Saturday, January 31, 2015
Multis Are a Matter of the Heart
Women who used multivitamin and mineral supplements for longer than three years reduced their risk of dying of cardiovascular disease (CVD) in a new study of U.S. adults (J. Nutr. 2015. Published online Jan. 7, 2015).
The study used data from more than 8, 600 subjects 40 years or older (from the NHANES III, 1988 to 1994) as well as mortality data reported by the National Death Index through 2011. They found a significant association with those who used the supplements for longer than three years compared with nonusers. This finding was largely driven by the significant association among women.
This research follows a number of studies showing multivitamins’ positive effects on heart health. In 2010, the use of multivitamins was inversely associated with heart attacks in women, especially those without a history of CVD who used the supplements for five years or longer (Am J Clin Nutr. 2010 Nov;92(5):1251-6). That study included 31,000 women with no history of CVD and 2,200 women with a history of CVD aged 49 to 83 years from Sweden.
Additionally, a 2003 study from Stockholm reported Low-dose multivitamins may prevent heart attacks in subjects aged 45 to 70, and another study from the same year found multivitamins with antioxidant properties had beneficial effects on homocysteine and low-density lipoprotein (LDL) oxidation measures.
The study used data from more than 8, 600 subjects 40 years or older (from the NHANES III, 1988 to 1994) as well as mortality data reported by the National Death Index through 2011. They found a significant association with those who used the supplements for longer than three years compared with nonusers. This finding was largely driven by the significant association among women.
This research follows a number of studies showing multivitamins’ positive effects on heart health. In 2010, the use of multivitamins was inversely associated with heart attacks in women, especially those without a history of CVD who used the supplements for five years or longer (Am J Clin Nutr. 2010 Nov;92(5):1251-6). That study included 31,000 women with no history of CVD and 2,200 women with a history of CVD aged 49 to 83 years from Sweden.
Additionally, a 2003 study from Stockholm reported Low-dose multivitamins may prevent heart attacks in subjects aged 45 to 70, and another study from the same year found multivitamins with antioxidant properties had beneficial effects on homocysteine and low-density lipoprotein (LDL) oxidation measures.
Wednesday, January 28, 2015
Alert for Corn Sensitive Individuals
Whole Foods now uses modified food starch in all of their prepared foods that contain mayonnaise. They use a product called JUST MAYO that contains modified food starch derived from corn. Anyone that has sensitivities to corn needs to avoid these products. Many of our clients have gotten ill after eating these.
As always, please note that if you see a product with modified food starch and it is gluten-free, it is derived from corn. Other modified food starch products can be derived from waxy maize, wheat, or potatoes. The FDA now does require that if the modified food starch is from wheat, it must be on the label.
And this is not the first time Whole Foods has ruined their prepared foods for large swaths of people. Much of their hot food contains yeast extract (hidden monosodium glutamate) and corn-derivatives such as dextrose.
As always, please note that if you see a product with modified food starch and it is gluten-free, it is derived from corn. Other modified food starch products can be derived from waxy maize, wheat, or potatoes. The FDA now does require that if the modified food starch is from wheat, it must be on the label.
And this is not the first time Whole Foods has ruined their prepared foods for large swaths of people. Much of their hot food contains yeast extract (hidden monosodium glutamate) and corn-derivatives such as dextrose.
Tuesday, January 27, 2015
Mercury Exposure from Fish May Not Matter?
New findings from research in the American Journal of Clinical Nutrition provide further evidence that the benefits of fish consumption on prenatal development may offset the risks associated with mercury exposure. The researchers suggest that the nutrients found in fish have properties that protect the brain from the potential toxic effects of the chemical.
Three decades of research in the Seychelles have consistently shown that high levels of fish consumption by pregnant mothers -- an average of 12 meals per week -- do not produce developmental problems in their children. In fact, the omega-3 content may also actively counteract the damage that mercury causes in the brain.
Children of mothers with higher levels of omega-3 fatty acids performed better on certain tests. One of the mechanisms by which mercury inflicts its damage is through oxidation and inflammation and this has led the researchers to speculate that not only does omega-3 provide more benefit in terms of brain development, but that these compounds may also counteract the negative effects of mercury. Alternatively, children of mothers with relatively higher levels of omega-6 fatty acids did poorer on tests designed to measure motor skills.
Steve: You need to choose fish for supplements rich in omega-3 fatty acids. Unfortunately, farmed-raised fish is not going to cut it. Opt for wild-caught whenever possible.
Three decades of research in the Seychelles have consistently shown that high levels of fish consumption by pregnant mothers -- an average of 12 meals per week -- do not produce developmental problems in their children. In fact, the omega-3 content may also actively counteract the damage that mercury causes in the brain.
Children of mothers with higher levels of omega-3 fatty acids performed better on certain tests. One of the mechanisms by which mercury inflicts its damage is through oxidation and inflammation and this has led the researchers to speculate that not only does omega-3 provide more benefit in terms of brain development, but that these compounds may also counteract the negative effects of mercury. Alternatively, children of mothers with relatively higher levels of omega-6 fatty acids did poorer on tests designed to measure motor skills.
Steve: You need to choose fish for supplements rich in omega-3 fatty acids. Unfortunately, farmed-raised fish is not going to cut it. Opt for wild-caught whenever possible.
How Much Do You Pay for Bloodwork?
Bloodwork Costly For Some Even With Insurance
Right now, most of us are thinking about scheduling wellness visits with our health professionals. If you see Bonnie, you know that bloodwork is an important part of the visit.
The problem? If you have a high deductible, your out-of-pocket cost can be prohibitive. Even if insurance covers most of the bloodwork, the lab inflates the prices so much that your co-pay is even steep.
The solution? We have used a local lab for over 20 years that does our entire bloodwork panel for a VERY reasonable price.
The benefits? You do not have to go through your physician. While you do pay for the bloodwork out-of-pocket, you can use an FSA or HSA credit card. You can self-submit a claim to insurance for potential reimbursement.
Contact us for details if this is seems like an attractive option for you.
Right now, most of us are thinking about scheduling wellness visits with our health professionals. If you see Bonnie, you know that bloodwork is an important part of the visit.
The problem? If you have a high deductible, your out-of-pocket cost can be prohibitive. Even if insurance covers most of the bloodwork, the lab inflates the prices so much that your co-pay is even steep.
The solution? We have used a local lab for over 20 years that does our entire bloodwork panel for a VERY reasonable price.
The benefits? You do not have to go through your physician. While you do pay for the bloodwork out-of-pocket, you can use an FSA or HSA credit card. You can self-submit a claim to insurance for potential reimbursement.
Contact us for details if this is seems like an attractive option for you.
OTC, Prescription Meds Linked to Dementia
A large study from yesterday's JAMA Internal Medicine links a significantly increased risk for developing dementia, including Alzheimer's disease, to taking commonly used medications with anticholinergic effects at higher doses or for a longer time. Many older people take these medications, which include nonprescription diphenhydramine (Benadryl).
It is the first study to show a dose response: linking more risk for developing dementia to higher use of anticholinergic medications. And it is also the first to suggest that dementia risk linked to anticholinergic medications may persist -- and may not be reversible even years after people stop taking these drugs.
The most commonly used medications in the study were tricyclic antidepressants like doxepin (Sinequan), first-generation antihistamines like chlorpheniramine (Chlor-Trimeton), and antimuscarinics for bladder control like oxybutynin (Ditropan).
Bonnie: This latest study is a prime example of the important implications for people taking medications -- and for those prescribing medications for older patients."
Anticholinergic-type drugs that block a neurotransmitter called acetylcholine. Here's a list of medications with anticholinergic effects.
It is the first study to show a dose response: linking more risk for developing dementia to higher use of anticholinergic medications. And it is also the first to suggest that dementia risk linked to anticholinergic medications may persist -- and may not be reversible even years after people stop taking these drugs.
The most commonly used medications in the study were tricyclic antidepressants like doxepin (Sinequan), first-generation antihistamines like chlorpheniramine (Chlor-Trimeton), and antimuscarinics for bladder control like oxybutynin (Ditropan).
Bonnie: This latest study is a prime example of the important implications for people taking medications -- and for those prescribing medications for older patients."
Anticholinergic-type drugs that block a neurotransmitter called acetylcholine. Here's a list of medications with anticholinergic effects.
Thursday, January 22, 2015
Natural treatment for menstrual cramps
Primary dysmenorrhea (menstrual cramps) is common among young women and results in their incapacitation. It can be accompanied by various symptoms that can disrupt their lives. The aim of a Pain Management Nursing study was to compare the effect of ginger, zinc sulfate, and placebo on the severity of primary dysmenorrhea in young women.
The first group received ginger capsules, the second group received zinc sulfate capsules, and the third group received placebo capsules. All participants took them for four days, from the day before the commencement of menstruation to the third day of their menstrual bleeding. The severity of dysmenorrhea was assessed every 24 hours.
The severity of pain was significantly different between, before, and after the intervention in both the ginger and the zinc sulfate groups. Compared with the placebo receiving group, participants receiving ginger and zinc sulfate reported more alleviation of pain during the intervention. Ginger and zinc sulfate had similar positive effects.
The first group received ginger capsules, the second group received zinc sulfate capsules, and the third group received placebo capsules. All participants took them for four days, from the day before the commencement of menstruation to the third day of their menstrual bleeding. The severity of dysmenorrhea was assessed every 24 hours.
The severity of pain was significantly different between, before, and after the intervention in both the ginger and the zinc sulfate groups. Compared with the placebo receiving group, participants receiving ginger and zinc sulfate reported more alleviation of pain during the intervention. Ginger and zinc sulfate had similar positive effects.
What farmers are abandoning wheat for...
U.S. farmers are ripping out wheat and planting more sorghum. Farmers harvest sorghum from South Dakota to Texas, the biggest producer. The crop can be grown on lower-quality soils because it performs better in warm, dry conditions than corn or soybeans. After drought expanded through the U.S. Great Plains two years ago, farmers probably planted several hundred thousand more acres than estimated by the USDA as they abandoned wheat. American production is usually exported, used in animal feed, biofuel or food products. As much as 35 percent of the domestic harvest is used in ethanol production. However, with the popularity of gluten-free products, sorghum is appearing in more food products.
Tuesday, January 20, 2015
Daily Value Is Misleading
The “Daily Value” printed on every Supplement Facts and Nutrition Facts panel on every supplement, is actually the minimum amount of a nutrient needed in order to prevent a deficiency disease from manifesting. In other words, nutrients really do prevent disease.
This runs counter to the prevailing regulations around dietary supplements, which by law are not allowed to “prevent, cure, treat” disease. To do so is reserved only for pharmaceutical drugs. That’s why every supplement box has the same warning box: “This product is not intended to diagnose, treat, prevent or cure any disease.”
The truth is, in the case of vitamin C, 90mg/day is the Daily Value. That means you need a minimum of 90mg/day in order to not succumb to the vitamin C-deficiency disease called scurvy.
In the 18th century, British sailors received the epithet “limeys.” This is because they would pack limes on their ships. They didn’t know it was vitamin C, but by eating limes, they would not get the blistering lips of other sea-faring folk.
A recent study in Science Reports, found vitamin C can help prevent the risk of another disease: lung cancer. Researchers found those people with the highest vitamin C intake had the lowest risk of lung cancer. Specifically, the risk of lung cancer decreased 7 percent for every 100mg/day increase in the intake of vitamin C.
This runs counter to the prevailing regulations around dietary supplements, which by law are not allowed to “prevent, cure, treat” disease. To do so is reserved only for pharmaceutical drugs. That’s why every supplement box has the same warning box: “This product is not intended to diagnose, treat, prevent or cure any disease.”
The truth is, in the case of vitamin C, 90mg/day is the Daily Value. That means you need a minimum of 90mg/day in order to not succumb to the vitamin C-deficiency disease called scurvy.
In the 18th century, British sailors received the epithet “limeys.” This is because they would pack limes on their ships. They didn’t know it was vitamin C, but by eating limes, they would not get the blistering lips of other sea-faring folk.
A recent study in Science Reports, found vitamin C can help prevent the risk of another disease: lung cancer. Researchers found those people with the highest vitamin C intake had the lowest risk of lung cancer. Specifically, the risk of lung cancer decreased 7 percent for every 100mg/day increase in the intake of vitamin C.
Saving Babies' Lives
Fortifying grain foods with the B vitamin folic acid has saved about 1,300 babies every year from being born with serious birth defects of the brain and spine known as neural tube defects (NTDs), according to new data published by the US Centers for Disease Control and Prevention in its publication Morbidity and Mortality Weekly Report (MMWR). The number of babies born in the United States with these conditions has declined by 35 percent since 1998.
About 3,000 pregnancies in the U.S. still are affected by NTDs annually. The March of Dimes says that even with fortified grain products, many women still may not be getting enough folic acid. The organization urges all women to take vitamins containing folic acid, but only about one-third of women do.
Bonnie: The results of this study are extra special to me because I helped the March of Dimes roll out one of the most successful public health campaigns in modern history.
About 3,000 pregnancies in the U.S. still are affected by NTDs annually. The March of Dimes says that even with fortified grain products, many women still may not be getting enough folic acid. The organization urges all women to take vitamins containing folic acid, but only about one-third of women do.
Bonnie: The results of this study are extra special to me because I helped the March of Dimes roll out one of the most successful public health campaigns in modern history.
Thursday, January 15, 2015
Food Supply Not Consistent With Dietary Guidance
"The US food system is primarily an economic enterprise, with far-reaching health, environmental, and social effects. A key data source for evaluating the many effects of the food system, including the overall quality and extent to which it provides the basic elements of a healthful diet, is the Food Availability Data System.
The objective of the present study was to update earlier research that evaluated the extent to which the US food supply aligns with the most recent federal dietary guidance, using the current Healthy Eating Index-2010 (HEI-2010) and food supply data extending through 2010. The HEI-2010 was applied to 40 years of food supply data (1970-2010) to examine trends in the overall food supply as well as specific components related to a healthy diet, such as fruits and vegetables. The HEI-2010 overall summary score hovered around half of optimal for all years evaluated, with an increase from 48 points in 1970 to 55 points (out of a possible 100 points) in 2010. Fluctuations in scores for most individual components did not lead to sustained trends. Our study continues to demonstrate sizable gaps between federal dietary guidance and the food supply.
This disconnect is troublesome within a context of high rates of diet-related chronic diseases among the population and suggests the need for continual monitoring of the quality of the food supply. Moving toward a food system that is more conducive to healthy eating requires consideration of a range of factors that influence food supply and demand." Journal of the Academy of Nutrition and Dietetics 1/2015
The objective of the present study was to update earlier research that evaluated the extent to which the US food supply aligns with the most recent federal dietary guidance, using the current Healthy Eating Index-2010 (HEI-2010) and food supply data extending through 2010. The HEI-2010 was applied to 40 years of food supply data (1970-2010) to examine trends in the overall food supply as well as specific components related to a healthy diet, such as fruits and vegetables. The HEI-2010 overall summary score hovered around half of optimal for all years evaluated, with an increase from 48 points in 1970 to 55 points (out of a possible 100 points) in 2010. Fluctuations in scores for most individual components did not lead to sustained trends. Our study continues to demonstrate sizable gaps between federal dietary guidance and the food supply.
This disconnect is troublesome within a context of high rates of diet-related chronic diseases among the population and suggests the need for continual monitoring of the quality of the food supply. Moving toward a food system that is more conducive to healthy eating requires consideration of a range of factors that influence food supply and demand." Journal of the Academy of Nutrition and Dietetics 1/2015
What precedes memory loss
Depression and behavioral changes may occur before memory declines in people who will go on to develop Alzheimer's disease, according to new research in Neurology.
Researchers have known that many people with Alzheimer's experience depression, irritability, apathy and appetite loss but had not recognized how early these symptoms appear. Pinpointing the origins of these symptoms could be important to fully understanding Alzheimer's effects on the brain and finding ways to counteract them.
All of the participants were cognitively normal at the start, but over the course of the study, 1,218 of them developed dementia. Those who developed dementia during the study were more likely to have mood and behavioral changes first. For example, four years into the study, 30 percent of those who would go on to develop dementia had developed depression. In comparison, after the same period of time, only 15 percent of those who did not develop dementia during the study had become depressed. In addition, those who would go on to develop dementia were more than 12 times as likely to have delusions than those who did not develop dementia.
Researchers have known that many people with Alzheimer's experience depression, irritability, apathy and appetite loss but had not recognized how early these symptoms appear. Pinpointing the origins of these symptoms could be important to fully understanding Alzheimer's effects on the brain and finding ways to counteract them.
All of the participants were cognitively normal at the start, but over the course of the study, 1,218 of them developed dementia. Those who developed dementia during the study were more likely to have mood and behavioral changes first. For example, four years into the study, 30 percent of those who would go on to develop dementia had developed depression. In comparison, after the same period of time, only 15 percent of those who did not develop dementia during the study had become depressed. In addition, those who would go on to develop dementia were more than 12 times as likely to have delusions than those who did not develop dementia.
If you like swimming in pools, don't read this
A new study from journal Environmental Science and Technology Letters suggests pharmaceuticals and chemicals from personal care products end up in swimming pools, possibly interacting with chlorine to produce disinfection byproducts with unknown properties and health effects.
Chlorination is used primarily to prevent pathogenic microorganisms from growing. Previous research has shown that many constituents of urine including urea, uric acid, and amino acids, interact with chlorine to produce potentially hazardous disinfection byproducts in swimming pools. However, chemicals from pharmaceuticals and personal care products, or PPCPs, also could be interacting with chlorine, producing potentially harmful byproducts.
Of the 32 chemicals investigated, the researchers detected three: N,N-diethyl-m-toluamide, known as DEET, the active ingredient in insect repellants; caffeine; and tri(2-chloroethyl)-phosphate (TCEP), a flame retardant. Because there are literally thousands of pharmaceuticals, this is just a small subset of compounds that could be present in swimming pools.
Bonnie: There is no way of getting around it. The amount of pathogens and toxicity you are exposed to in a pool, especially public pool, is astonishgly high
Chlorination is used primarily to prevent pathogenic microorganisms from growing. Previous research has shown that many constituents of urine including urea, uric acid, and amino acids, interact with chlorine to produce potentially hazardous disinfection byproducts in swimming pools. However, chemicals from pharmaceuticals and personal care products, or PPCPs, also could be interacting with chlorine, producing potentially harmful byproducts.
Of the 32 chemicals investigated, the researchers detected three: N,N-diethyl-m-toluamide, known as DEET, the active ingredient in insect repellants; caffeine; and tri(2-chloroethyl)-phosphate (TCEP), a flame retardant. Because there are literally thousands of pharmaceuticals, this is just a small subset of compounds that could be present in swimming pools.
Bonnie: There is no way of getting around it. The amount of pathogens and toxicity you are exposed to in a pool, especially public pool, is astonishgly high
Monday, January 12, 2015
PPIs no benefit to crying infants
Proton pump inhibitors (PPIs), given to crying infants with the thinking that the discomfort of gastroesophageal reflux (GER) explains the babies' tears, do not decrease crying or irritability, according to a systematic review.
Dorota Gieruszczak-Bialek, MD, from the Department of Pediatrics, Medical University of Warsaw, Poland, and colleagues report the findings of their review online December 30 in the Journal of Pediatrics.
In July 2104, Dr Gieruszczak-Bialek and colleagues searched two registries and three databases (MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials) for randomized controlled trials involving infants with GER or gastroesophageal reflux disease (GERD) that examined the effectiveness of PPIs. The systematic review identified 176 trials. Most were characterized by some researcher financial conflict, including support by PPI manufacturers, authors employed by PPI manufacturers, or authors with stock in companies that produce PPIs, Dr Gieruszczak-Bialek and coauthors note.
The authors included five placebo-controlled trials, each involving infants younger than 1 year with signs and symptoms of GERD, in their review. Crying or irritability was the primary outcome in two of the trials: a randomized clinical trial/crossover study of 30 infants aged 3 to 12 months conducted in Australia and a multicenter study of 162 infants aged 1 to 11 months at general pediatric clinics in the United States and Poland. The second of these two trials found that serious adverse events (lower respiratory tract infections) occurred more frequently in infants taking lansoprazole, 0.2 to 1.5 mg/kg per day, for 4 weeks. "Although a wide CI [confidence interval] around the effect calls for caution, the finding is important in light of other observations documenting that the administration of PPIs is not without risk," Dr Gieruszczak-Bialek and colleagues write.
All five trials examined the effectiveness of varying doses of esomeprazole, lansoprazole, omeprazole, or pantoprazole and used "reliable methods," such as video monitoring, a validated cry diary, or questionnaires to document crying and fussiness.
"Some trials showed a decrease in crying/irritability from baseline to the end of the intervention; a similar effect was observed in the control group. However, no significant differences between the study groups were observed. The data do not support the use of PPIs to decrease infant crying and irritability," the researchers write.
According to the National Institutes of Health, GER is common among infants; about half of infants younger than 3 months spit up multiple times per day. By age 14 months, many healthy infants no longer spit up.
The authors note that the evidence base remains limited, yet conclude that "[e]ven if further studies confirm that PPIs offer some benefit, the risks of these drugs, specifically increased risk of gastrointestinal and/or respiratory tract infections, may outweigh the benefits."
Dorota Gieruszczak-Bialek, MD, from the Department of Pediatrics, Medical University of Warsaw, Poland, and colleagues report the findings of their review online December 30 in the Journal of Pediatrics.
In July 2104, Dr Gieruszczak-Bialek and colleagues searched two registries and three databases (MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials) for randomized controlled trials involving infants with GER or gastroesophageal reflux disease (GERD) that examined the effectiveness of PPIs. The systematic review identified 176 trials. Most were characterized by some researcher financial conflict, including support by PPI manufacturers, authors employed by PPI manufacturers, or authors with stock in companies that produce PPIs, Dr Gieruszczak-Bialek and coauthors note.
The authors included five placebo-controlled trials, each involving infants younger than 1 year with signs and symptoms of GERD, in their review. Crying or irritability was the primary outcome in two of the trials: a randomized clinical trial/crossover study of 30 infants aged 3 to 12 months conducted in Australia and a multicenter study of 162 infants aged 1 to 11 months at general pediatric clinics in the United States and Poland. The second of these two trials found that serious adverse events (lower respiratory tract infections) occurred more frequently in infants taking lansoprazole, 0.2 to 1.5 mg/kg per day, for 4 weeks. "Although a wide CI [confidence interval] around the effect calls for caution, the finding is important in light of other observations documenting that the administration of PPIs is not without risk," Dr Gieruszczak-Bialek and colleagues write.
All five trials examined the effectiveness of varying doses of esomeprazole, lansoprazole, omeprazole, or pantoprazole and used "reliable methods," such as video monitoring, a validated cry diary, or questionnaires to document crying and fussiness.
"Some trials showed a decrease in crying/irritability from baseline to the end of the intervention; a similar effect was observed in the control group. However, no significant differences between the study groups were observed. The data do not support the use of PPIs to decrease infant crying and irritability," the researchers write.
According to the National Institutes of Health, GER is common among infants; about half of infants younger than 3 months spit up multiple times per day. By age 14 months, many healthy infants no longer spit up.
The authors note that the evidence base remains limited, yet conclude that "[e]ven if further studies confirm that PPIs offer some benefit, the risks of these drugs, specifically increased risk of gastrointestinal and/or respiratory tract infections, may outweigh the benefits."
Imaginary Weight Loss Pill?
Salk researchers have developed an entirely new type of pill that tricks the body into thinking it has consumed calories, causing it to burn fat. The compound effectively stopped weight gain, lowered cholesterol, controlled blood sugar and minimized inflammation in mice, making it an excellent candidate for a rapid transition into human clinical trials.
Unlike most diet pills on the market, this new pill, called fexaramine, doesn't dissolve into the blood like appetite suppressants or caffeine-based diet drugs, but remains in the intestines, causing fewer side effects.
"This pill is like an imaginary meal," says Ronald Evans, director of Salk's Gene Expression Laboratory and senior author of the new paper, published January 5, 2014 in Nature Medicine. "It sends out the same signals that normally happen when you eat a lot of food, so the body starts clearing out space to store it. But there are no calories and no change in appetite."
In the United States, more than a third of adults are obese and 29.1 million people have diabetes, according to the Centers for Disease Control and Prevention. Both obesity and diabetes lead to an increase in health spending, a greater risk of health complications and a shorter lifespan.
Evans' laboratory has spent nearly two decades studying the farensoid X receptor (FXR), a protein that plays a role in how the body releases bile acids from the liver, digests food and stores fats and sugars. The human body turns on FXR at the beginning of a meal, Evans and others have shown, to prepare for an influx of food. FXR not only triggers the release of bile acids for digestion, but also changes blood sugar levels and causes the body to burn some fats in preparation for the incoming meal.
Pharmaceutical companies aiming to treat obesity, diabetes, liver disease and other metabolic conditions have developed systemic drugs that activate FXR, turning on many pathways that FXR controls. But these drugs affect several organs and come with side effects. Evans wondered whether switching on FXR only in the intestines -- rather than the intestines, liver, kidneys and adrenal glands all at once -- might have a different outcome. "When you eat, you have to quickly activate a series of responses all throughout the body," says Evans. "And the reality is that the very first responder for all this is the intestine."
Evans and his colleagues developed the fexaramine compound by departing from the drug scaffold that most pharmaceutical companies typically pursue when targeting FXR. "It turns out that when we administer this orally, it only acts in the gut," explains Michael Downes, a senior staff scientist at Salk and co-corresponding author of the new work. Giving one such drug in a daily pill form that only reaches the intestines -- without transporting into the bloodstream that would carry the drug throughout the body -- not only curtails side effects but also made the compound better at stopping weight gain.
When the group gave obese mice a daily pill of fexaramine for five weeks, the mice stopped gaining weight, lost fat and had lower blood sugar and cholesterol levels than untreated mice. In addition, the mice had a rise in body temperature -- which signals metabolism ramping up -- and some deposits of white fat in their bodies converted into a healthier, energy-burning beige form of the tissue. Even the collection of bacteria in the guts of mice shifted when they received the drug, although what those changes mean isn't clear yet.
So, why does fexaramine in the intestines work even better than drugs that simultaneously activate FXR throughout the body? Evans thinks it has to do with the natural order in which the body's molecular pathways normally responds to a meal.
"The body's response to a meal is like a relay race, and if you tell all the runners to go at the same time, you'll never pass the baton," says Evans. "We've learned how to trigger the first runner so that the rest of the events happen in a natural order."
Since fexaramine doesn't reach the bloodstream, it is also likely safer in humans than other FXR-targeting drugs, the researchers hypothesize. They're already working to set up human clinical trials to test the effectiveness of fexaramine to treat obesity and metabolic disease. Ideally the drug, administered under a doctor's guidance, would work in conjunction with diet and lifestyle changes, similar to weight-loss surgeries or other obesity or diabetes drugs.
Unlike most diet pills on the market, this new pill, called fexaramine, doesn't dissolve into the blood like appetite suppressants or caffeine-based diet drugs, but remains in the intestines, causing fewer side effects.
"This pill is like an imaginary meal," says Ronald Evans, director of Salk's Gene Expression Laboratory and senior author of the new paper, published January 5, 2014 in Nature Medicine. "It sends out the same signals that normally happen when you eat a lot of food, so the body starts clearing out space to store it. But there are no calories and no change in appetite."
In the United States, more than a third of adults are obese and 29.1 million people have diabetes, according to the Centers for Disease Control and Prevention. Both obesity and diabetes lead to an increase in health spending, a greater risk of health complications and a shorter lifespan.
Evans' laboratory has spent nearly two decades studying the farensoid X receptor (FXR), a protein that plays a role in how the body releases bile acids from the liver, digests food and stores fats and sugars. The human body turns on FXR at the beginning of a meal, Evans and others have shown, to prepare for an influx of food. FXR not only triggers the release of bile acids for digestion, but also changes blood sugar levels and causes the body to burn some fats in preparation for the incoming meal.
Pharmaceutical companies aiming to treat obesity, diabetes, liver disease and other metabolic conditions have developed systemic drugs that activate FXR, turning on many pathways that FXR controls. But these drugs affect several organs and come with side effects. Evans wondered whether switching on FXR only in the intestines -- rather than the intestines, liver, kidneys and adrenal glands all at once -- might have a different outcome. "When you eat, you have to quickly activate a series of responses all throughout the body," says Evans. "And the reality is that the very first responder for all this is the intestine."
Evans and his colleagues developed the fexaramine compound by departing from the drug scaffold that most pharmaceutical companies typically pursue when targeting FXR. "It turns out that when we administer this orally, it only acts in the gut," explains Michael Downes, a senior staff scientist at Salk and co-corresponding author of the new work. Giving one such drug in a daily pill form that only reaches the intestines -- without transporting into the bloodstream that would carry the drug throughout the body -- not only curtails side effects but also made the compound better at stopping weight gain.
When the group gave obese mice a daily pill of fexaramine for five weeks, the mice stopped gaining weight, lost fat and had lower blood sugar and cholesterol levels than untreated mice. In addition, the mice had a rise in body temperature -- which signals metabolism ramping up -- and some deposits of white fat in their bodies converted into a healthier, energy-burning beige form of the tissue. Even the collection of bacteria in the guts of mice shifted when they received the drug, although what those changes mean isn't clear yet.
So, why does fexaramine in the intestines work even better than drugs that simultaneously activate FXR throughout the body? Evans thinks it has to do with the natural order in which the body's molecular pathways normally responds to a meal.
"The body's response to a meal is like a relay race, and if you tell all the runners to go at the same time, you'll never pass the baton," says Evans. "We've learned how to trigger the first runner so that the rest of the events happen in a natural order."
Since fexaramine doesn't reach the bloodstream, it is also likely safer in humans than other FXR-targeting drugs, the researchers hypothesize. They're already working to set up human clinical trials to test the effectiveness of fexaramine to treat obesity and metabolic disease. Ideally the drug, administered under a doctor's guidance, would work in conjunction with diet and lifestyle changes, similar to weight-loss surgeries or other obesity or diabetes drugs.
Thursday, January 08, 2015
Read This Before You Get a Colonoscopy
Bowel cleaning that uses two separate smaller dosages of polyethylene glycol electrolyte solution appears to introduce fewer alterations to the intestinal microbiota than a bowel cleanse with a single, larger dose of MoviPrep (Salix). The split-dose protocol has also been shown in previous studies to be effective for bowel cleansing before colonoscopy.
The results of the gut microbiome study appeared in Gut.
In general, bowel cleaning resulted in a 31-fold decrease in microbial load. Approximately one quarter (22%) of participants experienced a marked alteration in the community composition of their microbiota after bowel cleansing. The shift in the microbial community was larger in the single-dose protocol than in the double-dose protocol.
Although the gut microbiome recovered to baseline after both protocols, the recovery was more rapid in the double-dose protocol than the single-dose protocol. Patients who received the larger, single dose of polyethylene glycol required as long as 1 month to recover their gut microbiome.
The investigators noted that some of the bacterial species that were enriched after bowel cleansing were similar to those associated with irritable bowel syndrome. Moreover, patients with irritable bowel syndrome have elevated levels of fecal serine proteases, which are believed to increase intestinal permeability and possibly lead to visceral hypersensitivity.
The results of the gut microbiome study appeared in Gut.
In general, bowel cleaning resulted in a 31-fold decrease in microbial load. Approximately one quarter (22%) of participants experienced a marked alteration in the community composition of their microbiota after bowel cleansing. The shift in the microbial community was larger in the single-dose protocol than in the double-dose protocol.
Although the gut microbiome recovered to baseline after both protocols, the recovery was more rapid in the double-dose protocol than the single-dose protocol. Patients who received the larger, single dose of polyethylene glycol required as long as 1 month to recover their gut microbiome.
The investigators noted that some of the bacterial species that were enriched after bowel cleansing were similar to those associated with irritable bowel syndrome. Moreover, patients with irritable bowel syndrome have elevated levels of fecal serine proteases, which are believed to increase intestinal permeability and possibly lead to visceral hypersensitivity.
Avocado does it again
According to the American Heart Association, eating one avocado a day as part of a heart healthy, cholesterol-lowering moderate-fat diet can help improve bad cholesterol levels in overweight and obese individuals, according to new research published in the Journal of the American Heart Association.
Researchers evaluated the effect avocados had on traditional and novel cardiovascular risk factors by replacing saturated fatty acids from an average American diet with unsaturated fatty acids from avocados.
Low-density lipoprotein (LDL) -- the so called 'bad cholesterol' -- was 13.5 mg/dL lower after consuming the moderate fat diet that included an avocado.
Several additional blood measurements were also more favorable after the avocado diet versus the other two cholesterol-lowering diets as well: total cholesterol, triglycerides, small dense LDL, non-HDL cholesterol, and others.
Bonnie: It's about time the AHA got with the program!
Researchers evaluated the effect avocados had on traditional and novel cardiovascular risk factors by replacing saturated fatty acids from an average American diet with unsaturated fatty acids from avocados.
Low-density lipoprotein (LDL) -- the so called 'bad cholesterol' -- was 13.5 mg/dL lower after consuming the moderate fat diet that included an avocado.
Several additional blood measurements were also more favorable after the avocado diet versus the other two cholesterol-lowering diets as well: total cholesterol, triglycerides, small dense LDL, non-HDL cholesterol, and others.
Bonnie: It's about time the AHA got with the program!
Tuesday, January 06, 2015
Do Autoimmune Diseases Begin in the Gut?
Bonnie: Hey, Gastroenterologists! If you don't want to listen to us or your patients, maybe you'll listen to one of your colleagues. This piece appears on Medscape.
"My name is Dr Stephen Paget. I am the physician-in-chief emeritus at Hospital for Special Surgery, and professor of medicine at Weill Cornell School of Medicine in New York City.
Today I am going to talk about the microbiome, an extraordinary concept that is probably not well understood by most physicians but that truly defines us as people. The microbiome is those bacteria that live in various parts of our bodies, particularly the intestine. There are 100 times more genes in the bacteria inside us than each of us has as human beings. Our immune systems are defined by the microbiome and the interactions with those bacteria, almost 80% of which are not the usual bacteria that we know about.
It now has become clear that the makeup of those bacteria can define whether we are healthy or have disease. What is truly extraordinary is that we now have ways to change a person's bacterial growth and microbiome.
From Gut to Immune System
People who have persistent, antibiotic-resistant Clostridium difficile colitis are undergoing fecal transplant to enhance microbiomes that are not functioning well. Fecal transplant can be accomplished in various ways, even in pill form, to change the flora and the balance within the person's intestine, and heal them completely.
Animal models of different types of arthritis have shown that an animal that lives in a germ-free environment may not develop a certain type of arthritis. As soon as the animal is moved to an environment with specific bacteria, however, those bacteria interact with the animal's genetics and other environmental factors internally and externally to cause arthritis.
Thus, as we learn more about autoimmune diseases and types of arthritis, we have a tremendous opportunity to make a huge difference. Some scientists have shown that periodontal bacteria may play a significant role as a stimulus for rheumatoid arthritis. Similarly, intestinal bacteria play a significant role as a cause of various types of spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis.
This is a new world and a new age. We are coming to grips with who we are as organisms, both the organism that is visible on the outside and the organism that is inside us, with both working together in health and in disease."
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