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Worldwide Alert For Avian Influenza (Bird Flu)

There is a new strain of avian influenza that in the beginning was confined to transmission among birds only. However, with 8 deaths in humans reported in Asia by the end of January 2004 (7 children and one adult) there is a fear that the virus is possibly genetically adapting towards transmission between humans, which could cause a worldwide flu epidemic similar to the flu in 1918 where more than 40 million people died.

Presently the avian flu has killed a high percentage of chickens and ducks in Vietnam, China, Thailand, Indonesia, Pakistan, Cambodia, and Laos. Recently Japan, South Korea, and Taiwan have also been added to the countries where the avian flu has arrived in birds. The governments are busy killing chickens off by the millions in an attempt to stop transmission to man.

All of the human cases were found in people who lived close to chicken farms or who handled diseased chickens.
The virus strain has been characterized as the type A, H5N1 strain (= the H5N1 flu), of the avian influenza. This strain has surfaced in the past on two occasions. First, it hit 18 persons in Hong Kong in 1997 of which 8 persons died. With the help of strict isolation methods an epidemic was prevented. Secondly, in March of 2003 a father and son from Hong Kong had traveled to southern China and they returned sick with the flu. The father died, the son recovered. Disease investigation showed that the source of infection in all of these cases was contact with diseased birds or with live, infected poultry in open markets.

Unfortunately the present flu vaccines will not give protection against this strain. WHO officials had an emergency meeting at the end of January 2004 to discuss the strategy for preventing a worldwide epidemic with
this new influenza strain. Production of a new vaccine will take several months (up to 6 to 8 months), if it is done in the conventional way. The cheaper antiviral antibiotics such as amantadine and rimantadine that normally would cover an A type influenza are ineffective against this new flu strain. There are newer antiviral antibiotics, which are effective, but they are more expensive. With mass production they could become more affordable and this could interfere with the spread between humans, if the virus should adapt to this transmission behavior.

At the present time migratory birds that are infected with the flu virus are spreading the avian flu to birds in other neighboring countries. In the meantime farmers who are not satisfied with only a 10% reimbursement by their governments for forcefully killed chickens are selling chickens on open meat markets, some of which harbor the avian flu, and this is another possible mode of transmission. David A. Halvorson, a veterinary medicine doctor from the University of Minnesota in Saint Paul stated that the risk for avian flu in the US at the present time is low as the US is not importing any live poultry from Asia.

In an interview between Doug Kaufman from MD Consult and the CDC director Dr. Julie Gerberding on Jan. 29, 2004 it was learnt that 10 patients had died so far in Vietnam and Thailand. Six WHO scientist in Vietnam are working with officials to contain the avian flu in Asia so that it won't migrate similar to another outbreak of the same type of avian flu strain in Hong Kong in 1997. It appears that the killing of chickens has made some difference. On the other hand the spreading of the disease among wild ducks is of some concern.

The CDC and WHO are working together on this and are pushing for accelerated production of live and of inactivated vaccines against avian flu. This is a type of vaccine, which would make it impossible for future avian flu strains to cross into human hosts. The mass production of antiviral drugs is also being pursued. Dr. Gerberding stated that oseltamivir (brand name: Tamiflu), one of the newer antiviral drugs, would be effective in treating this type of avian flu (cited in Medscape Medical News Jan. 29, 2004).

Dr. Neill, an infection specialist and professor of medicine at the Brown University School of Medicine in Providence, Rhode Island, said that in case of a future human breakout of an epidemic with this flu the following instructions should be followed: 1. cover your mouth and nose with paper tissue when you sneeze or cough 2. frequently wash your hands with soap and water 3. use designated containers for disposal of the used paper tissues 4. symptomatic patients should use face masks to prevent the spread of the flu.

This article is based on the Lancet (The Journal) Vol. 363, Vol. 9406 (Jan. 31, 2004), on news stories from MD Consult and on Medscape news stories.

Link to Centers for Disease Control and Prevention on avian (bird) flu

More detail about this present flu (also CDC site)

Low Testosterone Linked To Alzheimers

A recent publication in the medical journal Neurology by Dr. Susan Resnick revealed a surprise link between a lack of testosterone and Alzheimers disease.

574 men from the Baltimore Longitudinal Study of Aging who had been followed for about 19 years were analyzed with respect to hormonal factors and their neurological status was also observed. Of these men who ranged in age from 32 to 87 years initially 54 were diagnosed with Alzheimers disease.

When the researchers looked at the hormone status of the men whose mental functioning stayed stable versus those who developed Alzheimers, it was clear that the height of the free testosterone level in the blood (expressed by dividing testosterone by the sex hormone-binding globulin) was a significant predictor for not getting Alzheimers. In other words, if men could maintain a stable level of free testosterone with aging they were significantly protected from Alzheimers disease. The effect was so marked that the blood test could predict 10-years in advance whether a man would develop Alzheimers in future or not. There was a 26% reduction in the risk of Alzheimers with each 10-unit increase in free testosterone.

The same edition of Neurology contains a second report by Dr. Gian Benedetto Melis and coworkers (University of Cagliari, Italy) where around 100 patients (males and females) with Alzheimers were compared with a similar number of patients without Alzheimers. All of their body mass index was in the normal range (20 to 22). These researchers found that the Alzheimers group (both male and female) had an extremely high sex hormone-binding globulin. The testicles in males and the adrenal glands in males and females can produce testosterone. Dr. Resnick remarked that free testosterone can enter the brain tissue (via the blood brain barrier) easily and act directly on the brain or can be converted to estrogen. Estrogen has been shown in other studies to have a protective effect against Alzheimers. Dr. Resnick cautioned that another study where males with low testosterone levels are getting testosterone supplementation has to be done first before a male should be advised to get treated with testosterone for prevention of Alzheimers disease.

This article is based on a publication by Dr. Resnick et al. in Neurology 2004;62:188-193,301-303.

Comments: It is interesting to note that the "old fashioned" remedies such as weight loss, exercise (particularly anaerobic exercises such as weight training) and a low glycemic diet will naturally increase testosterone levels and vitality in both sexes. A comprehensive program such as the zone diet (by Dr. Barry Sears) or a similar such low glycemic program when combined with exercise will automatically make you lose weight down to a normal body mass index and allow you to maintain it without hunger pangs. It will also normalize hormones in most people on its own as previously elevated insulin levels normalize and the sex hormone-binding globulin will normalize as well. This will make the necessary hormones available to you whether female or male, will prevent osteoporosis (from exercise) and provide enough hormones before and after menopause or andropause to most people. Only a minority of patients will need to get blood tests from their doctors depending on symptoms and those need to seek medical advice to see whether they might benefit from hormone replacement therapy.

Kidney Disease, Another Complication Of Metabolic Syndrome

The metabolic syndrome is a new disease entity that is known to be associated with obesity. In order to make the diagnosis of metabolic syndrome at least 3 of the 5 components listed in the table under this link (hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol level or LDL cholesterol, high glucose level, abdominal obesity) have to be present.

Dr. Jing Chen and colleagues of Tulane University School of Medicine in New Orleans, La., published an analysis of the Third National Health and Nutrition Examination Survey in the Feb.3, 2004 edition of the Annals of Medicine. Patients with chronic kidney disease were identified in this study where 3, 4 or 5 of the metabolic syndrome criteria were positive. Two criteria for chronic kidney disease were measured:

1. if there was a significant reduction of the filtration capacity of the kidney.

2. if there was critical leakage of blood protein into the urine.

Depending on how advanced the metabolic syndrome was (all 5 criteria of metabolic syndrome positive versus only 3 or 4) there was a higher or lower risk of developing chronic kidney disease.

Risk of developing kidney disease with various degrees of severity of the metabolic syndrome

I have depicted the results of this study in bar graph form here. It shows clearly that chronic kidney damage occurs in a dose-response curve pattern depending on how severe the degree of the metabolic syndrome is. With 5 factors of the metabolic syndrome present the risk to develop reduction in filtration capacity of the kidneys is almost 6-fold. This is 3-fold higher than in a person with a milder degree of metabolic syndrome where only two factors are present. Such a person would only have a 2-fold risk for developing chronic kidney damage (dark blue shaded bars in graph). A dipstick urine test can measure protein in urine, which is an alternative way to measure kidney damage due to the metabolic syndrome. These values followed a very similar dose-response curve (light blue shaded bars in graph). The authors of this study believe that the kidney damage inflicted by the metabolic syndrome is different from that caused by high blood pressure or by diabetes. Future studies will have to establish whether this type of kidney damage can be repaired by treating the metabolic syndrome with a low glycemic, calorie restricted diet coupled with exercise.

Based on an article published in: Ann Intern Med 2004:140:167-174.

Cinnamon A Natural Insulin Booster For Diabetics

In a recent edition of the medical journal Diabetes Care an interesting article appeared regarding the healing effects of the spice cinnamon. A medical research team in Pakistan (Dr. Khan et al.) in collaberation with a U.S. research team divided a group of 60 comparable diabetics (males and females) in the age range of 45 to 55 and fed one half different concentrations of cinnamon while the other half served as a placebo control. There were three different concentrations of capsules of cinnamon given: 1g, 3 g and 6 g. The placebo control group got capsules with inert material. Here are the results:

The placebo control group showed no change in blood values. The effect documented in this table was achieved after 40 days of cinnamon exposure and was "washed out" after 20 days. Other experiments had found that the substance MHCP (methylhydroxychalcone polymer) is the active ingredient in cinnamon that stimulates insulin and also acts on insulin receptors similar to insulin.

Dr. Richard A. Anderson and his colleagues at the Human Nutrition Research Center of the U.S. Department of Agriculture had already published a number of medical papers on the effects of cinnamon. He was the co-author of this study from the Department of Human Nutrition, NWFP Agricultural University of Peshawar, Pakistan.

The interesting observation here is that several cardiovascular risk factors (blood sugar, triglycerides and LDL cholesterol) are simultaneously being reduced with something as simple as cinnamon powder. The authors stated that the cinnamon oil is not effective, only the cinnamon powder or a cinnamon stick dipped into tea (the water soluble component of cinnamon or MHCP). Dr. Anderson also warned not to make the mistake to eat more cinnamon buns or apple pie as there would be unhealthy amounts of sugar, starch and fat added. He suggested that the best to do instead would be to simply sprinkle cinnamon powder over whatever you are presently eating, as this will reduce the risk of getting diabetes or will reduce the risk of a heart attack in diabetics.

This article based on: "Cinnamon improves glucose and lipids of people with type 2 diabetes." Diabetes Care - 01-DEC-2003; 26(12): 3215-8.

Here is a link to diabetes mellitus (type 2 diabetes).

Less Multiple Sclerosis (MS) With Vitamin D Supplement

In multiple sclerosis (MS) the body's immune system appears to attack the insulation material of nerve cells leading to areas of focal inflammation. These areas can be depicted with MRI scans. A new study showed that vitamin D supplementation (as part of a multivitamin supplement) was reducing the risk of developing MS in women when compared to women who did not take supplements. This study was published by Munger et al. from the Department of Nutrition, Harvard School of Public Health, Boston/MA, in the Jan. 13, 2004 edition of Neurology.

The study is based on data from two large nurses health studies (NHS with 92,253 women followed from 1980 to 2000 and NHSII with 95,310 women followed from 1991 to 2001). The study material was pooled into one database. Among these 187,563 women 173 developed MS during the course of the original studies. When the group of women who took 400 IU or more of Vit.D supplements (as multivitamins) were compared to the group who took less than 400 IU or none, the investigators found that they were 40% less likely to develop MS. Other factors that can lead to higher frequencies of MS such as smoking or latitude at birth had been adjusted for. There has not been a change in the results of the protective effect of Vit.D. With food being the only source for vitamin D (skim milk, fish) the protective effect against MS was not demonstrable. However, when food vitamin D was combined with additional multiple vitamin tablets (with vitamin D) the protective effect against MS was observed.

In the introduction the authors pointed out that Vit. D has been shown in other studies to be an immune response modulator weakening autoimmune reactions. This effect has been shown clearly in a mouse model of MS, called experimental autoimmune encephalopathy. There are also data available from human research, which showed that certain cytokines are released in the presence of vitamin D so that the immune cells are less likely to attack the brain tissue. There were also seasonal variations that could be demonstrated in this study, which indicated that MS lesions were progressing at times when vitamin D levels were low and that they were regressing when vitamin D levels were high.

The authors of this study stressed that this is the first study to suggest a protective effect of vitamin D against MS, which would have to be confirmed in other studies that preferably would also include males. It shows a very strong statistical connection, but cannot conclusively prove causation. The investigators said that further studies will also be needed to confirm the notion that vitamin D may be beneficial as part of the treatment in MS patients.