did not make people feel more sated. On the expenditure side, the additional calories were not expended and fat oxidation was reduced. The results provide further insight into the potential role of sugar-sweetened drinks - the largest single source of sugar in the American diet - in weight gain and obesity."

Dietary changes were measured only for a short time and caution must be used when extrapolating the study data to dietary changes over longer periods of time. As this study was in healthy-weight adults only, the authors also caution that overweight individuals may respond differently to dietary changes.

Breakfast the largest meal = losing weight; dinner the largest: gaining weight


A study by researchers from Loma Linda University School of Public Health and the Czech Republic has found that timing and frequency of meals play a role in predicting weight loss or gain.

Using information gleaned from more than 50,000 participants in the Adventist Health Study-2 (AHS-2), the researchers discovered four factors associated with a decrease in body mass index: eating only one or two meals per day; maintaining an overnight fast of up to 18 hours; eating breakfast instead of skipping it; and making breakfast or lunch the largest meal of the day. Making breakfast the largest meal yielded a more significant decrease in BMI than did lunch.

The two factors associated with higher BMI were eating more than three meals per day --snacks were counted as extra meals -- and making supper the largest meal of the day.

As a practical weight-management strategy, Hana Kahleova, MD, PhD, recommends eating breakfast and lunch, skipping supper, avoiding snacks, making breakfast the largest meal of the day and fasting overnight for up to 18 hours. A postdoctoral research fellow at LLUSPH when the study was conducted, Kahleova is now director of clinical research for the Physicians Committee for Responsible Medicine in Washington, DC, and is currently on sabbatical from the Institute for Clinical and Experimental Medicine in Prague, Czech Republic, as a postdoctoral research fellow and diabetes consultant physician.

Kahleova says the findings confirm an ancient nutritional maxim: "Eat breakfast like a king, lunch like a prince, and dinner like a pauper."

Titled "Meal frequency and timing are associated with Body Mass Index in the Adventist Health Study-2," the study was co-written by Gary Fraser, MBChB, PhD, a professor at LLU Schools of Medicine and Public Health, and director of AHS-2. It was published as an online advance on July 12 and will appear in the Sept. 2017 edition of the Journal of Nutrition.

Fraser said that irrespective of meal pattern, there was, on average, an increase in weight gain year by year until participants reached the age of 60. After age 60, most participants experienced a weight loss each year.

"Before age 60 years, those eating calories earlier in the day had less weight gain," Fraser said, adding that after age 60, the same behavior tended to produce a larger rate of weight loss than average. "Over decades, the total effect would be very important."

The team employed a technique called linear regression analysis and adjusted their findings to exclude demographic and lifestyle factors that might skew the results.


Perceiving oneself as less physically active than peers is linked to a shorter lifespan


Would you say that you are physically more active, less active, or about equally active as other people your age?

Your answer might be linked to your risk of premature death decades from now - no matter how physically active you actually are, according to research by Stanford scholars Octavia Zahrt and Alia Crum.

The research, appearing July 20 in Health Psychology, finds that people who think they are less active than others in a similar age bracket die younger than those who believe they are more active -- even if their actual activity levels are similar.

"Our findings fall in line with a growing body of research suggesting that our mindsets -- in this case, beliefs about how much exercise we are getting relative to others -- can play a crucial role in our health," Crum said.

Powerful effects of perception

Crum, an assistant professor of psychology, and Zahrt, a doctoral candidate at the Graduate School of Business, analyzed surveys from more than 60,000 U.S. adults from three national data sets. The surveys documented participants' levels of physical activity, health and personal background, among other measures. In one of the samples, participants wore an accelerometer to measure their activity over a week.

Zahrt and Crum were interested in one question in particular: "Would you say that you are physically more active, less active, or about as active as other persons your age?"

The researchers then viewed death records from 2011, which was 21 years after the first survey was conducted. Controlling for physical activity and using statistical models that accounted for age, body mass index, chronic illnesses and other factors, they found that individuals who believed that they were less active than others were up to 71 percent more likely to die in the follow-up period than individuals who believed that they were more active than their peers.

Fit on the Farm?

Much of the study's inspiration derived from Zahrt's experience when she arrived at Stanford. Zahrt, a native of Germany who previously studied in France and England, had stayed in shape by biking to school and making occasional trips to the gym.

But at Stanford, Zahrt said it seemed that "everyone was incredibly active" and perhaps she wasn't exercising as much as she should.

"Suddenly, I felt like I had done something wrong all these years," Zahrt said. "I felt unhealthy and I was stressed about fitting more exercise into my busy schedule. I really had a negative mindset."

While taking a health psychology class taught by Crum, Zahrt learned more about the effects of mindsets on health outcomes. For example, Crum's prior research shows that the health benefits people get out of everyday activities depend in part on their mindsets -- that is, whether or not they believe that they are getting good exercise. In her 2007 study, Crum made a group of hotel room attendants aware that the activity they got at work met recommended levels of physical activity. Through this shift in mindsets, the workers, many of whom had previously perceived themselves as inactive, experienced reductions in weight, body fat and blood pressure, among other positive outcomes. Zahrt wondered if many people, like her, had negative mindsets about their physical activity levels because of social comparison with more active peers, and if this might be harming their health. Her class paper on this topic sparked the collaboration leading to the published study.

How mindsets influence us

Zahrt and Crum offer possible explanations for mindsets and perceptions having such powerful effects on health. One is that perceptions can affect motivation, both positively and negatively. Those who are made aware of their healthy activity levels -- like the hotel room attendants in Crum's 2007 study -- can build on them and exercise more. Those who deem themselves unfit are more likely to remain inactive, fueling feelings of fear, stress or depression that negatively affect their health.

The researchers also cite the established influence of placebo effects, where patients who think they are getting a treatment experience physiological changes without receiving actual treatment. In the same way, people who believe they are getting good exercise may experience more physiological benefits from their exercise than those who believe they aren't getting enough exercise.

"Placebo effects are very robust in medicine. It is only logical to expect that they would play a role in shaping the benefits of behavioral health as well," Crum said.

The researchers emphasize that the study is correlational in nature and thus does not prove that perceptions of inactivity cause earlier death. However, other experimental research -- such as Crum's 2007 study - does suggest a causal nature to the link between perceived amounts of exercise and health outcomes.

Taking mindsets seriously

"So much effort, notably in public health campaigns, is geared toward motivating people to change their behavior: eat healthier, exercise more and stress less," Crum said. "But an important variable is being left out of the equation: people's mindsets about those healthy behaviors."

In fact, a growing volume of research from Crum and other labs shows that perceptions and mindsets predict health and longevity, for example, in the domains of stress, diet and obesity.

That our mindsets could have such potent effects on our physiology may seem provocative and unlikely at first glance, but Crum reminds us that we shouldn't be surprised by these results considering the "everyday experiences where our beliefs or a simple thought have very palpable and physiological effects."

"In the case of stress, a thought about something going wrong can make us sweat or [become] shaky or increase our heart rate," Crum continued. "With sexual arousal, a simple thought or idea can have immediate physical effects. We experience these things regularly, and yet we're not cataloguing them as something that matters. For whatever reason -- dualism or a prioritization of the material -- we tend to ignore the fact that our thoughts, mindsets and expectations are shaping our everyday physiology."

How can people use this finding? Many Americans think that vigorous exercise in a gym is the only way to attain a proper activity level, according to Zahrt and Crum. But being mindful of and feeling good about activities you do every day - like taking the stairs, walking or biking to work, or cleaning the house -- could be an easy first step for everyone to benefit their health.

"It's time that we start taking the role of mindsets in health more seriously," Crum said. "In the pursuit of health and longevity, it is important to adopt not only healthy behaviors, but also healthy thoughts."


Study finds day-to-day experiences affect awareness of aging, mood


A study of older adults finds an individual's awareness of aging is not as static as previously thought, and that day-to-day experiences and one's attitude toward aging can affect an individual's awareness of age-related change (AARC) - and how that awareness affects one's mood.

"People tend to have an overall attitude toward aging, good or bad, but we wanted to know whether their awareness of their own aging - or AARC - fluctuated over time in response to their everyday experiences," says Shevaun Neupert, an associate professor of psychology at North Carolina State University and lead author of a paper on the study.

For the study, researchers enrolled 116 participants between the ages of 60 and 90. Each participant took a survey to establish baseline attitudes toward aging. For the following eight days, participants kept a log of daily stressors (such as having an argument), completed a daily evaluation of age-related experiences (such as "I am becoming wiser" or "I am more slow in my thinking"), and reported on their affect, or mood.

"We found that people's AARC, as reflected in their daily evaluations, varied significantly from day to day," says Jennifer Bellingtier, a recent Ph.D. graduate from NC State and co-author of the paper. "We also found that people whose baseline attitudes toward aging were positive also tended to report more positive affect, or better moods."

"People with positive attitudes toward aging were also less likely to report 'losses,' or negative experiences, in their daily aging evaluations," Neupert says.

"However, when people with positive attitudes did report losses, it had a much more significant impact on their affect that day," Neupert says. "In other words, negative aging experiences had a bigger adverse impact on mood for people who normally had a positive attitude about aging."

The study expands on previous work that found having a positive attitude about aging makes older adults more resilient when faced with stressful situations.

The paper, "Aging Attitudes and Daily Awareness of Age-Related Change Interact to Predict Negative Affect," is published in the journal The Gerontologist.


A healthy lifestyle increases life expectancy by up to 7 years


People who do not smoke, are not obese, and consume alcohol moderately can expect to live seven years longer than the general population, and to spend most of these extra years in good health, according to a new study published today in Health Affairs.

A new study published today in Health Affairs shows that people who refrain from engaging in risky health behaviours not only have a very long life -- longer than the famously long-lived Japanese - but that most of these additional years of life are spent in good health.

The study, which analyzed data for more than 14,000 U.S. individuals, found that never-smokers who were not obese lived 4-5 years longer than the general population, and that these extra years were free of disability. The results of the analysis further indicated that individuals who also consumed alcohol moderately lived seven more disability-free years than the general population, and had a total life expectancy surpassing that of the population of Japan, a country that is often considered to be a vanguard of life expectancy. The study was conducted by Mikko Myrskylä, Director of the Max Planck Institute for Demographic Research, Germany; and Neil Mehta, Professor of Health Management and Policy at the University of Michigan, USA.

Several behaviours have a cumulative impact

"Improvements in medical technology are often thought to be the gatekeeper to healthier, longer life. We showed that a healthy lifestyle, which costs nothing, is enough to enable individuals to enjoy a very long and healthy life," said Mikko Myrskylä.

He added: "A moderately healthy lifestyle is enough to get the benefits. Avoiding becoming obese, not smoking, and consuming alcohol moderately is not an unrealistic goal."

This study was the first to analyze the cumulative impact of several key health behaviours on disability-free and total life expectancy. Previous studies have looked at single health behaviours. Mikko Myrskylä and his colleague instead examined several behaviors simultaneously, which allowed them to determine how long and healthy the lives of people who had avoided most of the well-known individual behavioral risk factors were.

Smoking and obesity affect health when aging

The researchers noted that each of the three unhealthy behaviours - obesity, smoking, and unhealthy consumption of alcohol - was linked to a reduction in life expectancy and to an earlier occurrence of disabilities.

But there were also differences: smoking was found to be associated with an early death but not with an increase in the number of years with disability, whereas obesity was shown to be associated with a long period of time with disability. Excessive alcohol consumption was found to be associated with both decreased lifespan and a reduced number of healthy years. However, the absence of all of these risky healthy behaviors was found to be associated with the greatest number of healthy years.

The most striking finding was the discovery of a large difference in average lifespan between the groups who were the most and the least at risk. Men who were not overweight, had never smoked, and drank moderately were found to live an average of 11 years longer than men who were overweight, had smoked, and drank excessively. For women, the gap between these two groups was found to be even greater, at 12 years.

"The most positive result is that the number of years that we have to live with physical limitations does not increase as we gain more years through healthy lifestyle. Instead, healthy lifestyle is associated with a strong increase in physically fit years. In other words, the years we gain through a healthy lifestyle are years in good health," said Mikko Myrskylä.

"Our results show how important it is to focus on prevention. Those who avoid risky health behaviours are achieving very long and healthy lives. Effective policy interventions targeting health behaviors could help larger fractions of the population to achieve the health benefits observed in this study," the researcher emphasized.

These results are important not only for individuals, but also for society. In an aging society, the health of the elderly determines the amount of money spent on the health system. In addition, healthy elderly people are better able to participate in the labor market and to perform social roles, such as caring for grandchildren.

The researchers used data from a long-term study conducted in the U.S., the Health and Retirement Study, which covered more than 14,000 individuals aged 50-89 over the 1998-2012 period. The participants were interviewed about their health and behaviors every two years. Those who reported having no limitations in the so-called activities of daily living (walking, dressing, bathing, getting out of bed, or eating) were classified as free of disability. The participants who had a body mass index of less than 30 were classified as not obese. Those who had smoked less than 100 cigarettes in their lifetime were considered never smokers. Men who had fewer than 14 drinks per week and women who had fewer than seven drinks per week were considered moderate drinkers.

The researchers analyzed the ages at which the individuals with these healthy behaviours first became disabled, how many years they lived with disability, and their total life expectancy. The researchers then compared these results with those of the general population, and with those of individuals with particularly risky behavioural profiles.


How physical exercise prevents dementia


Numerous studies have shown that physical exercise seems beneficial in the prevention of cognitive impairment and dementia in old age. Now researchers at Goethe University Frankfurt have explored in one of the first studies worldwide how exercise affects brain metabolism.

In order to further advance current state of knowledge on the positive influence of physical activity on the brain, gerontologists and sports physicians at Goethe University Frankfurt have examined the effects of regular exercise on brain metabolism and memory of 60 participants aged between 65 and 85 in a randomised controlled trial. Their conclusion: regular physical exercise not only enhances fitness but also has a positive impact on brain metabolism.

As the researchers report in the current issue of the medical journal Translational Psychiatry, they thoroughly examined all the participants in the SMART study (Sport and Metabolism in Older Persons, an MRT Study) by assessing movement-related parameters, cardiopulmonary fitness and cognitive performance. In addition, magnetic resonance tomography (MRT) and magnetic resonance spectroscopy (MRS) were used to measure brain metabolism and brain structure. Following this examination, the participants mounted an exercise bike three times a week over a period of 12 weeks. The 30-minute training sessions were individually adapted to each participant's performance level.

The participants were examined again after the end of the programme in order to document the effects of this physical activity on brain metabolism, cognitive performance and brain structure. The researchers also investigated to what extent exercise had led to an improvement in the participants' physical fitness. The study was conducted by the Gerontology Department of the Institute of General Medicine (headed by Professor Johannes Pantel) and the Department of Sports Medicine (led by Professor Winfried Banzer).

As expected, physical activity had influenced brain metabolism: it prevented an increase in choline. The concentration of this metabolite often rises as a result of the increased loss of nerve cells, which typically occurs in the case of Alzheimer's disease. Physical exercise led to stable cerebral choline concentrations in the training group, whereas choline levels increased in the control group. The participants' physical fitness also improved: they showed increased cardiac efficiency after the training period. Overall, these findings suggest that physical exercise not only improves physical fitness but also protects cells.

Tuesday, July 18, 2017

Grapefruit Juice and Some Drugs Don't Mix



Grapefruit juice and the actual grapefruit can be part of a healthy diet. Grapefruit has vitamin C and potassium—nutrients your body needs to work properly.

But it isn’t good for you when it affects the way your medicines work, especially if you have high blood pressure or arrhythmia (irregular or abnormal heart beat).

This food and drug interaction can be a concern, says Shiew Mei Huang, PhD, of the U.S. Food and Drug Administration. The FDA has required that some prescription and over-the-counter (OTC) drugs taken by mouth include warnings against drinking grapefruit juice or eating grapefruit while taking the drug, Huang says.

Here are examples of some types of drugs that grapefruit juice can cause problems with (interact):
  • Some statin drugs to lower cholesterol, such as Zocor (simvastatin) and Lipitor (atorvastatin).
  • Some drugs that treat high blood pressure, such as Procardia and Adalat CC (both nifedipine).
  • Some organ-transplant rejection drugs, such as Sandimmune and Neoral (both cyclosporine).
  • Some anti-anxiety drugs, such as buspirone.
  • Some corticosteroids that treat Crohn’s disease or ulcerative colitis, such as Entocort EC and Uceris (both budesonide).
  • Some drugs that treat abnormal heart rhythms, such as Pacerone and Nexterone (both amiodarone).
  • Some antihistamines, such as Allegra (fexofenadine).
Grapefruit juice does not affect all the drugs in the categories above. The severity of the interaction can be different depending on the person, the drug, and the amount of grapefruit juice you drink. Talk to your doctor, pharmacist or other health care provider and read any information provided with your prescription or OTC drug to find out:
  • If your specific drug may be affected.
  • How much, if any, grapefruit juice you can have.
  • What other fruits or juices may also affect your drug in a similar way to grapefruit juice.
How Grapefruit Juice Can Interfere With Medications

With most drugs that interact with grapefruit juice, “the juice lets more of the drug enter the blood,” Huang says. “When there is too much drug in the blood, you may have more side effects.”
For example, if you drink a lot of grapefruit juice while taking certain statin drugs to lower cholesterol, too much of the drug may stay in your body, increasing your risk for liver and muscle damage that can lead to kidney failure.

Many drugs are broken down (metabolized) with the help of a vital enzyme called CYP3A4 in the small intestine. Grapefruit juice can block the action of CYP3A4, so instead of being metabolized, more of the drug enters the blood and stays in the body longer. The result: too much drug in your body.

The amount of the CYP3A4 enzyme in the intestine varies from person to person, says Huang. Some people have a lot of enzymes and others just a little. So grapefruit juice may affect people differently even when they take the same drug.

Although scientists have known for several decades that grapefruit juice can cause too much of certain drugs in the body, Huang says more recent studies have found that the juice has the opposite effect on a few other drugs.

“Grapefruit juice can cause less fexofenadine to enter the blood,” decreasing how well the drug works, Huang says. Fexofenadine (brand name Allegra) is available as both prescription and OTC to relieve symptoms of seasonal allergies. Fexofenadine may also not work as well if taken with orange or apple juice, so the drug label states “do not take with fruit juices.”

Why this opposite effect? Instead of changing metabolism, grapefruit juice can affect proteins in the body known as drug transporters, which help move a drug into our cells for absorption. As a result, less of the drug enters the blood and the drug may not work as well, Huang says.


Poor sleep = poor physical and mental health


More than a third of Americans don't get enough sleep, and growing evidence suggests it's not only taking a toll on their physical health through heart disease, diabetes, stroke, and/or other conditions, but hurting their mental health as well.

According to a recent study led by Postdoctoral FellowIvan Vargas, PhD, in the journal Cognitive Therapy and Research, those who are sleep deprived lose some of their ability to be positive-minded people. That may not sound serious, but medical experts say an inability to think positively is a serious symptom of depression that could be dangerous if left unaddressed. An estimated 16.1 million adults experienced a major depressive episode in 2014.

"In general, we have a tendency to notice positive stimuli in our environment," said Vargas. "We tend to focus on positive things more than anything else, but now we're seeing that sleep deprivation may reverse that bias."

In their study, Vargas and his team took 40 healthy adults, and randomized them to either 28 consecutive hours awake, or a full eight hours of sleep. All participants participated in a computer test measuring their accuracy and response time at identifying happy, sad and neutral faces to assess how they pay attention to positive or negative information.

The team found that those who were acutely sleep deprived were less likely to focus on the happy faces. They didn't necessarily focus more on the negative, but were less likely to focus on the positive. The study may have implications for those experiencing depression and/or anxiety.
There are many symptoms of depression -- including feeling sad and no longer being able to enjoy things you typically would, but poor sleep is associated with a particularly serious sign of the condition.

"Depression is typically characterized as the tendency to think and feel more negatively or sad, but more than that, depression is associated with feeling less positive, less able to feel happy," Vargas says, "Similarly, if you don't get enough sleep, it reduces your ability to attend to positive things, which over time may confer risk for depression."

Interestingly enough, in the present study, those with a history of insomnia symptoms were less sensitive to the effects of the sleep loss. The authors believe this might be because those with a history of insomnia symptoms have more experience being in sleep-deprived conditions and have developed coping methods to modulate the effect of sleep loss.

Vargas and colleagues recently presented a related study at SLEEP 2017, the 31st Annual Meeting of the Associated Professional Sleep Societies LLC, on the association of insomnia and suicide, finding that people who suffer from insomnia are three times more likely to report thoughts of suicide and death during the past 30 days than those without the condition.

The study comes amid a growing body of knowledge associating sleep disorders and depression. For example, ongoing research presented this year at SLEEP 2017 from a multi-center NIH-sponsored "Treatment of Insomnia and Depression" study (abstract 0335 here) suggests that cognitive-behavioral therapy for insomnia (CBT-I) may help achieve depression remission in those suffering from both depression and insomnia who sleep at least 7 hours each night. (A clinical practice guideline published in 2016 in Annals of Internal Medicine recommends CBT-I (not sleep medications) as the initial treatment for chronic insomnia.

Additionally, a new study in the journal Child Development furthers our understanding of the connection between late night cell phone use, mental health, and disrupted sleep, finding that using a cell phone at night can increase depression in teenagers and lower their self-esteem.
 
 
 

Long working hours increases the risk of developing atrial fibrillation



People who work long hours have an increased risk of developing an irregular heart rhythm known as atrial fibrillation, according to a study of nearly 85,500 men and women published in the European Heart Journal.
The study showed that, compared to people who worked a normal week of between 35-40 hours, those who worked 55 hours or more were approximately 40% more likely to develop atrial fibrillation during the following ten years. For every 1000 people in the study, an extra 5.2 cases of atrial fibrillation occurred among those working long hours during the ten-year follow-up.

Prof Kivimaki and colleagues from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium analysed data from 85,494 men and women from the UK, Denmark, Sweden and Finland who took part in one of eight studies in these countries. They assessed the participants' working hours when they joined the studies between 1991 and 2004. Working hours were classified as less than 35 hours a week, 35-40 hours, which was considered as the standard working hours of full-time workers, 41 to 48 hours, 49 to 54 hours, and 55 hours or more a week. None of the participants had atrial fibrillation at the start of the studies.

During the ten-year follow-up period, there were 1061 new cases of atrial fibrillation. This gave an incidence rate of 12.4 per 1000 people in the study, but among the 4,484 people working 55 hours or more, the incidence was 17.6 per 1000. "Those who worked long hours had a 1.4 times higher risk of developing atrial fibrillation, even after we had adjusted for factors that could affect the risk, such as age, sex, socioeconomic status, obesity, leisure time physical activity, smoking and risky alcohol use," said Prof Kivimaki.

"Nine out of ten of the atrial fibrillation cases occurred in people who were free of pre-existing or concurrent cardiovascular disease. This suggests the increased risk is likely to reflect the effect of long working hours rather than the effect of any pre-existing or concurrent cardiovascular disease, but further research is needed to understand the mechanisms involved.

"A 40% increased extra risk is an important hazard for people who already have a high overall risk of cardiovascular disease due to other risk factors such as older age, male sex, diabetes, high blood pressure, high cholesterol, overweight, smoking and physical inactivity, or living with an established cardiovascular disease. For a healthy, young person, with few if any of these risk factors, the absolute increased risk of atrial fibrillation associated with long working hours is small."

The study does have some limitations, including the fact that working hours were only assessed once at the beginning of the study and that the type of job (for instance, whether it involved working night shifts) was not recorded.

However, Prof Kivimaki said: "The great strength of our study was its size, with nearly 85,000 participants, which makes it large by the standard of any study in this field. Obviously, monitoring of working hours over several years would be more ideal than a one-off measurement at the start of the study. However, I do not think the results would have been dramatically different with repeat measurements of working hours because people tend to keep their working patterns. In the current absence of trials with atrial fibrillation as the primary outcome in the general population, findings from observational studies such as this are particularly important in offering insights into the lifestyle determinants of this condition."

In an accompanying editorial, Dr Bakhtawar Mahmoodi and Dr Lucas Boersma, of St Antonius Hospital, Nieuwegein, The Netherlands, write: "The authors should be congratulated for the impressive collaborative effort required to integrate patient level data from multiple studies to increase the power. However, despite the efforts of the authors to thoroughly assess the reported association between long working hours and atrial fibrillation, there are many inherent limitations of the data that preclude from definite conclusions on acknowledging long working hours as an independent risk factor for atrial fibrillation."

They highlight the long, ten-year follow-up time during which there was no updated information on working hours and other factors that Prof Kivimaki and colleagues took into account in their analyses and which could have changed over this time. The type of jobs (office versus construction work) and irregular working hours, including night shifts, were not explored in the analyses, and these could have an impact on the risk of atrial fibrillation too. However, they conclude that the study "addresses an important topic and expands the literature on the aetiology of atrial fibrillation."

Monday, July 17, 2017

Artificial sweeteners linked to risk of weight gain, heart disease and other health issues


Artificial sweeteners may be associated with long-term weight gain and increased risk of obesity, diabetes, high blood pressure and heart disease, according to a new study published in CMAJ (Canadian Medical Association Journal)

Consumption of artificial sweeteners, such as aspartame, sucralose and stevia, is widespread and increasing. Emerging data indicate that artificial, or nonnutritive, sweeteners may have negative effects on metabolism, gut bacteria and appetite, although the evidence is conflicting.

To better understand whether consuming artificial sweeteners is associated with negative long-term effects on weight and heart disease, researchers from the University of Manitoba's George & Fay Yee Centre for Healthcare Innovation conducted a systematic review of 37 studies that followed over 400 000 people for an average of 10 years. Only 7 of these studies were randomized controlled trials (the gold standard in clinical research), involving 1003 people followed for 6 months on average.

The trials did not show a consistent effect of artificial sweeteners on weight loss, and the longer observational studies showed a link between consumption of artificial sweeteners and relatively higher risks of weight gain and obesity, high blood pressure, diabetes, heart disease and other health issues.

"Despite the fact that millions of individuals routinely consume artificial sweeteners, relatively few patients have been included in clinical trials of these products," said author Dr. Ryan Zarychanski, Assistant Professor, Rady Faculty of Health Sciences, University of Manitoba. "We found that data from clinical trials do not clearly support the intended benefits of artificial sweeteners for weight management."

"Caution is warranted until the long-term health effects of artificial sweeteners are fully characterized," said lead author Dr. Meghan Azad, Assistant Professor, Rady Faculty of Health Sciences, University of Manitoba. Her team at the Children's Hospital Research Institute of Manitoba is undertaking a new study to understand how artificial sweetener consumption by pregnant women may influence weight gain, metabolism and gut bacteria in their infants.

"Given the widespread and increasing use of artificial sweeteners, and the current epidemic of obesity and related diseases, more research is needed to determine the long-term risks and benefits of these products," said Azad.

The study was conducted by researchers from the University of Manitoba's George & Fay Yee Centre for Healthcare Innovation and the Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba.


Plant-based diets with high intake of sweets, refined grains may increase heart disease risk


Plant-based diets are recommended to reduce the risk of heart disease; however, some plant-based diets are associated with a higher risk of heart disease, according to a study published today in the Journal of the American College of Cardiology.

In prior studies of the impact of a plant-based diet, there were several limitations. Plant-based diets were defined as "vegetarian" which consist of a variety of dietary patterns that exclude some or all animal foods. These studies treat all plant foods equally, even though certain plant foods like refined grains and sugar sweetened beverages are associated with a higher risk of cardio-metabolic disease.

To overcome these limitations, the researchers created three versions of a plant-based diet: an overall plant-based diet which emphasized the consumption of all plant food and reduced (but did not eliminate) animal food intake; a healthful plant-based diet that emphasized the intake of healthy plant foods such as whole grains, fruits and vegetables; and an unhealthful plant-based diet which emphasized consumption of less healthy plant foods such as refined grains.

Researchers used a baseline sample of 73,710 women from the Nurses' Health Study, 92,320 women from the Nurses' Health Study 2 and 43,259 men from the Health Professionals Follow-Up Study. These participants responded to a follow-up questionnaire every two years for over two decades on lifestyle, health behaviors and medical history. Participants with coronary heart disease at baseline were excluded, as were participants with cancer, stroke and coronary artery surgery.

During follow-up, 8,631 participants developed coronary heart disease. Overall, adherence to a plant-based diet was associated with a lower risk of heart disease. A higher intake of a more healthful plant-based diet - one rich in whole grains, fruits, vegetables, etc. - was associated with a substantially lower risk of heart disease. However, a plant-based diet that emphasized less healthy plant foods like sweetened beverages, refined grains, potatoes and sweets had the opposite effect.

"When we examined the associations of the three food categories with heart disease risk, we found that healthy plant foods were associated with lower risk, whereas less healthy plant foods and animal foods were associated with higher risk," said Ambika Satija, ScD, a postdoctoral fellow at the Harvard T.H. Chan School of Public Health in Boston and the study's lead author. "It's apparent that there is a wide variation in the nutritional quality of plant foods, making it crucial to take into consideration the quality of foods in a plant-based diet."

In an accompanying editorial, Kim Allan Williams, MD, MACC, chair of the division of cardiology at Rush University Medical Center in Chicago, said the study adds to the substantial evidence that a predominately plant-based diet reduces heart disease risk. Not all plant-based foods are equally healthy, but plant-based diets with whole grains, unsaturated fats and an abundance of fruits and vegetables "deserve more emphasis in dietary recommendations."

Williams said, the long-term follow up allowed authors to examine dietary patterns and analyze the effect of gradual adherence to a plant-based diet through reduced animal food intake and increased plant food intake on heart disease risk. They said "just as physical activity is a continuum, perhaps an emphasis on starting with smaller dietary tweaks rather than major changes would be more encouraging and sustainable."

Limitations of the study include its observational nature and the self-reported diet assessments. However, these diet assessments were validated against multiple week diet records and biomarkers.


Daily crosswords linked to sharper brain in later life


The more regularly people report doing word puzzles such as crosswords, the better their brain function in later life, a large-scale and robust online trial has found.

Experts at the University of Exeter Medical School and Kings College London analysed data from more than 17,000 healthy people aged 50 and over, submitted in an online trial. In research presented at the Alzheimer's Association International Conference (AAIC) 2017, the team asked participants how frequently they played word puzzles such as crosswords.

The study, one of the largest of its kind, used tests from the CogTrackTM and PROTECT online cognitive test systems to assess core aspects of brain function. They found that the more regularly participants engaged with word puzzles, the better they performed on tasks assessing attention, reasoning and memory.

From their results, researchers calculate that people who engage in word puzzles have brain function equivalent to ten years younger than their age, on tests of grammatical reasoning speed and short term memory accuracy.

Keith Wesnes, Professor of Cognitive Neuroscience at the University of Exeter Medical School, said: "We found direct relationships between the frequency of word puzzle use and the speed and accuracy of performance on nine cognitive tasks assessing a range of aspects of function including attention, reasoning and memory. Performance was consistently better in those who reported engaging in puzzles, and generally improved incrementally with the frequency of puzzle use. For example, on test measures of grammatical reasoning speed and short-term memory accuracy, performing word puzzles was associated with an age-related reduction of around 10 years. We now need to follow up this very exciting association in a clinical trial, to establish whether engaging in puzzles results in improvement in brain function."

The study used participants in the PROTECT online platform, run by the University of Exeter and Kings College London. Currently, more than 22,000 healthy people aged between 50 and 96 are registered in the study, which is planning further expansion. The online platform enables researchers to conduct and manage large-scale studies without the need for laboratory visits. PROTECT is a 10 year study with participants being followed up annually to enable a better understanding of cognitive trajectories in this age range. PROTECT is funded by the Alzheimer's Society and the National Institute for Health Research (NIHR) Bioresource, including through its NIHR Clinical Research Network (CRN).

Clive Ballard, Professor of Age-Related Diseases at the University of Exeter Medical School, said: "We know that many of the factors involved in dementia are preventable. It is essential that we find out what lifestyle factors really make a difference to helping people maintain healthy brains to stop the soaring rise of the disease. We can't yet say that crosswords give you a sharper brain - the next step is to assess whether encouraging people to start playing word games regularly could actually improve their brain function."

Dr Doug Brown, Director of Research of Alzheimer's Society, said: "We know that keeping an active mind can help to reduce decline in thinking skills.

"This new research does reveal a link between word puzzles, like crosswords, and memory and thinking skills, but we can't say definitively that regular 'puzzling' improves these skills.

"To be able to say for sure, the crucial next step is to test if there are benefits in people who take up word puzzles.

"In the meantime our top tips to reduce the risk of developing dementia are keeping physically active, avoiding smoking and eating a healthy balanced diet."

Happiness can affect physical health


A new review indicates that subjective well-being--factors such as life satisfaction and enjoyment of life--can influence physical health. The review's investigators also examine why this is so and conditions where it is most likely to occur.

Subjective well-being may exert its effects on physical health through health behaviors, as well as through the immune and cardiovascular systems. Although scientists still are exploring and debating when happiness most affects health, there is no doubt that it can do so.

With more research, it may one day be informative for clinicians to monitor individuals' subjective well-being just as other factors are currently assessed. Individuals should also take responsibility for their health by developing happy mental habits.

"We now have to take very seriously the finding that happy people are healthier and live longer, and that chronic unhappiness can be a true health threat. People's feelings of well-being join other known factors for health, such as not smoking and getting exercise," said Prof. Ed Diener, co-author of the Applied Psychology: Health and Well-Being article. "Scores of studies show that our levels of happiness versus stress and depression can influence our cardiovascular health, our immune system strength to fight off diseases, and our ability to heal from injuries."

Friday, July 14, 2017

Fermented red clover extract stops menopausal hot flushes and symptoms


The vast majority of women in the menopause are familiar with the status of Red Clover as an herbal medicine that soothes hot flush symptoms and hormonal fluctuations. This holds true, new research shows, if the red clover is taken in a fermented form. Fermented Red Clover extract is demonstrated to decrease significantly both the number and severity of daily hot flushes.

The study also found that the extract prevents the normally accelerated menopausal bone loss affecting one in three women over the age of 50 (e.g. results showed treatment blunted bone loss in the spine completely). These findings are very promising as the benefits take place without any of the side effects of traditionally proscribed hormone therapies that increase the risk of cancers and cardiovascular diseases.

The above is the most important information from the scientific article "Combined Red Clover isoflavones and probiotics potently reduce memopausal vasomotor symptoms", that researchers at the Dept. of Endocrinology and Internal Medicine under the Dept. Clinical Medicine at Aarhus University/ Aarhus University Hospital have published in the journal PLOS one.

The study lead Professor Per Bendix Jeppesen has previously presented partial unpublished data to the media. These findings have rapidly been miss-reported to mean "Red Clover works", which as Per Bendix Jeppesen and his colleague Ph.D. Max Norman Tandrup Lambert explain, "is an oversimplification that is very close to being incorrect".

"It is the fermentation process of the Red Clover extract that makes the difference, as the lactic acid fermentation increases the bioavailability of the bioactive estrogen-like compounds (known as isoflavones or phytoestrogens) that Red Clover has in abundance," explains Max Norman Tandrup Lambert.

"The challenge with isoflavones is that they can be difficult to digest as they naturally occur in the plant bound to sugar molecules which prevent absorption. Hence, a large proportion of the isoflavones that are consumed (e.g. as a pill or capsule) can pass through the intestine without entering circulation. This problem is bypassed when the Red Clover extract undergoes a fermentation process. To be technical the process separates the sugar molecules from the isoflavones, thereby increasing bioavailability," explains Max Norman Tandup Lambert.

Max and Per Bendix Jeppesen are aware that the research findings inadvertently provide an invaluable seal of approval to an ecological farmer and business owner Michael Mohr Jensen, who has patented the production process of the fermented Red Clover extract. Michael Mohr Jensen sells the product from his private company "Herrens Mark" on Fyn. Presumably, the goal from the researchers perspective is to promote research that can help women in the menopause that also has a commercial side.

"That characterization does not apply to me," says Per Bendix Jeppesen. "For me, when I can see that research has a realistic use practically I get extra curious. The fact that the research we have contributed has direct practical application is a great positive, it doesn't happen enough even with all the universities talking about becoming more business orientated and the necessity of collaboration with businesses," says Per Bendix Jeppesen.

Interestingly, it was Michael Mohr Jensen who contacted Per Bendix Jeppesen to ask if he and other researchers from the Dept. of Endocrinology and Internal Medicine would investigate his hypothesis regarding fermented Red Clover extract as a healthier alternative to traditional estrogen therapy proscribed by doctors. In the ensuing collaboration it was Per Bendix Jeppesen and Max Norman Tandrup Lambert that advised the farmer in fine-tuning his Red Clover extract to improve the gastro-intestinal uptake of the active isoflavone compounds.

The fermentation development was a success and the results are now tested in Max Norman Tandrup Lambert's Ph.D. project - a study that recruited 130 women with menopause symptoms, of which 60 were selected based on criteria of at least five severe hot flushes per day and blood tests (including FSH, that indicates the "stage" of menopause).

"The women were separated into two groups of 30, so 30 drank 150ml Red Clover extract per day for 12 weeks, whilst the other 30 drank a masked placebo product. After 12 weeks we tested again and were speechless about the data. There was a much greater effect than we had hoped for." Says Max Norman Tandrup Lambert.

Per Bendix Jeppesen also emphasizes that the research project has avoided relying only on "self reports", which can be a considerable source of error in investigations into whether a treatment works. For example in this study the women's' hot flush symptoms were measured using a so called 'skin conductor', a device that is applied to the underside of the wrist that can determine the number hot flush events and their severity objectively based on sweat secretion. Similarly, the effect of the Red Clover extract on bone health has been tested via so-called DXA scans of the spine and hips.

All measurements are taken in the same way before and after 12 weeks of treatment; this enhances the credibility of the findings, as menopause symptoms are particularly difficult to measure.

###

Facts: Its just a phase, but...

  • 75 % of women experience menopause symptoms, for some it can be debilitating.
  • The primary symptoms of menopause are hot flushes, sweating, disrupted sleep and vaginal dryness.
  • Secondary symptoms are tiredness, poor memory, headache, joint pain, weight gain, decreased libido, anxiety and depression.
  • The most frequent menopause associated disease is osteoporosis, which affects one in three women over 50, where loss of bone density of a magnitude of around 4-6% can take place. The lifetime risk of developing osteoporosis for women is one in three.
  • Other menopause associated risk factors are cardiovascular disease and negative changes to fat metabolism and profile.


Not all muscle building supplements are equal




Popular muscle building supplements, known as branched-chain amino acids (BCAA) are ineffective when taken in isolation, according to new research from the University of Stirling.

The study, involving the universities of Exeter and Birmingham and published in Frontiers in Physiology, show that while BCAA supplements do stimulate the muscle building response in individuals after they lift weights, other muscle-building supplements are far more effective.

Other supplements that contain all necessary amino acids stimulate a greater muscle growth response, which suggests that taking BCAA supplements alone is not the best way to optimize muscle growth with weight training.

The scientists also investigated how effective the supplements were at stimulating the machinery inside the muscle itself that leads to muscle growth.

They found that while BCAA drinks stimulate the body's muscle building systems, they lack some essential amino acids that are necessary to support a maximal muscle growth response.

Professor Kevin Tipton, Chair in Sport, Health and Exercise Sciences at the University of Stirling, said: "Amino acids are the building blocks of proteins and the special class of amino acids, known as BCAA, stimulate the muscle growth response. These supplements are considered to be an important part of the nutrition plan for many bodybuilders, weightlifters and others seeking muscle growth.

"Our results show that the common practice of taking BCAA supplements in isolation will stimulate muscle protein synthesis - the metabolic mechanism that leads to muscle growth - but the total response will not be maximal because BCAA supplements do not provide other amino acids essential for the best response.

"A sufficient amount of the full complement of amino acids is necessary for maximum muscle building, following exercise. Athletes interested in enhancing muscle growth with training should not rely on these BCAA supplements alone."

The BCAA supplement enhanced the muscle growth response slightly compared to a placebo, however the muscle's response was more than double when a whey protein supplement containing the equivalent amount of BCAA that included the other amino acids, was taken.

A group of trained weightlifters took part in the study. They took the supplement in a dose equivalent to 20 grams of whey protein, after a resistance training session in the gym.


Thursday, July 13, 2017

Yoga could be a way to protect against cognitive decline in old age



Scientists in Brazil have imaged elderly female yoga practitioners' brains and found they have greater cortical thickness in the left prefrontal cortex, in brain areas associated with cognitive functions like attention and memory. The results suggest that yoga could be a way to protect against cognitive decline in old age.

As we age, the structure and functionality of our brains change and this often leads to cognitive decline, including impaired attention or memory. One such change in the brain involves the cerebral cortex becoming thinner, which scientists have shown is correlated with cognitive decline. So, how can we slow or reverse these changes?

You might think medication would be required, but surprisingly, the answer could lie in contemplative practices like yoga. Yoga practitioners consciously maintain postures, and perform breathing exercises and meditation.

"In the same way as muscles, the brain develops through training," explains Elisa Kozasa of Hospital Israelita Albert Einstein in São Paulo, Brazil, a researcher involved in the study, which was recently published in Frontiers in Aging Neuroscience. "Like any contemplative practice, yoga has a cognitive component in which attention and concentration are important."

Previous studies have suggested that yoga can have greater health benefits than similar aerobic exercises, and yoga practitioners have shown improved awareness, attention and memory. Older adults with mild cognitive impairment have also shown improvements after a short yoga training program.

But can practicing yoga over several years significantly shape your brain and if so, could it offset some of the changes that happen in the aging brain? The research team wanted to see if elderly long-term yoga practitioners had any differences in terms of brain structure compared with healthy elderly people who had never practiced yoga.

They recruited 21 female yoga practitioners (also known as yoginis) who had practiced yoga at least twice a week for a minimum of 8 years, although the group had an average of nearly 15 years of yoga practice. The researchers compared the yoginis with another group of 21 healthy women, who had never practiced yoga, meditation or any other contemplative practices, but who were well-matched to the yoginis in terms of their age (all the participants were 60 or over) and levels of physical activity. For more consistent results, the researchers only recruited women, and the participants completed surveys to see if there were any other factors at work that could affect brain structure, such as depression or level of formal education.

The researchers scanned the participants' brains using magnetic resonance imaging to see if there were any differences in brain structure. "We found greater thickness in the left prefrontal cortex in the yoginis, in brain regions associated with cognitive functions such as attention and memory," says Rui Afonso, another researcher involved in the study. As the groups were well-matched in terms of other factors that can change brain structure, such as education and levels of depression, yoga practice appears to underlie the yoginis' different brain structure.

The results suggest that practicing yoga in the long-term can change the structure of your brain and could protect against cognitive decline in old age. However, the team plan to carry out more studies to see if these brain changes result in enhanced cognitive performance in elderly yoginis.

Another possibility is that people with these brain features are more likely to be attracted to yoga. "We have compared experienced yoginis with non-practitioners, so we do not know if the yoginis already had these differences before they started yoga," explains Afonso. "This can only be confirmed by studying people for a few years from the time they start yoga."


Wednesday, July 12, 2017

Improving diet quality over time linked with reduced risk of premature death


People who improve the quality of their diets over time, eating more whole grains, vegetables, fruits, nuts, and fish and less red and processed meats and sugary beverages, may significantly reduce their risk of premature death, according to a new study from Harvard T.H. Chan School of Public Health. It is the first study to show that improving diet quality over at least a dozen years is associated with lower total and cardiovascular mortality, and underscores the importance of maintaining healthy eating patterns over the long term.

The study will be published in the July 13, 2017 issue of the New England Journal of Medicine.

"Overall, our findings underscore the benefits of healthy eating patterns including the Mediterranean diet and the DASH diet. Our study indicates that even modest improvements in diet quality could meaningfully influence mortality risk and conversely, worsening diet quality may increase the risk," said lead author Mercedes Sotos-Prieto, who worked on the study while a postdoctoral fellow in the Harvard Chan School Department of Nutrition and who is currently an assistant professor of nutrition at Ohio University.

Sotos-Prieto and colleagues analyzed the association between changes in diet quality among nearly 74,000 adults over a 12-year period (1986-1998) and their risk of dying over the subsequent 12 years (1998-2010). Data came from two long-term studies, the Nurses' Health Study and the Health Professionals' Follow-up Study, in which participants answered questions about their diets every four years and about their lifestyle and health every two years.

The researchers assessed people's diet quality by using three different scoring methods: the 2010 Alternate Healthy Eating Index, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score. Each of these methods assigns scores to various types of food or nutrients; less healthy foods or nutrients have lower scores and healthier foods or nutrients have higher ones.

The study found that improved diet quality over a 12-year period was associated with reduced risk of death in the subsequent 12 years, no matter which score was used. Food groups that contributed most to an improvement in diet quality were whole grains, fruits, vegetables, and fish or n-3 fatty acids.

A 20-percentile increase in diet-quality scores--the kind of increase that can be achieved by swapping out just one serving of red or processed meat for one daily serving of nuts or legumes--was linked with an 8%-17% reduction in the risk of death, depending on the diet score. In contrast, worsening diet quality was associated with a 6%-12% increase in the risk.

Among those who maintained higher rather than lower scores according to any of the three healthy diet patterns for 12 years, there was a 9%-14% reduction in mortality from any cause. Among those who had relatively unhealthy diets at the beginning of the study but whose diet scores improved the most, the risk of death in subsequent years was also significantly reduced.

"Our results highlight the long-term health benefits of improving diet quality with an emphasis on overall dietary patterns rather than on individual foods or nutrients. A healthy eating pattern can be adopted according to individuals' food and cultural preferences and health conditions. There is no one-size-fits-all diet," said Frank Hu, professor and chair of the Harvard Chan School Department of Nutrition and senior author of the study.


Surgery for early prostate cancer may not save lives


A major 20-year study provides further evidence that prostate cancer surgery offers negligible benefits to many men with early-stage disease. In such men, who account for most cases of newly diagnosed prostate cancer, surgery did not prolong life and often caused serious complications such as infection, urinary incontinence and erectile dysfunction.

The study, by a national research team including Washington University School of Medicine in St. Louis, was led by the Minneapolis Veterans Administration Health Care System. It is published July 13 in The New England Journal of Medicine.

In men with early prostate cancer, the study compared surgery with observation. With the latter, men only were treated if they developed bothersome symptoms, such as urinary difficulty or bone pain. Such symptoms may indicate progression of the cancer. Many men in the observation group received no treatment at all because early-stage prostate cancer often grows slowly and rarely causes symptoms.

"The findings will go a long way in helping to improve prostate cancer care," said co-author Gerald L. Andriole, MD, director of Washington University's Division of Urologic Surgery. "About 70 percent of patients newly diagnosed with prostate cancer cases are in the early stages, meaning the cancer is confined to the prostate gland, and they have nonaggressive tumors. As such, these patients have an excellent prognosis without surgery. This study confirms that aggressive treatment usually is not necessary. We hope the findings will steer doctors away from recommending surgery or radiation to their patients with nonaggressive early-stage prostate cancer and patients away from thinking it's necessary."

The American Cancer Society ranks prostate cancer as the second most common cancer in men and the third-leading cause of cancer deaths among men, after lung and colorectal cancer. In 2017, about 161,360 men will be diagnosed with prostate cancer, and 26,730 will die from it.

The study, known as the Prostate Cancer Intervention Versus Observation Trial, or PIVOT, is one of the largest and longest involving cancer patients. It got underway in 1994 just as the prostate-specific antigen blood test for prostate cancer became routine. With many more men diagnosed with prostate cancer, the standard treatment for all prostate cancers became surgery or radiation, with the thinking that removing or irradiating the tumor would increase survival. But over the next decade, reports of treatment-related complications raised concerns, as did data indicating that most early-stage cancers grew so slowly they were unlikely to cause health problems.

To evaluate any potential benefits of surgery, the researchers randomly assigned 731 men in the U.S. with localized prostate cancer to receive either surgery or observation at one of 44 Department of Veteran Affairs Health Care Centers or eight academic medical centers, including Washington University. The average age of men in the study was 67 at the time of enrollment.

Of the men who had prostate cancer surgery, 223 (61 percent) died of other causes after up to 20 years of follow-up, compared with 245 men (66 percent) in the observation group - a difference that is not statistically different. Further, 27 (7 percent) men in the surgery group died of prostate cancer, compared with 42 men (11 percent) in the observation group, but that difference also is not statistically significant.

However, the data show that surgery may have a mortality benefit in some men, particularly those with a long life expectancy and intermediate-risk prostate cancer. (Such men generally have PSA scores of 10-20 ng/ml and a Gleason score of seven. The latter score signifies tumor aggressiveness.)

"It would be a disservice to dismiss surgery as a viable option for patients with intermediate-risk prostate cancer," said Andriole, the School of Medicine's Robert K. Royce Distinguished Professor of Urologic Surgery. He treats patients at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University. "For these patients, and for some men with high-risk prostate cancer, surgery is often beneficial, as are other other treatments such as radiation."

Technology has advanced since the study began, allowing physicians to more accurately classify tumors and avoid overtreating patients who have prostate cancer.

Of the 364 men treated with surgery, 53 (15 percent) suffered from erectile dysfunction, and 63 (17 percent) reported having incontinence. Another 45 developed other complications.

"The benefits of surgery also need to be balanced against the negative long-term consequences of surgery that occur early and often," said senior author Timothy Wilt, MD, a physician-researcher with the Center for Chronic Disease Outcomes Research at the Minneapolis VA Health Care System and a professor of medicine at the University of Minnesota. "Our results demonstrate that for the majority of men with localized prostate cancer, selecting observation for their treatment choice can help them live a similar length of life, avoid death from prostate cancer and prevent harms from surgical treatment. Physicians can use information from our study to confidently recommend observation as the preferred treatment option for men with early prostate cancer."

Cognitive behavioral therapy improves functioning for people with chronic pain


Cognitive Behavioral Therapy (CBT) is the most frequently used psychological intervention for people with chronic pain, and new approaches for improving CBT outcomes may be found in the psychological flexibility model and Acceptance and Commitment therapy (ACT), according to research reported in The Journal of Pain.

Acceptance and Commitment Therapy (ACT) is based on the psychological flexibility model, which includes a therapeutic process known as "self-as-context" (SAC). Contextual self refers to a sense of self that is not based on self-evaluations. It is similar to being an observer of one's own psychological experiences. Researchers in the United Kingdom writing in The Journal of Pain examined whether ACT influences SAC and if changes in measures of SAC are associated with treatment outcomes.

"Psychological flexibility is the ability to be more aware, more focused on goals and more engaged. Another aspect of psychological flexibility pertinent to chronic pain, and supported by SAC, is called committed action, which involves goal-directed, flexible persistence," said co-author Lance M. McCracken, Professor of Behavioral Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London. "For pain management, ACT is an approach based on the psychological flexibility model and focuses on building effective patterns of behavior change rather than symptom reduction."

Four hundred twelve adults referred to a pain management center at Guy's and St. Thomas' Hospital in London were subjects for the study. They completed measures of treatment processes, such as SAC and committed action, and outcomes (pain-related interference, work and social adjustment, depression) before treatment, upon treatment completion and after nine months.

Wider outcomes research suggests that ACT is effective for enhancing daily functioning and for decreasing psychological distress. A study published in 2011 assessed the long-term efficacy of acceptance and commitment therapy in more than 100 people with chronic pain. The evidence showed at three-year follow-up that 65 percent of study subjects had reliably improved in at least one key clinical domain, and improvements in psychological flexibility were associated with improvements in outcomes measures.

Results of the current Kings College study showed that scores from both the process and outcomes measures significantly improved after treatment and were maintained at nine-month follow-up. The ACT-oriented treatment was associated with improved SAC as well as improved functioning. Changes in SAC were associated with changes in pain-related interference, work and social adjustment and depression.

"Greater psychological flexibility is associated with less pain-related anxiety and avoidance, less depression, less physical and psycho-social disability and other measures of patient function," said McCracken. "Based on studies of forms of CBT that did not include ACT, acceptance of pain, one component of psychological flexibility, may be a general mechanism by which CBT treatments achieve improvements in functioning, and more specific targeting of pain-related acceptance may lead to further improvement is CBT outcomes."

The authors concluded that that the study results are consistent with an increasing number of longitudinal and mediation studies showing that ACT for chronic pain improves patient functioning, specifically through enhanced psychological flexibility.


Tuesday, July 11, 2017

Stop eating tilapia ASAP


Eating seafood is a great way to get vital nutrients and vitamins. Tilapia is the most popular farmed fish in America because of its affordability. But health experts are warning consumers to stay as far away as possible from Tilapia.

Tilapia Contains Few Nutrients


Researchers from the Wake Forest University School of Medicine released a report on the omega-3 fatty acid content in popular fish. Tilapia scored far lower than most other fish on the list. Omega-3 fatty acids give fish most of their benefits, including Alzheimer’s risk reduction. Tilapia contains a TON of omega-6 fatty acids, which are terrible for you. The quantity of omega-6 in tilapia is higher than a hamburger or bacon.

Tilapia Could Cause Alzheimer


One of the omega-6 fatty acids in tilapia goes by the name of arachidonic acid – a compound which significantly increases the type of inflammatory damage that precedes Alzheimer’s. So while eating healthy fish like mackerel, halibut and sardines would reduce your risk of developing Alzheimer’s, this fish actually increases it.

Most Tilapia Is Farmed


Tilapia is the second most commonly farmed fish in the world. This is largely due to the fish’s hardiness; it can eat just about anything. Good for farmers, bad for consumers. It means they don’t have to spend lots of money on fish food as they would were they raising salmon. Farmers commonly feed the fish chicken and pig poop. The fish are also stuffed with antibiotics and genetically modified to grow faster.

Tilapia May Cause Cancer

Tilapia can carry up to 10 times the amount of carcinogens as other fish. This is because of the food the farmers feed the fish – poop, pesticides and industrial-grade chemicals. One toxic chemical researchers have found in the fish is dioxin, which is linked to the development and progression of cancer.

What’s more, your body doesn’t actually flush out dioxin for a whopping 7-11 years.

People who drink coffee live longer


Drinking coffee was associated with a lower risk of death due to heart disease, cancer, stroke, diabetes, and respiratory and kidney disease for African-Americans, Japanese-Americans, Latinos and whites.

People who consumed a cup of coffee a day were 12 percent less likely to die compared to those who didn't drink coffee. This association was even stronger for those who drank two to three cups a day -- 18 percent reduced chance of death.

Lower mortality was present regardless of whether people drank regular or decaffeinated coffee, suggesting the association is not tied to caffeine, said Veronica W. Setiawan, lead author of the study and an associate professor of preventive medicine at the Keck School of Medicine of USC.

"We cannot say drinking coffee will prolong your life, but we see an association," Setiawan said. "If you like to drink coffee, drink up! If you're not a coffee drinker, then you need to consider if you should start."

The study, which will be published in the July 11 issue of Annals of Internal Medicine, used data from the Multiethnic Cohort Study, a collaborative effort between the University of Hawaii Cancer Center and the Keck School of Medicine.

The ongoing Multiethnic Cohort Study has more than 215,000 participants and bills itself as the most ethnically diverse study examining lifestyle risk factors that may lead to cancer.

"Until now, few data have been available on the association between coffee consumption and mortality in nonwhites in the United States and elsewhere," the study stated. "Such investigations are important because lifestyle patterns and disease risks can vary substantially across racial and ethnic backgrounds, and findings in one group may not necessarily apply to others."

Since the association was seen in four different ethnicities, Setiawan said it is safe to say the results apply to other groups.

"This study is the largest of its kind and includes minorities who have very different lifestyles," Setiawan said. "Seeing a similar pattern across different populations gives stronger biological backing to the argument that coffee is good for you whether you are white, African-American, Latino or Asian."

Benefits of drinking coffee

Previous research by USC and others have indicated that drinking coffee is associated with reduced risk of several types of cancer, diabetes, liver disease, Parkinson's disease, Type 2 diabetes and other chronic diseases.

Setiawan, who drinks one to two cups of coffee daily, said any positive effects from drinking coffee are far-reaching because of the number of people who enjoy or rely on the beverage every day.

"Coffee contains a lot of antioxidants and phenolic compounds that play an important role in cancer prevention," Setiawan said. "Although this study does not show causation or point to what chemicals in coffee may have this 'elixir effect,' it is clear that coffee can be incorporated into a healthy diet and lifestyle."

About 62 percent of Americans drink coffee daily, a 5 percent increase from 2016 numbers, reported the National Coffee Association.

As a research institution, USC has scientists from across disciplines working to find a cure for cancer and better ways for people to manage the disease.

The Keck School of Medicine and USC Norris Comprehensive Cancer Center manage a state-mandated database called the Los Angeles Cancer Surveillance Program, which provides scientists with essential statistics on cancer for a diverse population.

Researchers from the USC Norris Comprehensive Cancer Center have found that drinking coffee lowers the risk of colorectal cancer.

But drinking piping hot coffee or beverages probably causes cancer in the esophagus, according to a World Health Organization panel of scientists that included Mariana Stern from the Keck School of Medicine.

Hearing from the WHO

In some respects, coffee is regaining its honor for wellness benefits. After 25 years of labeling coffee a carcinogen linked to bladder cancer, the World Health Organization last year announced that drinking coffee reduces the risk for liver and uterine cancer.

"Some people worry drinking coffee can be bad for you because it might increase the risk of heart disease, stunt growth or lead to stomach ulcers and heartburn," Setiawan said. "But research on coffee have mostly shown no harm to people's health."

Coffee by the numbers

Setiawan and her colleagues examined the data of 185,855 African-Americans (17 percent), Native Hawaiians (7 percent), Japanese-Americans (29 percent), Latinos (22 percent) and whites (25 percent) ages 45 to 75 at recruitment. Participants answered questionnaires about diet, lifestyle, and family and personal medical history.

They reported their coffee drinking habits when they entered the study and updated them about every five years, checking one of nine boxes that ranged from "never or hardly ever" to "4 or more cups daily." They also reported whether they drank caffeinated or decaffeinated coffee. The average follow-up period was 16 years.

Sixteen percent of participants reported that they did not drink coffee, 31 percent drank one cup per day, 25 percent drank two to three cups per day and 7 percent drank four or more cups per day. The remaining 21 percent had irregular coffee consumption habits.

Over the course of the study, 58,397 participants -- about 31 percent -- died. Cardiovascular disease (36 percent) and cancer (31 percent) were the leading killers.

The data was adjusted for age, sex, ethnicity, smoking habits, education, preexisting disease, vigorous physical exercise and alcohol consumption.

Setiawan's previous research found that coffee reduces the risk of liver cancer and chronic liver disease. She is currently examining how coffee is associated with the risk of developing specific cancers.


Poor sleep associated with the development of dementias such as Alzheimer's

 
Research from Washington University School of Medicine in St. Louis, Radboud University Medical Centre in the Netherlands, and Stanford University shows that disrupting just one night of sleep in healthy, middle-aged adults causes an increase in a brain protein associated with Alzheimer's disease. Further, a week of poor sleep leads to an increase in another brain protein that has been linked to brain damage in Alzheimer's and other neurological diseases. Shown are brain waves during slow-wave sleep, measured as a study participant slept.
 
A good night's sleep refreshes body and mind, but a poor night's sleep can do just the opposite. A study from Washington University School of Medicine in St. Louis, Radboud University Medical Centre in the Netherlands, and Stanford University has shown that disrupting just one night of sleep in healthy, middle-aged adults causes an increase in amyloid beta, a brain protein associated with Alzheimer's disease. And a week of tossing and turning leads to an increase in another brain protein, tau, which has been linked to brain damage in Alzheimer's and other neurological diseases.

"We showed that poor sleep is associated with higher levels of two Alzheimer's-associated proteins," said David M. Holtzman, MD, the Andrew B. and Gretchen P. Jones Professor, head of the Department of Neurology and the study's senior author. "We think that perhaps chronic poor sleep during middle age may increase the risk of Alzheimer's later in life."

These findings, published July 10 in the journal Brain, may help explain why poor sleep has been associated with the development of dementias such as Alzheimer's.

More than 5 million Americans are living with Alzheimer's disease, which is characterized by gradual memory loss and cognitive decline. The brains of people with Alzheimer's are dotted with plaques of amyloid beta protein and tangles of tau protein, which together cause brain tissue to atrophy and die. There are no therapies that have been proven to prevent, slow or reverse the course of the disease.
Previous studies by Holtzman, co-first author Yo-El Ju, MD, an assistant professor of neurology, and others have shown that poor sleep increases the risk of cognitive problems. People with sleep apnea, for example, a condition in which people repeatedly stop breathing at night, are at risk for developing mild cognitive impairment an average of 10 years earlier than people without the sleep disorder. Mild cognitive impairment is an early warning sign for Alzheimer's disease.

But it wasn't clear how poor sleep damages the brain. To find out, the researchers -- Holtzman; Ju; co-first author and graduate student Sharon Ooms of Radboud; Jurgen Claassen, MD, PhD, of Radboud; Emmanuel Mignot, MD, PhD, of Stanford; and colleagues -- studied 17 healthy adults ages 35 to 65 with no sleep problems or cognitive impairments. Each participant wore an activity monitor on the wrist for up to two weeks that measured how much time they spent sleeping each night.
After five or more successive nights of wearing the monitor, each participant came to the School of Medicine to spend a night in a specially designed sleep room. The room is dark, soundproof, climate-controlled and just big enough for one; a perfect place for sleeping, even as the participants wore headphones over the ears and electrodes on the scalp to monitor brain waves.

Half the participants were randomly assigned to have their sleep disrupted during the night they spent in the sleep room. Every time their brain signals settled into the slow-wave pattern characteristic of deep, dreamless sleep, the researchers sent a series of beeps through the headphones, gradually getting louder, until the participants' slow-wave patterns dissipated and they entered shallower sleep.
The next morning, the participants who had been beeped out of slow-wave sleep reported feeling tired and unrefreshed, even though they had slept just as long as usual and rarely recalled being awakened during the night. Each underwent a spinal tap so the researchers could measure the levels of amyloid beta and tau in the fluid surrounding the brain and spinal cord.

A month or more later, the process was repeated, except that those who had their sleep disrupted the first time were allowed to sleep through the night undisturbed, and those who had slept uninterrupted the first time were disturbed by beeps when they began to enter slow-wave sleep.

The researchers compared each participant's amyloid beta and tau levels after the disrupted night to the levels after the uninterrupted night, and found a 10 percent increase in amyloid beta levels after a single night of interrupted sleep, but no corresponding increase in tau levels. However, participants whose activity monitors showed they had slept poorly at home for the week before the spinal tap showed a spike in levels of tau.

"We were not surprised to find that tau levels didn't budge after just one night of disrupted sleep while amyloid levels did, because amyloid levels normally change more quickly than tau levels," Ju said. "But we could see, when the participants had several bad nights in a row at home, that their tau levels had risen."

Slow-wave sleep is the deep sleep that people need to wake up feeling rested. Sleep apnea disrupts slow-wave sleep, so people with the disorder often wake up feeling unrefreshed, even after a full eight hours of shut-eye.

Slow-wave sleep is also the time when neurons rest and the brain clears away the molecular byproducts of mental activity that accumulate during the day, when the brain is busily thinking and working.

Ju thinks it is unlikely that a single night or even a week of poor sleep, miserable though it may be, has much effect on overall risk of developing Alzheimer's disease. Amyloid beta and tau levels probably go back down the next time the person has a good night's sleep, she said.
"The main concern is people who have chronic sleep problems," Ju said. "I think that may lead to chronically elevated amyloid levels, which animal studies have shown lead to increased risk of amyloid plaques and Alzheimer's."

Ju emphasized that her study was not designed to determine whether sleeping more or sleeping better reduce risk of Alzheimer's but, she said, neither can hurt.

"Many, many Americans are chronically sleep-deprived, and it negatively affects their health in many ways," Ju said. "At this point, we can't say whether improving sleep will reduce your risk of developing Alzheimer's. All we can really say is that bad sleep increases levels of some proteins that are associated with Alzheimer's disease. But a good night's sleep is something you want to be striving for anyway."