Type 2 diabetes is one of the most challenging public health threats globally.  Obesity is a risk factor, and obesity worsens the condition.  Weight loss is pivotal in the management of diabetes and certainly is a goal for all type 2 diabetics.  Bariatric surgery can assist in weight loss.  Scientists recently did an observational study to determine if bariatric surgery (either gastric bypass or sleeve gastrectomy) along with intensive medical therapy was superior to intensive medication therapy alone in overweight or obese type 2 diabetics.  What they found was encouraging.

Researchers randomized 218 overweight or obese type 2 diabetic patients into three groups: 1) medication therapy alone, 2) medication therapy plus gastric bypass surgery, and 3) medication therapy plus sleeve gastrectomy.  All participants received counseling on lifestyle changes and were encouraged to participate in Weight Watchers.  The goal (and predefined endpoint) of each of the three interventions was to bring the HbA1c to 6% (or lower) within 12 months (HbA1c is a  measure of the average blood glucose levels over the past three months. It is more accurate than periodic home glucose testing).

Body weight, waist to hip ratio, HbA1c, and fasting blood glucose levels were measured in all of the study participants at months 3, 6, 9, and 12.   Here are the results:

  • 12% of the medication-only group achieved an HbA1c of 6% (or lower)
  • 42% of the gastric bypass plus medication group achieved an HbA1c of 6% (or lower)
  • 37% of the sleeve gastrectomy plus medication group achieved an HbA1c of 6% (or lower)
  • The patients that underwent either gastric bypass surgery or sleeve gastrectomy experienced a large and rapid improvement (3 months) in HbA1c and fasting blood glucose levels.
  • All of the gastric bypass patients that reached the desired HbA1c did so without medication, meaning they were eventually weaned off their initial medication regimen
  • Of the successful sleeve gastrectomy patients, 28% required at least one diabetes medication
  • On average medication use tended to increase in the medication-only group, and it tended to decrease in the two bariatric surgery groups
  • Average weight loss in the medication-only group was 5.2%
  • Average weight loss in the the gastric bypass plus medication group was 27.5%
  • Average weight loss in the sleeve gastrectomy plus medication group was 24.7%

While these results are staggering and encouraging, it must pointed out that bariatric surgery is an invasive procedure.  Even though it is now done laparoscopically, there is still a significant recovery period.  This may not be a viable option for all obese type 2 diabetic people.

The H5N1 influenza virus (also called “Avian” or “Bird” flu) is a deadly zoonotic infection, meaning it is transmitted from animals (birds) to humans.  The mortality rate is approximately 60% in humans, and most people who have become infected have had close contact with birds.  It does not appear that the disease is spread from person-to-person.

In an effort to understand why the virus is not easily transmitted between humans, scientists have made genetic modifications to the virus resulting in strains that are more easily transmitted from mammal-to-mammal.  These researchers found that only a few changes in the genetic structure of the virus were necessary to create a more virulent strain capable of being transmitted directly between people.

This has the medical community up in arms.  The obvious ethical questions surround the safety of creating such deadly strains that do not occur naturally.  The World Health Organization is now conducting international discussions addressing the safety issues, as well as any potential benefits, that may arise from continued research in this area.

H5N1 virus is more deadly than the more common seasonal flu.  The clinical course is often more aggressive, and the patient’s condition deteriorates more rapidly.  The initial symptoms include high fever, diarrhea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums.  Shortly after the appearance of initial symptoms, features of lower respiratory infection can occur, sometimes in as quickly as a few days.  This presents as breathing difficulties, hoarse voice, crackling sound when inhaling, and sometimes bloody sputum.

Cancer is a huge public health problem and ways to treat and prevent cancer are always on the forefront of medical research.  As we learn more about how cancer is formed and how it grows, we are better able to study means of cancer prevention and cancer treatment.  Scientists at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) , part of the National Institutes of Health,  have discovered another piece of the cancer puzzle.  But first, here is a little background information.

Cancer is caused by changes that occur in the genetic material within the chromosomes of the cell.   These changes can happen by a process called translocation, where the DNA from one chromosome breaks off and is joined to the DNA from another chromosome.  There are 3 theories to explain translocation:

  • Translocation occurs because of frequent physical interaction of the genes in the nucleus of the cell
  • Translocation occurs because of damage to the DNA
  • Certain genetic translocations are favored because they drive transformation of the cell.

Translocations do not always cause tumor formation and can sometimes be beneficial.  Translocation is how our immune system is effective against the many microorganisms we are exposed to.

The researchers at NIAMS used immune cells called B cells to study the mechanisms underlying translocation.  They found that the frequency of translocation was directly proportional to the amount of DNA damage.  They also discovered that an enzyme, called AID, damages approximately 150 genes in the B cell (thereby making them more susceptible to translocation).  They discovered that without AID, theory #1 (physical interactions of genes in the nucleus) was the most important determinant of translocation.

They conclude that if we can find ways to stop AID, we could potentially prevent the formation of many human cancers.  This is just another bit of extremely useful information that is made possible by the miracle of modern medicine.  This, along with so many more discoveries (that I will detail in upcoming posts) will ultimately lead us to eliminating this deadly disease.

 

Most of us know that exercise is good for us.  It keeps us healthy and prevents many chronic diseases.  I exercise at least 1 hour on most days and feel secure that this ensures my health and well-being.  Of course, I sit in front of my computer most of the rest of the day and watch TV or read most nights.  But, let’s not forget about that 1 hour of intense exercise I get most mornings!!!

The World Health Organization (WHO) appears to agree with me.  It recommends at least 150 minutes of “moderate intensity” aerobic activity throughout the week.  I exceed that, so I’m good.  But am I?

A study of over 200,000 Australians demonstrated evidence that prolong sitting increased the risk of “all-cause mortality” (basically, dying from any cause) independent of physical activity.  That means that despite my 1 hour of exercise, if I sit most of the day (which I do) I am at an increased risk for dying.   This appears to be true for both men and women, all age groups, body mass indices (BMI), level of physical activity, and whether there is pre-existing disease.  The risk increases the more you sit during the day.  Time spent sitting was stratified into 3 categories; sitting 4 to less than 8 hours, sitting 8 to less than 11 hours, and sitting 11 or more hours.  There was an 11% increase risk of dying when going from 1 category to the next (e.g. if you sit between 8 and 10.99 hours, you are 11% more likely to die than someone who sits from 4 to 7.9 hours).

My exercise is not in vain though.  By meeting the WHO’s recommendations of 150 minutes of moderate aerobic exercise a week, I am slightly more protected than someone who sits as much as me and does no exercise.

My take-home message:  I need to get up every couple of hours and clean something.  According to these study results, if I spend 3 – 4 hours less sitting and reading/writing and replace that time with walking, cooking, cleaning, etc. I will live longer and have a cleaner house!!!  It’s a win-win situation!

A novel vaccine for herpes is in phase 3 clinical trials (phase 3 is the last step before the Food and Drug Administration approves the drug for consumer use).  The results of this study are not overwhelming, but there is some promise.

Herpes Simplex Virus (HSV) is the infectious agent that causes genital herpes and cold sores.  In the last 3 decades human immunodeficiency virus (HIV) has been getting most of the attention, but let’s not forget about HSV.  Before HIV became a huge health concern, HSV was the “bad boy” of the sexually transmitted diseases (STDs).  As its name denotes, HSV is caused by a virus, and viral infections cannot be “cured”.  The bacterial STDs can be nasty (syphilis, gonorrhea, chlamydia, ect.), but they can be cured (if they are diagnosed) with antibiotics.  Treatment for  viral STDs can only decrease the amount of virus, but not eradicate it.

Genital herpes can be caused by either type 1 virus (HSV-1) or type 2 virus (HSV-2).  In the past genital infection was primarily caused by HSV-2.  However, the incidence of HSV-1 genital infection has been on the rise.  The good news is that most people who have been exposed to HSV do not experience symptoms.  Only about 10 – 25% of people exposed to HSV-2 (as demonstrated by the presence of antibodies against HSV-2) have recurring genital symptoms.  The bad news is that if a women transmits the disease to her baby, the infection is much worse and can even cause death.

GlaxoSmithKline hasn’t forgotten about herpes.  They spent 8 years conducting clinical trials to determine if their experimental vaccine was effective against HSV.  Two studies of this vaccine showed very promising results in couples where 1 partner had symptomatic disease and the other partner had no antibodies against HSV-2.  The vaccine was effective in women (although not 100% effective). This is a good thing!  The vaccine had no protective effect in men.  That is not a good thing.  These results were very good (for women) and prompted another study to confirm these results.

Unfortunately, these study results were a little more dismal.  In a nutshell, the vaccine was effective in 58% of the women against HSV-1 genital infection, but it did not prove to be effective against HSV-2.  Men were not included in this study due to the lack of efficacy from the last studies.  But all is not lost.  There were differences in the people who participated in the studies which may account for the differences in the efficacy of the vaccine.  In addition, the researchers are continuing to study why the vaccine did not protect against HSV-2.  If they can figure that out, there a likelihood that the vaccine can be modified to be more effective.

It’s doubtful that the FDA will approve the vaccine based on these results.  But nevertheless, this vaccine is a step in the right direction!!

The Federal Drug Administration (FDA) is warning consumers to beware of using certain anti-aging and skin lightening products containing mercury.  These products are formulated as creams, soaps, and lotions, and may also be used by adolescents as acne treatments.

All cosmetics are subjected to FDA approval before consumers may use them.  These mercury-containing products have not undergone FDA approval.  The FDA reports that these products are manufactured overseas and sold illegally in the United States.  They are more likely to be found in shops in Latino, Asian, African, and Middle Eastern neighborhoods, as well as online.  There have been reports of mercury poisoning caused by these products (some requiring hospitalization) in Minnesota, California, Texas, Virginia, Maryland, and New York.

The FDA is instructing anyone who uses these types of products to read the ingredients on the label.  If there is no label or ingredients listed, then don’t use the product.  If any of these terms are listed as an ingredient, the product contains mercury and should not be used:  mercurous chloride, calomel, mercuric, mercurio, or mercury.  If you have been using a product containing mercury, please stop using it immediately and call your physician.  You cannot throw the product away without taking special precautions.  It should be sealed in a leak-proof container.  It is also wise to check with your municipality to see if they have special protocols for disposing of hazardous substances.

Mercury is very toxic and can affect the kidneys and central nervous system, especially in small children.  Even those not using the product can be exposed.  Mercury can be present as a gas and inhaled by anyone nearby.  It can also be transferred by touch.

Signs and symptoms of mercury poisoning include:

  • Irritability
  • Shyness
  • Tremors
  • Changes in vision and/or hearing
  • Memory problems
  • Depression
  • Numbness and tingling in hands, feet, or around the mouth

 

To see pictures of some of these items, please visit http://www.health.state.mn.us/topics/skin/ and http://dhmh.maryland.gov/publicrelations/pr/Lists/Posts/Post.aspx?List=838aa932%2D428a%2D4211%2D856a%2D699ef62796b9&ID=17&Web=3069d104%2Dbcfc%2D4c0f%2Dae6f%2Dca28f24d570f

In this era of health consciousness many people take vitamins with the expectation of improving their health.  I know I do.  I take a multivitamin most days even though I eat a fairly decent diet.  I love my veggies and my fruits, but I admittedly don’t eat 5 servings most days.  So I thought a multivitamin would pick up the slack.  I didn’t take my multivitamin today, and I’m going to tell you why.

In the Iowa Women’s Study, the researchers conducting the trial hypothesized that vitamin and mineral use would not have any health benefits.  There had been studies prior to this showing that supplementing the diet (mainly with calcium and vitamins B,C,D, and E) had no beneficial effects.  What they found was startling!  They did confirm that most vitamin and mineral supplements did not add any benefit.  (Keep in mind that they were studying supplements, not a vitamin/mineral rich diet)  However, they found that those that supplemented with multivitamins, vitamin B6, folic acid, iron, magnesium, zinc, and copper had a higher risk of dying.  Plus, contrary to preceding studies, these researchers found that calcium supplementation actually decreased the risk of dying.  Interesting!!!

The women that took vitamins/minerals were, in general, better educated and more active and physically fit (had a lower body mass index and waist to hip ratio).  They had a lower prevalence of diabetes, high blood pressure, and smoking.  Their diet was even healthier; they ate fewer calories, total fat, monounsaturated fats,  and saturated fats, and ate more protein, polysaturated fats, carbohydrates, whole grain products, fruits, and vegetables.  This doesn’t sound right.  Does that mean we should all “eat, drink, and be merry!”?  I don’t know.  Maybe.

How can this be?!!  While the researchers admit that they don’t know for sure, they speculate that an increase in free radicals caused by the supplements may be to blame.  Other theories are floating around as well.

Now, I’ve been around long enough, and researched and read enough of the medical literature, to know that results in one population (in this case, older women) cannot be necessarily extrapolated to another population.  I also know that studies can be flawed, and often it takes more than 1 to confirm and validate results.  That being said, we really need to do more research to confirm these results, since many people take vitamins and minerals and it is a $20 billion industry!

Green tea is reputed to have many health benefits.  Antioxidants called polyphenols (also called catechins) are thought to be responsible for the medicinal properties of green tea.  In black tea these polyphenols are oxidized by an enzyme called polyphenol oxidase.  However, in green tea this enzyme is inactivated by the drying and steaming processes (vs. the fermentation used to process black and oolong teas).  Evidence has shown green tea to be protective against obesity, cancer, diabetes, heart disease, stroke, and dementia.  It also has antibacterial and antiviral properties.

I am going to focus on the fat burning properties of green tea.  Studies have shown that after taking the active ingredients in green tea plus caffeine (caffeine seems to have a synergistic effect, but decaffeinated tea also works) there was a 4% increase in the 24 hour energy expenditure (calories burned in 24 hours).  These results were compared to caffeine alone and placebo.  It was demonstrated that caffeine alone did not have the same results.  Neither did the placebo.  Furthermore, by monitoring the urine nitrogen concentrations and respiratory quotients, the researchers were able to conclude that these extra calories did not come from carbohydrates or proteins.  In fact the evidence seemed to show that there was a switch from using calories from carbohydrate to burning calories from fat.  It is important to note that the amount of active ingredient used in each study ranged from that in 2 to 6 cups of green tea.  If you are not a huge fan of tea, there are extracts of green tea leaves available that will give you the active polyphenols without having to drink 2 to 6 cups of tea.  However, experts say that drinking the tea is recommended, since it may be a combination of compounds in the tea that make it beneficial.

Long-term weight loss (4.6%) and reduced waist circumference (4.5%) was observed in 1 study. Other studies have shown similar results.  Of course these people took the polyphenol supplement every day.

It is not certain how polyphenols do their magic.  There are many proposed mechanisms, but the chemistry of green tea is complex and it is difficult to pin down exactly what is going on.  I guess it doesn’t really matter.  Green tea is awesome for our health!!

If you would like to read more, visit Health Benefits of Green Tea

The National Health and Nutrition Examination Survey (NHANES) is a large population-based survey being conducted by the Centers for Disease Control and Prevention.  Data collected from this survey is being used to further medical research all over the country.  I have personally used statistics gathered by this survey in articles I have written.

The survey combines both physical examinations and personal interviews to assess the health and nutritional status of average American children and adults.  The information from this survey has been used to develop pediatric growth charts, as well as establish baseline estimates of cholesterol, blood pressure, and the prevalence of hepatitis C in the United States.

You can participate in this study and be a part of this important fact-collecting process.  It is absolutely free, and you may even benefit from participating.    Some of the tests that are performed during the physical exam are not normally done by your regular doctor.  They are not invasive, but they may uncover some underlying condition that you have not yet been diagnosed with.  Although, the physicians doing the exams for NHANES will not diagnose you; they will give you the results of your tests so you can pass them on to your own doctor.

The physical examinations that are done will depend on your gender and age and can include:

  1. Physician’s exam – everyone
  2. Blood pressure – everyone 8 years and older
  3. Bone density – everyone 8 years and older
  4. Condition of teeth – everyone 5 years and older
  5. Vision test – everyone 12 years and older
  6. Hearing test – everyone 12 – 19 years and 70 years and older
  7. Height, weight, and other body measures – everyone
  8. Ophthalmology exam for eye diseases – everyone 40 years and older
  9. Breathing tests – everyone 6 – 79 years
  10. Kidney function tests – everyone 6 years and older
  11. Chlamydia and gonorrhea – everyone 14 – 39 years
  12. Exposure to environmental chemicals – selected individuals 6 years and older
  13. Pregnancy tests – females 12 years and older and girls 8 – 11 years who have preiods
  14. Anemia – everyone
  15. Total cholesterol and HDL (good cholesterol) – everyone 6 years and older
  16. Blood glucose levels – everyone 12 years and older
  17. Infectious diseases (including hepatitis C) – everyone 2 years and older
  18. Lead, cadmium, and mercury – everyone 1 year and older
  19. Liver function tests – everyone 12 years and older
  20. Nutritional status – everyone 1 year and older
  21. Thyroid function test – everyone 12 years and older
  22. Prostate specific antigen (PSA) – males 40 years and older
  23. Genital herpes – everyone 14 – 49 years
  24. HIV – everyone 18 – 49 years
  25. Human papillomavirus (HPV) – everyone 14 – 59 years

There is also an interview with questions designed to assess nutrition, use of drugs, alcohol, and tobacco, and sexual practices.

If this sounds like something you would be interested in participating visit the NHANES participant page.

I am not a big proponent of weight loss supplements, but as someone who has had my share of weight issues I have used them in the past.  In pharmacy school they told us to beware of a natural supplements because the Food and Drug Administration (FDA) doesn’t regulate them the same way as prescription and over-the-counter drugs.  This is true; however manufacturers of supplements are not free to do whatever they please.  At least not indefinitely, as evidenced by what I’m about to tell you.

On February 6, 2012 the FDA issued a “warning letter” to Globe All Wellness, LLC, the manufacturers of SlimXtreme™ Herbal Slimming Capsule (SlimXtreme), which can be purchased at www.diet66.com.  Globe All Wellness claims that users of SlimEtreme will “lose 25 pounds in 4 weeks”.  Sounds good, right?  Well, keep reading.  The FDA took samples of SlimXtreme and ran laboratory tests to determine the constituents of this product.  What they found is chilling!

They found sibutramine hydrocholoride in the capsules.  “So?”, you may ask.  Sibutramine is the generic name for Meridia, which was an obesity drug.  Note the use of the word “WAS”.  Meridia was taken off the market in 2010 because of the increased incidence of heart attacks and strokes in people who took Meridia, a 16% increase!!!  The language used in the letter the FDA issued to remove Meridia from the market was, “The trial demonstrated a 16 percent increase in the risk of serious heart events, including non-fatal heart attack, non-fatal stroke, the need to be resuscitated once the heart stopped, and death in a group of patients given sibutramine compared with another given placebo.  There was a small difference in weight loss between the placebo group and the group that received sibutramine.” Now, does that sound like something to risk for the sake of losing a few pounds?  Not to me!

So what is sibutramine doing in SlimXtreme?  The answer to that is simple.  The manufacturers were using illegal, shady and deceitful tactics to sell their product.  In fact, “shady” is not “Xtreme” enough.  That violates the most basic laws of the universe imposed upon all of us, “Treat each other well, and please don’t kill each other!”

Please friends, be careful when taking supplements, especially those for weight loss.  I am certainly not against herbal and natural products!!  I take them myself.  Just use caution.  Ask your pharmacist their opinion before purchasing them.

On a side note, this same company also makes ViaXtreme™ Ultimate Sexual Enhancer Dietary Supplement for Men (ViaXtreme).  When testing that product, the FDA found sildenafil, the active ingredient in Viagra.  Considering that men taking nitrates for heart conditions have died when taking Viagra, I find this reprehensible!!  Read more at http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2012/ucm294475.htm

and

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm228830.htm