Psychological stress can cause vision loss?

IMAGE: The vicious cycle of chronic and acute stressors and vision loss. view more 

Credit: Bernhard Sabel

Persistent psychological stress, which is widely recognized as a consequence of vision loss, is also a major contributor to its development and progression, according to a study now published in the EPMA Journal, the official journal of the European Association for Predictive, Preventive, and Personalized Medicine. Clinical practice implications of this finding include a recommendation to improve the clinician-patient relationship and provide stress-reduction treatments and psychological counseling to interrupt the vicious cycle of stress and progressive vision loss.


"There is clear evidence of a psychosomatic component to vision loss, as stress is an important cause ? not just a consequence ? of progressive vision loss resulting from diseases such as glaucoma, optic neuropathy, diabetic retinopathy, and age-related macular degeneration," says Prof. Bernhard Sabel, PhD, Director of the Institute of Medical Psychology at Magdeburg University, Germany, lead investigator of the study. Prof. Sabel has pioneered a holistic treatment approach that combines stress management, patient education, and vision recovery and restoration techniques at the SAVIR-Center for Vision Restoration in Germany.

The study, which will be presented in November 2018 at the 5th International Conference of "Low Vision and Brain" in Berlin, is based on a comprehensive analysis of hundreds of published research and clinical reports on the relationship of stress and ophthalmologic diseases. Some case reports are presented showing how stress induces vision loss and how reduction of stress contributes to vision restoration.
"Continuous stress and elevated cortisol levels negatively impact the eye and brain due to autonomic nervous system (sympathetic) imbalance and vascular deregulation," Prof. Sabel explains, emphasizing that both the eye and the brain are involved in vision loss, a fact that is often overlooked by treating physicians and is not systematically documented in the medical literature. He notes that of the relatively few scientific reports in the field of psychosomatic ophthalmology available, even fewer explore the relationship of stress, vision loss, and vision restoration. This is rather surprising given that many patients suspect that mental stress had contributed to their vision loss, representing a large disconnect between scientific activity and what the public needs.
"The behavior and words of the treating physician can have far-reaching consequences for the prognosis of vision loss. Many patients are told that the prognosis is poor and that they should be prepared to become blind one day. Even when this is far from certainty and full blindness almost never occurs, the ensuing fear and anxiety are a neurological and psychological double-burden with physiological consequences that often worsen the disease condition," adds Dr. Muneeb Faiq, PhD, All India Institute of Medical Sciences, New Delhi, India, and Department of Ophthalmology, NYU Langone Health, New York University School of Medicine, USA, and a co-investigator on the study. Increased intraocular pressure, endothelial dysfunction (Flammer syndrome), and inflammation are some of the consequences of stress causing further damage.
Adjunct therapies like brain stimulation, relaxation response, vision restoration, anxiety management, and social support counteract stress and induce a relaxation response by rebalancing the autonomic system of reducing sympathetic and activating parasympathetic activity. They have been used successfully in tandem with therapies to increase blood flow to the eye, thereby opening the window of opportunity for vision restoration.
The investigators believe this holistic approach can be used more widely in the clinical management of eye diseases. They advise that stress reduction and relaxation techniques (e.g., meditation, autogenic training, stress management training, and psychotherapy to learn to cope) should be recommended, not only as complementary to traditional treatments of vision loss, but possibly as preventive measures to reduce progression of vision loss. Secondly, doctors should try their best to inculcate positivity and optimism while giving their patients the information to which they are entitled, especially regarding the important value of stress reduction. In this way, the vicious cycle could be interrupted. Stress management is also pertinent to the caregivers/family members whose support and encouragement are important to maintain a stress-free state of mind, which in turn may keep the stress markers at bay.
Prof. Sabel and his colleagues note that, "future clinical studies are underway to confirm the causal role of stress in different low vision diseases to evaluate the efficacy of different anti-stress therapies for preventing progression and improving vision restoration in randomized trials as a foundation of psychosomatic ophthalmology."

Gout in the elderly linked to higher risk of dementia

The results of a study presented today at the Annual European Congress of Rheumatology (EULAR 2018) suggest that gout is associated with a 17-20% higher risk of dementia in the elderly.1
Gout is a very common condition. It is caused by deposits of crystals of a substance called uric acid (also known as urate) in the joints, which leads to inflammation. Periods of time when patients are experiencing gout symptoms are called flares. Flares can be unpredictable and debilitating, developing over a few hours and causing severe pain in the joints. Guidelines for the treatment of gout recommend lowering uric acid levels, although maintaining too low levels is a concern because uric acid is thought to protect the brain.2,3
"We welcome these results as they contribute to our understanding of the relationship between uric acid and dementia," said Professor Robert Landewé, Chairperson of the Scientific Programme Committee, EULAR. "Previous studies have shown contradictory results with some indicating an increased risk of dementia, while others reporting the opposite."
"Our study found a considerable increased risk of dementia associated with gout in the elderly," said Dr. Jasvinder Singh, Professor of Medicine and Epidemiology at the University of Alabama at Birmingham, USA (study author). "Further study is needed to explore these relationships and understand the pathogenic pathways involved in this increased risk."
The study included 1.23 million Medicare beneficiaries, of which 65,325 had incident dementia. In an analysis which was adjusted for various potential confounding variables including demographics, comorbidities and commonly used medications (HR 1.17, 95% CI 1.13-1.21), the results showed that gout is independently associated with a significantly higher risk of dementia.1 The association was larger in older age groups, females, black race, and people with higher medical comorbidity.1
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Screening for aortic aneurysms in older men questioned

Screening programs for aortic aneurysms in the abdomen is now being questioned in a study published in The Lancet. As the condition becomes less common, general ultrasound scans for 65-year-old men may do more harm than good, the researchers assert.
"You run the risk of both over-diagnosing and over-treating a disease that does not at all represent the same problem anymore, which is a very positive development," says Minna Johansson, specialist in family medicine, PhD student at Sahlgrenska Academy, Sweden, and the lead author of the article.
Aortic aneurysms in the abdomen, or abdominal aortic aneurysms, are a localized enlargement of the aorta. The condition mainly affects older men, is strongly linked to smoking, but there usually are no symptoms. If the artery ruptures, however, the mortality rate is more than 80 percent. The purpose of screening is to find the aneurysms before symptoms and thereby enable preventive surgery. On the downside, screening finds aortic aneurysms that never would have ruptured or caused symptoms even if they remained undetected. This means that screening leads some men to undergo a surgery that will not benefit them but that poses a risk of serious complications and even death. In addition, the diagnosis can lead to anxiety, described by patients as "living with a ticking time bomb in the stomach."
In the current study, information on 25,265 older men who were screened was compared with an age-matched control group of 106,087 men who had not been screened. It was possible to compare contemporaneous groups of screened and non-screened men because the screening program was introduced in Swedish administrative regions in stages during the 2006-2015 period.
The researchers also studied the incidence and mortality from abdominal aortic aneurysms among all Swedish men between the ages of 40 and 99 from 1987 to 2015. It was already known that the disease decreased during the period, but the role screening played was not known.
"Mortality has declined by over 70 percent, and this trend was seen in both screened and unscreened counties and in both screened and unscreened age groups," Minna Johansson says. "If the screening program had any impact at all on the decline, it was very small. This very positive reduction in mortality was probably due to a decline in smoking".
The researchers argue that time outpaced the studies that formed the basis for introduction of the screening program. In the current study, it appeared that only seven percent of the mortality reduction from abdominal aortic aneurysms that were ascertained in the largest randomized study in the field remained in today's setting. This effect was so small that it is uncertain whether it actually existed.
The decreasing mortality of the disease for reasons other than screening has led to growing problems with over-diagnosing and over-treatment. Therefore, the balance between the benefits and harms has changed for the worse, the study shows. Of 10,000 men summoned for screening, at best two will have avoided death from abdominal aortic aneurysms after six years.
At the same time, 49 men receive a diagnosis that would never have caused health problems, and of them 19 will undergo preventive surgery that they therefore cannot benefit from, but nevertheless still comes with a risk of death and serious complications.
An alternative to current screening, to which over 80 percent of all older men in Sweden attend, may be to screen only men at high risk, such as current and former heavy smokers and people in families with a history of the disease. Another option is to focus more on reducing smoking in the population in general, which would also lead to many other important health benefits. Minna Johanson and her co-authors anticipate continued discussion on the issue.
"This is a difficult ethical dilemma. It's important that the men who are summoned for screening are informed that there are serious risks arising from participation and that the chance to benefit is at best very small today. We came to the conclusion that it is doubtful that the benefits of screening outweigh the harms and that the Swedish screening program should therefore be revisited," says Minna Johansson.

NSAIDs shown to have causal role in cardiovascular risk of patients with osteoarthritis

The results of a study presented today at the Annual European Congress of Rheumatology (EULAR 2018) suggest that over two thirds of the increased cardiovascular risk associated with osteoarthritis is linked to the use of non-steroidal anti-inflammatory drugs (NSAIDs).2

Osteoarthritis is a common condition that makes a person's joints stiff and painful, particularly in the morning. It is caused by, amongst others, thinning of the cartilage within the joints, which allows the bones to rub against each. Joint swelling and pain are frequent symptoms. It is the most common of all the different types of arthritis, and typically becomes more common as people get older.

"The examination of cardiovascular risk among individuals with osteoarthritis is an important area of research as very little is known about the association, despite osteoarthritis being the most common rheumatic disease with high prevalence among the elderly," said Professor Thomas Dörner, Chairperson of the Abstract Selection Committee, EULAR. "This study is important because it provides new information about the potential causal role of NSAIDs for the observed cardiovascular complications among individuals with osteoarthritis."

Recent research suggests that osteoarthritis is an independent risk factor for cardiovascular disease (CVD) and several mechanisms have been suggested to account for this association.3 One of these is the frequent use of NSAIDs in the treatment of osteoarthritis as they have been shown to be a proven risk factor for CVD.1

"To the best of our knowledge, this is the first longitudinal study to evaluate the mediating role of NSAID use in the relationship between osteoarthritis and CVD in a large population?based sample," said Professor Aslam Anis, School of Population and Public Health, University of British Columbia (study author). "Our results indicate that osteoarthritis is an independent risk factor for CVD and suggest a substantial proportion of the increased risk is due to the use of NSAIDs. This is highly relevant because NSAIDs are some of the most commonly used drugs to manage pain in patients with osteoarthritis."

Results of the study demonstrate that people with osteoarthritis had a 23% higher risk of developing CVD. The increased risk of congestive heart failure (CHF), ischemic heart disease (IHD), and stroke was 42%, 17% and 14% respectively. Investigators then calculated the impact of NSAID use on the increased risk and found that 68% of the total effect of osteoarthritis on CVD risk was due to NSAID use. The proportion of the increased risk due to NSAIDs seen in CHF was calculated at 45% and more than 90% for IHD and stroke respectively.

This population-based cohort study used data from 7,743 osteoarthritis patients and 23,229 non-osteoarthritis controls matched for age and gender from health administrative data from British Columbia, Canada. Statistical analysis was used which adjusted the results for age, gender, socioeconomic status, body mass index, and several conditions known to be associated with CVD, such as chronic obstructive pulmonary disease (COPD), high blood pressure, diabetes, high cholesterol, and Romano comorbidity score.2


About Rheumatic and Musculoskeletal Diseases
Rheumatic and musculoskeletal diseases (RMDs) are a diverse group of diseases that commonly affect the joints but can affect any organ of the body. There are more than 200 different RMDs, affecting both children and adults. They are usually caused by problems of the immune system, inflammation, infections or gradual deterioration of joints, muscle and bones. Many of these diseases are long term and worsen over time. They are typically painful and Iimit function. In severe cases, RMDs can result in significant disability, having a major impact on both quality of life and life expectancy.4

Foods combining fats and carbohydrates more rewarding than foods with just fats or carbs

IMAGE: This visual abstract shows that foods containing fat and carbohydrate are more reinforcing than equicaloric foods containing primarily fat or carbohydrate. This effect is independent of liking and is reflected... view more 

Credit: DiFeliceantonio and Coppin et al./Cell Metabolism

Researchers show that the reward center of the brain values foods high in both fat and carbohydrates--i.e., many processed foods--more than foods containing only fat or only carbs. A study of 206 adults, to appear June 14 in the journal Cell Metabolism, supports the idea that these kinds of foods hijack our body's inborn signals governing food consumption.

"The biological process that regulates the association of foods with their nutritional value evolved to carefully define the value of a food so that organisms can make adaptive decisions," says senior author Dana Small, director of Yale University's Modern Diet and Physiology Research Center. "For example, a mouse should not risk running into the open and exposing itself to a predator if a food provides little energy."

"Surprisingly, foods containing fats and carbohydrates appear to signal their potential caloric loads to the brain via distinct mechanisms. Our participants were very accurate at estimating calories from fat and very poor at estimating calories from carbohydrate. Our study shows that when both nutrients are combined, the brain seems to overestimate the energetic value of the food," she says.

In work that could help explain brain-body mechanisms underlying the genetic predisposition for obesity, eating in the absence of hunger, and difficulty losing or keeping off excess weight, Small and colleagues in Germany, Switzerland, and Canada looked at the neural response to food cues.

Test subjects underwent brain scans while being shown photographs of familiar snacks containing mostly fat, mostly sugar, and a combination of fat and carbs.

Allocated a limited amount of money to bid on their first-choice foods, subjects were willing to pay more for foods that combined fat and carbohydrates. What's more, the fat-carb combo lit up neural circuits in the reward center of the brain more than a favorite food, a potentially sweeter or more energy-dense food, or a larger portion size.

Our hunter-gatherer ancestors ate mostly woody plants and animal meat, the researchers noted. "In nature, foods high in fat and carbohydrate are very rare and tend to have fiber, which slows metabolism," Small says. "By contrast, it is very common for processed foods to have high fat and high carbohydrate loads."

After the domestication of plants and animals and the development of grain and dairy production around 12,000 years ago, opportunities to consume fat and carbohydrates together increased, but processed foods like donuts, which could contain 11 grams of fat and 17 grams of carbohydrate, have only been around for 150 years, not long enough for us to evolve a new brain response to them.
Scientists believe our past experience with the nutritive properties of carbohydrates releases dopamine in the brain through an as-yet-unknown metabolic signal. These kinds of signals seem to help regulate what and how much we eat.

The researchers theorize that the simultaneous activation of fat and carbohydrate signaling pathways launches an effect that human physiology has not evolved to handle. Consistent with this suggestion, rodents given access to fat alone or carbohydrate alone regulate their total daily caloric intake and body weight. But given unrestricted access to fat and carbohydrates, they quickly gain weight.

Link between allergen in red meat and heart disease

IMAGE: Shown are cross-sectional ultrasound images of coronary arteries from patients enrolled in the study. Plaque buildup (colored areas) in an artery from a patient that lacks sensitivity to red meat... view more 

Credit: Courtesy of Angela Taylor, M.D., University of Virginia Health System

A team of researchers says it has linked sensitivity to an allergen in red meat to the buildup of plaque in the arteries of the heart. While high saturated fat levels in red meat have long been known to contribute to heart disease for people in general, the new finding suggests that a subgroup of the population may be at heightened risk for a different reason - a food allergen. The study, which is supported by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health, appears in Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB), a peer-reviewed journal of the American Heart Association.

"This novel finding from a small group of subjects from Virginia raises the intriguing possibility that allergy to red meat may be an underrecognized factor in heart disease," said study leader Coleen McNamara, M.D., a professor of medicine in the Cardiovascular Research Center of the University of Virginia Health System, Charlottesville. "These preliminary findings underscore the need for further clinical studies in larger populations from diverse geographic regions and additional laboratory work."

The number of people with red meat allergies in the United States is unclear, but researchers estimate that it may be 1 percent of the population in some areas. The number of people who develop blood antibodies to the red meat allergen without having full-blown symptoms is much higher--as much as 20 percent of the population in some areas, the researchers say.

Only in recent years did scientists identify the main allergen in red meat, called galactose-α-1,3-galactose, or alpha-Gal, a type of complex sugar. They also found that a tick--the Lone Star tick--sensitizes people to this allergen when it bites them. That is why red meat allergies tend to be more common where these ticks are more prevalent, such as the Southeastern United States, but also extending to other areas, including Long Island, New York.

Researchers have suspected for some time that allergens can trigger certain immunological changes that might be associated with plaque buildup and artery blockages, but no one had identified a specific substance that is responsible for this effect. In the current study, researchers showed for the first time that a specific blood marker for red meat allergy was associated with higher levels of arterial plaque, or fatty deposits on the inner lining of the arteries. The blood marker they identified is a type of antibody (immunoglobulin or IgE) that is specific to the alpha-Gal allergen.

To identify this blood marker, the researchers analyzed blood samples from 118 adults and detected antibodies to alpha-Gal, indicating sensitivity to red meat, in 26 percent of them. Using an imaging procedure, the researchers found that the quantity of plaque was 30 percent higher in the alpha-Gal sensitized patients than in the non-sensitized patients. These plaques, a hallmark of atherosclerosis (hardening of the arteries), also tended to be more structurally unstable, which means that they have an increased likelihood of causing heart attack and stroke.

The evidence for a link between red meat allergens and coronary artery disease is still preliminary, the researchers noted, so they plan to conduct detailed animal and human studies to confirm their initial findings. Currently, the only treatment for red meat allergy once it is diagnosed is strict avoidance of red meat.

"While more studies are needed, the current work provides a potential new approach or target for preventing or treating heart disease in a subgroup of people who are sensitized to red meat," said Ahmed Hasan, M.D., Ph.D., a medical officer and program director in NHLBI's Atherothrombosis & Coronary Artery Disease Branch.

For now, consumers are encouraged to follow current recommendations for a heart-healthy lifestyle. This includes adapting a healthy diet, such as eating plenty of vegetables, fruits, whole grains, and other heart-healthy foods. Lean red meats can be part of a heart-healthy diet for those who are not allergic. Other heart-healthy lifestyle changes also include aiming for a healthy weight, managing stress, getting more exercise, and quitting smoking.

Social rejection is painful and can lead to violence. Mindfulness may provide a solution.

People who have greater levels of mindfulness -- or the tendency to maintain attention on and awareness of the present moment -- are better able to cope with the pain of being rejected by others, according to a new study led by a team of Virginia Commonwealth University researchers.
"Social rejection can have a number of negative outcomes both for the rejected person's own health and well-being, as well as their interpersonal relationships," said lead author Alexandra Martelli, a doctoral candidate in the Department of Psychology in the College of Humanities and Sciences. "Therefore it is critical that researchers find adaptive ways at responding to social rejection, and mindfulness may be one effective emotion regulation strategy."
The study, "When Less is More: Mindfulness Predicts Adaptive Affective Responding to Rejection via Reduced Prefrontal Recruitment," will be published in the journal Social Cognitive and Affective Neuroscience.
Researchers from VCU, the University of California, Los Angeles, and the University of Kentucky were curious to discover if mindfulness could be a buffer against the distress and pain of social rejection.
They ran an experiment in which 40 undergraduate students self-reported their levels of mindfulness, and then were placed in an fMRI scanner. The researchers observed live images of the participants' brain activity as they played a virtual ball-tossing game with what they believed to be two other partners.
For the last third of the game, the participants stopped receiving any ball tosses from the other players, mimicking the conditions of social rejection.
After the scanning session, the participants were interviewed about how distressed they were during the game. Participants with higher levels of mindfulness reported less distress from being excluded.
The link between mindfulness and reduced social distress also was seen in the brain imaging, as researchers found there was less activation in the left ventrolateral prefrontal cortex, which is known to assist in the "top-down" inhibitory regulation of both physical and social forms of pain.
The researchers also examined the communication between the ventrolateral prefrontal cortex and other brain areas during social rejection. They found that more mindful individuals showed less functional connectivity between the ventrolateral prefrontal cortex and two brain regions that help generate the experience of social distress, the amygdala and the dorsal anterior cingulate cortex.
"Our findings suggest that mindful people are not as distressed or pained by social rejection," the researchers wrote. "The neural results imply that a reason for mindful individuals' adaptive responses to rejection is that they do not excessively recruit (and therefore tax) 'top-down', inhibitory brain regions to inhibit social distress. Instead, mindful individuals may use more 'bottom-up' emotion-regulation strategies that prevent rejection from being distressing in the first place. Interventions that seek to help socially-isolated and rejected individuals may benefit from this mechanistic and biologically-informed information."
Martelli is a researcher in the Social Psychology and Neuroscience Lab at VCU. The lab, led by David Chester, Ph.D., an assistant professor in the Department of Psychology and a co-author on the study, seeks to understand why people try to harm one another after experiences such as rejection.
"Mindfulness has beneficial effects for many psychological and behavioral maladies," Chester said.
"Yet in many ways, our understanding of how mindfulness achieves these helpful outcomes is not fully understood. Our findings help shed light on the underlying biological and psychological mechanisms through which mindfulness helps people cope with distressing social experiences, such as rejection and exclusion."
Specifically, he said, the study suggests that mindful individuals are not as distressed by social rejection and that mindful individuals appear to successfully regulate such distressing emotions by not using effortful, inhibitory processes that suppress their feelings of social pain.
"This is important because the use of such 'top-down,' suppressive emotion regulation has been shown to backfire and is linked with poor emotion-related outcomes such as impulsivity," he said. "Mindful people are likely using a more 'bottom-up' regulatory approach, which makes sense given these individuals' tendency to focus on the organic origins of their feelings. On a practical level, our findings point to the utility of mindfulness in coping with interpersonal stressors. People dealing with exclusion or rejection may likely benefit from training in mindfulness techniques."
The study's findings are relevant to the Social Psychology and Neuroscience Lab's mission, Martelli said, because they further understanding of the underlying neural mechanisms of aggression and violence within interpersonal relationships.
"An over-reliance on top-down emotion-regulation strategies can result in self-regulatory failure," Martelli said. "Therefore, more bottom-up strategies, such as mindfulness, may be effective at regulating difficult emotions such as anger or frustration that typically result in violent or aggressive acts."