Asthma and chronic obstructive pulmonary disease (COPD) patients who are treated with inhaled corticosteroids may face a significantly higher relative risk for both the development and progression of diabetes, new Canadian research suggests. The warning stems from an analysis of data involving more than 380,000 respiratory patients in Quebec. Inhaler use was associated with a 34 percent increase in the rate of new diabetes diagnoses and diabetes progression, the researchers found. What's more, asthma and COPD patients treated with the highest dose inhalers appear to face even higher diabetes-related risks: a 64 percent jump in the onset of diabetes and a 54 percent rise in diabetes progression. “High doses of inhaled corticosteroids commonly used in patients with COPD are associated with an increase in the risk of requiring treatment for diabetes and of having to intensify therapy to include insulin,” the study team noted in a news release.
Based on their results, researchers from McGill University and the Lady Davis Research Institute at Jewish General Hospital in Montreal suggest “patients instituting therapy with high doses of inhaled corticosteroids should be assessed for possible hyperglycemia and treatment with high doses of inhaled corticosteroids limited to situations where the benefit is clear.”
Lead investigator Samy Suissa colleagues report their findings in the most recent issue of the American Journal of Preventive Medicine.
The research team wrote that despite the fact that inhalers are recommended for use solely by the most severely ill COPD patients, they are typically prescribed for a much broader pool that amounts to about 70 percent of all COPD patients. The authors found that more than 30,000 of the COPD/asthma patients in their study developed a new diagnosis diabetes over the course of five and a half years of treatment. This amounted to a diabetes onset rate of a little more than 14.2 out of every 1,000 inhaler patients per year.
“These are not insubstantial numbers,” Suissa said. “Over a large population,m the absolute numbers of affected people are significant.” In addition, in the same timeframe nearly 2,100 patients already diagnosed with diabetes before using inhalers experienced a worsening of their disease that ultimately required upgrading their diabetes care from pills to insulin shots.
Dr. Stuart Weiss, an endocrinologist with the New York University Medical Center, suggested that concern should be directed more at the underlying causes of both diabetes and asthma/COPD rather than at inhalers themselves. “I would say that a lot more attention should first be paid to the lifestyle choices, dietary-wise, that lead to the pro-inflammatory conditions that raise the risk for both type 2 diabetes as well as COPD and asthma,” said Weiss, who is also a clinical assistant professor at the NYU School of Medicine in New York City. “We don't look at asthma as being a dietary condition, but it absolutely is. Which means that in terms of diabetes and asthma risk, the body is reacting to similar stresses brought about by the over-consumption of overprocessed foods and the lack of consumption of green vegetables.”
Noting that the underlying risk for both conditions is similar, Weiss said he suspected the steroids themselves should not bear all the blame. “What may be more at the root of this problem,” he said, “is the fact that those who are most at risk for diabetes are the same people who have the worst asthma and COPD that requires steroid treatment in the first place.” “Yes, we do know that steroids increase insulin resistance and that people treated with steroids require more aggressive diabetes management,” he conceded. “But if we don't generally take an approach that deals with the poor quality of food that people are routinely consuming, the incidence of both these diseases will continue to go up at a dramatic rate.”
About 10 to 15 percent of children experience recurrent abdominal pain, the researchers said. The pain can be due to irritable bowel syndrome — which is usually relieved by defecation — or can be “functional abdominal pain,” which is not explained by another disease. While LGG has been tested before in children with abdominal pain, the studies were small and showed mixed results. The new study, which involved 141 children with irritable bowel syndrome or functional abdominal pain, was conducted in Italy between 2004 and 2008. Researchers gave the kids either the probiotic or a placebo for eight weeks. Neither the doctors nor the patients were aware which treatment they received.
Following the treatment, the patients were followed up for another 8 weeks. During the treatment and follow-up, the severity and frequency of abdominal pain decreased for both groups, but the probiotic group experienced a more drastic reduction. For instance, after 12 weeks, patients who took the probiotic reported experiencing, on average, 1.1 episodes of pain per week, compared with 3.7 weekly episodes before the treatment. Those who took the placebo reported experiencing 2.2 pain episodes per week, compared with 3.5 episodes initially.
And a greater percentage of parents of children who took the probiotic reported that their children experienced a decline in pain,compared with those whose kids took the placebo. Among kids who took the probiotic, it was mostly children with irritable bowel syndrome who showed improvements, the researchers said.
Why does it work?
The results suggest LGG may be specifically beneficial for those with irritable bowel syndrome, the researchers said. It's possible that children with irritable bowel syndrome have an imbalance of good and bad bacteria in their guts, which contributes to the pain, and the probiotics relieves pain by restoring the proper balance, Francavilla said. Probiotics have also been suggested to reduce inflammation in the gut, as well as stimulate the release of analgesic substances that relieve pain. The researchers noted they cannot be sure whether the beneficial effects will last for more than a few weeks after treatment is stopped.
The results were published in the journal Pediatrics.
Treating obese women's depression may help them lose weight, a new study suggests. Although researchers couldn't determine which condition may cause the other, obesity and depression frequently strike together. Obese women who saw their depression lessened in a treatment program also lost more weight than women whose depression didn't improve or worsened, researchers said.
“I expect that the relationship between depression and physical activity goes in both directions,” said study researcher Dr. Gregory Simon, a senior investigator and psychiatrist at Group Health Research Institute in Seattle. “Increased physical activity leads to improvement in depression, and improvement in depression leads to increased physical activity.” “You can't prove which came first.”
The researchers evaluated 203 women, ages 40 to 65, who had an average body mass index of 38.3 at the study's start, and found that obesity increased a woman's risk of depression by 50 percent to 150 percent.
Participants were then split into two groups: one focused only on helping the women lose weight, and the other also treating the women's depression. The researchers held 26 group treatment sessions over 12 months, and checked in on the women six, 12 and 24 months after the study began.
Of those whose depression had loosened its grip — as measured by a small drop on a test called the Hopkins Symptom Checklist depression score — 38 percent had lost at least 5 percent of their body weight. Of those whose depression scores stayed the same or increased, 21 percent lost that much weight.
While the study's purpose wasn't to make recommendations about exercise, Simon said, it's advisable for people suffering from depression to seek more opportunities for physical activity. “There certainly is evidence that exercise alone is an effective treatment for depression, whether you're overweight or obese or not, or even if you're a normal weight,” he said.
The study was unusual because it focused on the sometimes-overlooked link between depression and obesity, without focusing solely on the role of weight loss, said Robert E. Thayer, a psychology professor at California State University in Long Beach who has researched how people regulate their moods with food and exercise.
“These findings suggest that, like other negative moods that motivate eating as a kind of self-medication, depression is no exception,” said Thayer, who was not involved with the study. “It's a useful addition to the scientific literature.”
Simon said future studies could focus on learning which antidepressants — many of which can bring on weight gain as a side effect — contribute most to that situation. “Losing weight can certainly have a positive effect on people's moods,” he said.
The research was published in the November/December issue of the journal General Hospital Psychiatry.
Before treatment, the couple completed detailed questionnaires on their eating habits over the past month. When the researchers analysed the data, they identified two common diet patterns among the women. 1). The Mediterranean diet – defined as high in vegetables, vegetable bits, fish and beans, but low in snack foods and 2). The health conscious diet – which is high in fruits, vegetables, whole grains, beans and fish, and low in meat and snack foods.
The researchers found there was no link between the health-conscious diet and rates of pregnancy. But, the group that most closely adhered to the Mediterranean diet was more likely to become pregnant. The researchers did not assess pregnancy outcome, so the diet's relationship to the ultimate success of fertility treatment is not clear.
The Mediterranean and health-conscious diets had many similarities, but there are a few potential reasons why the former may affect fertility treatment success said the researchers.
One is the high intake of vegetable oils in the Mediterranean diet. Researchers noted that the Omega-6 fatty acids in these oils are the precursors to hormone-like substances in the body called prostaglandins. Prostaglandins, in turn, are involved in the menstrual cycle, ovulation and pregnancy maintenance.
In addition, the study found that women who most closely followed the diet Mediterranean way had higher levels of vitamin B6. One previous study found giving vitamin B to women who were having difficulty getting pregnant increased their chances of conception.
Still, diet is part of a person's overall lifestyle and the study could not account for all of the factors that could clarify the connection between the natural ways to Increase fertility Mediterranean diet and pregnancy rates
For pulmonary ailments, certain mediaeval physicians had a useful medical textbook on hand offering detailed information remarkably similar to those a modern doctor might use today. One of the fathers of medicine, the great Persian scholar Avicenna left a wealth of information in his many works. Iranian academics dust off one of these in an article published today in the SAGE journal Therapeutic Advances in Respiratory Disease, sharing in English details of Avicenna's work that still fascinate both physicians and historians of medicine alike.
Seyyed Mehdi Hashemi and Mohsen Raza dug deep into Avicenna's original ancient text, housed in the Central Library of the Tehran University of Medical Sciences in Iran, where they both work. In particular, they aimed to highlight Avicenna's work on respiratory diseases, which may be informative or interesting to physicians and pulmonologists today.
Avicenna discusses respiratory diseases in volume three of the Canon of Medicine, covering the functional anatomy and physiopathology of the pulmonary diseases that were known in his time in detail. His descriptions of the signs and symptoms of various respiratory diseases and conditions are remarkably similar to those found in modern pulmonary medicine. The topic is covered under five chapters: breathing, voice, cough and haemoptysis, internal wounds and inflammations and principles of treatments.
The authors also highlight both herbal and non-herbal treatments Avicenna recommends for respiratory diseases, and their signs and symptoms from the second volume of the Canon of Medicine. Avicenna suggested 21 herbs to treat respiratory disorders, and today we know that several of these herbs contain bioactive compounds with analgesic, antispasmodic, bronchodilatory or antimicrobial activities. For instance, Avicenna would have prescribed opium at that time for cough and haemoptysis, a practice which today has an established therapeutic basis.
“In the time of Avicenna, the presentation of respiratory diseases, their treatment and their prognosis was much different than in modern times,” says Hashemi. Mediaeval physicians had a greater reliance on history, physical examination (which was mostly based on visual observation), individual variation, environmental factors, diet, and so on, for diagnosis and treatment.
Even so, several of Avicenna's observations related to signs and symptoms, aggravating and relieving factors and the treatment of pulmonary disorders are still valid and can be explained by modern science. For example, one of the important symptoms in the diagnosis of asthma that Avicenna discusses is dyspnea during sleep that leads to awakening. Avicenna also observed plaster-like material in tuberculosis patients' sputum, which is now known as lithoptysis (stone spitting), where a patient coughs up calcified material due to perforated bronchial lymph node.
Despite many limitations and the lack of modern instruments in his day, Avicenna adopted a scientific approach to the diagnosis and treatment, not only of respiratory disorders, but also more generally to illnesses he treated and mentioned throughout the Canon of Medicine.
Dr. Nick and his colleagues analyzed epidemiological and health data on 156 CF patients over 40 year of age who receive care at National Jewish Health, the largest adult cystic fibrosis clinic in the nation. In addition, data were analyzed on nearly 3,000 patients from around the nation who were included in the Cystic Fibrosis Foundation Patient Registry from 1992-2007.
The researchers found that the fate of females changes considerably in the older CF population. It has long been recognized that a “gender gap” is present in CF, favoring males. Historically, females have been diagnosed later, had a poorer prognosis, and survived fewer years than males.
Accordingly, Dr. Nick's analysis showed that fewer females diagnosed as children survived to age 40. However, among those diagnosed as adults, females represented a significant majority, accounting for 72 percent of patients in Colorado and 54 percent nationally. Among the adult diagnosed patients, females survived on average 9 to 14 years longer than males.
The complex factors that account for the differential fate of female CF patients is not understood, although Dr. Nick believes it could be a mixture of behavioral and biological factors.
Dr. Nick's findings also indicate that patients diagnosed as adults do not really have milder diseases — as is commonly believed — just a delayed onset of an equally severe form of the disease. Although patients diagnosed as adults live longer than those diagnosed as children, the adult-diagnosed patients lose lung function as rapidly those diagnosed in childhood, and approximately 85% die of respiratory failure or post-transplant complications.
Dr. Nick believes there is a significant number of adults whose CF remains undiagnosed. His analysis indicates that once those patients are accurately diagnosed, proper care can significantly improve their health. Patients diagnosed as adults and subsequently followed at a CF center reversed progressive lung function decline and improved their lung function for at least four years. Older patients commonly do not get specialized CF care. It is generally recognized that the team approach to treatment provided by the 112 CF Foundation-accredited Care Centers results in better clinical outcomes. However, less than half of long-term CF survivors continued to be seen at CF Centers as they pass 40 years, with the fewest among the adult-diagnosed patients.
“In the coming years, more and more cystic fibrosis patients will be living into their 40s, 50s and beyond,” said Dr. Nick. “Our findings concerning the role of gender, in survival, progression of disease, and type of care in current long-term survivors provides important insights that will help us prepare for better treatment of the steadily aging CF population.”
Lead researcher Dr. Jeffrey M. Lackner from the State University of New York, Buffalo said cognitive behavioral therapy was known to be a very promising treatment for IBS, with the current findings helping to identify which patients would likely maintain a positive response.
Lackner and his colleagues are conducting a larger, longer-term study, as the current study being a small one, it remains unclear how long the benefits of cognitive behavioral therapy may last i. e. do they carry over to 9 months, a year or more.
IBS symptoms include bouts of abdominal cramps, bloating and changes in bowel habits i. e. diarrhoea or constipation, or alternating episodes of both. While, no one knows the exact cause of the disorder, there are certain symptom triggers like particular foods, large meals and emotional stress.
Cognitive behavioral therapy helps IBS patients to recognize their symptom triggers and manage them. Other treatment options include general diet changes, like reducing gas-producing foods; fibre supplements, if constipation is a primary symptom; and anti-diarrhoeal medications, when diarrhoea is a primary symptom.
There are two prescription medications for specific IBS cases: Lotronex, for women with diarrhoea dominant IBS not responding to other treatments; and Amitiza, for constipation dominant IBS.
Around 20% of people have IBS symptoms, with women affected at about twice the rate of men
Food allergies, by some accounts, affect about 4 percent of adults and 5 percent of children under the age of 6 in the United States, though this study raises questions about the reliability of such figures.
Food allergies can cause a variety of problems, ranging from mild skin rashes or nausea to a life-threatening, whole-body reaction known as anaphylaxis. The allergies can also have serious effects on patients' social interactions, school and work attendance, family economics and overall quality of life. “It's a life-defining diagnosis in a way,” said Chafen.
The National Institute of Allergy and Infectious Diseases is working on new clinical practice guidelines and, as part of its efforts, enlisted Chafen and her colleagues to review the current evidence on food allergies.
The researchers started their work by sifting through thousands of scientific papers, published between 1988 and 2009, that focused on the four foods — milk, eggs, fish and peanut and tree nuts — responsible for more than half of all allergies. They ultimately reviewed 72 studies, including one meta-analysis on prevalence, 18 studies on diagnosis, 28 studies on management, and four meta-analyses and 21 additional studies on prevention.
When examining the literature, the researchers found there was no universal definition of “food allergy,” in spite of NIAID's defining it as an “adverse immune response” that is “distinct from other adverse responses” such as a food intolerance. In fact, 82 percent of the studies provided their own definition of food allergy.
“This validates the idea that there exists a great deal of complexity and confusion in the field of food allergy, even at the level of the medical literature,” said co-author Marc Riedl, MD, MS, section head of clinical immunology and allergy at UCLA.
Along the same lines, there was a lack of uniformity for criteria in making a diagnosis. The current gold standard is the food challenge, during which a physician gives a patient a sample of the suspected offending food, sometimes in capsule form, and then monitors for allergic reaction. However, this test requires specialized personnel, is expensive and has a risk of anaphylaxis. Office-based tests were used to diagnose many patients; these include a skin-prick test, during which a dilute extract of the potential allergen is placed on the skin, and a blood test that determines the presence of food-specific allergic antibodies known as IgE.
As the researchers discuss in their paper, the concern with the latter two tests is that they're not definitive: Patients with non-specific symptoms, such as a rash or digestive troubles, and positive skin-prick or blood tests actually have less than a 50 percent chance of having a food allergy. In order to make a proper diagnosis, they pointed out, physicians need to evaluate the data within the context of a patient's history and have a great understanding of symptoms consistent with true food allergy.
What this means, then, is there is a potential for the overdiagnosis of food allergy.
“I frequently see patients in my clinical practice who have food intolerance, but have previously had inadequate or inappropriate evaluation and been told they have a 'food allergy',” said Riedl. “This causes a great deal of unnecessary anxiety and concern for the patient.”
Previous studies have tried to determine whether the skin-prick or blood test is superior over the other, but in reviewing the evidence, Chafen and her colleagues found “no statistical superiority in either test.” They also found generally inconclusive results from 10 previous studies in which the tests were combined, in an effort to improve diagnostic accuracy.
“I was very surprised,” said Chafen. “I'm a general internist and I thought diagnostic strategies were more-studied.”
In terms of treatment, Chafen said expert opinion is that an elimination diet — having the patient stop consuming the food that causes the allergic reaction — is the most common. Although the approach is a common-sense one (“If a patient breaks out in hives repeatedly after drinking milk, it's your instinct as a physician to say, 'Don't drink milk,'” Chafen said), the researchers found the treatment hasn't been well-studied.
It would be unethical to conduct controlled studies of elimination diets for patients with serious, life-threatening allergic reactions, but as pointed out in the paper, there are few studies of this approach on patients with relatively minor symptoms.
“In these instances, the benefits of an elimination diet are uncertain based on published evidence and potential benefits need to be weighed against the potential nutritional risks of such a diet, particularly in children,” the researchers wrote.
Chafen and her colleagues also found that immunotherapy, a treatment in which the body's immune system is altered by administering increasing doses of the allergen over time, appeared to be effective at eliminating symptoms in the short term. Immunotherapy isn't a licensed method for allergy treatment, but the researchers urged more study on its long-term effect and safety.
In all, the researchers concluded, the food-allergy field is in need of uniformity in the criteria for what constitutes an allergy and a set of evidence-based guidelines upon which to make this diagnosis. NIAID, which put together an expert panel and has reviewed the group's analysis, is planning to finalize such guidelines later this summer.
As for Chafen, who sees patients with potential food allergies, these findings have encouraged her to rely more on specialists to help clinch a diagnosis. “People need to be seen by someone with a deep understanding of diagnostic tests and criteria,” she said. “The distinction between food intolerance and food allergy is really important.”
The study was funded by NIAID. Other Stanford authors on the study are Dena Bravata, MD, a PCOR affiliate; and Vandana Sundaram, MPH, assistant director of research for CHP/PCOR. Paul Shekelle, MD, PhD, with the RAND Corp.'s Southern California Evidence-Based Practice Center and the West Los Angeles VA Medical Center, is the senior author.
Current chemotherapies do not work against cancer stem cells, which is why cancer recurs and spreads. Researchers believe that eliminating the cancer stem cells is key to controlling cancer.
In the current study, researchers took mice with breast cancer and injected varying concentrations of sulforaphane from the broccoli extract. Researchers then used several established methods to assess the number of cancer stem cells in the tumors. These measures showed a marked decrease in the cancer stem cell population after treatment with sulforaphane, with little effect on the normal cells. Further, cancer cells from mice treated with sulforaphane were unable to generate new tumors. The researchers then tested sulforaphane on human breast cancer cell cultures in the lab, finding similar decreases in the cancer stem cells.
“This research suggests a potential new treatment that could be combined with other compounds to target breast cancer stem cells. Developing treatments that effectively target the cancer stem cell population is essential for improving outcomes,” says study author Max S. Wicha, M.D., Distinguished Professor of Oncology and director of the U-M Comprehensive Cancer Center.
The concentrations of sulforaphane used in the study were higher than what can be achieved by eating broccoli or broccoli sprouts. Prior research suggests the concentrations needed to impact cancer can be absorbed by the body from the broccoli extract, but side effects are not known. While the extract is available in capsule form as a supplement, concentrations are unregulated and will vary.
This work has not been tested in patients, and patients are not encouraged to add sulforaphane supplements to their diet at this time.
Researchers are currently developing a method to extract and preserve sulforaphane and will be developing a clinical trial to test sulforaphane as a prevention and treatment for breast cancer. No clinical trial is currently available.
Curcumin, one of the principal components of the Indian spice turmeric, seems to delay the liver damage that eventually causes cirrhosis, suggests preliminary experimental research in the journal Gut. Curcumin, which gives turmeric its bright yellow pigment, has long been used in Indian Ayurvedic medicine to treat a wide range of gastrointestinal disorders.
Previous research has indicated that it has anti-inflammatory and antioxidant properties which may be helpful in combating disease. The research team wanted to find out if curcumin could delay the damage caused by progressive inflammatory conditions of the liver, including primary sclerosing cholangitis and primary biliary cirrhosis.
Both of these conditions, which can be sparked by genetic faults or autoimmune disease, cause the liver's plumbing system of bile ducts to become inflamed, scarred, and blocked. This leads to extensive tissue damage and irreversible and ultimately fatal liver cirrhosis.
The research team analysed tissue and blood samples from mice with chronic liver inflammation before and after adding curcumin to their diet for a period of four and a period of eight weeks.
The results were compared with the equivalent samples from mice with the same condition, but not fed curcumin.
The findings showed that the curcumin diet significantly reduced bile duct blockage and curbed liver cell (hepatocyte) damage and scarring (fibrosis) by interfering with several chemical signalling pathways involved in the inflammatory process.
These effects were clear at both four and eight weeks. No such effects were seen in mice fed a normal diet.
The authors point out that current treatment for inflammatory liver disease involves ursodeoxycholic acid, the long term effects of which remain unclear. The other alternative is a liver transplant.
Curcumin is a natural product, they say, which seems to target several different parts of the inflammatory process, and as such, may therefore offer a very promising treatment in the future.
Source: Anna Baghdasaryan, Thierry Claudel, Astrid Kosters, Judith Gumhold, Dagmar Silbert, Andrea Thüringer, Katharina Leski, Peter Fickert, Saul J Karpen, Michael Trauner. Curcumin improves sclerosing cholangitis in Mdr2-/- mice by inhibition of cholangiocyte inflammatory response and portal myofibroblast proliferation. Gut, 2010; 59: 521-530