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Sleep Apnea Linked to Carb Craving in Diabetes

Sleep Apnea study at Palm Beach Research
June 15, 2012 (Boston, Massachusetts) — In a small study of patients visiting a sleep clinic in New Jersey, researchers found that those with type 2 diabetes were at high risk for sleep apnea and that sleep apnea was associated with carbohydrate craving. "Since the prevalence of sleep apnea among diabetics was high in this study, along with the fact that the risk of carbohydrate craving was also very elevated in this group, primary care physicians as well as endocrinologists need to routinely screen for sleep apnea among type 2 diabetics," Mahmood I. Siddique, DO, from Sleep & Wellness Medical Associates LLC, Hamilton, New Jersey, told Medscape Medical News. He presented the study findings this week at SLEEP 2012: Associated Professional Sleep Societies 26th Annual Meeting. Changes in Leptin and Ghrelin "Studies among the general population have shown that sleep apnea and sleep deprivation may affect carbohydrate craving by hormonal changes in leptin and ghrelin," said Dr. Siddique, associate clinical professor of medicine, Robert Wood Johnson Medical School in New Brunswick, New Jersey. "The impact of sleep apnea, however, on carbohydrate craving among diabetics has not been extensively studied, especially in a real-world setting," he explained. "Studies have shown that sleep apnea can worsen diabetes but self-reported carbohydrate craving among this group has not been examined." The study involved 55 adults with a mean age of 62.5 years; 43% were men. The researchers assessed the risk for sleep apnea using the validated Berlin questionnaire, which predicts sleep apnea by incorporating body mass index (BMI), hypertension status, and characterization of snoring and daytime sleepiness. They assessed carbohydrate craving using the Likert scale from 1 (highest) to 5 (lowest). Fifty-four percent of study participants were diabetic, and 82% of these individuals were at high risk for sleep apnea, scoring 2 to 4 on the Berlin questionnaire. Compared with participants without diabetes, the risk for sleep apnea among patients with diabetes was high (odds ratio [OR], 5; 95% confidence interval [CI], 1.8 - 18.9), the researchers found. Further, the diabetic patients had almost double the risk for carbohydrate craving as their nondiabetic counterparts (33% vs 14%). The odds of moderate to high carbohydrate craving was more than double in all patients at high risk for sleep apnea (Berlin score, 2 - 4) vs those at low risk (Berlin score, 0 - 1). The odds ratio was 2.27 (95% CI, 0.76 - 6.7). "Novel Study" Clete Kushida, MD, PhD, professor and medical director of the Stanford Sleep Medicine Center in Palo Alto, California, and past president of the American Academy of Sleep Medicine, told Medscape Medical News, "This is a fairly novel study in that I don't think carbohydrate craving has been looked at in the context of diabetics and sleep apnea. However, it's a small sample size and requires further study." Dr. Kushida was not involved in the study. In a conference statement, the study's principal investigator, Anthony Cannon, MD, American Diabetes Association regional president for central and southern Pennsylvania and southern New Jersey, said, "Current national guidelines on the management of diabetes need to consider sleep apnea as an independent risk factor more vigorously." "The management of patients with diabetes and or metabolic syndrome based solely on pharmacotherapy, exercise and nutritional modifications without taking into account the risk of sleep apnea may not lead to optimal outcomes for patients suffering from these chronic diseases," Dr. Cannon added. He said, "Clearly, a greater awareness among physicians is needed, as sleep apnea is often undiagnosed by primary care physicians. Public policy can play a key role in the educational awareness of the association between sleep apnea and diabetes among both physicians and patients." The study authors and Dr. Kushida have disclosed no relevant financial relationships. SLEEP 2012: Associated Professional Sleep Societies 26th Annual Meeting. Abstract #0912. Presented June 13, 2012

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Gene May Link Diabetes and Alzheimer’s

In recent years it became clear that people with diabetes face an ominous prospect – a far greater risk of developing Alzheimer’s disease. Now researchers at The City College of New York (CCNY) have shed light on one reason why. Biology Professor Chris Li and her colleagues have discovered that a single gene forms a common link between the two diseases. They found that the gene, known to be present in many Alzheimer’s disease cases, affects the insulin pathway. Disruption of this pathway is a hallmark of diabetes. The finding could point to a therapeutic target for both diseases. The researchers report their finding in the June 2012 issue of the journal Genetics. "People with type 2 diabetes have an increased risk of dementia. The insulin pathways are involved in many metabolic processes, including helping to keep the nervous system healthy," said Professor Li, explaining why the link is not far-fetched. Although the cause of Alzheimer’s is still unclear, one criterion for diagnosis of the disease after death is the presence of sticky plaques of amyloid protein in decimated portions of patients’ brains. Mutations in the human "amyloid precursor protein" (APP) gene, or in genes that process APP, show up in cases of Alzheimer’s that run in families. In the study, Professor Li and her colleagues scrutinized a protein called APL-1, made by a gene in the worm Caenorhabditis elegans (C. elegans ) that happens to be a perfect stand-in for the human Alzheimer’s disease gene. "What we found was that mutations in the worm-equivalent of the APP gene slowed their development, which suggested that some metabolic pathway was disrupted," said Professor Li. "We began to examine how the worm-equivalent of APP modulated different metabolic pathways and found that the APP equivalent inhibited the insulin pathway." This suggested that the human version of the gene likely plays a role in both Alzheimer’s disease and diabetes. They also found that additional mutations in the insulin pathway reversed the defects of the APP mutation. This helped explain how these genes are functionally linked. The APL-1 is so important, they found, that “when you knock out the worm-equivalent of APP, the animals die," Li explained. “This tells us that the APP family of proteins is essential in worms, as they are essential in mammals,” like us. Professor Li and her colleagues hope that this new insight will help focus research in ways that might lead to new therapies in the treatment of both Alzheimer’s disease and diabetes. "This is an important discovery, especially as it comes on the heels of the U.S. government’s new commitment to treat and prevent Alzheimer’s disease by 2025," said Dr. Mark Johnston, editor-in-chief of "Genetics." "We know there’s a link between Alzheimer’s and diabetes, but until now, it was somewhat of a mystery. This finding could open new doors for treating and preventing both diseases." The research has identified one link in the chain, an Alzheimer's disease-related protein to the insulin pathway. This may provide insights into why type II diabetes patients are at higher risk for Alzheimer's. However, the protein fragments into many parts, each of which may attach to and signal neurons and other cells along the way. "The big question," said Professor Li, “Is how the amyloid precursor protein and its cleavage products intersect with the insulin pathway.” Each intersection offers a possible target for drugs and other treatment. Professor Li plans to continue down the pathway, mapping its crossroads as she goes. Source: City College of New York

Goodbye Prostate Cancer

 How do you know when your new cancer drug is working better than expected? When they shut down the clinical trial so that every participating patient can receive it.

...Click for Rest of Story...

Study: 'Smart bomb' drug attacks breast cancer

Doctors have successfully dropped the first "smart bomb" on breast cancer, using a drug to deliver a toxic payload to tumor cells while leaving healthy ones alone.

In a key test involving nearly 1,000 women with very advanced disease, the experimental treatment extended by several months the time women lived without their cancer getting worse, doctors planned to report Sunday at a cancer conference in Chicago.

More importantly, the treatment seems likely to improve survival; it will take more time to know for sure. After two years, 65 percent of women who received it were still alive versus 47 percent of those in a comparison group given two standard cancer drugs.

That margin fell just short of the very strict criteria researchers set for stopping the study and declaring the new treatment a winner, and they hope the benefit becomes more clear with time. In fact, so many women on the new treatment are still alive that researchers cannot yet determine average survival for the group.

"The absolute difference is greater than one year in how long these people live," said the study's leader, Dr. Kimberly Blackwell of Duke University. "This is a major step forward."

A warning to hopeful patients: the drug is still experimental, so not available yet. Its backers hope it can reach the market within a year.

The treatment builds on Herceptin, the first gene-targeted therapy for breast cancer. It is used for about 20 percent of patients whose tumors overproduce a certain protein.

Researchers combined Herceptin with a chemotherapy so toxic that it can't be given by itself, plus a chemical to keep the two linked until they reach a cancer cell where the poison can be released to kill it.

This double weapon, called T-DM1, is the "smart bomb," although it's actually not all that smart — Herceptin isn't a homing device, just a substance that binds to breast cancer cells once it encounters them.

Doctors tested T-DM1 in 991 women with widely spread breast cancer that was getting worse despite treatment with chemotherapy and ordinary Herceptin. They were given either T-DM1 infusions every three weeks or infusions of Xeloda plus daily Tykerb pills — the only other treatments approved for such cases.

The median time until cancer got worse was nearly 10 months in the women given T-DM1 versus just over 6 months for the others. That is about the same magnitude of benefit initially seen with Herceptin, which later proved to improve overall survival, too, Blackwell said.

T-DM1 caused fewer side effects than the other drugs did. Some women on T-DM1 had signs of liver damage and low levels of factors that help blood clot, but most did not have the usual problems of chemotherapy.

"People don't lose their hair, they don't throw up. They don't need nausea medicines, they don't need transfusions," said Blackwell, who has consulted in the past for Genentech, the study's sponsor.

"The data are pretty compelling," said Dr. Michael Link, a pediatric cancer specialist at Stanford University who is president of the American Society of Clinical Oncology, the group hosting the Chicago conference where the results were being presented.

"It's sort of a smart bomb kind of therapy, a poison delivered to the tumor ... and not a lot of other collateral damage to other organs," he said.

Dr. Louis Weiner, director of Georgetown Lombardi Comprehensive Cancer Center, said the results strongly suggest T-DM1 improves survival. It delivers more drug directly to tumors with less side effects, "a clear advance," he said.

Denise Davis, 51, a customer service representative at a propane company, was diagnosed three years ago with breast cancer that had spread to her liver and bones. Since February of last year, the Lynchburg, Va., woman has made the two-hour trip to Duke in Durham, N.C., every three weeks to get infusions of T-DM1.

"I call it 'Herceptin-plus,'" she said. Scans every six weeks show "everything is still shrinking or stable," she said. "Right now, I'm feeling pretty good about it. The only way I'd feel a little better is if it took care of everything, but I'll take what I can get."

Genentech, part of the Swiss company Roche, plans to seek approval later this year to sell the drug in Europe and the United States. Another company, ImmunoGen Inc., made the technology combining the drugs.

Genentech says the price of T-DM1 has not been determined. Herceptin costs more than $4,000 a month plus whatever doctors charge to infuse it. Herceptin's U.S. patent doesn't expire until 2019.

Task Force Recommends Against Hormones for Post-Menopausal Women

By Jennifer Corbett Dooren

A federal task force has once again examined the use of hormone replacement therapy, and is again recommending against hormones for preventing fractures, dementia and other chronic diseases in women who are already past menopause.

The U.S. Preventive Services Task Force issued the draft guidelines on the use of estrogen and progestin to take into account new findings from the landmark Women’s Health Initiative study that looked at hormone use, along with other studies issued in the past decade.

The recommendations don’t apply to women who are experiencing menopause and use hormones to treat hot flashes and other symptoms.

The federally funded Women’s Health Initiative, known as WHI, was halted in 2002 when initial results showed women taking a combination of estrogen and progestin had a higher risk of breast cancer, heart disease and stroke than women who received a placebo. Although participants stopped taking hormones at that time, researchers have continued to monitor them to analyze outcomes.

In 2002, the task force issued recommendations against combination use of estrogen and progestin in post-menopausal women, and later advised against estrogen-only use in these women as well.

Dr. Kirsten Bibbins-Domingo, a task force member and an associate professor of medicine, epidemiology and biostatistics at the University of California, San Francisco, said the recommendations for post-menopausal women haven’t changed. But, she said, it was important to take a new look at the issue given the additional information that has come out in recent years. For example, one study suggested women taking estrogen-only therapy had a lower risk of invasive breast cancer.

The task force notes that the vast majority of women currently using hormone therapy are younger and transitioning through menopause. The FDA has approved hormones to prevent menopausal symptoms and to prevent fractures, according to the task force. The products carry a boxed-warning stating that estrogen with or without progestin “should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risk for the individual woman.”

As the Health Blog noted recently, much research suggests that the benefits of hormone-replacement therapy outweigh the risks for women who start it near menopause. Data from WHI suggests much of the harm seen in women was among those in their 60s and 70.

Unlike previous task force recommendations, such as one issued earlier this month advising against prostate-cancer screening with a PSA test in men, the updated recommendation on hormone-replacement therapy for postmenopausal women aren’t controversial. However, the task force is taking comments on the draft hormone therapy recommendations from now until June 26.

http://palmbeachresearch.com/?p=1535

Sugar can make you dumb, US scientists warn

Eating too much sugar can eat away at your brain power, according to US scientists who published a study showing how a steady diet of high-fructose corn syrup sapped lab rats' memories.
Researchers at the University of California Los Angeles (UCLA) fed two groups of rats a solution containing high-fructose corn syrup - a common ingredient in processed foods - as drinking water for six weeks.
One group of rats was supplemented with brain-boosting omega-3 fatty acids in the form of flaxseed oil and docosahexaenoic acid (DHA), while the other group was not.

Before the sugar drinks began, the rats were enrolled in a five-day training session in a complicated maze. After six weeks on the sweet solution, the rats were then placed back in the maze to see how they fared.
"The DHA-deprived animals were slower, and their brains showed a decline in synaptic activity," said Fernando Gomez-Pinilla, a professor of neurosurgery at the David Geffen School of Medicine at UCLA.
"Their brain cells had trouble signaling each other, disrupting the rats' ability to think clearly and recall the route they'd learned six weeks earlier."
A closer look at the rat brains revealed that those who were not fed DHA supplements had also developed signs of resistance to insulin, a hormone that controls blood sugar and regulates brain function.
"Because insulin can penetrate the blood-brain barrier, the hormone may signal neurons to trigger reactions that disrupt learning and cause memory loss," Gomez-Pinilla said.
In other words, eating too much fructose could interfere with insulin's ability to regulate how cells use and store sugar, which is necessary for processing thoughts and emotions.
"Insulin is important in the body for controlling blood sugar, but it may play a different role in the brain, where insulin appears to disturb memory and learning," Gomez-Pinilla said.
"Our study shows that a high-fructose diet harms the brain as well as the body. This is something new."
In the US, high-fructose corn syrup is commonly found in soft drink, condiments, applesauce, baby food and other processed snacks.
The average American consumes more than 40 pounds (18 kilograms) of high-fructose corn syrup per year, according to the US Department of Agriculture.
While the study did not say what the equivalent might be for a human to consume as much high-fructose corn syrup as the rats did, researchers said it provides some evidence that metabolic syndrome can affect the mind as well as the body.
"Our findings illustrate that what you eat affects how you think," said Gomez-Pinilla.
"Eating a high-fructose diet over the long term alters your brain's ability to learn and remember information. But adding omega-3 fatty acids to your meals can help minimise the damage."
The study appeared in the Journal of Physiology

A Stem-Cell-Based Drug Gets Approval in Canada

In a boost for the field of regenerative medicine, a small biotechnology company has received regulatory approval in Canada for what it says is the first manufactured drug based on stem cells.

The company, Osiris Therapeutics of Columbia, Md., said Thursday that Canadian regulators had approved its drug Prochymal, to treat children suffering from graft-versus-host disease, a potentially deadly complication of bone marrow transplantation.

“It’s really a good day for the concept and the hope behind stem cell therapies becoming a reality,” C. Randal Mills, the chief executive of Osiris, said in an interview.

Prochymal is a preparation of mesenchymal stem cells, which are obtained from the bone marrow of healthy young adult donors. The stem cells are separated out from the marrow and expanded in culture, so that one donation is enough to make as many as 10,000 doses.

Because these are adult stem cells, they do not raise the ethical concerns of embryonic stem cells, whose creation usually involves the destruction of human embryos.

Graft-versus-host disease occurs when the immune cells in a bone-marrow transplant see the recipient’s organs as foreign and attack them, causing potentially severe damage to the skin, liver and digestive tract. This happens most often when the donor is not an exact match for the recipient.

Doctors try using steroids or other drugs to damp the immune attack, but in many cases those don’t work, and the patient may die.

Prochymal is approved in Canada for children whose condition is not controlled by steroids. In a small trial, about 60 percent of such children had a clinically meaningful response to the drug, Osiris said.

“Any drug or a cell that has activity in the patients with severe disease is exciting and important,” said Dr. Joanne Kurtzberg, director of the pediatric blood and marrow transplant program at Duke University Medical Center.

Dr. Kurtzberg, who helped Osiris present its case to Canadian regulators, said the drug has saved some children’s lives from graft-versus-host disease and could lead to more successful bone marrow transplants.

Osiris is not expected to gain much revenue from patients with a rare disease in Canada. But it is a welcome success for a 20-year-old company that has had its share of failures.

In 2009, Prochymal failed in two late-stage clinical trials, showing little to no advantage over placebo in treating graft-versus-host disease. The company is also trying to develop Prochymal as a treatment for Crohn’s disease, diabetes, heart attacks and other illnesses, but has had some failures there as well.

Sanofi, the big French company that had the rights to sell Prochymal outside North America, said in February that it had discontinued its work on the drug.

Dr. Mills, Osiris’s chief executive, said the company realized the drug was most effective in the most severe cases of graft-versus-host-disease that did not respond to steroids, leading it to do the small trial in children.

Dr. Mills said that the Food and Drug Administration indicated that it would require more data before approval, prompting Osiris to seek approval in Canada first. He said the company would apply to the F.D.A. later this year.

Stem cells are already used in medicine. Bone marrow or stem cell transplants are used to treat various cancers and genetic diseases. But those transplants are medical procedures, not products sold by a drug company.

There are cell therapies that have been approved by regulators, such as Carticel, a Genzyme product that uses a patient’s own cells to repair cartilage in injuries. Last year the F.D.A. approved a cord blood product for use in transplantation. Those products are not manufactured for off-the-shelf use like Prochymal is, Dr. Mills said.

Osiris announced the approval after regular stock trading ended. After hours, the stock rose 14 percent to $6.00.

Study finds java drinkers live longer

One of life's simple pleasures just got a little sweeter. After years of waffling research on coffee and health, even some fear that java might raise the risk of heart disease, a big study finds the opposite: Coffee drinkers are a little more likely to live longer. Regular or decaf doesn't matter.
The study of 400,000 people is the largest ever done on the issue, and the results should reassure any coffee lovers who think it's a guilty pleasure that may do harm.
"Our study suggests that's really not the case," said lead researcher Neal Freedman of the National Cancer Institute. "There may actually be a modest benefit of coffee drinking."
No one knows why. Coffee contains a thousand things that can affect health, from helpful antioxidants to tiny amounts of substances linked to cancer. The most widely studied ingredient — caffeine — didn't play a role in the new study's results.
It's not that earlier studies were wrong. There is evidence that coffee can raise LDL, or bad cholesterol, and blood pressure at least short-term, and those in turn can raise the risk of heart disease.
Even in the new study, it first seemed that coffee drinkers were more likely to die at any given time. But they also tended to smoke, drink more alcohol, eat more red meat and exercise less than non-coffee-drinkers. Once researchers took those things into account, a clear pattern emerged: Each cup of coffee per day nudged up the chances of living longer.
The study was done by the National Institutes of Health and AARP. The results are published in Thursday's New England Journal of Medicine.
Careful, though — this doesn't prove that coffee makes people live longer, only that the two seem related. Like most studies on diet and health, this one was based strictly on observing people's habits and resulting health. So it can't prove cause and effect.
But with so many people, more than a decade of follow-up and enough deaths to compare, "this is probably the best evidence we have" and are likely to get, said Dr. Frank Hu of the Harvard School of Public Health. He had no role in this study but helped lead a previous one that also found coffee beneficial.
The new one began in 1995 and involved AARP members ages 50 to 71 in California, Florida, Louisiana, New Jersey, North Carolina, Pennsylvania and Atlanta and Detroit. People who already had heart disease, a stroke or cancer weren't included. Neither were folks at diet extremes — too many or too few calories per day.
The rest gave information on coffee drinking once, at the start of the study. "People are fairly consistent in their coffee drinking over their lifetime," so the single measure shouldn't be a big limitation, Freedman said.
Of the 402,260 participants, about 42,000 drank no coffee. About 15,000 drank six cups or more a day. Most people had two or three.
By 2008, about 52,000 of them had died. Compared to those who drank no coffee, men who had two or three cups a day were 10 percent less likely to die at any age. For women, it was 13 percent.
Even a single cup a day seemed to lower risk a little: 6 percent in men and 5 percent in women. The strongest effect was in women who had four or five cups a day — a 16 percent lower risk of death.
None of these are big numbers, though, and Freedman can't say how much extra life coffee might buy.
"I really can't calculate that," especially because smoking is a key factor that affects longevity at every age, he said.
Coffee drinkers were less likely to die from heart or respiratory disease, stroke, diabetes, injuries, accidents or infections. No effect was seen on cancer death risk, though.
Other research ties coffee drinking to lower levels of markers for inflammation and insulin resistance. Researchers also considered that people in poor health might refrain from drinking coffee and whether their abstention could bias the results. But the study excluded people with cancer and heart disease — the most common health problems — to minimize this chance. Also, the strongest benefits of coffee drinking were seen in people who were healthiest when the study began.
About two-thirds of study participants drank regular coffee, and the rest, decaf. The type of coffee made no difference in the results.
Hu had this advice for coffee lovers:
— Watch the sugar and cream. Extra calories and fat could negate any benefits from coffee.
— Drink filtered coffee rather than boiled — filtering removes compounds that raise LDL, the bad cholesterol.
Researchers did not look at tea, soda or other beverages but plan to in future analyses.
Lou and Mariann Maris have already compared them. Sipping a local brew at a lakefront coffee shop, the suburban Milwaukee couple told of how they missed coffee after briefly giving it up in the 1970s as part of a health kick that included transcendental meditation and eating vegetarian.
Mariann Maris switched to tea after being treated for breast cancer in 2008, but again missed the taste of coffee. It's one of life's great pleasures, especially because her husband makes it, she said.
"Nothing is as satisfying to me as a cup of coffee in the morning," she said.
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Online:
New England Journal: http://www.nejm.org

Dietary Supplements Increase Cancer Risk

Beta-carotene, selenium and folic acid – taken up to three times their recommended daily allowance, these supplements are probably harmless. But taken at much higher levels as some supplement manufacturers suggest, these three supplements have now been proven to increase the risk of developing a host of cancers.
"It's not that these nutrients are toxic – they're essential and we need them, but we need them in a certain balance," says Tim Byers, MD, MPH, professor of epidemiology at the Colorado School of Public Health and associate director for prevention and control at the University of Colorado Cancer Center.
Byers is senior author of a commentary recently published in the Journal of the National Cancer Institute that discusses the clinical and policy implications of the increased cancer risk from high dose dietary supplements.
"We have a window into less than half of the biology of what these nutrients are doing," Byers says. "We say generalized things about them, calling them an antioxidant or an essential mineral, but true biology turns out to be more complex than that. The effects of these supplements are certainly not limited to the label we give them. And, as we've seen, sometimes the unintended effects include increased cancer risk."
Currently the FDA regulates dietary supplements as food, but, as Byers and colleagues suggest, supplements, especially at high doses, are more accurately described as inhabiting a mid-ground between food and drugs. Like drugs, supplement ingredients are biologically active – sometimes for better and sometimes for worse
"We need to do a better job as a society in ensuring that the messages people get about value versus risk is accurate for nutritional supplements," Byers says. "My conclusion is that taking high doses of any particular nutrient is more likely to be a bad thing than a good thing."
Source: University of Colorado, Denver

Drinking coffee = protection against strokes

May 11, 2012 (London, United Kingdom) — A new meta-analysis, including the most contemporary studies that have examined coffee consumption and risk of cardiovascular events in a general population, has found that moderate intake may help protect against ischemic stroke [1].

Presenting the results at the recent European Society of Hypertension (ESH) European Meeting on Hypertension 2012, Dr Lanfranco D'Elia (Federico II University of Naples, Italy) told heartwire : "The first message is that coffee intake is not associated with a higher risk of stroke," which he says is reassuring. "Second, the analysis showed that low to moderate intake--one to three cups of coffee per day--was associated with lower risk of stroke in the general population, across a wide range of countries, including some in Europe, the US, and Japan."

However D'Elia stressed that these results apply to the general population only and that findings with regard to coffee intake and risk in those with cardiovascular disease have been conflicting. Nevertheless, he believes that "one coffee a day is not dangerous for people with heart disease."

Protective effect independent of most identifiable confounders

D'Elia and colleagues performed a meta-analysis of the available prospective studies, including those that estimated baseline coffee consumption and risk of stroke in the general population, from 1966 to 2011. However, the majority of studies included were performed in the late 2000s, including a recent Swedish study and one from the Netherlands.

One to three cups of coffee per day was associated with lower risk of stroke in the general population.
For this analysis, coffee consumption was stratified into moderate (one to three cups/day), high (three to six), and very high (six or more) and compared with the reference category (zero to one). For each study, the values of relative risk (RR) and their confidence interval were extracted and then combined using a random effect model. Eight general-population studies were included in the analysis, for a total of 11 cohorts (484 757 participants, 7272 stroke events, follow-up two to 24 years).

In the pooled analysis, habitual moderate coffee consumption was associated with decreased risk of stroke (RR 0.86, 95% CI 0.75–0.98; p < 0.02).

Stroke risk in the high-consumption category showed a trend in the same direction, toward a reduction (RR 0.87, 95% CI 0.70–1.08; p=0.02), which reached statistical significance upon sensitivity analysis with the exclusion of a single outlier study (RR 0.81, 95% CI 0.70–0.95; p=0.01).

Habitual very high coffee consumption was not associated with any effect on stroke risk (RR 1.05, p=0.71).

D'Elia said that unlike low to moderate coffee intake, both "high" and "very high" consumption showed a significant heterogeneity between studies.

Statistical analysis did not find any significant sources of heterogeneity (length of follow-up, publication year, gender, countries, etc) that affected the relationship between coffee intake and stroke risk, but he noted, "We cannot exclude the potential limitations of the analysis around the standardization of coffee preparation or different types of coffee.

"The results of this meta-analysis, which included prospective studies of samples of the general population, indicate that coffee consumption is not associated with a higher risk of stroke and that actually habitual moderate consumption may exert a protective effect independently from most identifiable confounders," he concluded.

Diabetes Drug Could Also Treat Leading Cause of Blindness

Article on Website 

University of Texas Medical Branch at Galveston researchers have discovered that a drug already prescribed to millions of people with diabetes could also have another important use: treating one of the world’s leading causes of blindness.

In laboratory rat and cell-culture experiments, the scientists found that metformin, which is commonly used to control blood sugar levels in type 2 diabetes, also substantially reduced the effects of uveitis, an inflammation of the tissues just below the outer surface of the eyeball. Uveitis causes 10 to 15 percent of all cases of blindness in the United States, and is responsible for an even higher proportion of blindness globally. The only treatment now available for the disorder is steroid therapy, which has serious side effects and cannot be used long-term.

“Uveitis has various causes — the most common are infectious diseases and autoimmune disorders— but they all produce inflammation within the eye,” said UTMB professor Kota V. Ramana, senior author of a paper on the study now online in the journal Investigative Ophthalmology & Visual Science. “Metformin inhibits the process that causes that inflammation.”

The scientists discovered metformin’s efficacy when they tested it in rats given an endotoxin that mimicked the inflammatory effects of bacterial infection. The results showed clearly that metformin was a very effective anti-uveitis agent.

“We found that the drug is therapeutic as well as preventive — if we gave our rats the drug beforehand, they didn’t develop uveitis, and if we gave it after uveitis had developed, it was therapeutic,” said UTMB professor Satish Srivastava, also an author of the IOVS paper. “Metformin’s strong anti-inflammatory properties make this possible.”

According to the researchers, metformin works by activating an enzyme called AMPK, which in turn damps down the activity of the protein NF-kappa B. The inhibition of NF-kappa B suppresses the production of inflammatory signaling molecules — cytokines and chemokines — needed to initiate and sustain uveitis.

Because metformin is already used so widely as a therapy for diabetes, the UTMB scientists believe that it has a good chance of being rapidly adopted as an anti-uveitis drug.

“I think after a few more pre-clinical studies are done, we can get this drug to patients in a shorter time than usual,” Ramana said. “Its safety is already known, so all that we need to see is its efficacy in humans.”

Source: University of Texas Medical Branch at Galveston

Breast cancer is rare in men, but they fare worse

Men rarely get breast cancer, but those who do often don’t survive as long as women, largely because they don’t even realize they can get it and are slow to recognize the warning signs, researchers say.

On average, women with breast cancer lived two years longer than men in the biggest study yet of the disease in males.

The study found that men’s breast tumors were larger at diagnosis, more advanced and more likely to have spread to other parts of the body. Men were also diagnosed later in life; in the study, they were 63 on average, versus 59 for women.

Many men have no idea that they can get breast cancer, and some doctors are in the dark, too, dismissing symptoms that would be an automatic red flag in women, said study leader Dr. Jon Greif, a breast cancer surgeon in Oakland, Calif.

The American Cancer Society estimates 1 in 1,000 men will get breast cancer, versus 1 in 8 women. By comparison, 1 in 6 men will get prostate cancer, the most common cancer in men.

“It’s not really been on the radar screen to think about breast cancer in men,” said Dr. David Winchester, a breast cancer surgeon in NorthShore University HealthSystem in suburban Chicago who was not involved in the study. Winchester treats only a few men with breast cancer each year, compared with at least 100 women.

The researchers analyzed 10 years of national data on breast cancer cases, from 1998 to 2007. A total of 13,457 male patients diagnosed during those years were included, versus 1.4 million women. The database contains about 75 percent of all U.S. breast cancer cases.

The men who were studied lived an average of about eight years after being diagnosed, compared with more than 10 years for women. The study doesn’t indicate whether patients died of breast cancer or something else.

Greif prepared a summary of his study for presentation Friday at a meeting of American Society of Breast Surgeons in Phoenix.

Dr. Akkamma Ravi, a breast cancer specialist at Weill Cornell Medical College in New York, said the research bolsters results in smaller studies and may help raise awareness. Because the disease is so rare in men, research is pretty scant, and doctors are left to treat it the same way they manage the disease in women, she said.

Some doctors said one finding in the study suggests men’s breast tumors might be biologically different from women’s: Men with early-stage disease had worse survival rates than women with early-stage cancer. But men’s older age at diagnosis also might explain that result, Greif said.

The causes of breast cancer in men are not well-studied, but some of the same things that increase women’s chances for developing it also affect men, including older age, cancer-linked gene mutations, a family history of the disease, and heavy drinking.

There are no formal guidelines for detecting breast cancer in men. The American Cancer Society says routine, across-the-board screening of men is unlikely to be beneficial because the disease is so rare.

For men at high risk because of a strong family history or genetic mutations, mammograms and breast exams may be helpful, but men should discuss this with their doctors, the group says.

Men’s breast cancer usually shows up as a lump under or near a nipple. Nipple discharge and breasts that are misshapen or don’t match are also possible signs that should be checked out.

Tom More, 67, of Custer, Wash., was showering when he felt a pea-size lump last year near his right nipple. Because a golfing buddy had breast cancer, More didn’t put off seeing his doctor. The doctor told More that he was his first male breast cancer patient.

Robert Kaitz, a computer business owner in Severna Park, Md., thought the small growth under his left nipple was just a harmless cyst, like ones that had been removed from his back. By the time he had it checked out in 2006, almost two years later, the lump had started to hurt.

The diagnosis was a shock.

“I had no idea in the world that men could even get breast cancer,” Kaitz said. He had a mastectomy, and 25 nearby lymph nodes were removed, some with cancer. Chemotherapy and radiation followed.

Tests showed Kaitz, 52, had a BRCA genetic mutation that has been linked to breast and ovarian cancer in women. He may have gotten the mutation from his mother, who is also a breast cancer survivor. It has also been linked to prostate cancer, which Kaitz was treated for in 2009.

A powerboater and motorcycle buff, Kaitz jokes about being a man with a woman’s disease but said he is not embarrassed and doesn’t mind showing his breast surgery scar.

The one thing he couldn’t tolerate was tamoxifen, a hormone treatment commonly used to help prevent breast cancer from returning in women. It can cause menopausal symptoms, so he stopped taking it.

“It killed me. I tell you what — night sweats, hot flashes, mood swings, depression. I’d be sitting in front of the TV watching a drama and the tears wouldn’t stop pouring,” he said.

Doctors sometimes prescribe antidepressants or other medication to control those symptoms.

Now Kaitz gets mammograms every year. Men need to know that “we’re not immune,” he said. “We have the same plumbing.”

AP Medical Writer Lindsey Tanner

Palm Beach Research Sponsors Mergen Martial Arts

Palm Beach Research Center is proud to announce its Sponsorship of MergenMartialArts.com

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Mind – Develop greater discipline, concentration, and self-respect 

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Berries Keep Your Brain Sharp

Berries Keep Your Brain Sharp 

Berries are good for you, that’s no secret. But can strawberries and blueberries actually keep your brain sharp in old age? A new study by researchers at Brigham and Women’s Hospital (BWH) finds that a high intake of flavonoid rich berries, such as strawberries and blueberries, over time, can delay memory decline in older women by 2.5 years. This study is published by Annals of Neurology, a journal of the American Neurological Association and Child Neurology Society, on April 26, 2012.

“What makes our study unique is the amount of data we analyzed over such a long period of time. No other berry study has been conducted on such a large scale,” explained Elizabeth Devore, a researcher in the Channing Laboratory at BWH, who is the lead author on this study. “Among women who consumed 2 or more servings of strawberries and blueberries each week we saw a modest reduction in memory decline. This effect appears to be attainable with relatively simple dietary modifications.”

The research team used data from the Nurses’ Health Study—a cohort of 121,700 female, registered nurses between the ages of 30 and 55—who completed health and lifestyle questionnaires beginning in 1976. Since 1980, participants were surveyed every four years regarding their frequency of food consumption. Between 1995 and 2001, memory was measured in 16,010 subjects over the age of 70 years, at 2-year intervals. Women included in the present study had a mean age of 74 and mean body mass index of 26.

Findings show that increased consumption of blueberries and strawberries was associated with a slower rate of memory decline in older women. A greater intake of anthocyanidins and total flavonoids was also associated with reduced memory decline. Researchers observed that women who had higher berry intake had delayed memory decline by up to 2.5 years.

“We provide the first epidemiologic evidence that berries appear to slow progression of memory decline in elderly women,” notes Dr. Devore. “Our findings have significant public health implications as increasing berry intake is a fairly simple dietary modification to reduce memory decline in older adults.”

This study was funded by grants from the National Institutes of Health (P01 CA87969) and the California Strawberry Commission. The study was independently controlled by the investigators who performed the data analysis.

Source: Brigham and Women’s Hospital

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Eating Chocolate makes you thin?

March 26, 2012 — A recent study showed that frequent chocolate consumption was associated with lower body mass index (BMI), even when adjusting for calorie intake, saturated fat intake, and mood.

Beatrice A. Golomb, MD, PhD, associate professor of medicine at the University of California, San Diego, and colleagues described their findings in a research letter published in the March 26 issue of the Archives of Internal Medicine.

The authors used data from 1018 patients already being screened for inclusion in a widely sampling clinical study evaluating noncardiac effects of statin medications. Of the 1018 participants, 1017 answered the question, "How many times a week do you consume chocolate?" BMI was calculated for 972 participants (95.6%); and 975 (95.8%) answered the validated Fred Hutchinson Food Frequency Questionnaire.

The investigators performed analyses with and without adjustment for calorie intake, saturated fat (satfat) intake, and mood. Fruit and vegetable intake was not associated with chocolate consumption (β, 0.004; P = .55), but satfat intake was significantly related to both chocolate consumption (β, 0.035; P < .001) and higher BMI.

The amount of chocolate consumed was examined, in addition to the frequency of chocolate consumption. Activity (number of times in a 7-day period the participant engaged in vigorous activity for at least 20 minutes) and mood (Center for Epidemiological Studies Depression scale [CES-D]) were also examined.

The relationship between chocolate consumption frequency and BMI was calculated in unadjusted models, in models adjusted for age and sex, and in models adjusted for activity, satfats, and mood.

Study participants consumed chocolate a mean 2.0 (SD, 2.5) times per week and exercised 3.6 (SD, 3.0) times per week. Frequency of chocolate consumption was associated with greater intake of calories and satfats and higher CES-D scores (P < .001 for each of these 3 associations); these all related positively to BMI. Chocolate consumption frequency was not associated with greater activity (P = .41), but it was associated with lower BMI (unadjusted P = .01). This association remained with and without adjustment for age and sex, as well as for calories, satfats, and depression.

Although chocolate consumption frequency was associated with lower BMI, the amount of chocolate consumed was not (eg, per medium chocolate serving or 1 oz [28 g], β, 0.00057 and P = .97, in an age- and sex-adjusted model).

"The connection of higher chocolate consumption frequency to lower BMI is opposite to associations presumed based on calories alone, but concordant with a growing body of literature suggesting that the character — as well as the quantity — of calories has an impact on [metabolic syndrome (MetS)] factors," write the authors.

They further explain that as chocolate products are frequently high in sugar and fat, they are often assumed to contribute to an increased BMI. The authors note that this may still be true in some cases.

"[O]ur findings — that more frequent chocolate intake is linked to lower BMI — are intriguing," write the authors. "They accord with other findings suggesting that diet composition, as well as calorie number, may influence BMI. They comport with reported benefits of chocolate to other elements of MetS," the authors write, noting that a randomized trial studying the metabolic benefits of chocolate in humans may be warranted.

This study was funded by a grant from the National Heart, Lung and Blood Institute, National Institutes of Health, and was supported by the University of California, San Diego, General Clinical Research Center. The authors have disclosed no relevant financial relationships.