Archive for the ‘Chronic Illness’ Category

Pertussis is Back

August 24th, 2010

Bordetella Pertussis, B. Pertussis, Whooping Cough, Vaccinate

Just like Britney Spears, whose career died and then came roaring back, Bordetella pertussis (B. pertussis, or whooping cough) is back with a vengeance. It’s one of those illnesses that everyone thinks was wiped out because kids have been getting vaccinated against it since the 1940s.

But despite the continued high level of vaccinations, Pennsylvania’s Department of Health just issued a health warning of unusually high levels of pertussis, and California has reported an epidemic, with 2,774 cases confirmed in 2010 alone. According to the New York Department of Health, "Since the 1980s, the number of reported pertussis cases has gradually increased in the United States. In 2005, over 25,000 cases of pertussis cases were reported in the United States, the highest number of reported cases since 1959. Approximately 60 percent of the cases were in adolescents and adults."

For some people, their first thought might be, "Serves those parents right who refused to vaccinate their children." But they’d be wrong.

So whence the comeback of pertussis? According to the U.S. Centers for Disease Control, a 2009 study of the pertussis virus in the Netherlands showed that variations in the virus have produced a higher level of pertussis toxin (Ptx), and that this has led to the resurgence of the disease. What this means is that the virus strains have become more infectious, compromising the efficacy of the vaccine and making the disease more contagious.  Plus, the effects of the vaccine diminish over time, so adults may have lost their protections. Says Dr. Tom Clark, an epidemiologist with the CDC, "Immunity wears off, especially for adults who are decades past their most recent vaccination."

Pertussis spreads from person to person by direct contact with mucous droplets. In other words, you get it from infected people who cough or sneeze in your presence, and it’s highly contagious. Early symptoms resemble a mild cold — runny nose, sneezing, low-grade fever, mild coughing — but then it blossoms into a severe cough within several weeks, causing severe inflammation of the lungs. The cough may be accompanied by whooping or gasping for breath, vomiting, seizures, and pneumonia. Standard medical treatment is with antibiotics, typically azithromycin (Zithromax), erythromycin, and clarithromycin (Biaxin).

Once the disease develops, it can take a long time to recover, even after treatment with antibiotics. According to Dr. Stephen Ostroff, Pennsylvania’s acting physician general, "Think of it like a tornado going through your neighborhood. The tornado may go through relatively quickly, but it takes a long time to clean up the damage. That’s true of this infection as well."

Part of the problem is that adolescents and adults, in whom pertussis is most prevalent, tend to wait for weeks before seeking medical care for a cough. When they finally do go to their doctor, the physician may not think of pertussis as the cause. According to Dr, Clark, "You only begin to think about pertussis when it’s been going on for weeks and weeks and then treatment is much less likely to make a difference, and you’ve spread it to other people." Plus, testing to confirm pertussis is not that reliable. It may take several weeks to get results from a culture of nasal secretions. And while there’s a quicker genetic test based on a cheek swab, not all labs perform it. The kicker is that both tests are only reliable in earliest stages of the disease — much earlier than most people seek care.

So what can you do to avoid falling prey to the disease? Many in the medical establishment suggest getting a booster (Tdap) of the DTP vaccine if you’re between the ages of 19 and 64 and haven’t previously received it. This vaccine ostensibly protects against diptheria, tetanus, and whooping cough. On the other hand, it’s not going to be that effective against the newer strains of the virus with the higher levels of pertussis toxin. It’s also worth noting that the vaccine has been controversial given the serious side effects it may trigger, including permanent neurological damage, brain injury, seizures, allergic reactions, and death. Most physicians feel the risk of whooping cough far outweighs the purportedly slim risk of vaccine side effects, so you may indeed have a physician recommend the booster to you if the current trend of increased disease incidence continues. Plus, there is a new, less dangerous iteration of the vaccine now out, called the acellular version, as opposed to the whole cell vaccine. If you do get talked into a vaccine, at least insist that it be the acellular variety. It appears, though, that some emerging strains of bacteria have already become resistant to the acellular vaccine.

If you don’t want the vaccine, how can you avoid whooping cough? Steer clear of anyone coughing, sneezing, wheezing, wiping his nose or displaying cold symptoms. If you must mingle with the potentially sick masses, the usual advice applies. Wash you hands well after being out in public and look to natural immune boosters and pathogen destroyers — to which no bacteria can become resistant.

hc:

Arthritis and Nutrition

August 19th, 2010

Moose, Arthritis, Osteoarthritis, Early Diet, Nutrition

A 50-year study of moose (those antlered animals, not the Loyal Order guys in funny hats) on Isle Royal in Lake Superior indicates that osteoarthritis may have its origins in poor nutrition. According to an article in The New York Times, the study involved the examination of numerous moose carcasses that showed, among other things, that these leggy critters are subject to arthritis. After examining some 1,200 carcasses (be assured, Bullwinkle J. Moose was not one of them), scientists found that more than 50 percent had arthritis and that the disease looks much the same in moose as it does in people. Arthritis affects the hips and knees of wild moose, making them especially vulnerable to their main predator, the wolf. Among humans, osteoarthritis also affects knees and hips, causing pain and debilitation (and making sufferers vulnerable to pharmaceutical predators).

Scientists involved in the study said that the evidence indicated that poor early nutrition was the main cause of moose arthritis. According to Dr. Rolf Peterson of Michigan Technological University, arthritic moose tended to be small as measured by their metatarsal bones, and small metatarsals correlate to poor early nutrition.  The scientists were able to determine that the small moose were born during times of food scarcity, as a result of which their mothers had difficulty producing enough milk. They theorize that if the arthritis had been due to wear and tear, the moose would have had to walk further to find food when they were grown. But the evidence indicted that the moose had plentiful food as adults, leaving early nutrition as the most likely source of the problem.

There is significant evidence of a correlation between poor early nutrition and increased incidence of arthritis in human beings as well. For example, studies of the bones of 16th century Native Americans in the Southeast show an increase in the incidence of osteoarthritis after contact with the Spanish changed the Native American diet from fish and wild plants to one focused on corn. In fairness, the Spanish also vastly increased the workload for these people, which, it could be argued, may have contributed to arthritis. But the study showed that the Native Americans became smaller and more subject to anemia and malnutrition as a result of the dietary changes imposed on them and that this was a significant contributor to the increased incidence of osteoarthritis. The Times article also points to studies in Britain and in China that showed that low birth weight and poor in utero nutrition are linked to the later development of osteoarthritis (as well as other disabilities.)

The idea that carrying excess weight contributes to osteoarthritis is also being looked at anew as a result of the link between nutrition and the condition. No longer is obesity seen simply as creating extra wear and tear on joints and cartilages. Obesity is often fueled by a poor diet.  Says Dr. Peter Bales of the University of California of Davis Health System, and authority on arthritis, "Poor diet results in inflammatory changes and damage in cartilage cells, which in turn lead to cartilage breakdown and the development of osteoarthritis."

According to Dr. Bales, the proper diet can significantly reduce the pain and stiffness associated with the disease. And his diet of choice? The Mediterranean diet, of course.  Why?  It’s less acidic, reducing the release of free radicals that can damage joints and cartilage. Plus the diet’s emphasis on vegetables, whole grains, olive oil, fruits and fish can support cartilage growth and slow its deterioration.   Bales also recommends limiting one’s intake of sugary and processed foods because they result in AGEs (advanced glycosylation end products). AGEs bind to the collagen in joints and cartilage rendering them more brittle.  He says increased vitamin C intake is important (vitamin C is alkalizing and anti-inflammatory) as is supplementation with fish oil, glucosamine, chondroitin, MSM, and  SAMe (S-adenosylmethionine). In addition, to Dr. Bales recommendations, I would also add supplementation with a formula containing avocado soy unsaponifiables, undenatured chicken collagen, ginger, cetyl myristoleate, and boswellia extract.

Around 1863, the German philosopher Ludwig Feuerbach, wrote, "Man is what he eats," which has come down to us as "you are what you eat." And while Feuerbach had a spiritual meaning in mind, I can’t help but be struck by its literal relevance in the case of osteoarthritis. Both the type of nutrition one has as a child and the diet one eats as an adult have direct impact on the health or deterioration of the joints and cartilages in later life (as well as on the entire system). Whether moose or man, it seems, the effects of bodily wear and tear combined with genetic predisposition can be triggered or fended off by the dietary choices both we and our parents make.

:hc

Avandia Cardiovascular Safety Cover Up

July 20th, 2010

Avandia, Heart Attacks, Heart Risks, GlaxoSmithKline

If you’ve followed this blog for a while, you may look at pharmaceutical companies with a bit of skepticism. But the recent news about GlaxoSmithKline (GSK), the pharmaceutical giant that brought you medicines like the antidepressant Paxil, may make you want to swear off prescription drugs altogether. According to the New York Times, between 1999 and 2010, GSK hid data that showed that its diabetes drug Avandia posed severe heart attack risks.

The Avandia issue was first raised in 2007, when a Cleveland Clinic cardiologist did a study based on data that GSK was forced to publish as the result of a lawsuit. The study publicized Avandia’s heart risks. Apparently, when the company released the drug in 1999, it had conducted its own studies to show that Avandia was superior to the competing diabetes drug, Actos, in terms of cardiovascular safety.  In fact, the study showed just the opposite. The drug was less safe for the heart than Actos. In fact, it was much less safe. So the company borrowed a page from political scandals past and covered up the data for the next 11 years — this despite the fact that, in most cases, federal law requires results like these to be posted on the company website and turned into federal regulators. Let’s hear it for GSK.

GSK has quite a history. Lest you forget, last year GSK settled a suit because it hid data showing that its antidepressant Paxil caused increased suicidal thoughts and acts in children and teenagers. It was also sued by 49 states in 2006 because it prevented competition by generic versions of Paxil, thereby gouging the Medicare programs in those states. GSK settled out of court, agreeing to pay $14 million. And in 2005, it settled a case in which it was accused of using fraudulent lawsuits to delay generic competitors for its anti-inflammatory drug, Relafen. A fine corporate tradition, indeed!

So why did GSK pursue its corporate tradition of hiding the facts in the case of Avandia? Largely because the company viewed Avandia as essential to its success. The New York Times reported that it obtained documents showing that the company feared a loss of $600 million in sales between 2002 and 2004 alone, if the drug’s safety risks were to "see the light of day outside GSK."  (That amount makes the $14 million settlement mentioned above look like a shrewd business investment.)

Of course, GSK isn’t the only pharmaceutical corporation to be nabbed for fraudulent activity. In 2009, Pfizer paid $2.3 billion to settle accusations that it marketed drugs to physicians illegally, resulting in huge and unnecessary payments by the government. In other words, Medicare and Medicaid paid out large sums for prescriptions for these drugs, which, because of the illegal uses, should not have been reimbursable. Then there was the case of Bayer subsidiary, Cutter Biologicals, and three other companies that paid $600 million in settlements due to allegations that they knowingly sold AIDS infected clotting factor to hemophiliacs. More recently, Ortho-McNeil Pharmaceutical LLC and Ortho-McNeil-Janssen Pharmaceuticals, Inc., were sued for illegally marketing the drug Topamax, an anti-epileptic drug, for uses not included on the label. Ortho-McNeil pleaded guilty and paid a fine of $6.4 million.  And sister company Ortho-McNeil-Janssen was ordered to pay $74 million because their complicity caused un-reimbursable health claims to have to be paid out by federal and Medicaid programs.

Enough said about the ethics of big Pharma. But if corporate ethics were the only problem with pharmaceutical manufacturers, the solution would be as simple as coming up with appropriate regulation.  Unfortunately, the problem has deeper roots, and Avandia provides a good example.

The Avandia advertisements claim that the drug improves the body’s insulin sensitivity so that the body is better able to use insulin to lower blood sugar. While that might seem a positive contribution, the quick-fix approach, unfortunately, leaves much else unaddressed. As I have written before, diabetes is not like other diseases that proceed in a straight-line from a starting point to an end point. Diabetes actually follows multiple, mutually reinforcing paths — an echo effect if you will, with each echo reinforcing and amplifying all the other echoes, or "effects." This distinction is of vital importance because it mandates multiple points of intervention if you wish to reverse diabetes and not just slow its progression.

But the profit-obsessed pharmaceutical industry focuses not on eliminating or reversing disease, but on delivering solutions that merely suppress symptoms and that can be sold as commodities — pills, injections, technology-based treatments, therapies and so on. Drug companies do not approach bodily dysfunction from a system-wide or holistic point of view. After all, where’s the money in dietary and lifestyle changes, or in the use of non-patentable herbal solutions. If you step back and look at the whole picture, you can see that operating under the premise that disease can best be treated by means of pre-packaged fixes that merely suppress symptoms might lead to poor ethics. In order to make money, these companies need to sell commodities, as opposed to selling better health. But good health doesn’t necessarily respond to commodities. It requires disciplined behavior and often systematic, multi-dimensional approaches. Little wonder, then, that companies that base their livelihood on an approach that can’t really deliver the goods, resort to making up the rules as they go along.

:hc

Processed Meat Is High Risk

July 15th, 2010

Processed Meat, Sodium, Nitrates, Heart Disease, Diabetes

A new study by researchers at the Harvard School of Public Health (HSPH) in Boston found that people who eat processed meats like bacon, sausage, and deli meats have a 42 percent higher risk of getting heart disease and a 19 percent higher risk of getting Type 2 diabetes for each daily serving of about 1.8 ounces (50 grams) they have. In other words, the 42 percent higher risk for heart disease and increased diabetes risk comes from eating as little as 1.8 ounces of processed meat.

The researchers systematically winnowed 1600 studies from all over the world down to the 20 that were most relevant. (This is called a "meta-analysis" because it is an analysis of other studies.) These 20 studies involved 1,218,310 people from 10 countries in North America, Australia, Europe and Asia. The researchers defined any meat prepared by curing, salting, smoking or adding chemical preservatives as processed. Unprocessed meats were defined as those served in the state they were taken from pigs, cattle, or sheep (but cooked). Poultry and vegetable sources of protein were excluded from the study.

Interestingly, in this study, eating unprocessed red meat — beef, pork, and lamb — did not correspond to a higher risk for either disease in this study. I’ve reported very different results from prior studies. In fact, last year, I wrote a health blog about a study conducted by the National Institutes for Health and the AARP tracking more than half a million people between the ages of 50 and 71 for more than a decade. That study found that those subjects who ate the equivalent of a small hamburger daily had a 30 percent elevated risk of death from all causes, but particularly from cancer and heart problems. The elevated risk for women was particularly startling, with those who ate the most red meat, increasing their mortality risk by 36% and their risk of dying from heart failure by 50%. (Note: we’re not talking about grass fed or organic beef here, which might significantly change the equation.)

In any event, it makes sense that processed meats would be more deadly than the unprocessed variety, but not because of the amount of saturated fats and cholesterol. These were similar in the processed and unprocessed meats. So were the "lifestyle factors" of those eating processed and unprocessed meats. The real difference, it seems, was the much higher sodium nitrate preservatives content found in processed meats.  According to study leader Dariush Mozaffarian, assistant professor in the HSPH department of epidemiology, "…processed meats contained, on average, four times more sodium and 50% more nitrate preservatives. This suggests that differences in salt and preservatives, rather than fats, might explain the higher risk of heart disease and diabetes seen with processed meats, but not with unprocessed red meats."

While this is not exactly new news, it is the first worldwide study to indicate a possible negative impact of salt and nitrate preservatives on the body. I’ve mentioned in many places that refined commercial, iodized table salt is a contributor to high blood pressure, a cause of heart disease. (Note: not all salts are created equal.) Nitrates are another story.  Found naturally in vegetables and fruits, nitrates are added to meats and other foods to maintain color and act as a preservative.  The body converts nitrates to nitrites, and nitrites have a controversial relationship to cancer, with some studies showing a high correlation to cancer, and others showing none. The National Academy of Science, for one, maintains that nitrites are unlikely to cause any kind of cancer, but the Harvard study cited above shows a clear correlation between intake of sodium and nitrates in processed meats and an increased risk of heart diseases and diabetes.  Moreover, it also indicates that, despite the research controversies, there may be more of a link between intake of nitrates and colorectal cancer, as well as other cancers than recognized by the medical establishment.

Interestingly, physicians use nitrates to intervene in cases of heart attacks and angina because it dilates the arteries of the heart and increases blood flow. There are three main forms — nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. When used in these forms, it can be injected into the bloodstream (in heart attack emergencies), taken as a spray, a pill, a paste, or a patch. The hotdog variety of nitrate, however, serves no purpose other than sensory pleasure for those so inclined. I know of no doctor who recommends eating a hotdog when experiencing a heart attack or angina.

Again, there’s plenty of evidence that processed meats are deadly. The HSPH study showed that a mere serving a day is enough to have dire impact. The upshot is that if you’re going to eat the cow, it’s probably somewhat better to eat it in a more cow-like state. On the other hand, if you want to live longer and stay healthier, you’re probably better off not eating the cow at all…or at least restrict your eating to organic, grass fed cows.

:hc

Red Wine, the Heart Helper

July 13th, 2010

Wine, Resveratrol, Heart Disease, Cancer, Fat Cells

The medical community is locked in a debate as to whether or not red wine is actually good for you. Some contend that the libation offers balm for the heart; others tout studies showing that wine is carcinogenic or harmful in various ways. Now, a recent study conducted by scientists at the University of Ulm, Germany, scored one for those in the pro-wine camp. The study investigated how the compound reservatrol, which is found in the skin of red grapes and in red wine, actually works in human fat cells. 

A few months back, I wrote about scientists who theorized that resveratrol has a role in weight control associated with moderate consumption of red wine, even though the resveratrol levels in red wine are not actually that high.  Nevertheless, the study showed that women who drank a moderate amount of red wine gained less weight than those who did not drink at all.  The scientists thought it likely that resveratrol inhibited the development of new fat cells and hindered the storage of fat already present in cells. They also credited resveratrol with the beneficial cardiac effects of drinking red wine.

The new Ulm study found parallel effects. In a controlled environment, resveratrol inhibited the development of immature human fat cells and affected how those cells functioned. Although similar results have previously been observed in animal cells, this was the first such study to be conducted on human cells. The scientists also found that resveratrol stimulated the absorption of glucose into cells and prevented the conversion of molecules into fat. Plus, they found that resveratrol activates sirtuin 1, a protein that protects against heart inflammation. All told, the study indicates that resveratrol affects metabolism in a way that interferes with obesity and other metabolic processes that could lead to cardiac disease.

A second study, conducted at the Israel Institute of Technology in Haifa, showed that the health of blood vessel cells was improved by moderate consumption of red wine. The researchers followed 18 healthy adults who happily agreed to consume two portions (8.5 ounces) of red wine daily for three weeks in a row. When the researchers compared blood samples taken before and after the study, they found that "daily red wine consumption for 21 consecutive days significantly enhanced vascular endothelial function."  In other words, drinking red wine improved the health of the small layer of endothelial cells that lines the blood vessels, which led to improved blood flow and heart health. It also decreased cell death. According to the authors, "Moderate consumption of red wine provides cardiovascular protection, but the mechanisms that underlie this protection are unclear."

Even so, the Ulm researchers couldn’t help but think about possible pharmaceutical indications. Said the study authors, "Our findings open up the new perspective that resveratrol-induced intracellular pathways could be a target for prevention or treatment of obesity-associated endocrine and metabolic adverse effects. Resveratrol may act on different levels of cell signaling." In other words, they’re looking for ways to use resveratrol to prevent or treat obesity. Let’s hope that doesn’t mean that you’ll need a prescription for Cabernet in the future.

But you can get resveratrol from sources other than wine, should you prefer not to get "happy" or to hazard the other potential risks associated with alcohol. You can, for instance, take resveratrol supplements. Studies show that the bioavailability of resveratrol in supplement form at least equals that of red wine, and at much higher levels. Or you can go directly to the source and either eat a bunch of red grapes or drink grape juice (preferably juiced yourself, from organic grapes). In fact, a Cornell University study found more resveratrol in grape juice than in 60% of the wines studied. Other foods such as cacao, peanuts, and various berries also contain resveratrol, but in lesser amounts.

Should you decide that you do prefer to go the way of Bacchus, you should know that not all wines are equal in terms of resveratrol content. It turns out that Pinot Noir has a far higher resveratrol content than other red wines. Maybe Miles in the movie, Sideways, was onto something. Another Cornell University study, this one analyzing hundreds of wines from around the globe, found that a Pinot Noir from New York State, not France, scored highest in resveratrol content.

:hc

Exercise Beats Drugs for Depression

July 6th, 2010

Depression, Exercise

Combating depression is big business in the US. In fact, it’s the biggest business in the pharmaceutical industry. Americans currently spend around $10 billion a year for antidepressants. Despite the fact that antidepressants may cause significant side effects such as sexual dysfunction, weight gain, dry mouth, nausea, sleep disturbances, tremors, dizziness, congenital defects, stroke, and ironically, increased depression. And although plenty of evidence suggests that they often don’t work, the medical community seems inclined to hand out prescriptions for them like Halloween candy. As I’ve written before, antidepressants are the most prescribed of all medications, and the number of prescriptions keeps growing — across all age levels.

But what if a free, no side-effects treatment worked just as well or even better for depression? Would the medical community endorse it? A recent article in Time Magazine touts the work of Dr. Jasper Smits, a psychologist in Dallas, Texas, who has developed a program using exercise as the primary treatment for depression, anxiety, and a variety of other mood disorders And the thing is, it works. As Dr. Smits says, "Exercise appears to affect, like an antidepressant, particular neurotransmitter systems in the brain, and it helps patients with depression re-establish positive behaviors. For patients with anxiety disorders, exercise reduces their fears of fear and related bodily sensations such as a racing heart and rapid breathing."

Dr. Smits and Dr. Michael Otto of Boston University reviewed dozens of studies on the impact of exercise on mental health and recently presented their findings at a major conference in Baltimore. At least some of those studies date way back. For example, in 1999, James A. Blumenthal and colleagues at Duke University showed that exercise was more effective than Zoloft for patients with major depression. The study followed 156 depressed older adults. Some were given Zoloft (Pfizer’s trade name for the antidepressant setraline), some 30 minutes of exercise three times a week, and some both. After six months, the group who exercised without also taking Zoloft did better than the other two groups. Now that’s a curious finding given Zoloft’s professed purpose.

Even more, the group that took the antidepressant and exercised had a higher rate of relapse into depression than did the group that merely exercised. At the time, Dr. Blumenthal theorized that taking antidepressants might actually undermine self-esteem, no matter their biochemical impact. He said, "It is conceivable that the concurrent use of medication may undermine the psychological benefits of exercise by prioritizing an alternative, less self-confirming attribution for one’s improved condition." Translated, this means that instead of feeling that they worked hard to develop the discipline required to beat depression through exercise, the subjects felt that they got better only because they took a pill. Ultimately, this made them feel less in control of their condition.

Other old studies also confirm the positive impact of exercise on mental health. A 1988 epidemiological study established the link between physical inactivity and a greater risk of depression. The link between inactivity and depression was strengthened by a 1991 study. More recent research published in 2002 showed that exercise improves the brain’s operating condition in aging people and animals. Another study published in 2002 showed that the, "Age-related decrease in the intensity of physical exercise increases the risk of depressive symptoms among older adults." 

Dr. Smits expresses surprise that his colleagues consider his approach novel, given all this history. "I was really surprised that more people weren’t working in this area when I got into it," he says. Certainly, there’s ample research to support the efficacy of exercise for improving mental health, so why don’t doctors hand out prescriptions for exercise before sending patients to the drug store? Why are so few researchers developing programs?

Maybe the problem is that the pharmaceutical companies (and therefore the medical community as a whole) can’t cash in on exercise programs as well as they can on pills. The numbers tell the story. Wyeth’s Effexor rakes in about $3.93 billion in annual profits, Pfizer made $3 billion annually just on Zoloft before the patent expired in 2006, and Eli Lilly earns about $2.7 billion a year selling Cymbalta. Drug companies have zero incentive to stop flooding physician inboxes with materials endorsing their products. And in fact, patients seeking these drugs keep the rosters full at medical offices, giving doctors even less reason to refer patients to the gym instead of the pharmacy.

In any event, there’s good reason to do whatever you can to end depression. A 2009 study found that the mortality rate associated with depression was as high as the mortality rate associated with smoking. Instituting a daily exercise regimen, along with an intelligent supplement program, will help you to beat depression better than pharmaceuticals will, and the only side effects will be improving your overall health and probably adding years to your life.

:hc

AIDS Immunity Secret

June 12th, 2010

AIDS Vaccine & HIV Infections

The secret to AIDS immunity may reside in the body’s own genes. Apparently, one out of every 200 people or so who get infected with HIV never comes down with AIDS. These people, known as “elite controllers,” never show any sign of disease and don’t need medication, even many years after HIV infection. Scientists figured that if they could find out what protects the elite controllers, they might be on the road to developing an effective AIDS vaccine.

Drs. Arup Chakraborty of MIT and Bruce D. Walker of Harvard University and the Ragon Institute for HIV research at Massachusetts General Hospital, put out a special call to the medical community to find research subjects, which wasn’t so easy given that controllers rarely report to a doctor’s office since they show no signs of illness. Eventually, though, they enrolled 1,100 elite controllers plus 800 people who had developed full-blown AIDS in a study, and the results are now in.

What they found wasn’t at all what they expected, according to Dr. Walker. “I actually had to pull out text books,” he says. The research team found that elite controllers have unusual genes that affect how their killer T-cells operate. Killer T-cells are specialized white blood cells that fight infection. Under normal conditions, the T-cells work together as a team to vanquish infected cells, with various T-cells attacking different components of the infected cell. The reason AIDS usually overtakes the immune system is that the virus mutates so quickly that the slow-moving swarm of T-cells can’t keep up. But in elite controllers, apparently, the killer T-cells work alone rather than in a swarm, and they become extremely aggressive in doing so. They kill the virus before it can progress. Plus, these T-cells react strongly to a broad range of targets, so they kill off mutations as soon as they develop.

The downside of this scenario is that such highly activated T-cells can turn against the victim’s own body, since the cells react to such a broad range of stimuli. And so, people with these super-aggressive T-cells have a higher incidence of autoimmune conditions. But on the other hand, the T-cells fight all manner of infection effectively — not just the AIDS virus, and so these individuals have more protection against infectious diseases like hepatitis, to mention just one.

The thing that gives hope to the researchers is the fact that normal people also have these super-aggressive, broad-spectrum killer T-cells, although in very limited numbers. This gives the scientists hope that they might be able to trigger the body to create more of these cells through a targeted vaccine.  “We think they might be coaxed into action with the right vaccine,” Dr. Chakraborty said. The scientists believe that once activated, the elite cells might clone themselves and multiply fast enough to overwhelm cells infected with HIV.

“What we need to do with a vaccine is train bigger [elite] T-cell armies that will be there when a person first encounters the HIV virus,” said Dr. Walker.

Traditional methods of developing vaccines haven’t been working in the case of AIDS because of the ability of the virus to mutate so quickly, and so this discovery potentially is key. The experts contend that the best hope for an AIDS vaccine lies in studying the body’s own mechanisms for controlling the disease. “I think it’s becoming more and more apparent that conventional ways of designing vaccines are not going to work for HIV,” according to HIV vaccine specialist Helen Horton of the Seattle Biomedical Research Institute. “I think this is definitely where we need to be headed.”

Unfortunately, though, the researchers say that a vaccine still lies at least 10 years in the future. Considering that over 34 million people worldwide now have AIDS, that 2.7 million new AIDS infections occurred in 2008 alone, and that the incidence of the disease keeps increasing, this seems a very long time to wait. In the meantime, I have seen numerous examples that if you keep your immune system optimized using natural immune system boosters, it tends to keep the viral load substantially down (sometimes to undetectable levels) in HIV positive patients. And although not a cure, it’s certainly better than the alternative — at least until a functioning vaccine comes along.

:hc

Mediterranean Diet May Prevent Alzheimer’s: Health Blog

May 22nd, 2010

Alzheimer's, Mediterranean Diet

Currently, about 5.3 million people in the US have Alzheimer’s Disease, incurring about $172 billion annually in costs. Worldwide, those costs soar to over $315 billion annually when you include dementia, and costs are expected to soar to $20 trillion over the next 40 years in the U.S. alone. The disease isn’t going away anytime soon, and in fact, during the years 2000 and 2006, the mortality rate for Alzheimer’s rose by 46.1 percent. Just for perspective, during that same time period, the incidence of fatal heart disease went down by 11 percent and incidence of fatal stroke declined by 18 percent. Considering the devastating effects of the disease on both victims and their families, as well as the staggering expenses and the continuing lack of any effective interventions, a preventative that reduces the risk of getting the disease by 40 percent seems a near miracle.

Such a preventative does indeed exist, according to results of a new study. The preventative isn’t a vaccine or pill, in spite of the fortunes poured into research trying to find such a palliative. Rather, the preventative is diet — specifically, the Mediterranean diet.  According to the authors of the study, “Epidemiological evidence linking diet, one of the most important modifiable environmental factors, and risk of Alzheimer’s disease is rapidly increasing.”

The research team from Columbia University, led by Dr. Yian Gu, tracked the diets of 2,148 healthy people over age 65 for an average of four years. Subjects underwent testing for Alzheimer’s disease every 18 months. At the end of the study period, more than 10 percent (253 subjects) had developed Alzheimer’s. The researchers found that those who ate a more Mediterranean-like diet — focusing on olive oil-based salad dressing, nuts, fish, tomatoes, poultry, broccoli, fruits, dark and green leafy vegetables, and less red meat, organ meat and high-fat dairy products — were 40 percent less likely to develop Alzheimer’s than those following a more “normal” diet.

Study leader Dr. Gu attributed the results to a number of factors. Because the diet is so heart healthy, it may protect the brain from strokes that make it more vulnerable to Alzheimer’s. Also, it may be that the brain is protected by the nutrients that the diet is so rich in — such as omega-3 fatty acids, antioxidants and folate. Also, the combination of foods may have an important impact.  According to Dr. Gu, “… vitamin B12 and folate are homocysteine-related vitamins that may have an impact on Alzheimer’s disease via their ability of reducing circulating homocysteine levels, vitamin E might prevent Alzheimer’s disease via its strong antioxidant effect, and fatty acids may be related to dementia and cognitive function through atherosclerosis, thrombosis, or inflammation via an effect on brain development and membrane functioning or via accumulation of beta-amyloid.”

In other words, although the particular benefit associated with the Mediterranean diet vis-à-vis Alzheimer’s may be unknown, it is safe to say that somewhere within its multifaceted benefits and protective impact something about the Mediterranean diet has profound impact on your likelihood of developing Alzheimer’s.

The message is clear, but it’s no secret that getting people to follow any diet is a Herculean task. If a vaccine had been developed that offered a 40 percent chance of Alzheimer’s protection, no doubt the masses would line up for it, but a nutritious diet that offers the same benefit (plus other benefits) isn’t likely to be followed by most unless there’s a major shift in consciousness. A vaccine is one time and forget it. People can handle that. But asking most people to give up their fast foods, barbequed meat, and snack foods is just plain asking too much! And so, the search continues for other, easier, one-shot Alzheimer’s preventatives. And in fact, a few hopeful possibilities have popped up recently. One comes from the development of a new nutritional drink called Souvenaid that apparently repairs brain synapses. Souvenaid is a “medical food” marketed for Alzheimer’s disease by Danone (called Dannon in the US), consisting of a cocktail of nutrients including uridine monophosphate, choline, the omega-3 fatty acids EPA and DHA, phospholipids, B vitamins, and antioxidants.

Research (paid for by Danone) has indicated that brains afflicted with Alzheimer’s show low numbers of synapses (junctions between two neurons or between a neuron and a muscle) in connection with symptoms such as memory impairment and language deterioration. According to Dr. Richard Wurtman, professor at the Massachusetts Institute of Technology and co-author of the Souvenaid study, the three components of the drink — uridine, choline, and the omega-3 fatty acid DHA — work together to restore synapses. Although thee nutrients are found separately in the body and in certain foods, individual supplements won’t do the trick. It is only when taken together in the right proportions that the cocktail increases the production of fatty constituents and proteins needed for synapses. Wurtman’s study showed that the drink delayed the symptoms of Alzheimer’s, especially in those with mild, but real, cases. Keeping in mind that the study was paid for by Danone in support of their product, the results are still interesting.

On another front, a research team in Portugal just found that caffeine may slow the progression of Alzheimer’s, dementia, and associate conditions. According to study leaders Alexandre de Mendonca of the University of Lisbon, and Rodrigo Cunha, of the University of Coimbra, “A few epidemiological studies showed that the consumption of moderate amounts of caffeine was inversely associated with the cognitive decline associated with aging as well as the incidence of Alzheimer’s disease. This was paralleled by animal studies showing that chronic caffeine administration prevented memory deterioration and neurodegeneration in animal models of aging and of Alzheimer’s disease.” This, of course, is positive for those whose Alzheimer’s hasn’t progressed so far that they can’t remember to drink their coffee every day.

And finally, studies have shown that L-carnosine based formulas may also be helpful in preventing or slowing down the progression of Alzheimer’s.

What does it all add up to? For Alzheimer’s prevention, a Mediterranean diet modified with a daily spot o’ tea and an L-carnosine formula may just do the trick. You’ll not only reduce your risk of developing Alzheimer’s — you’ll also increase your lifespan and reduce your risk for heart disease.

:hc

Good Carbs, Bad Carbs: Health Blog

May 13th, 2010

High Glycemic Carbohydrates and Heart Disease

To paraphrase the band, Led Zeppelin, “Good carbs, bad carbs, you know I’ve had my share….” Well, in another case of life imitating art, according to a new study published in the Archives of Internal Medicine, women who ate the most “high-glycemic” carbohydrates — the carbs that cause quick spikes in the level of blood sugar — had more than twice the risk of heart disease compared to women who ate the least high-glycemic carbs. Plus, among women who followed a low-glycemic diet, those with type-2 diabetes were better able to control their blood sugar levels and rely less on medications than those who ate high-glycemic carbohydrates like white bread and potatoes.

The study followed 47,749 Italian adults — 15,171 men and 32,578 women. Based on their responses to dietary questionnaires, the researchers calculated their overall carbohydrate intakes as well as the average glycemic index of the foods they consumed and the glycemic loads of their diets. 

According to study leader Sabina Sieri of Fondazione IRCCS Istituto Nazionale dei Tumori, in Milan, Italy, “High consumption of carbohydrates from high-glycemic foods, rather than overall quantity of carbohydrate consumed, appears to influence the risk of developing heart disease in women.” In other words, not the quantity of carbs but the type seems to be the differentiating factor. The risk is not caused by “a diet high in carbohydrates, but by a diet rich in rapidly absorbed carbohydrates,” says Sieri.

As a result of years spent studying the potential for various carbohydrates to raise blood sugar, researchers developed the glycemic index (GI) to quantify the impact of assorted food items. The glycemic index rates carbohydrates based on how quickly they convert to pure glucose in the body, using a scale of 0 to 100. Pure glucose ranks at 100 and high-glycemic foods typically come in at 70 or above. Medium GI foods rate scores between 56 and 69, while low GI foods score 55 and under. The high-glycemic foods associated with heart disease in the study include the usual suspects — cake, white bread, candy — but there are some surprises, too. For instance, from the glycemic index standpoint, it’s hard to do worse than a baked potato, which has a glycemic index of 85. And while you might think that you should eliminate pasta and turn to brown rice, you’d be dead wrong n terms of GI.  It turns out that a two-ounce serving of cooked pasta, which has a glycemic index of 42, elevates blood sugar less than a serving of brown rice, which has a glycemic index of 55 — keeping in mind that both still score as low glycemic foods. 

According to Glycemicindex.com, “Choosing low GI carbs — the ones that produce only small fluctuations in our blood glucose and insulin levels — is the secret to long-term health, reducing your risk of heart disease and diabetes, and is the key to sustainable weight loss.”  The reason this is so is that the rapid increase of blood sugar and the associated rapid release of the hormone insulin damages cells throughout the body, which leads to heart disease, diabetes, and other ills.

As for the results of the new study, there are a couple of wrinkles to consider. First, eating high GI foods does not seem to increase the risk of heart disease in men. According to the study authors, high GI carbs raise the levels of blood glucose and of harmful blood fats known as triglycerides while reducing levels of protective HDL or “good” cholesterol, for both men and women. But only in women did that increase the risk of heart disease. The study authors theorized that adverse changes associated with carbohydrate intake, including triglyceride levels, are stronger risk factors for heart disease in women than in men. 

The other wrinkle is that the Glycemic index may not be the best way to understand how carbs affect blood sugar levels. That’s why researchers at Harvard came up with a little ditty they call “glycemic load.” GI is based on how fast 50 grams — 1.765 ounces — of the food in question raises blood sugar levels. Glycemic load “takes into account both the amount of carbohydrate in the food and the impact of that carbohydrate on blood sugar levels.” Watermelon is a good example. It has a very high GI (72), but because it contains so little carbohydrate per serving, its glycemic load is quite low (8). From this point of view, brown rice returns to the table as a not-so-bad comestible. In fact, pasta is in a dead heat with steamed brown rice, each of which has a GL of 16. However, boil that rice in excess water for 25 minutes and it becomes a glycemic loser, with a GL of 29. Of the grains, by the way, barley wins, with a GL of only 8, if you use the hull-less variety and boil it for 25 minutes.

Of course, all this nitpicking about high- versus low-glycemic foods becomes irrelevant if you stick to the Mediterranean diet, which emphasizes fresh vegetables, fruits, olive oil, a bit of fish and very little meat. But in the event that you’re tempted to wander in the valley of carbohydrate-loading, it’s good to know the effects of your culinary indulgences.

:hc

Heart-Stopping News: Health Blog

March 23rd, 2010

Cardiac Catheterization, Heart Disease

Many, many years ago when I worked for Kaiser Permanente, I came down with a really bad flu and felt miserable. In desperation, I headed off to the Kaiser clinic to see if they could help. After diagnosing the flu, the doctor wrote up a prescription for antibiotics. “Antibiotics,” I blurted out through my fevered haze. “Aren’t antibiotics for bacterial infections? Isn’t the flu a viral infection? How will that help?”

“It won’t really,” he answered, “but you were expecting me to give you something to help, right?”

Since then, I’ve learned that doctors abide by the principal that to be a good physician, you must do something for the patient, whether needed or not. And so we have the common phenomenon of the unnecessary procedure — including unnecessary hysterectomies, unnecessary CT scans, and so on. Now a new entry has just been added to the list of common procedures the patient could have lived without. New research by the Duke University Medical School indicates that a whole lot of cardiac catheterizations are being performed on patients who have no significant artery disease.

The study examined the US national cardiac registry to identify two million people who underwent cardiac catheterization between 2004 and 2008.  Of these, 400,000 had stable chest pain without previous diagnosis of heart disease. The catheterization results showed that only 38% of these patients actually had significant coronary blockages. Study director Dr. Manesh Patel comments, “We’re spending a lot of energy and money to evaluate chest pain which often leads to cardiac catheterization, which, we now know, often finds that patients don’t have significant obstructive disease. Our research shows that our methods for identifying patients at risk for obstructive disease need significant improvement.”

Physicians generally perform catheterizations for diagnostic purposes to identify the presence, location, and severity of coronary atherosclerosis, according to Dr. Patel, as a preliminary step in evaluating if angioplasty (and don’t get me started on angioplasties) or bypass surgery will be needed. The procedure for diagnostic catheterizations involves inserting a tube into a blood vessel in the arm or leg and guiding it to the heart, where it sends information to an x-ray machine.  This provides information to locate blockages in arteries, measure pressure and oxygen in the heart chambers, and evaluate the overall health of the cardiovascular system. Catheters also can have balloons attached that inflate to clear arteries — at which point, you’re actually performing a coronary angioplasty. Clearing the arteries in this way can “theoretically” prevent and stop heart attacks.

A case can be made that catheterization is useful as a diagnostic tool when there actually is heart disease and significant blockage of the arteries, but it’s being commonly applied to patients who have neither of these conditions. And there is no justification for that. Again, in almost two-thirds of patients with stable chest pain but no prior heart disease, the cardiac catheterization found no significant artery disease.

If the procedure came without risks, this wouldn’t be a problem other than for the expense and time involved, but the fact is that catheterization is an invasive procedure.  Complications can include bleeding, infection, and pain where the catheter was inserted; damage to blood vessels; allergic reactions to the dye used, and in rare cases, the catheter may scrape or poke a hole in a blood vessel as it’s threaded to the heart. More serious, but less common complications include arrythmias, kidney damage from the dye, blood clots that can trigger stroke or heart attack, low blood pressure, and a build up of fluid in the sac around the heart.

It doesn’t help that most patients — 84 percent — first go through supposedly less risky noninvasive procedures like stress tests before catheterizations, to find out if they need the catheterization. But the research concluded that these noninvasive tests have remarkably poor predictive value, and they carry risks of their own. The nuclear cardiac stress test, for instance, blasts patients with an enormous dose of radiation — more than any other diagnostic test, including CT scans. According to Wikipedia, “Stress test results are often falsely negative for many people…It has become clear that stress testing recognizes most people at risk for heart attacks too late, unfortunately only after the disease and symptoms of the disease have developed.” In other words, stress tests carry a lot of risk for questionable benefit.

Dr. Patel says, “Our research shows that our methods for identifying patients at risk for obstructive disease need significant improvement.” He adds that the whole process for caring for patients with heart pain needs to be reevaluated, including how histories are taken, how risk factors are assessed, and the role of diagnostic procedures.

Meanwhile, cardiac catheterization is big business. According to Surgery.com, more than 1.5 million cardiac catheterizations were performed per year, as measured in 2009.  The use of the procedure was expected to increase to more than three million by 2010.  A 2007 article in diagnosticimaging.com pegged the cost of a typical cardiac catheterization at about $10,000.  In 1990, about $4.5 billion was spent in the U.S. to perform about 1,000,000 cardiac catheterizations. Add to that the price of preliminary stress tests, and you’ve got a lot of money being spent for nothing, and a lot of people undergoing diagnostic testing that might create problems where there were none.

Then again, like my flu doctor, it is a way for your doctor to make you feel he’s done something (even if there’s no benefit), assuming that’s all you’re looking for. And besides, it’s free — paid for by your insurance company.

:hc

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