RESEARCH
LOW VITAMIN D LEVELS LINKED TO DEPRESSION
Low levels of vitamin D have been linked to depression, according to psychiatrists working with the Cooper Center Longitudinal Study. It is believed to be the largest such investigation ever undertaken.
Low levels of vitamin D already are associated with a cavalcade of health woes from cardiovascular diseases to neurological ailments. This new study, published in Mayo Clinic Proceedings, helps clarify a debate that erupted after smaller studies produced conflicting results about the relationship between vitamin D and depression.
"Our findings suggest that screening for vitamin D levels in depressed patients and perhaps screening for depression in people with low vitamin D levels might be useful," said E. Sherwood Brown, professor of psychiatry at University of Texas Southwestern Medical Centre and study author.
"But we don't have enough information yet to recommend going out and taking supplements," said Brown, who co-authored the study with The Cooper Institute, Dallas.
Researchers examined the results of almost 12,600 participants from late 2006 to late 2010, the journal Mayo Clinic Proceeding reports.
Brown and colleagues found that higher vitamin D levels were tied with a significantly decreased risk of current depression, particularly among people with a prior history of depression, according to a Texas statement.
Low vitamin D levels were tied with depressive symptoms, particularly those with a history of depression, so primary care patients with a history of depression may be an important target for assessing vitamin D levels.
Vitamin D is found in many dietary sources, such as fish, eggs, fortified milk, and cod liver oil. The sun also contributes significantly to the daily production of vitamin D, and as little as 10 minutes of exposure is thought to be enough to prevent deficiencies.
SOURCE: Mayo Clinic Proceedings
LIFELONG ACTIVE BRAINS HAVE FEWER DEPOSITS OF ALZHEIMER'S
PROTEIN
People who challenge their brains throughout their lifetimes, through reading, writing and playing games, are less likely to develop protein deposits in the brain linked with Alzheimer's.
Prior studies have suggested that people who are well educated and stay mentally active build up brain reserves that allow them to stay sharp even if deposits of the destructive protein called beta amyloid form in the brain.
A new study, based on brain-imaging research, suggests that people who stay mentally engaged beginning in childhood and remain so throughout their lives actually develop fewer amyloid plaques.
"We're not talking about the brain's response to amyloid. We're talking about the actual accumulation of amyloid," Dr. William Jagust of the University of California, Berkeley, whose study appears in the Archives of Neurology, said. "It's a brand new finding."
While small, the study also shows that starting brain-stimulating activities early enough might offer a way to prevent Alzheimer's-related plaques from building up in the brain.
Currently, there are no drugs that can prevent Alzheimer's disease, which scientists now think begins 10 to 15 years before memory problems set in.
Alzheimer's Disease International estimates there are now 36 million people with the disease worldwide. As the population ages, that number will increase to 66 million by 2030, and to 115 million by 2050.
The new study involved the use of an imaging agent known as Pittsburgh Compound B or PiB, which works with positron emission tomography, or PET scanners. This chemical sticks to and highlights deposits of beta amyloid.
"Beta amyloid is the protein that many people feel may be the initiating factor in Alzheimer's disease. It is the protein that is in the plaques of the brains of people with Alzheimer's," Jagust said.
STARTING CROSSWORD PUZZLES LATE WON'T HELP
The researchers studied 65 healthy, cognitively normal people aged 60 and older. Study participants were asked a battery of questions about how mentally active they had been during different periods of their lives starting at age six.
The questions included whether they had read newspapers, went to the library, wrote letters or e-mails and played games.
They also underwent extensive testing to assess their memory and thinking skills and their brains were scanned using the new tracer to look for amyloid deposits in the brain.
The team compared the brain scans with those of 10 Alzheimer's patients and 11 healthy people in their 20s.
They found that people who had been the most mentally active had lower levels of beta amyloid than others who had been less mentally active.
People in the study who had recently taken up crosswords and other mental exercises did not appear to see much benefit.
"What our data suggests is that a whole lifetime of engaging in these activities has a bigger effect than being cognitively active just in older age," said Susan Landau, another Berkeley researcher who worked on the study.
She said amyloid probably starts accumulating many years before symptoms appear, so by the time memory problems start, there is little that can be done. "The time for intervention may be much sooner," she said in a statement.
One weakness is that the study relies on people's memory of their mental activities, Jagust said.
He said staying mentally engaged may make the brain more efficient, which could have a protective effect, but that is still not clear.
Jagust said "there is no downside to cognitive activity". It can only do good, even if for reasons other than reducing amyloid deposits in the brain:
"And actually, cognitive activity late in life may well turn out to be beneficial for reducing amyloid. We just haven't found that connection yet," he added.
SOURCE: Archives of Neurology
BREAST CANCERS & LEUKAEMIAS SLOWED BY A SINGLE THERAPY
Targeting a single protein can help fight both breast cancers and leukaemias, according to two reports published in the Journal of Experimental Medicine.
The single protein is HSP90, which acts as a chaperone to protect other proteins in the cell.
A team led by Ute Moll at the University of Göttingen in Germany found that blocking HSP90 activity rendered normally protected proteins vulnerable to attack and destruction. One of these proteins, called migration inhibitory factor, drives the growth of breast tumours. HSP90 inhibitors slowed the growth of MIF-expressing breast tumours in mice but had little effect on tumours lacking MIF.
HSP90 inhibitors also look promising for certain forms of leukaemia, according to a study by David Weinstock and coworkers at the Dana-Farber Cancer Institute. They showed that HSP90 inhibitors slowed the growth of leukaemias driven by hyperactive versions of the enzyme JAK2, many of which become resistant to JAK2-blocking drugs. The HSP90 inhibitors delayed the growth of resistant leukaemia cells in mice.
Together these studies suggest that HSP90 may represent a therapeutic target in many cancers.
SOURCE:
Journal of Experimental Medicine
ASPIRIN 'REDUCES RISK OF CANCER'
First international randomised control trial to prove aspirin can prevent cancer.
The results of a study published in The Lancet show a regular dose of aspirin can half the number of cancer cases in people with a hereditary risk of the disease.
The research, led by Newcastle University in the UK, found that a long-term, regular dose of aspirin halved the number of cancer cases among men and women with Lynch syndrome - an inherited genetic disorder that puts people at high-risk of bowel and endometrial (womb) cancer.
The research, led by Newcastle University in the UK, found that a long-term, regular dose of aspirin halved the number of cancer cases among men and women with Lynch syndrome - an inherited genetic disorder that puts people at high-risk of bowel and endometrial (womb) cancer.
Professor Fin Macrae, head of colorectal medicine and genetics at Royal Melbourne Hospital, said the findings were a world first and a huge step forward in our understanding of the role of aspirin as a preventative medicine.
“The evidence linking aspirin and a lower cancer risk has been accumulating for a long time,” Professor Macrae said.
“However, this is the first international randomised control trial to focus on and prove that for some people with a hereditary risk of bowel cancer, a long-term regular dose of aspirin can actually prevent cancer.
“Previous, shorter trials have not been able to prove this link as the positive benefits of aspirin are not seen immediately,” he said, “this can take some years.”
The study involving scientists and clinicians from 43 centres in 16 countries followed nearly 1000 patients, in some cases for more than 10 years.
The trial was overseen by Newcastle Hospitals NHS Foundation Trust and funded by Cancer Research UK. International support for the trial came from local cancer agencies, including the Cancer Council Victoria who managed recruits across Australia in both metropolitan and remote regions.
The patients were split into two groups – one group who took two aspirin every day and the other who took two placebo tablets.
The number of people diagnosed with bowel cancer in the group of men and women taking aspirin was half the number of those taking the placebos.
Professor Macrae said the results of the long-term study offered real hope to people with a hereditary risk of bowel cancer.
“It’s recommended that people speak to their doctor or health professional before they start taking any medication long term, such as aspirin,” he said.
Cancer Council Victoria CEO Todd Harper said the results of the study were extremely promising but that advice for the general population remains the same.
“The results are very promising but more research is needed before we would encourage all Australians to take a daily dose of aspirin.
However we do know that a healthy lifestyle – which includes eating well, not smoking and being physically active – can significantly reduce the risk of bowel cancer.
“Bowel cancer is our second biggest cancer killer yet 90% of cases can be cured if found early.
“That’s why we encourage men and women aged 50 and over to complete a faecal occult blood test (FOBT) every two years.
“Bowel cancer often develops without symptoms so this simple, at-home test can save lives,” Mr Harper added.
FOBTs can be purchased from Cancer Council Victoria at www.cancervic.org.au or by calling the Cancer Council Helpline on 13 11 20.
Tests cost $30 or $22 for those on a pension or with a Health Care Card.
Source: Burn J, Gerdes A-M, Macrae F et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial. The Lancet, Early Online Publication, 28 October 2011
SHORT HIGH INTENSITY TRAINING CAN HELP REGULATE BLOOD SUGAR
Researchers at McMaster University have found that brief high intensity workouts, as little as six sessions over two weeks, rapidly lower blood sugar levels in type 2 diabetics, offering a potential fix for patients who struggle to meet exercise guidelines.
A total of 30 minutes of high-intensity intermittent exercise per week, involving a total time commitment of 75 minutes, lowered 24-hour blood sugar concentrations, reduced blood sugar spikes after meals, and increased skeletal muscle mitochondrial capacity, a marker of metabolic health.
The small proof-of-principle study appears in the latest edition of the Journal of Applied Physiology.
"These findings are intriguing because they suggest that exercising very strenuously for short periods of time, may provide many of the same health benefits as traditional exercise training," says Martin Gibala, Professor in the Department of Kinesiology at McMaster and supervising author of the study. "This is the first study to show that intense interval training may be a potent, time-efficient strategy to improve glycaemic regulation in people with type 2 diabetes."
International guidelines recommend 150 minutes of moderate to vigorous exercise per week - twice the training time commitment of study participants - which can be tough to manage for many people including those with diabetes, adds Gibala.
For the study, researchers gave each volunteer a baseline exam to test blood sugar over a 24-hour period, assess fitness levels and take biopsies of thigh muscle to measure proteins linked to health status.
Each workout involved riding a stationary bike for 10 bouts of 60 seconds at roughly 90 percent of maximal heart rate, with one minute between each burst of exercise. The routine also included a warm up and cool down such that each training session lasted 25 minutes in total.
Participants showed improved blood sugar levels even though they did not lose weight during the short two-week study.
"The improved glycaemic control may be linked to changes in the subjects' muscles, such as an improved ability to clear glucose from the blood after meals", says Gibala. "We need to conduct further research to identify the mechanisms behind these results."
Source: JP Little, JB Gillen et al. Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes J Appl Physiol jap.00921.2011; published ahead of print August 25, 2011
Video of Martin Gibala explaining the research can be found here
LONGEVITY PROTEINS LINKED TO ANXIETY
Excess of sirtuins can produce anxiety, a possible evolutionary adaptation to dietary restriction.
Over the past decade, Massachusetts Institute of Technology (MIT) biologist Leonard Guarente and others have shown that very-low-calorie diets provoke a comprehensive physiological response that promotes survival, all orchestrated by a set of proteins called sirtuins.
In new research published in Cell, Guarente and colleagues have shown that sirtuins may also play a key role in the psychological response to dietary restriction.
In response to calorie restrictions, sirtuins are elevated in the brain. Mice become more anxious. Furthermore, in two large genetic studies of humans, the team found that mutations that boost production of sirtuins are commonly associated with higher rates of anxiety and panic disorder.
The researchers believe that this anxiety may be an evolutionary adaption that makes animals - including humans - more cautious under the stressful condition of having to forage more widely for scarce food.
“It makes sense, because behaviour effects would be as adaptive, and as selected by evolution, as physiological effects. I don’t think it’s surprising that behaviour really falls under the umbrella of natural selection,” says Guarente, the Novartis Professor of Biology at MIT.
When they looked at the cellular mechanisms behind this, they found that sirtuins appear to influence levels of serotonin, the neurotransmitter that plays a key role in regulating mood. Low serotonin levels usually result in anxiety and depression.
"We were very surprised to see that, but it also made it relatively easy for us to figure out the mechanism by which sirtuins were regulating mood," said Guarente.
Guarente and colleagues found that the sirtuins were reducing serotonin by activating monamine oxidase (MAO), an enzyme that breaks down the serotonin. This is the same path that antidepressants known as MAO inhibitors use: they target MAO to stop it reducing serotonin.
The research suggests that anxiety could potentially be treated with drugs that inhibit sirtuins. On the other hand, it also raises a caution when treating patients with drugs that activate sirtuins, several of which are now in clinical trials for metabolic diseases, including diabetes. Those drugs can’t enter the brain, but some researchers are exploring the possibility of using sirtuin inhibitors to treat neurological disorders such as Alzheimer’s disease. If such drugs were developed and approved, doctors might need to watch for anxiety as a possible side effect.
Most of the experimental studies were performed in Guarente’s lab at MIT, while the genetic studies were done primarily by collaborators at Virginia Commonwealth University and the University of Lausanne in Switzerland. Lead author of the paper is Sergiy Libert, a postdoc in Guarente’s lab.
Source: Libert S, Pointer K, et al. SIRT1 Activates MAO-A in the Brain to Mediate Anxiety and Exploratory Drive. Cell, 08 December 2011
THE CONNECTION BETWEEN CAFFEINE & ASTHMA
Caffeine is a drug found in coffee, tea, cola drinks and cocoa. It is very similar to
theophylline, a bronchodilator that opens up the airways in the lungs and
relieves the symptoms of asthma, such as wheezing, coughing and breathlessness.
Scientists are interested in finding out whether caffeine has the same effect on the lungs as theophylline. Older studies have shown some doubt, but reviews of more recent studies have been more promising, especially in treating respiratory conditions brought on by exercise.
There are two major reasons why it is important to know if caffeine is a bronchodilator. The first is because it may be beneficial for asthmatics to take caffeine in order to relieve the symptoms of asthma. The second is because consuming caffeine may affect the results of important tests that determine how bad someone's asthma is.
If caffeine acts as a bronchodilator and widens the airways, then a patient who has consumed caffeine before taking the test would show a better result in a lung function test than they would have if they had not consumed any caffeine. The potential problem with this is that if the test results are better than expected doctors may prescribe a lower dose or a weaker drug than is really necessary, which can lead to problems with asthma management.
A recent Cochrane Review carefully examines all the available high-quality clinical trials on caffeine in asthma. This review was conducted to discover if people should avoid consuming caffeine before taking lung function tests.
The authors included randomised trials (RCTs) of oral caffeine compared to placebo or coffee compared to decaffeinated coffee in adults with asthma. Seven trials involving a total of 75 people with mild to moderate asthma were assessed and the studies were all of cross-over design.
The review found that even small amounts of caffeine can improve lung function for up to four hours. Therefore caffeine can affect the result of a lung function test (e.g. spirometry) and so caffeine should be avoided before taking a lung function test if possible, and previous caffeine consumption should be recorded.
It is not known if taking caffeine leads to improvements in symptoms. It may be that in order to improve the symptoms of asthma, caffeine is needed in such large amounts that the drug's adverse effects would become a problem, so more research is needed.
The authors condluded, "caffeine appears to inmprove airways function modestly, for up to four hours, in people with asthma. People may need to avoid caffeine for at least hour hours prior to lunch function testing, as caffeine ingestion could cause misinterpretation of the results. Drinking caffinated coffee before taking exhaled nitric oxide measurements does not appear to affect the results of the test, but more studies are needed to confirm this."
Source: Welsh EJ, Bara A, Barley E, Cates CJ. Caffeine for asthma. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD001112. DOI: 10.1002/14651858.CD001112.pub2
RESEARCHERS ANNOUNCE STEM CELL BREAKTHROUGH
Scientists from the Wellcome Trust Sanger Institute in Cambridge, England, have developed a new technique to reprogram human cells, such as skin cells, into stem cells. Their process increases the efficiency of cell reprogramming by one hundred-fold and generates cells of a higher quality at a faster rate.
Until now cells have been reprogrammed using four specific regulatory proteins. By adding two further regulatory factors, Liu and co-workers brought about a dramatic improvement in the efficiency of reprogramming and the robustness of stem cell development. The new streamlined process produces cells that can grow more easily.
"This research is a milestone in human stem cells," explains Wei Wang, first author on the research from the Wellcome Trust Sanger Institute. "Our technique provides a foundation to unlock the full potential of stem cells."
Stem cells are unspecialised cells that are able to renew themselves through cell division and can be induced to become functional tissue- or organ-specific cells. It is hoped that stem cells will be used to replace dying or damaged cells with healthy, functional cells. This could have wide-ranging uses in medicine such as organ replacement, bone replacement and treatment of neurodegenerative diseases.
With more than 20 years of research, gold standard stem cells are derived from mice, largely because they are easy to work with and provide accurate and reproducible results. The team's aim was to develop human cells of equivalent quality to mouse stem cells.
"The reprogrammed cells developed by our team have proved to have the same capabilities as mouse stem cells," states Pentao Liu, senior author from the Sanger Institute. "Our approach will enable researchers to easily engineer and reprogramme human stem cells to generate cell types for cell replacement therapies in humans."
Retinoic acid receptor gamma and liver receptor homolog (Lrh-1), the additional regulatory factors used by Liu and co-workers, were introduced into the skin cells along with the four other regulatory proteins. The team's technology produced reprogrammed cells after just four days, compared to the seven days required for the four-protein approach. Key indicators of successfully reprogrammed cells, Oct4 and Rex-1 genes, were seen to be switched on much faster in a much higher number of cells, demonstrating increased efficiency in reprogramming. "This is the most promising and exciting development in our attempt to develop human stem cells that lend themselves in practical applications. It bears comparison to other technologies as it is simple, robust and reliable," says Allan Bradley, Senior Group Leader and Director of Emeritus at Sanger Institute.
Source: Wang et al. (2011) Rapid and efficient reprogramming of somatic cells to induced pluripotent stem cells by retinoic acid receptor gamma and liver receptor homolog 1 doi: 10.1073/pnas.1100893108
Funding: This work was supported by the Wellcome Trust and by the China Scholarship Council
A CLEAR LINK: AIR POLLUTION AND HEART DISEASE
Environmental toxicants such as dioxins, PCBs, and pesticides can pose a risk for cardiovascular disease.
For the first time a link has been demonstrated between atherosclerosis and levels of long-lived organic environmental toxicants in the blood.
The study, carried out by researchers at Uppsala University, was published this week in the journal Environmental Health Perspectives.
Cardiovascular diseases, including heart attacks and strokes, are the most common cause of death in industrialised countries, and the most important underlying cause of these diseases is atherosclerosis. Unbalanced blood fats, diabetes, smoking, and high blood pressure are traditionally recognised risk factors for atherosclerosis.
Previous studies have also reported possible links between cardiovascular disease and high levels of persistent (long-lived and hard-to-degrade) organic environmental toxicants, such as dioxins, PCBs, and pesticides. These compounds are fat-soluble and can therefore accumulate in vessel walls. However, no earlier studies have investigated possible links between exposure to these compounds and atherosclerosis.
The current study measured the circulating levels of the above group of compounds in about 1,000 Swedes living in Uppsala. Atherosclerosis in the carotid artery was also measured using ultrasound.
The findings show a clear connection between increasing levels of environmental toxicants and atherosclerosis, even after taking into consideration the traditional risk factors. There was also a link to tangible signs of fat accumulation in vessel walls.
"These findings indicate that long-lived organic environmental toxicants may be involved in the occurrence of atherosclerosis and thereby lead to future death from cardiovascular diseases," says Lars Lind, professor at the Department of Medical Sciences, Uppsala University.
"In Sweden, and in many countries in the world, many of these substances are forbidden today, but since they are so long-lived they're still out there in our environment. We ingest these environmental toxicants with the food we eat, and since they are stored in our bodies, the levels grow higher the older we get," says Monica Lind, Associate Professor in Environmental Medicine at Occupational and Environmental Medicine.
The researchers will continue to study how these compounds affect atherosclerosis in experimental models. In addition they will monitor the individuals included in their study to determine whether a direct connection exists between exposure to these substances and the occurrence of heart attacks and strokes in humans.
Funding: The study was funded in part by the Swedish Research Council and the Swedish Research Council Formas.
Source: P Monica Lind, Bert van Bavel, Samira Salihovic, Lars Lind. Circulating Levels of Persistent Organic Pollutants (POPs) and Carotid Atherosclerosis in the Elderly. Environmental Health Perspectives, 2011
TREATING A RISING EPIDEMIC: AGE-RELATED LIVER DISEASE
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease, with the highest prevalence in those over 60 years.
NAFLD is hepatic steatosis associated with metabolic abnormalities such as central obesity, insulin resistance, type 2 diabetes and dyslipidaemia. It is also governed by genetic background, sex, age, and environmental factors (food intake, level of physical activity).
The mildest form of NAFLD is simple steatosis, characterised by hepatic fat (triglyceride [TG]) accumulation alone.On the other end of the spectrum is a necroinflammatory fibrosing disorder called steatohepatitis.
The key implications of NAFLD are increased risk of developing type 2 diabetes, cardiovascular disease and cancers such as colon cancer. There is increased standardised mortality, including deaths from decompensated cirrhosis and hepatocellular carcinoma (HCC).
Hepatic steatosis (defined as greater than 5.5% TG content) has been estimated at 31% overall, with significant ethnic variation - 45% in hispanics, 33% in whites, and 24% in blacks. The National Health and Nutritional Examination Survey (NHANES) identified the increasing contributing of NAFLD as the cause for chronic liver disease rising from 47% in the 1988-1994 cohort to 76% in the 2005 - 2008 cohort. Epidemiological data are consistent with the clinical observation that NAFLD is now the most common liver disorder seen in liver clinics of Western countries.
Advanced age is associated with disease severity and fibrosis progression; 39% in those aged 40 to 50 years, and to over 40% in those greater than 70 years. A relatively high proportion of individuals with progressive forms of NAFLD develop cirrhosis by the time there are in their 70s or beyond.
The prevalence and severity of NAFLD is also influenced by presence of metabolic risk factors, such as overweight/obesity and type 2 diabetes.
Because steatosis rearely illicit any symptoms, it is usually discovered from abnormal liver tests, a liver ultrasound or CT scan in people with normal liver enzymes.
Clinicians need to consider early interventions to optimise the management of modifiable metabolic risk factors, like glycaemic control in type 2 diabetes, hypertension, and dyslipidaemia, each of which could also contribute to disease progression in NAFLD.
For all patients with NAFLD, the cornerstone to management remains correction of modifiable risk factors. Exercise and dietary restriction can be very effective in carefully selected patients and should be used in a multidisciplinary approach, involving physiotherapists, dieticians, and occupational therapists to overcome potential physical limitations in older patients, such as osteoarthritis or decreasing mobility from other causes.
Source: Mechanisms and implications of age-related changes in the liver: nonalcoholic Fatty liver disease in the elderly. Gan L, Chitturi S, Farrell GC. Curr Gerontol Geriatr Res. 2011;2011:831536. Epub 2011 Sep 12
YEAR FOLLOWING HIP FRACTURE COULD BE DEADLY FOR WOMEN
Women age 65 and older who fracture a hip are much more likely to die from any cause during the following year than they would be if they had avoided injury, a new study suggests.
Among women who broke a hip, more than half of the short-term deaths occurred within three months after the broken hip, and nearly 75 percent occurred within six months, the investigators found.
The increased risk of death associated with hip fractures was especially dramatic among younger women. In the 65- to 69-year-old age group, the odds of death were five times higher for women in a post-fracture year than they were for non-injured women of the same age, according to the study published online Sept. 26 in the Archives of Internal Medicine.
Women in their 70s had double the risk of dying within a year after breaking a hip, the researchers found.
Women aged 80 and older had the same risk of dying within the year regardless of whether or not they broke a hip. For women in their 80s who were in excellent health, however, a hip fracture nearly tripled their risk of dying within a year.
“Our study suggests that it is the hip fracture, and not just poor health, that puts these women at higher risk of dying,” said study author Dr. Teresa Hillier, a senior investigator at the Kaiser Permanente Centre for Health Research in Portland, Ore.
“We also found women are at the highest risk of dying within the first three months after hip fracture, which leads us to hypothesise that hospitalisation, surgery and immobility lead to other complications that ultimately result in their death,” she added.
As part of a larger ongoing study involving nearly 10,000 women aged 65 and older, researchers followed 1,116 women who suffered hip fractures and compared them to nearly 4,500 similar women who didn’t break a hip.
Experts at the National Osteoporosis Foundation recommend that all women over the age of 65 and those who may also be at greater risk for osteoporosis (thinning or weakening of the bone) have a bone density scan to determine if they are at greater risk for fractures. Low body weight, smoking or long-term steroid use are associated with increased risk of osteoporosis.
The experts also offered the following tips to help prevent hip fractures:
• Consume enough calcium and vitamin D.
• Perform weight-bearing and balancing exercises.
• Don’t smoke.
• Fall-proof your home.
“This study is a wake-up call that the first year after a hip fracture is a critical time for all elderly women, but especially for younger women, ages 65 to 69, who face a much higher death rate compared to their peers,” added study lead author Dr. Erin S. LeBlanc, an investigator at the Kaiser Permanente Center for Health Research.
“We need to do more to prevent hip fractures from occurring, and we need to study how best to care for women after fracture to prevent these deaths,” LeBlanc said.
Source: LeBlanc ES, Hillier TA, et al. Hip Fracture and Increased Short-term but Not Long-term Mortality in Healthy Older Women. Arch Intern Med. Published online September 26, 2011.
THE MYSTERY OF PAIN RELIEF FOR POSTOPERATIVE PATIENTS SOLVED
The most effective single dose oral analgesics for acute postoperative pain in adults have been identified by Oxford researchers in a Cochrane review of 45,000 participants across 350 studies.
While reliable results were obtained for 46 drug/dose combinations in all painful postsurgical conditions, a key finding was that no drug produced high levels of pain relief in all patients.
They have published an evaluation of the expected effects from taking commonly used painkillers at specific doses, in order for clinicians to make evidence based decisions.
“If the first painkiller a person tries doesn’t seem to be working, then a clinician should look to find an alternative reliable drug and see if it is more effective in that individual patient. There are plenty of options that have a solid evidence base,” stated the authors.
The range of results varies considerably between different painkillers.
Over 70% of participants with moderate or severe acute pain who took a single-dose achieved good pain relief with 120mg etoricoxib or the combination of 500mg paracetamol plus 200mg ibuprofen.
With other drugs, such as 1,000mg aspirin and 600mg paracetamol taken on their own, only 35% benefitteD.
The worst was codeine, with only 14% getting significant pain relief. The period over which pain was relieved also varied, from about two hours to about 20 hours.
The worst was codeine, with only 14% getting significant pain relief. The period over which pain was relieved also varied, from about two hours to about 20 hours.Dr Andrew Moore, from the Oxford Pain Research Unit at Oxford University, said: “Our aim was to bring all this information together, and to report the results for those drugs with reliable evidence about how well they work or any harm they may do in single oral doses.
“Pain relief doesn’t have to be a mystery. There is a body of reliable evidence about how well 46 different drug/dose combinations work against acute pain, but the review also shows there are many examples of drugs for which there is insufficient evidence, and the drugs in question should probably not be used to treat acute pain,” he added.
Moore RA, Derry S, McQuay HJ, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD008659. DOI: 10.1002/14651858.CD008659.pub2
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SEX LIVES OF DIABETIC MEN IMPROVE WITH WEIGHT LOSS
A new Australian study shows that if you're an overweight man with diabetes, changing your eating habits may improve your sex life more than popping a pill can.
Abdominal obesity and type 2 diabetes mellitus are associated with sexual and endothelial dysfunction, lower urinary tract symptoms (LUTS), and chronic systemic inflammation.
Researchers led by Professor Gary Wittert (MBBch, MD, FRACP, FRCP) of the University of Adelaide studied thirty-one obese men with type 2 diabetes, with a mean age of 59.7 years. They put the men on one of two diets: a low-calorie diet (LCD) using liquid meal replacements or a high-protein diet of fresh fruits, vegetables, lean meat and fish, for 8 weeks. All continued on, or were switched to, the high protein diet for another 44 weeks.
In obese men with type 2 diabetes even a modest weight loss of 5% resulted in a rapid reversal of sexual and urinary problem within 8 weeks. The improvement continued for 12 months, according to the study published August 5 in The Journal of Sexual Medicine.
At 8 weeks, weight and waist decreased by 8-10% and 5% with the LCD and high protein diet, respectively.
Both diets significantly improved plasma glucose, low-density lipoprotein (LDL), SHBG, IIEF-5, SDI and IPSS scores, and endothelial function. Erectile function, sexual desire, and urinary symptoms improved by a similar degree with both diets. C-reactive protein and IL-6 decreased with the high protein diet.
The study followed the men for a year, switching all the men to the high-protein, more nutritional diet after eight weeks. By the end, the men from both groups had lost around 10 percent of their weight and had continued to show improvement in erectile and urologic function.
On average, their scores on a scale used to measure erectile function had improved from the "severe erectile dysfunction" to the "mild erectile dysfunction" category.
Professor Wittert stated, "Our findings are consistent with the evidence that not only erectile function, but also lower urinary tract symptoms are a marker of cardio-metabolic risk. The evidence that improvement can be achieved by modest weight loss, in particular when a diet is of high nutritional quality, is of public health significance in framing public health messages that resonate with men."
"This important paper supports earlier publications that lifestyle is relevant and can positively affect sexual function", stated Irwin Goldstein, Editor-in-Chief of The Journal of Sexual Medicine.
"At a time when oral drugs are very popular, it can now be shown that weight loss is an important non-pharmacologic therapeutic intervention in restoring erectile and urinary function and cardio-vascular health. Obesity is an epidemic, and such data reinforce the positive relationship between eating right, losing weight, improved sexual function and voiding and overall cardiovascular health”, Goldstein continued.
Professor Wittert’s team is planning to integrate exercise into their next study. He said he already tells his diabetic patients to integrate a daily walk into their routine.
"When you get home," he said, "instead of sitting down in front of the telly, take your wife by the hand and say, 'Come, darling, let's go for a walk.' After a month of this, her heart will get fonder and your erection will get stronger."
SOURCE: Joan Khoo, Cynthia Piantadosi, Rae Duncan, Stephen G. Worthley, Alicia Jenkins, Manny Noakes, Matthew I. Worthley, Kylie Lange, Gary A. Wittert. Comparing Effects of a Low-energy Diet and a High-protein Low-fat Diet on Sexual and Endothelial Function, Urinary Tract Symptoms, and Inflammation in Obese Diabetic Men. The Journal of Sexual Medicine, 2011
WOULD YOU TEST FOR ALZHEIMER’S?
PREDICTING ALZHEIMER’S WITH A BLOOD TEST – ALMOST 100%
ACCURATE
There are 1500 new cases of dementia in Australia every week, and one-quarter of Australians over the age of 85 suffer from dementia. It's the third leading cause of death. A new blood test for Alzheimer's disease is 96% accurate at identifying the disease and possibly detects it even before symptoms such as memory loss (dementia) develop.
The cost of Alzheimer's-related care in Australia is estimated at $5.4 billion annually. This figure is set to rise with the first of the 4.6 million baby boomers this year reaching 65, after which the likelihood of developing Alzheimer's doubles every five years.
Alzheimer's has a somewhat mysterious pathology. To date, the development of a definitive diagnostic test for this disease has remained elusive. The only definitive way to diagnose the disease has been by direct examination of brain tissue after the patient dies.
Using human protein microarrays to characterise the differential expression of serum autoantibodies in Alzheimer's and non-demented control (NDC) groups, Professor Robert Nagele and his team identified potential diagnostic biomarkers for Alzheimer's.
Robert Nagele, PhD, is a professor of medicine at the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine.
The research showed Alzheimer's can be linked to characteristic alterations in serum autoantibody expression profiles. These changes allowed for the identification and selection of specific autoantibodies that can serve as diagnostic biomarkers.
With only ten autoantibody diagnostic biomarkers, Alzheimer's serum samples are readily distinguished from NDC sera with a sensitivity of 96.0% and a specificity of 92.5%.
The researchers believe the development of a reliable and accurate blood test for Alzheimer's will have profound clinical impact. The relative non-invasiveness, low cost, and dynamism of protein microarrays make a diagnostic of this kind well-suited for incorporation into routine health care.
The developer of the test, Professor Nagele, explained, ''This is a simple test that has high accuracy and can be run from a single drop of blood. Brain cells die and when they die, they pop; they explode, like a water balloon breaking. Your body makes antibodies against the cell debris. We believe that happens so it can facilitate the cleanup of the cell debris. Many of these are related to the presence of the disease."
But without a treatment or a cure, would people want to know?
Surprisingly, yes, said Dr. Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health.
Professor Blendon conducted a survey of 2,678 adults from five countries that was released recently at the Alzheimer's Association International Conference. About two-thirds of respondents said they were likely to get a test to predict whether they would get Alzheimer's before any symptoms appeared.
It is posible that some people who know Alzheimer's is in their future may make different life choices. They can plan their care and put their finances in order. They may be able to seek clinical trials and assistance with how to best cope with the disease.
However, many doctors and social workers who treat Alzheimer's and care for their families say the push for early testing is premature and is only likely to raise anxiety levels.
"The tests are so inaccurate at this point that I don't know what the value is other than to create a lot of anxiety," said Debra Greenberg, geriatrics social worker at Montefiore Medical Center in New York.
Taking a daily vitamin D3 supplement might extend your life, at least if you’re an older woman. That’s the suggestion of a comprehensive review published by the Cochrane Collaboration.
Numerous observational studies and randomised trials have observed that optimal vitamin D status has a positive effect on our health and may reduce cancers and cardiovascular diseases. The available evidence on vitamin D and mortality has been intriguing but inconclusive.
Recently, the results of a number of randomised trials testing the influence of vitamin D supplementation on mortality have become available.
To analyse this new data and assess the role of vitamin D supplementation for prevention of mortality in adults, scientists undertook a systematic review of the existing evidence for the Cochrane Collaboration. The lead scientist was Dr Goran Bjelakovic from the University of Nis in Serbia.
The Cochrane Collaboration is an international, non-profit organisation which publishes high-quality systematic reviews of health care research. The Cochrane Library is generally considered to be one of the most respected and reliable sources of evidence. No external funding was supplied.
The review included fifty eligible studies including 94,148 participants – mostly women living in nursing homes, with an average age of 74, from high-income countries.
The results suggested that vitamin D3 reduces mortality by about 6%. This corresponds to a requirement to treat 161 participants over a median of two years to save one additional life.
Other forms of vitamin D, including vitamin D2 (ergocalciferol) and the active metabolites (alfacalcidol and calcitriol), had no significant effect on mortality.
People who took vitamin D3 with calcium were more likely to develop kidney stones. Alfacalcidol and calcitriol increased the risk of hypercalcaemia.
The authors concluded that vitamin D in the form of vitamin D3 seems to decrease mortality in predominantly elderly women who are mainly in institutions and dependent care.
SOURCE: Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud C.Cochrane Database Syst Rev. 2011 Jul 6;(7):CD007470. Review.
GUT FEELINGS: ANXIETY MAY LIVE IN YOUR GUT, NOT YOUR HEAD
The bacteria which colonises in people’s stomachs may have a far more dramatic impact on mental health conditions like depression and anxiety than previously thought, according to a new study published in the Journal of Gastroenterology.
For the first time, researchers at McMaster University have conclusive evidence that bacteria residing in the gut influence brain chemistry and behaviour.
Common types of gastrointestinal disease, including irritable bowel syndrome, have been associated with anxiety or depression. In addition, there has been speculation that some psychiatric disorders, such as late onset autism, may be associated with an abnormal bacterial content in the gut.
"The exciting results provide stimulus for further investigating a microbial component to the causation of behavioural illnesses," said researcher Stephen Collins, Professor of Medicine and Associate Dean Research, Michael G. DeGroote School of Medicine.
For each person, the gut is home to about 1,000 trillion bacteria with which we live in harmony. These bacteria perform a number of functions vital to health: They harvest energy from the diet, protect against infections and provide nutrition to cells in the gut. Any disruption can result in life-threatening conditions, such as antibiotic-induced colitis from infection with the "superbug" Clostridium difficile.
In order to come to their conclusions, the researchers sought to determine the impact of antibiotics on gut bacteria. They utilised mice in the experiment and attempted to gauge the alterations in brain chemistry that would occur. Eventually, they noted that mice became less anxious when given oral antibiotics with an increased brain-derived neurotrophic factor (BDNF) – a chemical linked with depression and anxiety.
Previous research has focused on the role bacteria play in brain development early in life. This latest research indicates that while many factors determine behaviour, the nature and stability of bacteria in the gut appear to influence behaviour and any disruption, from antibiotics or infection, might produce changes in behaviour.
These results lay the foundation for investigating the therapeutic potential of probiotic bacteria and their products in the treatment of behavioural disorders, particularly those associated with gastrointestinal conditions such as irritable bowel syndrome.
This is an important first step in understanding some of the lesser known causes of depression.
The research was funded by grants from the Canadian Institutes of Health Research (CIHR) and the Crohn's and Colitis Foundation of Canada (CCFC).
SOURCE: Premysl Bercik, E. Denou, Josh Collins, W. Jackson, J. Lu, J. Jury, Y. Deng, P. Blennerhassett, J. Macri, K.D. McCoy, E.F. Verdu, S.M. Collins. Gastroenterology - May 2011
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IS BOTOX JUST A PAIN IN THE NECK?
Neck disorders become more common with age and are disabling and costly. Botulinum toxin injections are regularly used to treat neck pain. However, a new Cochrane Review shows botulinum toxin probably won't help ease neck pain, nor will it help neck pain sufferers better perform physical activities or improve their quality of life.
Botulinum toxin can temporarily stop muscles from contracting, thereby reducing muscle tightness or spasm.
It is used to successfully treat a range of conditions including wrinkles, migraines and excessive sweating. It is also used to treat "cervical dystonia”, in which neck muscles contract involuntarily, and neck pain linked to the condition. Botox is just one of the several brand names for the drug which is given through injections. None of the brands have been approved to treat neck pain, but doctors may use the drug "off-label" for that purpose.
The review included nine trials and 503 participants that examined the effects of botulinum toxin Type-A for patients with neck pain that had lasted for at least four to six weeks. In some instances, they also had pain that extended into the head. This is called a 'cervicogenic headache'.
High quality evidence was available from five trials and found no significant difference in pain at four weeks, between those who received botulinum toxin Type-A for subacute and chronic neck pain and those who received placebo injections.
Low quality evidence showed that botulinum toxin Type-A injections were no better than placebo for neck pain at six months (one trial with 24 participants) or for disability (one trial with 45 participants). Very low quality evidence from one study (31 participants) suggested that botulinum toxin Type-A was better than placebo for patients with chronic neck pain when patients reported on their overall sense of benefit at four weeks.
Evidence from a single small study in patients with neck pain and accompanying headache (32 participants) showed that botulinum toxin Type-A was no better than placebo at four weeks and six months after treatment.
There was very low quality evidence (two trials, 95 participants) showing that botulinum toxin Type-A combined with exercise for chronic neck pain patients, was no better at four weeks or six months, than a variety of other treatments (exercise, or exercise combined with dry needling, or lidocaine, or ultrasound) for several different types of outcomes including pain, disability and quality of life.
"The available evidence just suggests that it doesn't work," study author Dr Paul Michael Peloso told Reuters Health. Dr Peloso is also the head of clinical research at the drug company Merck in Rahway, New Jersey, USA.* If patients have neck pain, "they and their physicians should be discussing other therapies," Peloso added.
In addition, people given botulinum toxin were more likely to have a side effect, including soreness or flu-like symptoms, than those not given the drug.
Peloso and his colleagues noted that some of the studies had limitations. For example, it wasn't clear how some groups had been randomised, or if adequate trial blinding had taken place.
But taken together, the studies suggested botulinum toxin had done nothing to help relieve neck pain or related headaches, either alone or when added to exercise programs or other medications, when researchers reassessed patients at four weeks and six months after injections.
*Merck does not make botulinum toxin, although it does market pain products that could be used for neck pain.
SOURCE:
Langevin P, Peloso PMJ, Lowcock J, Nolan M, Weber J, Gross A, Roberts J, Goldsmith CH, Graham N, Burnie SJ, Haines T. Botulinum toxin for subacute/chronic neck pain. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD008626. DOI: 10.1002/14651858.CD008626.pub2
GREEN TEA LOWERS CHOLESTEROL, JUST A LITTLE
Drinking green tea appears to cut "bad" cholesterol while leaving levels of good cholesterol unchanged and encouraging people to drink more of the beverage could have significant health effects, according to a new study.
Tea is one of the most commonly consumed beverages worldwide. Teas from the plant Camellia sinensis can be grouped into green, black and oolong tea. Cross-culturally tea drinking habits vary.
Camellia sinensis contains the active ingredient polyphenol, which has a subgroup known as catechins. Catechins are powerful antioxidants and appear to decrease the absorption of cholesterol in the gut.
The research team pooled the results of 14 randomised trials in which participants drank green tea or took an extract for periods ranging from three weeks to three months, or were assigned to a placebo group.
On average, green tea reduced total cholesterol by 0.18 mmol/L compared to levels seen in those taking the placebo (P < 0.001). Low density lipoprotein (LDL) cholesterol fell by a mean of 0.05 mmol/L, or slightly less than 2 percent (P < 0.001). The mean change in blood high density lipoprotein (HDL) cholesterol concentration was not significant.
Subgroup and sensitivity analyses showed that these changes were not influenced by the type of intervention, treatment dose of green tea catechins, study duration, individual health status, or quality of the study.
This reduction is fairly small, warned Nathan Wong, who runs the heart disease prevention program at the University of California, Irvine.
Green tea "should not be recommended in place of well-proven cholesterol-lowering medicines for people with high cholesterol," he said. But Wong said that smaller amounts "could be a useful component of a heart-healthy diet," with benefits that go beyond its effect on cholesterol.
SOURCE: Zheng XX, Xu YL, Li SH, Liu XX, Hui R, Huang XH. Am J Clin Nutr. 2011 Jun 29. [Epub ahead of print]
DOES SELENIUM PREVENT CANCER?
There is a worldwide debate about the association between selenium exposure and cancer risk. A key question is whether or not selenium supplements decrease the incidence or mortality of cancer. New data from the Cochrane Collaboration questions the benefit, with some of the studies reviewed suggesting selenium may actually harm patients by increasing their risk for non-melanoma skin cancer.
Selenium is a trace element essential to humans. Found naturally in meat, fish and nuts, selenium is important for the immune system and thyroid. It is thought by some to help prevent several types of cancers at high doses.
The daily selenium recommendations from the US and World Health Organization (WHO) vary between 30 and 55 micrograms per day for adults.
To get a better picture of the role of selenium in cancer prevention, scientists from Germany, Switzerland, Belgium, Italy and the UK undertook a systemic review of the existing evidence for the Cochrane Collaboration.
The Cochrane Collaboration is an international, non-profit organisation which publishes high-quality systematic reviews of health care research. The Cochrane Library is generally considered to be one of the most respected and reliable sources of evidence. No external funding was supplied.
The systematic review included fifty-five eligible studies including more than one million participants. Studies reviewed cancer prevention and specific cancers such as prostate, urinary/bladder, lung, stomach, colon/colorectal and female breast cancer.
The data show that although the forty-nine prospective, observational studies suggested a link between selenium intake and a slight reduction in cancer risk (more so in men than women), the six randomised trials failed to support an association, even among people who took doses at least four times higher than the daily recommendation.
The review analysed two types of selenium supplements in case they acted differently in the body when ingested. The trials with the most reliable results found that organic selenium did not prevent prostate cancer in men, and increased the risk of non-melanoma skin cancer in women and men.
Other trials found that participants using selenium salt or organic supplements had a decrease in liver cancer cases. However, due to methodological shortcomings this evidence was less convincing.
In addition, some of the trials raised the question of whether high doses of selenium might be dangerous. For example, by increasing the risk of diabetes.
There was no evidence that low levels of selenium lead to an increased risk of cancer.
"We still do not have an exact picture of what selenium is doing to human health," said researcher and contributor Dr. Marco Vinceti, University of Modena and Reggio Emilia, Italy.
The authors recommended further evaluation of the effects of selenium supplements in populations according to their nutritional status as these may differ between undernourished and adequately nourished groups of people.
Currently, there is no convincing evidence that individuals, particularly those who are adequately nourished, will benefit from selenium supplementation with regard to their cancer risk. The choice of whether to take supplements remains an individual one.
SOURCE
: Dennert G, Zwahlen M, Brinkman M, Vinceti M, Zeegers MP A, Horneber M. Selenium for preventing cancer. Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No.: CD005195. DOI: 10.1002/14651858.CD005195.pub2
SLEEP APNOEA PATIENTS BENEFIT FROM VERY LOW-ENERGY
DIET
New findings suggest a 9-week very low-energy diet can significantly help patients with sleep apnoea and improve symptoms one year later.
Obstructive sleep apnoea (OSA) is a common condition that occurs when the airway from the mouth to the lung collapses during sleep. A person with OSA may have hundreds of these episodes throughout the night, disrupting their sleep and reducing oxygen supply to vital organs.
People with OSA have an increased risk of motor vehicle accidents and high blood pressure, and may have an increased risk of heart attack and stroke. Some associated symptoms include:
• Daytime sleepiness, fatigue and tiredness
• Poor concentration
• Irritability and mood changes
• Impotence and reduced sex drive
• Need to visit the toilet frequently at night
In the over-30 year age group, the disorder is about three times more common in men than women.
While between 60-70% of sleep apnoea patients are overweight/obese, additional contributing factors include alcohol consumption, nasal congestion/obstruction, facial bone shape and size of muscles, large tonsils, certain illness (e.g. thyroid) and medications.
Researchers from the Korlinska Institute, Sweden, tested a nine week very low-energy diet followed by counselling, on 63 males (aged 30-65 years) with moderate to severe sleep apnoea and BMIs between 30 and 40.
Those who managed to lose weight during the nine week diet managed to keep their weight down during the subsequent year. This medium-term weight loss significantly helped improve their symptoms.
One year later, 48% of patients were able to cease using continuous positive airway pressure (C-PAP) and 10% experienced a total remission of OSA.
Those with the most severe symptoms when the study began experienced the greatest improvement, as did participants who had lost the most weight.
SOURCE: Johansson K, Hemmingsson E, Harlid R, Lagerros YT, Granath F, Rössner S, Neovius M. Longer term effects of very low energy diet on obstructive sleep apnoea in cohort derived from randomised controlled trial: prospective observational follow-up study. BMJ 2011;342: d3017 (Published 1 June 2011)
INTERESTED IN THIS TOPIC?
Register for The 5th Annual Anti-Ageing & Aesthetic Medicine Conference, to be held in Melbourne, Australia on 20-21 August, 2011, to see:
Dr Derek Mahoney “Improving Facial balance & Sleep Apnoea Problems without Surgery”
Ms Debora Dale-Young “Sleep- Are You Getting Enough?”
Dr Conrad Hicks “Weight Loss & Beyond: Biology and Proposed Mechanism of Action”
Dr Andre Berger “Setting Up a Complete Anti-Ageing Practice”utrition is a deb
MALNUTRITION: A CRITICAL COMPONENT OF WOUND HEALING
Malnutrition is a debilitating prevalent condition in the geriatric and hospital setting. It is associated with many adverse outcomes including impaired wound healing and increased mortality. New data show nutrition intervention may directly enhance the healing process in surgical, burns and pressure ulcer patients.
Australian and international studies report malnutrition rates of approximately 40% in the hospital setting. It is very common in geriatric patients and patients in catabolic phases of stress, after injury or surgery.
Nutrition is regarded as one of the major influences on the successful outcome of wound healing, along with normal immune system function and reduced mortality.
Wound healing is a process that can be divided into four overlapping, but distinct, phases (haemostasis, inflammation, proliferation, and remodelling). If the wound-healing process is affected negatively, it can result in chronic wounds which demand many resources in the daily clinical routine.
During the wound-healing process much energy is needed. This can be very challenging for undernourished and malnourished patients.
The cellular and biochemical events that constitute the wound-healing cascade require energy, amino acids, oxygen, metals, trace minerals and vitamins for successful completion. Many nutritional deficiencies impact on wound healing by impeding fibroblast proliferation, collagen synthesis and epithelialisation.
There are also nutrients that can enhance wound-healing responses.
Trials with nutrition interventions show positive results. For example, in obese non-bariatric and post-bariatric patients, appropriate nutritional supplementation significantly reduced surgical complications associated with obesity and bariatric surgery.
Early nutrition intervention was also associated with significantly improved clinical outcomes after upper GI surgery, head and neck cancer surgery, breast implant surgery and in patients with burns.
Pressure ulcers are localised injuries to the skin or underlying tissue, usually over a bony prominence, as a result of unrelieved pressure. Predisposing factors are classified as intrinsic (e.g., limited mobility, poor nutrition, co-morbidities, aging skin) or extrinsic (e.g., pressure, friction, shear, moisture).
Nutrition intervention directly and significantly enhances the healing process in these patients.
In Australia, nutrition screening upon hospital admission is not mandatory. Malnutrition remains under-reported and often poorly documented.
Unidentified malnutrition not only heightens the risk of adverse complications for patients. It can potentially result in foregone reimbursements to the hospital through casemix-based funding schemes.
Many health professionals are now recommending mandatory nutrition screening be widely adopted in line with published best-practice guidelines to effectively target and reduce the incidence of hospital malnutrition and improve patient outcomes.
INTERESTED IN THIS TOPIC?
Register for The 5th Annual Anti-Ageing & Aesthetic Medicine Conference, to be held in Melbourne, Australia on 20-21 August, 2011, to see:
Henry Osiecki “Surgery, Wound Healing and Nutrition”
Dr David Topchain “Taking it out and putting it in: Liposuction and Fat Transfer”
VITAMIN D DEFICIENCY IN IBD INCREASED RISK OF
OSTEOPOROSIS
The association between inflammatory bowel disease (IBD) and osteoporosis has been known for decades but has only recently received more recognition. A new study shows Vitamin D deficiency puts patients with IBD at greater risk of osteoporosis, osteopenia and an overall higher rate of abnormal bone density.
Much effort has been made to define the mechanisms underlying the development of IBD and to broaden the spectrum of effective treatment.
IBD is a fairly common condition with the number of patients split equally between those with Crohn's disease and those with ulcerative colitis.
Previous research has suggested a high prevalence of osteoporosis and overall abnormal bone density in IBD patients is likely caused by corticosteroid use and excess of inflammatory cytokines, as well as from calcium and Vitamin D malabsorption.
The study, "Vitamin D Deficiency and Abnormal DEXA Scans in Inflammatory Bowel Disease Patients," aimed to determine the association between Vitamin D deficiency and abnormal bone density in IBD patients.
Children and adults with IBD between the ages of 10 and 70 participated in the prospective study between 2008 and 2010.
The study found a reduction in bone density, with a diagnosis of osteoporosis or osteopenia, in 22% of patients with IBD. Fifty percent of these patients were under age 50.
Dr. Bincy P. Abraham, Assistant Professor of Medicine at the Baylor College of Medicine, and Director of the Baylor Clinic Inflammatory Bowel Disease Program reported that, “IBD patients with an abnormal bone density exam had a significantly higher rate of Vitamin D deficiency than those who had normal DEXA scans”.
Crohn's disease patients with Vitamin D deficiency were four times more likely to have a higher rate of abnormal bone density exams compared to patients with ulcerative colitis. As Crohn's disease usually affects the small intestine, the part of the gut that absorbs the most nutrients, this result was perhaps not surprising.
However, both Crohn's disease and ulcerative colitis patients diagnosed with osteoporosis had a significantly higher rate of Vitamin D deficiency irrespective of prednisone intake.
"Abnormal bone density was relatively high among our IBD patients with Vitamin D deficiency irrespective to age, gender or corticosteroid use that would place them at a significantly higher risk of having an abnormal DEXA result," said Dr. Abraham.
"It remains important for those caring for IBD patients to evaluate for Vitamin D nutritional deficiency and for its potential consequence of osteopenia or osteoporosis."
Source: American College of Gastroenterology
Vitamin D has many important roles in calcium and phosphorus metabolisms, the prevention of the cancer, therapeutic effects of autoimmune disease, and the protective effects on the atherosclerotic cardiovascular disease and diabetes. These functions are quite essential factors for the treatment of anti-ageing medicine.
Vitamin D - The Ancient Anti-Ageing Hormone will be presented by Dr Selvam Rengasamy (Malaysia), Obstetrician & Gynaecologist and American Anti-ageing Board Certified Physician, at the 5th Annual Anti-Ageing & Aesthetic Medicine Conference to be held in Melbourne, Australia on 20-21 August, 2011.
EXERCISE PROTECTS TELOMERES & BOOSTS IMMUNE SYSTEM
Several studies show psychological stress leads to shorter telomeres – the protective caps on the ends of chromosomes that are a measure of cell age and health. New findings suggest that exercise may prevent this damage.
Chronic psychological stress is associated with detrimental effects on physical health, and may operate in part through accelerated cell ageing as indexed by shorter telomeres at the ends of chromosomes.
Exercise is associated with reduced risk of several age-related diseases as well as with increased longevity.
While these associations are well established, evidence of the molecular and cellular factors associated with reduced disease risk and increased longevity resulting from physical activity is sparse.
Nobel laureate Elizabeth Blackburn and her colleagues, from University of California/San Francisco (UCSF) examined telomeres in leukocytes or white blood cells. The leukocytes of the immune system defend the body against both infectious agents and cell damage.
The study focused on three groups: post-menopausal women who were the primary caregivers for a family member with dementia; young to middle-aged adults with post-traumatic stress disorder; and healthy, non-smoking women ages 50 to 65 years.
“Our findings suggest that traumatic and chronic stressful life events are associated with shortening of telomeres in cells of the immune system, but that physical activity may moderate this impact,” said co-author Jue Lin, PhD.
Jue Lin, Eli Puterman, Aoife O'Donovan, Jeff Krauss, Alanie Lazaro, Wanda Truong, Joshua Cheon, Elissa Epel, Elizabeth H. Blackburn. “Psychological stress and its relationship to telomere length maintenance” [Abstract #1834/24]. Presented at AACR 102nd Annual Meeting, April 4, 2011. An earlier paper is available here .
Telomeres are tiny units of DNA at the ends of chromosomes that protect and stabilise chromosomes. Every time a cell divides, some telomeres drop off. After a certain number of cell divisions, which varies depending on the cell type, the telomeres reach a critical length and the cell typically dies. Sometimes, however, the cells cease to divide and are subjected to genomic instability, promoting inflammation in the body.
Scientists have known for more than a decade that the length of telomeres in immune system cells is a marker of cell ageing. In recent years, they have discovered that shorter telomeres are associated with a broad range of ageing-related diseases and are predictive of incidence and poor prognosis of cardiovascular disease and a variety of cancers.
Telomerase Activation: The Key to Unlocking the Ageing Puzzle will be presented by Mr Noel Patton (USA) at the 5th Annual Anti-Ageing & Aesthetic Medicine Conference to be held in Melbourne, Australia on 20-21 August, 2011.
ZINC: CURE FOR THE COMMON COLD?
Previous trials looking at whether zinc can combat a cold have produced conflicting results. New evidence, however, shows zinc supplements can reduce length and severity of common cold.
Based on a review of 15 randomised, double-blind, placebo-controlled trials in more than 1,300 people, zinc was found to reduce the duration of colds by about a day on average, if taken within 24 hours of symptoms starting.
People taking zinc were also half as likely to have symptoms after a week, and had less severe symptoms than those taking a placebo.
Taking zinc for at least five months also appeared to protect people against catching colds, while children who took zinc were less likely to be absent from school or to be prescribed antibiotics.
The researchers say the findings could help reduce the amount of time lost from work and school, with the common cold accounting for 40 per cent of sick days.
The study was carried out by researchers from The Cochrane Collaboration, an international, non-profit organisation which publishes high-quality systematic reviews of health care research. The Cochrane Library is generally considered to be one of the most respected and reliable sources of evidence. No external funding was supplied.
Lead researcher Meenu Singh, of the Post Graduate Institute of Medical Education and Research in Chandigarh, India, said: "This review strengthens the evidence for zinc as a treatment for the common cold.”
Importantly, the researchers also say that zinc supplementation can potentially lead to side effects (which include bad taste and nausea for zinc lozenges). They report that because of this “and the differences in study populations...it is difficult to make firm recommendations about the dose, formulation and duration that should be used”.
As there were no studies in participants in whom common cold symptoms might be troublesome (for example, those with underlying chronic illness, immunodeficiency, asthma, etc.), the use of zinc currently cannot be recommended for them.
The body of evidence for zinc supplementation seems to be swinging in favour of its benefit, and the choice of whether to take supplements is an individual one.
Singh M, Das RR. Zinc for the common cold. Cochrane Database of Systematic Reviews 2011, Issue 2.
The Power of the
Brain Train
Australian senior executives are to undergo ‘brain training’ in an Australian-first clinical trial aimed at making staff smarter, healthier and more productive.
To harness an organisation’s psychological capital, Paul Taylor, from The Body-Brain Performance Institute, blends the latest research from the disciplines of neuroscience, physiology and psychology with lessons from the armed forces and elite athletes to create powerfully effective programs.
It is hoped that the trial will highlight the benefits of looking after workforce well-being.
Over 12-weeks, 60 volunteers from a large corporation will partake in a broad range of scientific tests, bio-age and brain power assessments from which individualised peak performance programs will be designed.
Executives will learn how to deal with stress and conflict, and high level coaching will help facilitate the long-term adoption of peak performance rituals with re-evaluation of critical measures along the way.
Elements of the training are also being trialled by senior executives at National Australia Bank, Cisco and Accenture.
The trial is part of a growing trend in which online brain training programs in the United States have grown into a $US295 million business.
Mr Taylor, a former British Royal Navy aircrew officer turned nutritionist and personal trainer, believes “peak performance” offices are the way of the future.
“Progressive companies are increasingly realising healthy, happy staff are sharper and more productive,” he said.
Brain Train Programs can also mean changing the work environment. Escalators may be replaced with stairs and the canteen restocked with nutrient-rich 'brain food'. Hydration meters may be fitted in toilets to show staff how urine colour indicates dehydration levels which can affect brain function.
''There's so much money that big business spends on marketing, advertising and other aspects of their business, but they're not investing in their biggest asset - their human or psychological capital,'' said Mr Taylor.
Click here to see Paul Taylor explain how exercise and nutrition can improve brain power in the office.
Paul Taylor will be sharing his findings at The 5th Annual Anti-Ageing & Aesthetic Medicine Conference to be held in Melbourne, Australia on 20-21 August, 2011.
Advanced-Stage
Cancer Responds to pH Manipulation Therapy
A cutting edge technique called ‘cancer pH manipulation therapy’ may be an exciting new development in the treatment of advanced-stage cancers.
Preliminary findings show cancer pH manipulation therapy normalised tumour markers in four weeks in a patient with metastatic endometrial carcinoma without the use of chemotherapy.
Dr Mark Rosenberg, Medical Director of the Institute for Healthy Aging and Director of the Integrative Cancer Therapies Fellowship with the American Academy of Anti-Aging Medicine (A4M), recently announced these findings of a novel technique for treating advanced-stage cancer.
“My findings are of course preliminary, but I do believe that this protocol is the most exciting treatment that I have ever seen for the treatment of advanced-stage cancers. Chemotherapy is insufficient because it does not affect cancer stem cells. My treatment, theoretically, will treat cancer stem cells, as well as non-stem cells”.
“If we can truly kill the cancer stem cells, we are not just talking treatment, but rather we are talking cure. Even if this is not a cure, this protocol may induce remissions that may be used repeatedly as needed, without inducing resistance.”
Cancer pH manipulation therapy targets cancers that feed on and process glucose through a mechanism known as glycolysis. Most cancers (both stem cells and non-stem cells) rely more heavily on glycolysis than normal tissue. And glycolysis produces lactic acid.
Based on his earlier findings, Dr Rosenberg has developed an oral protocol which blocks three mechanisms that cancer cells use to efflux lactic acid – which is essential for the cancer cells to prevent apoptosis (programmed cell death).
After the acid pumps are blocked, the cancer cells are fed with an infusion of high dose glucose. As the cancer cells feed they create lactic acid that is unable to be pumped out of the cells. In Dr Rosenberg’s words, “the more they eat the faster they die.”
Subsequently, Dr Rosenberg has begun treating a second patient diagnosed with stage IIIC primary peritoneal carcinoma with this therapy. Her tumour marker had been rapidly rising prior to treatment. Using the protocol, Dr Rosenberg achieved a 40% reduction in tumour markers in just two weeks.
Dr Rosenberg will be sharing his findings at The 5th Annual Anti-Ageing & Aesthetic Medicine Conference to be held in Melbourne, Australia on 20-21 August, 2011.
Dr Rosenberg will also run an INTEGRATIVE CANCER THERAPIES WORKSHOP on Friday 19 August, 2011. This workshop will provide comprehensive clinical education on cancer care including:
• Safe & Effective Protocols
• Engaging Multiple Modalities
• Pharmaceuticals
• Nutraceuticals
• Vaccines & Immunotherapy
• Novel Drugs/Substances
• Mind-Body Techniques