Elderly who have trouble identifying odors face risk of dementia Smell loss predicts cognitive decline in healthy older people

A long-term study of nearly 3,000 adults, aged 57 to 85, found that those who could not identify at least four out of five common odors were more than twice as likely as those with a normal sense of smell to develop dementia within five years.

Although 78 percent of those tested were normal - correctly identifying at least four out of five scents - about 14 percent could name just three out of five, five percent could identify only two scents, two percent could name just one, and one percent of the study subjects were not able to identify a single smell.

Five years after the initial test, almost all of the study subjects who were unable to name a single scent had been diagnosed with dementia. Nearly 80 percent of those who provided only one or two correct answers also had dementia, with a dose-dependent relationship between degree of smell loss and incidence of dementia.

"These results show that the sense of smell is closely connected with brain function and health," said the study's lead author, Jayant M. Pinto, MD, a professor of surgery at the University of Chicago and ENT specialist who studies the genetics and treatment of olfactory and sinus disease. "We think smell ability specifically, but also sensory function more broadly, may be an important early sign, marking people at greater risk for dementia."

"We need to understand the underlying mechanisms," Pinto added, "so we can understand neurodegenerative disease and hopefully develop new treatments and preventive interventions."

"Loss of the sense of smell is a strong signal that something has gone wrong and significant damage has been done," Pinto said. "This simple smell test could provide a quick and inexpensive way to identify those who are already at high risk."

The study, "Olfactory Dysfunction Predicts Subsequent Dementia in Older US Adults," published September 2?, 2017, in the Journal of the American Geriatrics Society, follows a related 2014 paper, in which olfactory dysfunction was associated with increased risk of death within five years. In that study, loss of the sense of smell was a better predictor of death than a diagnosis of heart failure, cancer or lung disease.

For both studies, the researchers used a well-validated tool, known as "Sniffin'Sticks." These look like a felt-tip pen, but instead of ink, they are infused with distinct scents. Study subjects smell each item and are asked to identify that odor, one at a time, from a set of four choices. The five odors, in order of increasing difficulty, were peppermint, fish, orange, rose and leather.

Test results showed that:

• 78.1 percent of those examined had a normal sense of smell; 48.7 percent correctly identified five out of five odors and 29.4 percent identified four out of five.
• 18.7 percent, considered "hyposmic," got two or three out of five correct.
• The remaining 3.2 percent, labelled "anosmic," could identify just one of the five scents (2.2%), or none (1%).

The olfactory nerve is the only cranial nerve directly exposed to the environment. The cells that detect smells connect directly with the olfactory bulb at the base of the brain, potentially exposing the central nervous system to environmental hazards such as pollution or pathogens. Olfactory deficits are often an early sign of Parkinson's or Alzheimer's disease. They get worse with disease progression.

Losing the ability to smell can have a substantial impact on lifestyle and wellbeing, said Pinto, a specialist in sinus and nasal diseases and a member of the Section of Otolaryngology-Head and Neck Surgery at UChicago Medicine. "Smells influence nutrition and mental health," Pinto said. People who can't smell face everyday problems such as knowing whether food is spoiled, detecting smoke during a fire, or assessing the need a shower after a workout. Being unable to smell is closely associated with depression as people don't get as much pleasure in life."

"This evolutionarily ancient special sense may signal a key mechanism that also underlies human cognition," noted study co-author Martha K. McClintock, PhD, the David Lee Shillinglaw Distinguished Service Professor of Psychology at the University of Chicago, who has studied olfactory and pheromonal communication throughout her career.

McClintock noted that the olfactory system also has stem cells which self-regenerate, so "a decrease in the ability to smell may signal a decrease in the brain's ability to rebuild key components that are declining with age, leading to the pathological changes of many different dementias."

In an accompanying editorial, Stephen Thielke, MD, a member of the Geriatric Research, Education and Clinical Center at Puget Sound Veterans Affairs Medical Center and the psychiatry and behavioral sciences faculty at the University of Washington, wrote: "Olfactory dysfunction may be easier to quantify across time than global cognition, which could allow for more-systematic or earlier assessment of neurodegenerative changes, but none of this supports that smell testing would be a useful tool for predicting the onset of dementia."

"Our test simply marks someone for closer attention," Pinto explained. "Much more work would need to be done to make it a clinical test. But it could help find people who are at risk. Then we could enroll them in early-stage prevention trials."

"Of all human senses," Pinto added, "smell is the most undervalued and underappreciated - until it's gone."

Meditation might be useful addition to heart-healthy lifestyle and medical treatment

Meditation has the potential to reduce some risk factors for heart disease, but the gold standard for lowering risk remains a heart-healthy lifestyle and following medical recommendations, according to a new scientific statement from the American Heart Association.

Studies have shown that meditation can have long-term effects on the brain and how it works, and numerous studies on the potential benefits of meditation have been published, which prompted the American Heart Association to review current high-quality scientific studies to determine whether the practice has a role in reducing heart disease.

Although the practice of meditation dates back as far as 5000 BC and is associated with certain philosophies and religions, meditation is increasingly practiced as a secular and therapeutic activity.

About 8 percent of Americans practice some sort of meditation and, in the National Health Interview Survey, conducted by the National Center for Complementary and Integrative Health, which is part of the National Institutes of Health, 17 percent of patients with cardiovascular disease expressed an interest in participating in a clinical trial of meditation.

A writing group composed of cardiovascular disease experts and a neuroscientist reviewed existing research on whether common types of sitting meditation had an impact on cardiovascular risk factors and disease.

The review excluded studies on combination mind-body practices, such as yoga and Tai Chi, since the physical activity included in these practices has an established positive impact on heart disease risk. The studies of sitting meditation, including a variety of common forms such as: Samatha; Vipassana (Insight Meditation); Mindful Meditation; Zen Meditation (Zazen); Raja Yoga; Loving-Kindness (Metta); Transcendental Meditation; and Relaxation Response showed that meditation:

• May be associated with decreased levels of stress, anxiety and depression, and improved quality of sleep and overall well-being;
• May help lower blood pressure, although there is not enough evidence to determine whether or how much it may lower blood pressure in a given individual;
• May help individuals stop smoking; and
• Might be associated with a decreased risk of heart attack, although there are only a few studies on this, and more studies are needed before any conclusions can be made.

"Although studies of meditation suggest a possible benefit on cardiovascular risk, there hasn't been enough research to conclude it has a definite role," said Glenn N. Levine, M.D., chair of the writing group of the AHA Scientific Statement that is published in the Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

"Since education on how to meditate is widely available and meditation has little if any risk associated with it, interested people may want to use these techniques, in addition to established medical and lifestyle interventions, as a possible way to lower heart disease risk. However, it's important that people understand that the benefits remain to be better established and that meditation is not a substitute for traditional medical care," said Levine, who is professor of medicine at Baylor College of Medicine in Houston, Texas.

Levine notes that until we know more, the mainstay for the prevention and treatment of heart disease remains lifestyle advice and medical treatment that has been carefully studied and shown to work, including cholesterol therapy, blood pressure control, smoking cessation and regular physical activity.

Activities such as commuting, being active at work or doing household chores can save your life

Physical activity of any kind can prevent heart disease and death, says a large international study involving more than 130,000 people from 17 countries published this week in The Lancet.

The Prospective Urban Rural Epidemiology (PURE) study, led by the Population Health Research Institute of McMaster University and Hamilton Health Sciences, shows any activity is good for people to meet the current guideline of 30 minutes of activity a day, or 150 minutes a week to raise the heart rate.

Although previous research, from high income countries, shows leisure time activity helps prevent heart disease and death, the PURE study also includes people from low and middle-income countries where people don't generally don't participant in leisure-time physical activity.

"By including low and middle-income countries in this study, we were able to determine the benefit of activities such as active commuting, having an active job or even doing housework," said principal investigator Dr. Scott Lear. He added that one in four people worldwide do not meet the current activity guideline and that number is nearly three of four in Canada.

The PURE study showed that by meeting the activity guidelines, the risk for death from any cause was reduced by 28%, while heart disease was reduced by 20%, and it didn't matter what type of physical activity the person did. The benefits also continued at very high levels with no indication of a ceiling effect; people getting more than 750 minutes of brisk walking per week had a 36% reduction in risk of death. However, less than 3% of participants achieved this level from leisure time activity while 38% of participants achieved this level from activities such as commuting, being active at work or doing household chores.

Lear said that in order to realize the full benefits of physical activity, it needs to be incorporated into daily life. "Going to the gym is great, but we only have so much time we can spend there. If we can walk to work, or at lunch time, that will help too."

"For low and middle income countries where having heart disease can cause a severe financial burden, physical activity represents a low-cost approach that can be done throughout the world with potential large impact," said Dr. Salim Yusuf, director of the Population Health Research Institute and the principal investigator of the overall PURE study.

"If everyone was active for at least 150 minutes per week, over seven years a total of 8% of deaths could be prevented," he added.

Milk-alternative drinks do not replace the iodine in cows' milk

Consumers of milk-alternative drinks may be at of risk iodine deficiency, according to the findings of a new study in the British Journal of Nutrition.

In the first study of its kind in the United Kingdom, researchers from the University of Surrey examined the iodine content of 47 milk-alternative drinks (including soya, almond, coconut, oat, rice, hazelnut and hemp, but excluding those marketed specifically at infants and children) and compared it with that of cows' milk.

Researchers discovered that the majority of milk-alternative drinks did not have adequate levels of iodine, with concentration levels found to be around 2% of that found in cows' milk. Cows' milk and dairy products are the main source of iodine in the diet however findings from the study show that most milk-alternative drinks are not an adequate substitute. 

Iodine is required to make thyroid hormones, and is particularly important during pregnancy as it is essential for normal foetal brain development. Previous research in this area by the University of Surrey has shown that low iodine status in pregnant mothers is linked to lower IQ and reading scores in their children (up to 9 years of age).

A glass of a milk-alternative drink would only provide around 2 mcg of iodine which is a very small proportion of the adult recommended iodine intake of 150 mcg/day. In pregnancy, that recommendation goes up to 200 mcg/day. 

Worryingly, most milk-alternative drinks are not fortified with iodine and their iodine content is very low. If avoiding milk and dairy products, consumers need to ensure that they have iodine from other dietary sources, where possible.. If considering taking an iodine supplement, you should avoid kelp which can provide excessive amounts of iodine.

1 in 3 older adults take something to help them sleep but many don't talk to their doctors

• IMAGE: This is the percentage of Americans age 65-80 who report trouble falling asleep. view more 

Credit: University of Michigan

Sleep doesn't come easily for nearly half of older Americans, and more than a third have resorted to some sort of medication to help them doze off at night, according to new results from the National Poll on Healthy Aging.

But most poll respondents said they hadn't talked to their doctor about their sleep, even though more than a third said their sleep posed a problem. Half believe -- incorrectly -- that sleep problems just come naturally with age.

The poll was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and is sponsored by AARP and Michigan Medicine, U-M's academic medical center.

Those who turn to medications may not realize that prescription, over-the-counter and even "natural" sleep aids carry health risks, especially for older adults, either alone or in combination with other substances. In fact, national guidelines strongly warn against prescription sleep medicine use by people over age 65.

Despite this, the nationally representative poll of people ages 65 to 80 finds that 8 percent of older people take prescription sleep medicine regularly or occasionally. Among those who report sleep troubles three or more nights a week, 23 percent use a prescription sleep aid. Most who use such drugs to help them sleep had been taking them for years. Manufacturers and the U.S. Food and Drug Administration say such drugs are only for short-term use.

Medication: not the only option

"Although sleep problems can happen at any age and for many reasons, they can't be cured by taking a pill, either prescription, over-the-counter or herbal, no matter what the ads on TV say," says poll director Preeti Malani, M.D., a U-M physician trained in geriatric medicine. "Some of these medications can create big concerns for older adults, from falls and memory issues to confusion and constipation," even if they're sold without a prescription.

"The first step for anyone having trouble sleeping on a regular basis should be to talk to a doctor about it," she continues. "Our poll shows that nearly two-thirds of those who did so got helpful advice - but a large percentage of those with sleep problems simply weren't talking about it."

She notes that non-medication-based sleep habits are the first choice for improving sleep in older people.

Sleep and health

In all, 46 percent of those polled had trouble falling asleep one or more nights a week. Fifteen percent of the poll respondents said they had trouble falling asleep three or more nights a week.

Other health conditions can contribute to sleep difficulties. Twenty-three percent of poll respondents who had trouble sleeping said it was because of pain. And 40 percent of those with frequent sleep problems said their overall health was fair or poor. Other reasons for sleep troubles included having to get up to use the bathroom at night, and worry or stress.

Insomnia and other irregular sleep patterns can interfere with daytime functioning, and are associated with memory issues, depression and an increased risk of falls and accidents. Even so, many said they didn't see sleep issues as a health problem - in fact, this belief was the most common reason that poll respondents said they didn't talk to their doctor about sleep.

This also highlights the need for doctors to ask their older patients about their sleep habits and what they're doing to address any issues they may be having

"We know that sleep is a critical factor for overall health as we age, and this new research highlights sleep problems as both a significant health issue for older adults and an underacknowledged one both by patients and their providers," says Alison Bryant, Ph.D., senior vice president of research for AARP. "We need to help people understand that lack of sleep is not just a natural part of aging."

More about medication use

In all, 14 percent of the poll respondents said they regularly took a prescription sleep medication, prescription pain medication, OTC sleep aid or herbal supplement to help them sleep. Another 23 percent took one of these options occasionally; most of the occasional users said they chose OTC sleep aids.

The most recent Beers Criteria established by the American Geriatrics Society, which guides the use of medications among older people, gives a strong warning against use of prescription sleep drugs, which are sold under such names as Ambien, Lunesta and Sonata.

Meanwhile, even though OTC sleep aids can be purchased without a doctor's guidance or prescription, they still carry health risks for older people, Malani notes. Most of them contain diphenhydramine, an antihistamine that can cause side effects such as confusion, urinary retention and constipation.

Among poll respondents with frequent sleep problems who took something occasionally to help them sleep, OTC sleep remedies were the most common choice. But among those with frequent sleep issues who took something on a regular basis to try to sleep, prescription sleep medications were the most common option, with 17 percent reporting use.

Use of melatonin and other herbal remedies may be perceived as safer, but less is known about their potential side effects and they are not subject to the FDA's approval process for medications, says Malani. But any issue that prompts someone to buy an OTC or herbal remedy on a regular basis is something they should discuss with their doctor, she adds.

The poll results are based on answers from a nationally representative sample of 1,065 people ages 65 to 80, who answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it.

Quitting daily aspirin therapy may increase second heart attack, stroke risk

Stopping long-term, low-dose aspirin therapy may increase your risk of suffering a cardiovascular event, according to new research in the American Heart Association's journal Circulation.

Aspirin, taken in low doses, is used to help reduce the risk for recurrent heart attack or stroke. Aspirin inhibits clotting, lowering the risk of cardiovascular events. Nearly 10 to 20 percent of heart attack survivors stop daily aspirin use within the first three years following their event. In broader patient settings, discontinuation rates of up to 30 percent and poor aspirin compliance in up to 50 percent of patients have been reported.

To study the health effects of stopping aspirin therapy, Swedish researchers examined the records of 601,527 people who took low-dose aspirin for heart attack and stroke prevention between 2005 and 2009. Participants were older than 40, cancer-free and had an adherence rate of greater than 80 percent in the first year of treatment.

In three years of follow-up, there were 62,690 cardiovascular events. Researchers also found:

• one out of every 74 patients who stopped taking aspirin had an additional cardiovascular event per year;
• a 37 percent higher rate of cardiovascular events for those who stopped aspirin therapy compared to those who continued; and
• an elevated risk of cardiovascular events that increased shortly after discontinuation of therapy and did not appear to diminish over time.

"Low-dose aspirin therapy is a simple and inexpensive treatment," said Johan Sundstrom, M.D., Ph.D., lead author and professor of epidemiology at Uppsala University in Sweden. "As long as there's no bleeding or any major surgery scheduled, our research shows the significant public health benefits that can be gained when patients stay on aspirin therapy."

Studies have suggested patient's experience a "rebound effect" after stopping aspirin treatment, this is possibly due to increased clotting levels from the loss of aspirin's blood-thinning effects. Because of the large number of patients on aspirin and the high number who stop treatment, the importance of a rebound effect may be significant, Sundstrom said.

"We hope our research may help physicians, healthcare providers and patients make informed decisions on whether or not to stop aspirin use," Sundstrom said.

The American Heart Association recommends that people at high risk of heart attack should take a daily low-dose of aspirin (if told to by their healthcare provider) and that heart attack survivors also take low-dose aspirin regularly.

Being in a good mood for your flu jab boosts its effectiveness

New research by a team of health experts at the University of Nottingham has found evidence that being in a positive mood on the day of your flu jab can increase its protective effect.

Flu vaccination is estimated to only be effective in 17-53% of older adults compared to 70-90% of younger people. With the onset of winter and so-called 'flu season', the research is likely to be of interest to everyone having their autumn flu jab.

This new Nottingham-based study is the first to examine several psychological and behavioural factors that have been shown to affect how well vaccinations work. The researchers set out to understand which factor, or combination of factors has the greatest impact on the ability of vaccinations to protect against disease.

The team measured negative mood, positive mood, physical activity, diet and sleep three times a week over a 6 week period in a group of 138 older people due to have their flu jab. Then they examined how well the jab was working by measuring the amount of influenza antibody in the blood at 4 weeks and 16 weeks after the vaccination.

The results showed that of all of the factors measured, only positive mood over the 6 week observational period predicted how well the jab worked - with good mood associated with higher levels of antibody. In fact, when the researchers looked at influences on the day of vaccination itself, they found an even greater effect on how well it worked, accounting for between 8 and 14% of the variability in antibody levels.

Professor Kavita Vedhara, from the University's Division of Primary Care, said: "Vaccinations are an incredibly effective way of reducing the likelihood of catching infectious diseases. But their Achilles heel is that their ability to protect against disease is affected by how well an individual's immune system works. So people with less effective immune systems, such as the elderly, may find vaccines don't work as well for them as they do in the young.

"We have known for many years that a number of psychological and behavioural factors such as stress, physical activity and diet influence how well the immune system works and these factors have also been shown to influence how well vaccines protect against disease."

The study, published in Brain, Behavior and Immunity, was unusual in that, by chance, the vaccination that participants received was identical to the one they had received in the previous year. This has happened only once before since the turn of the century. As a result, the researchers found that participants had very high levels of antibody - and therefore protection - for two out of three of the viruses present in the vaccination, even before they were vaccinated.

This so-called 'ceiling effect' meant that this study was unlikely to see further large increases in antibody levels for these two viruses and therefore was unlikely to reveal an effect of psychological and behavioural factors. As a result the team focused its analyses on the one strain which was the least 'immunogenic' i.e. the strain with low levels of antibody prior to vaccination.

The researchers say the approach of focusing on individual viral strains is not uncommon, but recommend that future research is best conducted in the context of a vaccination with more novel viral strains to further confirm the positive mood effect on vaccination.

How to remove a tick and prevent future bites

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A woman removing a tick from her arm.

Credit: American Academy of Dermatology

As tick populations grow and spread across the country, their prevalence is increasing the public's risk for some troubling diseases. Of these diseases, say dermatologists from the American Academy of Dermatology, Lyme disease, Rocky Mountain spotted fever, Powassan virus and alpha-gal syndrome -- a mysterious red meat allergy -- are among the most serious.

"Although most ticks do not carry disease, it's important to be mindful of these risks and keep an eye out while you're outdoors," said board-certified dermatologist Lindsay Strowd, MD, FAAD, an assistant professor of dermatology at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. "If you notice a tick crawling on you or attached to your skin, remove it immediately to prevent any potential infection."

To remove a tick that is attached to your skin, Dr. Strowd recommends the following tips:

1. Use tweezers to remove the tick. Sterilize the tip of the tweezers using rubbing alcohol and grasp the tick as close to the skin's surface as possible.
2. Pull upward with steady, even pressure. Avoid twisting, squeezing or crushing the tick, as this can cause its head or mouth to break off and remain in your skin. If this happens, use tweezers to remove the remaining parts. If you cannot remove the rest of the tick, see a board-certified dermatologist.
3. Dispose of the tick. Place it in a sealed bag or container; submerse the tick in alcohol; or wrap it tightly in tape. You may also want to save the tick in a sealed jar. That way, if you develop any symptoms after the bite, the tick can be tested for disease.
4. Clean the bite area with soap and water.

"Although ticks can bite at any time, they're most active in April through September," said Dr. Strowd. "Fortunately, there are many things people can do to protect themselves and their families against ticks."

To prevent tick bites, Dr. Strowd recommends the following tips:

1. Walk in the center of trails. Avoid walking through heavily wooded and brushy areas with tall grass.
2. If you must walk through heavily wooded areas, wear long pants and long sleeves. Pull your socks up over your pants, and tuck your shirt into your pants to prevent ticks from crawling up your body. It's also a good idea to wear light-colored clothes so that ticks can be spotted easily.
3. Use insect repellent that contains 20 to 30 percent DEET on exposed skin and clothing. Make sure to follow the product instructions. Parents should apply this product to their children, making sure to avoid the hands, eyes and mouth.
4. Examine your skin after spending time in heavily wooded or brushy areas. Conduct a full-body tick check to make sure that no ticks are crawling on you. Since ticks prefer warm, moist areas, be sure to check your armpits, groin and hair. You should also check your children and pets, as well as any gear you used outside.

"If you develop any symptoms within a few weeks after a tick bite, such as a rash, fever or body aches, see a board-certified dermatologist," said Dr. Strowd. "Make sure you tell the doctor about your recent tick bite, when the bite occurred and where you most likely acquired the tick."

Foot pain? New study says look at hip and knees

A study by researchers at Hospital for Special Surgery (HSS) and Harvard Medical School suggests new guidelines may be in order for evaluating and treating lower extremity pain. Investigators set out to determine if there was a relation between foot pain and lower extremity joint pain, and they found a significant association between foot pain and knee or hip pain.

"Our overall goal was to provide practitioners with evidence-based guidance for evaluation and options for treatment for their patients," the researchers wrote in their paper, which appeared in the Journal of the American Podiatric Medical Association.

"The study shows that a physician evaluating a patient for foot pain should also ask about possible hip or knee pain, and vice versa, so we can address all of a patient's issues. In medicine, many times it comes down to 'what does your MRI look like or what does your x-ray look like?' But it's really important to conduct a thorough medical history and physical exam," says Brian Halpern, MD, a sports medicine physician at HSS and study co-author. "A comprehensive orthopedic evaluation may prompt a broader treatment strategy and possibly a referral to another specialist."

"Studying the interaction between the knee and the foot, or the hip and the foot is very important because it's a kinetic chain," says Rock G. Positano, DPM, MPH, director of the Non-Surgical Foot and Ankle Service, Joe DiMaggio Sports Medicine Foot and Ankle Center at HSS.

The kinetic chain, the notion that the body's joints and segments have an effect on one another during movement, can play a key role in pain. "The foot is the first part of the body that makes contact with the ground. Its primary function is a shock absorber. If the shock-absorbing capability of the foot is somehow altered or minimized, it's going to affect other body parts," Dr. Positano explains.

"The foot is also the foundation of the body," he adds. "If the foundation is not sound, it could have a deleterious effect on the joints above the foot and ankle, namely the knee and the hip."

In the population-based study, investigators analyzed information from a database of 2,181 people who had participated in the NIH-funded Framingham Foot Study between 2002 and 2008. "Access to this rich database was indispensable to test our hypothesis that there was a relation between foot pain and hip or knee pain," explained Howard Hillstrom, PhD, director of the Motion Analysis Laboratory at HSS and co-investigator of the Framingham Foot Study. "It would have been very difficult to organize such a large study from scratch."

Participants completed a questionnaire evaluating foot pain, pain location (including side of pain) and severity. They also indicated whether they had experienced pain, aching or stiffness in the hip or knee and specified the side of any reported pain. In the study, 16% of participants reported bilateral foot pain, 6% right foot pain only and 5% left foot pain only. Slightly more women than men reported foot pain.

Researchers found that foot pain was associated with bilateral and same-side knee pain in men and women. For example, men with right foot pain compared to those with no foot pain were five to seven times more likely to have pain in their right knee or in both knees.

Foot pain was also associated with hip pain on the same side in men. In women, bilateral foot pain was associated with hip pain on both sides, on the same side or on the opposite side.

A theory that may explain study results looks at how an individual modifies his movements and postures when experiencing pain. This can result in malalignment and other problems, and the challenge for physicians is to develop a treatment plan to address all issues, according to the study authors. "The correlated and compensatory posture and movement theory may explain how multi-joint arthritis develops, as well as other abnormalities and associated pains that can result from overuse or trauma to one or more structures in the kinetic chain," the researchers wrote.

They went on to state that the findings "advocate for a change in the paradigm of how patients with lower extremity pain should be evaluated clinically... In a world where medical imaging has come to the forefront of patient diagnoses and care, these results remind health care providers that the basic physical examination and patients' history remain important in identifying pain and related patterns in patients."

Dr. Positano notes that it is also up to patients to be proactive, making sure they discuss all orthopedic issues they may have during the doctor visit.

Both high, low levels of magnesium in blood linked to risk of dementia

People with both high and low levels of magnesium in their blood may have a greater risk of developing dementia, according to a study published in the September 20, 2017, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"These results need to be confirmed with additional studies, but the results are intriguing," said study author Brenda C.T. Kieboom, MD, MSc, of Erasmus University Medical Center in Rotterdam, the Netherlands. "Since the current treatment and prevention options for dementia are limited, we urgently need to identify new risk factors for dementia that could potentially be adjusted. If people could reduce their risk for dementia through diet or supplements, that could be very beneficial."

The study involved 9,569 people with an average age of 65 who did not have dementia whose blood was tested for magnesium levels. The participants were followed for an average of eight years. During that time, 823 people were diagnosed with dementia. Of those, 662 people had Alzheimer's disease.

The participants were divided into five groups based on their magnesium levels. Both those with the highest and the lowest levels of magnesium had an increased risk of dementia, compared to those in the middle group.

Both the low and high groups were about 30 percent more likely to develop dementia than those in the middle group. Of the 1,771 people in the low magnesium group, 160 people developed dementia, which is a rate of 10.2 per 1,000 person-years. For the high magnesium group, 179 of the 1,748 people developed dementia, for a rate of 11.4 per 1,000 person-years. For the middle group, 102 of the 1,387 people developed dementia, for a rate of 7.8.

The results were the same after researchers adjusted for other factors that could affect the risk of dementia and magnesium levels, such as body mass index, smoking status, alcohol use and kidney function.

Kieboom noted that almost all of the participants had magnesium levels in the normal range, with only 108 people with levels below normal and two people with levels above normal.
Foods that are good sources of magnesium include spinach, almonds, cashews, soy and black beans, whole grains, yogurt and avocados.

Kieboom said that if the results are confirmed, blood tests to measure magnesium levels could be used to screen for people at risk of dementia. She emphasized that the study does not prove that high or low levels of magnesium cause dementia; it only shows an association.

Limitations of the study include that magnesium levels were measured only once, so they could have changed, and that magnesium levels in the blood do not always represent the total level of magnesium in the body.

Physically active mid-lifers more likely to be active into old age

Men who are physically active in mid-life are more likely to continue the habit into older age as well, finds a long term tracking study published in the online journal BMJ Open.

Playing sport is the physical activity most likely to stand the test of time, the findings show, prompting the researchers to suggest that encouraging early and sustained participation in sports might help people to stay active in old age.

The health benefits of being physically active throughout the life course are well known, but the transition from mid-life to old age often coincides with major life events, such as retirement, when both the amount and frequency of exercise are likely to change, say the researchers.

To find out what types of physical activity endure through middle age to later life, the researchers tracked the behaviour of nearly 3,500 men for up to 20 years, all of whom were taking part in the British Regional Heart Study.

This involved nearly 8,000 men on family doctor patient lists from 24 British towns, who first entered the study between 1978 to 1980 when they were aged between 40 and 59. They were subsequently monitored after 12, 16, and 20 years.

Each participant filled in a detailed questionnaire on their medical history and lifestyle, which included questions on the amount and type of physical activity they engaged in: walking; recreational activities, such as recreational walking, home improvements (DIY), gardening and chores; and sports/formal exercise.

The responses were scored according to the intensity and frequency of the activity, and the figures combined to give a total activity score. Men who played sports also disclosed how long they had been doing it for.

Complete data were available for 3,413 men who were still alive at the 20 year time point.

Throughout the 20-year study the proportion of men classified as active remained at around two thirds at each check up. However, this masked the changes in the types of activity the men did over time.

Sport was the most stable activity, with just under half of men reporting playing sport at least occasionally at each check up.

The proportion of men who reported high levels of walking rose from just under 27% at the start of the study to 62% at the 20 year check up, possibly because retirement might free up more time, say the researchers.

But there were sharp falls in the proportion who engaged in recreational activities, with over half the men (56%) reporting high levels at the start of the study, but only 40% doing so at the 20 year check up.

This could be because ill health may curtail more strenuous activities in older age, suggest the researchers.

The other key finding was that men who were active in midlife were nearly three times as likely to be physically active 20 years later, after taking account of potentially influential factors.

Interestingly, sport participation in midlife predicted physical activity in old age more strongly than other types of physical activity. The odds were even greater for those who had played sports for 25 years or more: these men were nearly 5 times as likely to be physically active into older age compared with men who didn't play sports.

The authors of this research, from University College London, suggest there may be a number of reasons for this. "One possibility is that people's enjoyment of sport may be more likely to persist into old age than preferences for other types of activity," they write.

"Sport participation in mid-life may help maintain physical function and [physical activity] self-efficacy in later life, increasing psychological and physical readiness for [physical activity] in old age," they add.

Daniel Aggio, lead author of this study, said: "Early engagement in sport and structured exercise may be vital for developing the necessary motor skills needed to establish a lifelong habit for physical activity. However, it may also be important to provide opportunities to take up other forms of activity, such as walking, during the transition to old age."

Midlife depression may stem from tension with mothers and siblings

Relationships with our mothers and siblings change as we become adults and start our own families, but the quality of those relationships still has an effect on our well-being, particularly at midlife. 

A new study led by Iowa State University researcher Megan Gilligan found that tension with our mothers and siblings, similar to our spouses, is associated with symptoms of depression. The research, published in the journal Social Sciences, found all three relationships have a similar effect and one is not stronger than another.

"Family scholars have focused a lot on the relationship we have with our spouse," said Gilligan, an assistant professor of human development and family studies. "There is this assumption that as you go through your life course, you leave these other relationships with your parents and siblings behind, but you don't. You carry those with you."

The relationship between mothers and daughters is even more significant. The research shows tension between mothers and adult children was a stronger predictor of depression for daughters than it was for sons. However, gender did not make a difference in relationships with spouses and siblings. Gilligan says this makes sense based on her previous research.

"We know that mothers and daughters in adulthood have the closest relationships and also the most conflictual. These are really intense relationships," she said. "Later in life, adult children start providing more care to their parents, and daughters in particular are often caregivers for their mothers."
Midlife is key to findings

Midlife is often characterized as stable and uneventful, but in reality, it is a time of change and transition for many people, Gilligan said. For example, adult children may be leaving the house and aging parents start requiring more care. Additionally, researchers know that midlife adults often react more strongly to family conflict than older adults do.

While there is a great deal of research on young families and family dynamics later in life, there is a gap at midlife, Gilligan said. Given the potential for greater conflict with mothers or siblings related to these midlife changes, it is important to understand the consequences of negative relationships on our psychological well-being.

"Midlife is a time when siblings are often coming back together as they prepare and navigate care for parents," she said. "For that reason, it's a pivotal time when these family relationships might be experiencing more tension, more strain, more discord."

Professionals should consider whole family
 
The research team used data collected through the Within-Family Differences Study. Their analysis included 495 adult children within 254 families. For a majority of families, multiple siblings participated in the study. Researchers measured depressive symptoms and tension among family members through survey questions. They controlled for race, gender and education.

In the paper, Gilligan and her colleagues explained that they expected all three relationships would predict depressive symptoms, but the effect would vary depending on the salience of the relationship. The fact that they found no significant difference between spouses, mothers and siblings is important to note, especially for practitioners. Gilligan says instead of focusing solely on a romantic partner or spouse, marriage and family therapists should ask about other sources of family stress.

"These findings show that we are navigating other family relationships at the same time and we're not experiencing them in isolation; we're experiencing them simultaneously," Gilligan said. "The stress people are experiencing may be the result of a romantic partner or spouse. However, it could also be that they're fighting with their siblings or they're experiencing a lot of tension with their mother even though they are 50 years old."

Taking a break from dieting may improve weight loss

Avoiding continuous dieting may be the key to losing weight and keeping the kilos off, the latest University of Tasmania research shows.

In findings published today in the International Journal for Obesity, School of Health Sciences researchers showed in a randomised controlled trial, that taking a two-week break during dieting may improve weight loss.

The study, funded by the National Health and Medical Research Council (NHMRC) of Australia, investigated the body's 'famine reaction' to continued dieting and its impact on weight loss in men with obesity.

During the study, two groups of participants took part in a 16-week diet which cut calorie intake by one third.

One group maintained the diet continuously for 16 weeks while the other maintained the diet for two weeks, then broke from the diet for two weeks eating simply to keep their weight stable, and repeated this cycle for 30 weeks in total to ensure 16 weeks of dieting.

Those in the intermittent diet group not only lost more weight, but also gained less weight after the trial finished.

The intermittent diet group maintained an average weight loss of 8 kg more than the continuous diet group, six months after the end of the diet.

Head of the University of Tasmania's School of Health Sciences Professor Nuala Byrne, who led the study with a team of collaborators from Queensland University of Technology and the University of Sydney, said dieting altered a series of biological processes in the body, which led to slower weight loss, and possibly weight gain.

"When we reduce our energy (food) intake during dieting, resting metabolism decreases to a greater extent than expected; a phenomenon termed 'adaptive thermogenesis' - making weight loss harder to achieve," Professor Byrne said.

"This 'famine reaction', a survival mechanism which helped humans to survive as a species when food supply was inconsistent in millennia past, is now contributing to our growing waistlines when the food supply is readily available."

Professor Byrne said while researchers in the past had shown that as dieting continued weight loss became more difficult, this latest MATADOR (Minimising Adaptive Thermogenesis And Deactivating Obesity Rebound) study looked more closely at ways to lessen the famine response and improve weight loss success.

However Professor Byrne said while this two-week intermittent diet proved to be a more successful means of weight loss compared with continuous dieting, other popular diets which included cycles of several days of fasting and feasting were not any more effective that continuous dieting.

"There is a growing body of research which has shown that diets which use one to seven day periods of complete or partial fasting alternated with ad libitum food intake, are not more effective for weight loss than conventional continuous dieting," she said.

"It seems that the 'breaks' from dieting we have used in this study may be critical to the success of this approach.

Older adults are aware of medication risks

Geriatrics experts know that certain medications may have risks for older adults that outweigh their benefits, especially when safer alternatives are available. Medications that could be "potentially inappropriate" for older adults are included on recommendation lists that your healthcare provider can consult, such as the American Geriatrics Society (AGS) Beers Criteria or the STOPP-START list.

However, despite these recommendations, 25 percent of older adults take at least one potentially inappropriate medication every year. Taking these medications can increase the risk of being hospitalized due to a medication-related problem. Although 70 percent of older adults are willing to stop taking certain medications, healthcare providers continue to prescribe some potentially inappropriate medicines to older adults.

Researchers from the Institut Universitaire de Gériatrie in Montréal, Canada, designed a survey to learn about older adults' awareness of drug-related health risks. They conducted the survey over the telephone with 2,665 participants, aged 65 or older.
The researchers learned that:

- 88 percent of the participants had used at least one prescription medication within the last 12 months.- 42 percent of the participants used medicines considered potentially inappropriate for older adults, including:

Sedative and hypnotic medications, such as tranquilizers and sleeping pillsGlyburide (a type of medicine prescribed for people with diabetes)
Proton pump inhibitors (medicines prescribed for acid reflux and several other conditions)
-65 percent of participants knew that some prescriptions could be potentially harmful.
- 42 percent of participants had discussed stopping one or more prescribed medications with their healthcare provider.
- Both adults younger than 80 and older adults who were more aware of medication risks were more likely to have conversations with healthcare providers about stopping prescriptions.
Just 7 percent of participants knew what the term "de-prescribing" meant. De-prescribing is the medical term for your healthcare provider taking you off a prescribed medication to improve your health or reduce the risk for adverse side effects.
- About half of the survey participants researched information about medications on their own.

The researchers suggested that the more information people have about potential risks associated with their medications, the more likely they may be to discuss reducing potentially inappropriate medications.

###

This summary is from "Older Adults' Awareness of Deprescribing: A Population-based Survey." It appears online ahead of print in the Journal of the American Geriatrics Society.

Link between youth football & later-life emotional, behavioral impairment

A new study has found an association between participation in youth tackle football before age 12 and impaired mood and behavior later in life. The study appears in Nature's Translational Psychiatry.

Researchers from Boston University's Chronic Traumatic Encephalopathy (CTE) Center studied 214 former American football players, including 43 who played only through high school and 103 who played only through college. The average age of the former players at the time of the study was 51. Participants received telephone-administered cognitive tests and completed online measures of depression, behavioral regulation, apathy and executive functioning (initiating activity, problem-solving, planning and organization).

Results from former players who started playing tackle football before the age of 12 were compared against those of participants who started playing at age 12 or later.

The study showed that participation in youth football before age 12 increased the risk of problems with behavioral regulation, apathy and executive functioning by two-fold and increased the risk of clinically elevated depression scores by three-fold. The increased risk was independent of the total number of years the participants played football, the number of concussions they reported, or whether they played through high school, college or professionally.

The researchers chose the cutoff of age 12 because the brain undergoes a key period of development and maturation between the years 10-12 in males. They examined other age cutoffs as well, though the age 12 cutoff led to the most robust findings. In addition, even when a specific age cutoff was not used, younger age of first exposure to football was associated with worse clinical function.

The new study follows previous research from the BU CTE Center that examined former professional players. In those studies, the former NFL players who started tackle football prior to age 12 had worse memory and mental flexibility, as well as structural brain changes on MRI scans, compared to former players who began at age 12 or older.

Comprehensive meta-analysis affirms cranberries' role in promoting a healthy urinary tract

A thorough review of dozens of studies led scientists to conclude that healthcare professionals should be telling their patients to have cranberry products as a first step in reducing recurrent UTIs. The comprehensive meta-analysis and assessment of human clinical trials, published in the official journal of the American Urological Association, The Journal of Urology^®, assures practitioners and their patients that cranberry products are a low cost, low risk and effective way to help prevent recurrent UTIs.

To answer the question, "Can Cranberries Contribute to Reduce the Incidence of Urinary Tract Infections?" a total of 28 studies showing results from nearly 5,000 patients were considered. Authors found a statistically significant risk reduction in repeat UTIs overall, but not significant for any particular subgroup. However, patients with recurrent UTIs who ingested cranberry products and had undergone gynecological surgery, experienced a significant reduction in UTIs.

"Our investigation supports that cranberry products can be a powerful tool to fight off frequent UTIs," explains lead author, Dr. Ângelo Luís. "While recommendations for dosage and duration of treatment require further study, the efficacy of the medicinal properties of cranberry products has been well-established."

The review explains that the medicinal properties of cranberries may be attributed to their unique polyphenol, proanthocyanidins - or PACs, for short. Their ability to keep infection-causing bacteria from sticking to the urinary tract walls may be the major reason for their effectiveness in limiting infection growth and recurrence.

According to the authors, scientists and practitioners continue to explore the use of alternative therapies in the prevention of common infections as part of the global movement to reduce antibiotic use and resistance. It is estimated that one third of women in the United States will get a UTI by the age of 24.]

Sleep deprivation is an effective anti-depressant for nearly half of depressed patients

Sleep deprivation -- typically administered in controlled, inpatient settings -- rapidly reduces symptoms of depression in roughly half of depression patients, according the first meta-analysis on the subject in nearly 30 years, from researchers at the Perelman School of Medicine at the University of Pennsylvania. Partial sleep deprivation (sleep for three to four hours followed by forced wakefulness for 20-21 hours) was equally as effective as total sleep deprivation (being deprived of sleep for 36 hours), and medication did not appear to significantly influence these results.
The results are published today in the Journal of Clinical Psychiatry.

Although total sleep deprivation or partial sleep deprivation can produce clinical improvement in depression symptoms within 24 hours, antidepressants are the most common treatment for depression. Such drugs typically take weeks or longer to experience results, yet 16.7 percent of 242 million U.S. adults filled one or more prescriptions for psychiatric drugs in 2013. The findings of this meta-analysis hope to provide relief for the estimated 16.1 million adults who experienced a major depressive episode in 2014.

Previous studies have shown rapid antidepressant effects from sleep deprivation for roughly 40-60 percent of individuals, yet this response rate has not been analyzed to obtain a more precise percentage since 1990 despite more than 75 studies since then on the subject.

"More than 30 years since the discovery of the antidepressant effects of sleep deprivation, we still do not have an effective grasp on precisely how effective the treatment is and how to achieve the best clinical results," said study senior author Philip Gehrman, PhD, an associate professor of Psychiatry and member of the Penn Sleep Center, who also treats patients at the Cpl. Michael J. Crescenz VA Medical Center. "Our analysis precisely reports how effective sleep deprivation is and in which populations it should be administered."

Reviewing more than 2,000 studies, the team pulled data from a final group of 66 studies executed over a 36 year period to determine how response may be affected by the type and timing of sleep deprivation performed (total vs early or late partial sleep deprivation), the clinical sample (having depressive or manic episodes, or a combination of both), medication status, and age and gender of the sample. They also explored how response to sleep deprivation may differ across studies according to how "response" is defined in each study.

"These studies in our analysis show that sleep deprivation is effective for many populations," said lead author Elaine Boland, PhD, a clinical associate and research psychologist at the Cpl. Michael J. Crescenz VA Medical Center. "Regardless of how the response was quantified, how the sleep deprivation was delivered, or the type of depression the subject was experiencing, we found a nearly equivalent response rate."

The authors note that further research is needed to identify precisely how sleep deprivation causes rapid and significant reductions in depression severity. Also, future studies are needed to include a more comprehensive assessment of potential predictors of treatment outcome to identify those patients most likely to benefit from sleep deprivation.

Increased physical activity boosts cognition

It is estimated that up to 75 percent of breast cancer survivors experience problems with cognitive difficulties following treatments, perhaps lasting years. Currently, few science-based options are available to help. In the journal Cancer, University of California San Diego School of Medicine researchers report in a pilot study of 87 female breast cancer survivors, an increase in physical activity more than doubled the women's post-treatment mental processing speed.

In a 12-week, randomized trial, half the women were enrolled in a physical activity intervention program tailored to each person's interests and abilities and incorporating wearable activity devices, while the other half were assigned to a control group that received emails addressing women's health topics, healthy eating, stress reduction and general brain health.

"Whether or not they receive chemotherapy, many breast cancer survivors experience a decline in brain function that impacts memory, thinking and concentration," said Sheri Hartman, PhD, assistant professor in the Department of Family and Preventive Medicine and co-director of the diet and physical activity shared resource at UC San Diego Moores Cancer Center. "The women who participated in the physical activity intervention experienced a significant improvement in cognitive processing speed and some improvements in their perceived mental abilities. This study supports the idea that exercise could be a way to help improve cognition among breast cancer survivors."

The study tested changes in cognition using both National Institutes of Health (NIH) Toolbox Cognition Domain, a computer-based test of cognitive abilities, and the Patient Reported Outcomes Measurement Information System for self-reporting brain function abilities and problems in all patients at the start and end of the 12-week period. This is the first completed randomized controlled trial using both a test of cognition and a self-reported method to assess the impact of physical activity on cancer survivors.

In the tests, women in the exercise arm showed more than double the improvements in processing speed, which measures how fast information can be taken in and used, compared to the control group. Looking closer, women in the intervention arm who were two years or less from diagnosis were four times more likely to show improvement in this area.

"This is a preliminary study, but it appears that intervening closer to diagnosis may be important to having an impact, and this is the population we may need to target," said Hartman.

Women in the intervention arm also had three times the improvements in self-report cognition abilities compared to the control group.

While the tests evaluated several aspects of cognition, only speed processing showed a significant improvement. Researchers recommend larger and longer trials evaluating the necessary duration of exercise and intensity of activities to determine if increased physical activity might impact other aspects of cognition.

Before the start of the study, all participants wore a research-grade accelerometer on their hips for seven days to measure physical activity at baseline and again for the last seven days of the trial to compare changes in minutes of moderately intense activity.

During the study period, women in the exercise arm wore a Fitbit One activity tracker. Data collected was sent to researchers to extract activity levels and to provide feedback and encouragement to engage in at least 150 minutes of moderate-to-vigorous physical activity per week, as recommended by the NIH. Researchers provided support through phone calls and emails.

"Survivors often report that their thinking is slower or feels more foggy. The brain just doesn't work at the same level as before cancer treatment," said Hartman. "By providing a program with support, women are more likely to make difficult behavioral changes that lead to an increase in physical activity."

The intervention program led to an approximately 100-minute increase in weekly physical activity in the participants in the exercise arm.

Participants were enrolled in the study between February 2015 and July 2016. To be eligible, women needed to be between 21 and 85 years of age and have been diagnosed and treated for breast cancer no more than five years before enrollment in the study. Participants were predominantly well-educated, non-Hispanic white women. Future research in cancer populations with greater diversity is needed, the authors said.

Diet is one of the strongest predictors of type 2 diabetes risk in older wome

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A pioneering method, developed at Chalmers University of Technology, has demonstrated its potential in a large study, showing that metabolic fingerprints from blood samples could render important new knowledge on the connection between food and health. The study finds that diet is one of the strongest predictors of type 2 diabetes risk in older women.

Researchers from Chalmers University of Technology and Sahlgrenska Academy, University of Gothenburg, have found that several diet and nutrient biomarkers -- molecules that can be measured in blood that are related to diet -- are linked with both risk to have type 2 diabetes and future risk of developing diabetes.

The study, published in the leading nutrition research journal American Journal of Clinical Nutrition, was carried out on 600 women from Gothenburg where diagnosis of diabetes was made at the start of the study, at their age 64, and again after 5 ½ years.

The results underline that diet is an important factor when it comes to risk for developing type 2 diabetes, with fish, whole grains, vegetable oils and good vitamin E status found to be protective against type 2 diabetes, while red meat and saturated fat increased the risk for developing the disease.

"What is really important is that we were able to reach these conclusions without having any additional information on diet from the subjects," said lead author Doctor Otto Savolainen, who works at the Division of Food and Nutrition Science and the Chalmers Mass Spectrometry Infrastructure at Chalmers University of Technology.

The blood samples were analysed at Chalmers, where a unique metabolic fingerprint, including many different diet biomarkers, could be linked to each woman at the specific time the sample was taken. Using this method it was possible for the first time to objectively determine the impact of key dietary components on future type 2 diabetes risk, as well as to find differences in dietary patterns between women with and without type 2 diabetes.

"Collecting information about diet can be complicated and time consuming, and is always biased by what people remember and think they should report. Dietary biomarkers don't have this problem, and highlight that dietary recommendations to avoid red meat and saturated fat and increase intake of plant-based oils and whole grains do seem to hold true, at least in this group of women," says Associate Professor Alastair Ross, responsible senior researcher at Chalmers, at the Division of Food and Nutrition Science.

"The new method has allowed us to measure several markers of diet and nutrient status at the same time in a large number of people, which we believe is the first time this has been done," he says.

Although the role of diet is often discussed as a preventive measure for developing type 2 diabetes, this new research provides strong support for dietary guidelines, and underlines the importance of changing diet to improve health.

"New methods such as ours will help to improve how we measure diet and understand in more detail how dietary patterns relate to disease," says Alastair Ross.

Caffeine linked to lower risk of death in women with diabetes

Women with diabetes who regularly drink caffeinated coffee or tea may live longer than those who don't consume caffeine at all, according to new research being presented at this year's European Association for the Study of Diabetes (EASD) Annual Meeting in Lisbon, Portugal (11-15 September). No association was found for men with diabetes.

This observational study found that the more caffeine women consumed the lower their risk of dying compared to those who never consumed caffeine. Importantly, the protective effect depended on the source of the caffeine: higher levels of caffeine consumption from coffee were associated with a reduced risk of death from any cause, particularly from cardiovascular disease; while women who consumed more caffeine from tea were less likely to die from cancer.

More than 80% of the world's adult population consume caffeine daily, mostly from coffee and tea. Average daily coffee consumption is between 100 mg and 300 mg per day, depending on age and country. The mean in the USA, for example, is 165 mg per day. Many studies have shown a beneficial effect of drinking coffee on the risk of death from all causes in the general population, but little is known about the role of caffeine on mortality in people with diabetes.

In this study, a group of medical residents from various institutions in Portugal (Dr. João Sérgio Neves and Professor Davide Carvalho from the University of Porto and colleagues across Portugal examined the association between varying levels of caffeine intake and mortality in over 3,000 men and women with diabetes from the 1999 to 2010 National Health Nutrition Examination Survey (NHANES)--a study tracking the health and nutritional status of a nationally representative sample of adults in the USA since 1971. Participants reported their caffeine intake from coffee, tea, and soft drinks when they entered the study using 24-hour dietary recalls -- structured interviews to accurately assess intake for the previous 24 hours.

Over the course of the 11-year study, 618 people died. The researchers found that women with diabetes who consumed up to 100mg per day (one regular cup of coffee) were 51% less likely to die than those who consumed no caffeine; women with diabetes who consumed 100-200mg per day had a 57% lower risk of death compared with non-consumers, and for those consuming over 200mg per day (2 regular cups of coffee) the reduced risk of death was 66%.

This association was independent of influential factors including age, race, education level, annual family income, smoking, body mass index, alcohol intake, high blood pressure, and diabetic kidney disease. No beneficial effect of caffeine consumption was noted in men with diabetes.

There was a decrease in cancer related mortality among women that consumed more caffeine from tea. When divided into four groups of tea consumption (zero, low, medium, high), the high caffeine from tea consumers had an 80% reduced risk of cancer compared with women with zero caffeine consumption from tea. However, as the overall consumption of tea was low in this cohort, these results must be interpreted with caution and considered as exploratory, requiring confirmation in larger studies.

The authors conclude: "Our study showed a dose-dependent protective effect of caffeine consumption on all-cause mortality among women. The effect on mortality appears to depend on the source of caffeine, with a protective effect of coffee consumption on all-cause mortality and cardiovascular mortality, and a protective effect of caffeine from tea on cancer mortality among women with diabetes. However our observational study cannot prove that caffeine reduces the risk of death but only suggests the possibility of such a protective effect."

Consuming large amounts of artificial sweeteners may increase risk of developing type 2 diabetes

Artificial sweeteners can change the body's response to glucose when consumed in large amounts, and could add to the risk of developing type 2 diabetes (T2DM), says new research being presented at this year's annual meeting of the European Association for the Study of Diabetes (EASD) in Lisbon, Portugal (11-15 Sept).

Previous studies have indicated that habitual consumption of large amounts of non-caloric artificial sweeteners (NAS) is associated with an increased risk of developing T2DM; however the underlying mechanisms for how this occurs are unknown.

This study was conducted by Associate Professor Richard Young of the Adelaide Medical School, University of Adelaide, Adelaide, Australia, as well as colleagues from other Adelaide-based research institutions, and aimed to investigate the effects of consuming large amounts of NAS on the body's response to glucose.

The researchers recruited 27 healthy subjects who were given a quantity of two different NAS (sucralose and acesulfame-K) equivalent to drinking 1.5L of diet beverage per day, or an inactive placebo. These were consumed in the form of capsules taken three times a day before meals over the two-week period of the study. At the end of the two weeks, subjects had their response to glucose tested, examining glucose absorption, plasma glucose, and levels of insulin and gut peptides.

The team found that NAS supplementation caused an increase in measures of the body's response to glucose, measured using a technique known as the incremental area under the curve (iAUC). This was greater for both glucose absorption and blood glucose, while the iAUC for the gut peptide GLP-1, which acts to limit the rise in blood glucose after meals, was reduced. None of these measures were altered in those subjects who were given a placebo.

The study determined that just 2 weeks of NAS supplementation was enough to enhance glucose absorption and increase the magnitude of the response of blood glucose as a result.
The authors conclude that "This study supports the concept that artificial sweeteners could reduce the body's control of blood sugar levels and highlights the potential for exaggerated post-meal glucose levels in high habitual NAS users, which could predispose them to developing type 2 diabetes".

Type 2 diabetes is a reversible condition

A body of research putting people with Type 2 diabetes on a low calorie diet has confirmed the underlying causes of the condition and established that it is reversible.

Professor Roy Taylor at Newcastle University, UK has spent almost four decades studying the condition and will present an overview of his findings at the European Association For The Study Of Diabetes (EASD 2017) in Lisbon.

In the talk he will be highlighting how his research has revealed that for people with Type 2 diabetes:

• Excess calories leads to excess fat in the liver
• As a result, the liver responds poorly to insulin and produces too much glucose
• Excess fat in the liver is passed on to the pancreas, causing the insulin producing cells to fail
• Losing less than 1 gram of fat from the pancreas through diet can re-start the normal production of insulin, reversing Type 2 diabetes
• This reversal of diabetes remains possible for at least 10 years after the onset of the condition

"I think the real importance of this work is for the patients themselves," Professor Taylor says. "Many have described to me how embarking on the low calorie diet has been the only option to prevent what they thought - or had been told - was an inevitable decline into further medication and further ill health because of their diabetes. By studying the underlying mechanisms we have been able to demonstrate the simplicity of type 2 diabetes."

Get rid of the fat and reverse Type 2 diabetes
The body of research by Professor Roy Taylor now confirms his Twin Cycle Hypothesis - that Type 2 diabetes is caused by excess fat actually within both liver and pancreas.

This causes the liver to respond poorly to insulin. As insulin controls the normal process of making glucose, the liver then produces too much glucose. Simultaneously, excess fat in the liver increases the normal process of export of fat to all tissues. In the pancreas, this excess fat causes the insulin producing cells to fail.

The Counterpoint study which was published in 2011, confirmed that if excess food intake was sharply decreased through a very low calorie diet, all these abnormal factors would be reversed.
The study showed a profound fall in liver fat content resulting in normalisation of hepatic insulin sensitivity within 7 days of starting a very low calorie diet in people with type 2 diabetes. Fasting plasma glucose became normal in 7 days. Over 8 weeks, the raised pancreas fat content fell and normal first phase insulin secretion became re-established, with normal plasma glucose control.

Keep the weight off and keep the diabetes at bay
"The good news for people with Type 2 diabetes is that our work shows that even if you have had the condition for 10 years, you are likely to be able to reverse it by moving that all important tiny amount of fat out of the pancreas. At present, this can only be done through substantial weight loss", Professor Taylor adds.

The Counterbalance study published in 2016, demonstrated that Type 2 diabetes remains reversible for up to 10 years in most people, and also that the normal metabolism persists long term, as long as the person doesn't regain the weight.

Professor Taylor explained the science behind the mechanisms: "Work in the lab has shown that the excess fat in the insulin producing cell causes loss of specialised function. The cells go into a survival mode, merely existing and not contributing to whole body wellbeing. Removal of the excess fat allows resumption of the specialised function of producing insulin. The observations of the clinical studies can now be fully explained."

He added: "Surprisingly, it was observed that the diet devised as an experimental tool was actually liked by research participants. It was associated with no hunger and no tiredness in most people, but with rapidly increased wellbeing. The 'One, Two' approach used in the Counterbalance study was a defined two phase programme. The Phase 1 is the period of weight loss - calorie restriction without additional exercise. A carefully planned transition period leads to Phase 2 - long term supported weight maintenance by modest calorie restriction with increased daily physical activity."
This approach consistently brings about 15kg of weight loss on average.

After the details were posted on the Newcastle University, UK website, this has been applied clinically and people who were highly motivated have reported that they have reversed their type 2 diabetes and continued to have normal glucose levels (normoglycaemic) over years.

Older drivers who experience falls may be at a higher risk for car crashes

As we age, our ability to drive may help us live independently, shop for ourselves, and maintain social connections. Although car crash rates are low among older adults and are declining, older adults do still have higher rates of fatal crashes. Falls, which are a common and preventable cause of injury among older adults, may lower our ability to drive safely.

Experts believe that falls are related to driving in four ways:

• They can cause physical injury that limits mobility (our ability to move) and interferes with driving performance.
• Falling can increase the fear of falling, which leads to a reduction in physical activity . Reduced physical activity can weaken our physical strength, which also could reduce fitness for driving.
• Falls can affect an older adult's mental well-being, making them more fearful and leading to changes in driving behaviors.
• Falls and difficulty driving may be caused by common factors, such as vision problems.

A research team created a study to see whether falls were related to driving risks and behaviors among older adults. Their study was published in the Journal of the American Geriatrics Society.
To test their theory that falls are related to car crashes, crash-related injuries, and changes in driving performance, the researchers reviewed 15 studies of driving behavior among older adults involving nearly 47,000 people.
The researchers learned that older adults who had fallen were 40 percent more likely to experience a car crash after their fall than older adults who had not fallen.
Based on estimates of car crashes involving older drivers and older adults who fall, falls -- or the things that cause falls and crashes -- accounted for more than 177,000 additional car crashes each year.
Researchers also learned that falls may be an independent factor impairing an older adult's ability to drive safely, suggesting that some motor vehicle crashes might be caused by the falls themselves - regardless of the driver's underlying health and functioning.
The researchers suggested that taking steps to reduce the conditions that contribute to both falls and car crashes could reduce the occurrence of both. Some strategies for doing so include:

• Cataract surgery (a type of eye surgery that helps address cloudy vision)
• Exercise to improve physical and mental well-being
• Efforts to improve mental function

The researchers also suggested that for older adults who fall, post-fall rehabilitation might help improve functional ability and enable them to drive more safely.

Too many older diabetes patients are being overtreated New study shows that t

Up to 11 percent of older Americans insured through Medicare are receiving too much medication to control their diabetes, and around 7 percent are being undertreated. This is according to a study in the Journal of General Internal Medicine which is published by Springer. The research involved the analysis of Medicare insurance claims data in 2011 from 78,792 diabetes patients 65 years and older living in ten eastern American states.

Diabetes treatment is a balancing act in which the risks and difficulties of treatment must be constantly weighed up against the potential harm of undertreatment. Aggressive blood sugar control can cause dangerously low blood sugar (called hypoglycemia), heart attacks or strokes, temporary cognitive impairment and fractures. In specific cases outlined by the American Geriatrics Society and the American Diabetes Association, it is appropriate to de-intensify therapy or remove prescribed treatments for older adults with well controlled diabetes.

The data show that 8,560 (10.9 percent) of older patients potentially received too much diabetes medication in 2011, while 5,487 (6.9 percent) were undertreated. Overtreatment was more likely among patients who were also eligible for Medicaid (healthcare for families and individuals with limited means) and those older than 75 years. Overtreatment was less likely among Hispanics and people living in urban areas.

The deintensification of diabetes therapy was more common for Medicare beneficiaries with six or more chronic conditions, as well as those who had more outpatient visits or who lived in urban areas. It was much less likely for patients older than 75 years.

"The oldest Medicare beneficiaries are the least likely to benefit from tight glycemic control and most likely to be harmed, so it is troubling that they were more likely to be overtreated and less likely to have their medication regimens de-intensified," explains co-author Sussman of Ann Arbor Veterans Affairs Medical Center and the University of Michigan.

"By focusing at both overtreatment and undertreatment ends of the diabetes quality spectrum, we can best begin to improve the quality of diabetes care in all respects, ensuring that patients get needed care while avoiding unnecessary potential harm," he adds.

Antidepressants associated with significantly elevated risk of death

Antidepressant medications, most commonly prescribed to reduce depression and anxiety, increase the risk of death, according to new findings by a McMaster-led team of researchers.
It's widely known that brain serotonin affects mood, and that most commonly used antidepressant treatment for depression blocks the absorption of serotonin by neurons. It is less widely known, though, that all the major organs of the body--the heart, kidneys, lungs, liver--use serotonin from the bloodstream.

Antidepressants block the absorption of serotonin in these organs as well, and the researchers warn that antidepressants could increase the risk of death by preventing multiple organs from functioning properly.

The researchers reviewed studies involving hundreds of thousands of people and found that antidepressant users had a 33% higher chance of death than non-users. Antidepressant users also had a 14% higher risk of cardiovascular events, such as strokes and heart attacks. The findings were published today in the journal Psychotherapy and Psychosomatics.

"We are very concerned by these results. They suggest that we shouldn't be taking antidepressant drugs without understanding precisely how they interact with the body," says author Paul Andrews, an associate professor at McMaster University who led the research team.

Taken by one in eight adult Americans, antidepressants are among the most frequently used medications. They are often prescribed by family doctors without a formal diagnosis of depression, on the assumption they are safe. Since depression itself can be deadly--people with depression are at an increased risk of suicide, stroke and heart attack--many physicians think that antidepressants could save lives by reducing depressive symptoms.

New device delivers cognitive behavioral therapy to patients to teach the user skills for treatment of substance abuse

Release

Today, the U.S. Food and Drug Administration permitted marketing of the first mobile medical application to help treat substance use disorders (SUD). The Reset application is intended to be used with outpatient therapy to treat alcohol, cocaine, marijuana and stimulant SUDs. The application is not intended to be used to treat opioid dependence.
 
According to the Substance Abuse and Mental Health Services Administration, SUD occurs when an individual’s recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school or home. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use and pharmacological criteria.

The Reset device is a mobile medical application system containing a patient application and clinician dashboard. The device delivers cognitive behavioral therapy to patients to teach the user skills that aid in the treatment of SUD and are intended to increase abstinence from substance abuse and increase retention in outpatient therapy programs. The system is intended to be used in conjunction with outpatient therapy and in addition to a contingency management system, a widely-used program for treating SUD that uses a series of incentives to reward patients for adherence to their treatment program.

The FDA reviewed data from a multi-site, unblinded 12-week clinical trial of 399 patients who received either standard treatment or standard treatment with the addition of a desktop-based version of Reset which could be accessed at the clinic or at home. The data showed a statistically significant increase in adherence to abstinence for the patients with alcohol, cocaine, marijuana and stimulant SUD in those who used Reset, 40.3 percent, compared to the patients who did not, 17.6 percent. The clinical trial did not demonstrate the effectiveness of using the Reset device in patients reporting opioids as their substance of abuse.

The Reset device is indicated as a prescription-only adjunct treatment for patients with SUD who are not currently on opioid replacement therapy, who do not abuse alcohol solely, or whose primary substance of abuse is not opioids.

Data from the clinical studies did not indicate any side effects associated with the device. The adverse events evaluated were typical of patients with SUD, including cardiovascular disease, gastrointestinal events, depression, mania, suicidal behavior, suicidal ideation and attempts.

The Reset device was reviewed through the de novo premarket review pathway, a regulatory pathway for some low- to moderate-risk devices that are novel and for which there is no legally marketed predicate device to which the device can claim substantial equivalence.

The FDA permitted marketing of the Reset device to Pear Therapeutics.

High-fiber diets do not always lead to weight loss

In the era of personalized nutrition, there might be value in getting your stool tested and your gut bacteria counted before starting on a new diet. The results can be used to predict whether a particular diet will work for you. This follows a study in the International Journal of Obesity, published by Springer Nature, which shows that the increasingly popular fibre-rich "New Nordic Diet" might not work for everyone. Its success depends on the particular combination of bacteria in the intestines of the dieter. The study was led by Mads Hjorth and Arne Astrup of the Department of Nutrition, Exercise and Sports at the University of Copenhagen in Denmark.

"These results are a breakthrough demonstrating that certain bacterial species play a decisive role in weight regulation and weight loss," explains Astrup. "Now we can explain why a high fibre diet does not always lead to weight loss. Human intestinal bacteria is an important part of the answer and will from now on play a role in the treatment of the overweight."

A group of 62 overweight participants were randomly assigned to follow either the "New Nordic Diet" or the "Average Danish Diet". These eating plans vary greatly in the volume of dietary fibre and wholegrain being consumed. The former is the more fibre-rich option and places greater emphasis on wholefoods such as vegetables and fruits. The participants' weight and body measurements were taken before and after they started their 26-week diets.

The results of their stool samples were used to divide participants into two different enterotype or gut bacteria groups. This was done based on the abundance of Prevotella bacteria types found in their intestines compared to Bacteroides species. About half of the group fell in the high volume Prevotella-to-Bacteroides group, whereas the other half were placed in the low ratio group. After the initial 26-week study period, all 62 participants followed the New Nordic Diet for another year.

On average, the 31 subjects who ate the New Nordic Diet for 26 weeks lost 3.5 kilograms, whereas the 23 subjects following the Average Danish Diet lost 1.7 kilograms. The New Nordic Diet worked best for participants in the high volume Prevotella group. They lost 3.15 kilograms more body fat when they followed the New Nordic Diet compared to the Average Danish Diet. Their waistlines also decreased more significantly, and their weight loss was maintained after following the diet for one year. The type of diet followed had no influence on how much weight participants in the low ratio group lost.

"People with a high Prevotella/Bacteroides ratio were more susceptible to body fat loss on a diet rich in fibre and wholegrain compared to an average Danish diet," Hjorth explains.

"The health promoting aspects of the New Nordic Diet in terms of body weight regulation seem mainly to apply to a subset of the population," he adds. "This could apply to as much as half of the population."

Hjorth says that research into the human gut microbiota is increasingly playing a role in personalizing nutrition. He believes that the two relatively stable groups or enterotypes of bacteria species into which people can be grouped could be valuable markers to predict whether specific diets will work for them or not.