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Health and Fitness

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*** a monthly newsletter ***          Vol.2, No.7, July 15, 2003

New In Vitro Fertilization (IVF) Gold Standard Declared

At a recent conference in Montreal/Canada about "Measuring Human Embryo Quality" several IVF research groups exchanged the latest on single embryo transfer, which has become the standard for in vitro fertilization. These techniques are important for treating infertile couples.

In the past an in vitro fertilized egg was implanted into the woman's uterus, but the success rate of a normal pregnancy was extremely low (in the order of 15% to 20%).

Subsequently more than one fertilized egg was implanted to improve the success rate, but this led to twins, triplets and multiple pregnancies with a high complication rate and death due to premature deliveries. Subsequently it was found that the success rate was much higher after a few cell divisions, which were allowed to take place outside the uterus in vitro cultures. Dr. William Schoolcraft (director of the Colorado Centre for Reproductive Medicine at a private clinic in Englewood, Col.) reported that embryos that were cultured for 5 days until the blastocyst stage in vitro are much more stable for implantation.

For the past 5 to 6 years they and other groups have only employed this technique, which according to him is now the gold standard. Although they were largely still using two embryos for transfer into the uterus for IVF. It has become increasingly clear that the risk of twin pregnancies in these already high risk situations is ranging from 4- to 10-times the risk of a single embryo transferred (singleton) into the uterus. Because of this his group has decided to only do singleton transfers. The other new finding is that it matters tremendously what culture medium is used for incubating the fertilized egg for the 5 day period in culture and what the exact conditions are. They found that for optimal results they have to use two different growth media, the first 3 days a low glucose or glucose free medium that mimics the environment of the fallopian tube. On day 4 and 5 the medium must mimic the environment inside the uterus, which requires it to be rich in amino acids and contain glucose.

An embryologist, Dr. Barry Behr from the Stanford University Medical Centre in California, reported that the same culture medium is not necessarily suitable for all patients, but individualization and close observation of the wellbeing of the embryo and the mother is necessary. To optimize maximum quality of the embryos growth factors may also have to be introduced into the culture medium and further research is going on in this direction.

This report is based on a summary in The Medical Post , June 24, 2003, page 8.

Here is a useful link regarding the topic of infertility: Link to chapter on infertility in my nethealthbook.com

Report Says: High Blood Pressure Increasing In The US

Dr. Hajjar, of the University of South Carolina in Columbia and Dr. Kotchen, of the

Medical College of Wisconsin in Milwaukee have compared a large group of people in the US in the years 1999-2000 with prior studies in 1988-1991and 1991-1994 where peoples' blood pressures were measured.

The latest study involved more than 5000 people, the prior studies more than 9000 people each. Almost 29% of the population has a blood pressure of 140/90 or higher in the latest study.

Compared to the 1988-1991study this is a significant increase of 3.7%. More than half of this was explained on the basis that the population's weight (measured by body mass index calculation) had increased. The sub groups who had the largest increase in blood pressure were as follows:

1. diabetics with high blood pressure. In this high risk group only about 25% had a blood pressure readings of less than 130/85, which is the target value.

2. Mexican Americans had a significantly poorer awareness and control of their elevated blood pressures than the non-Hispanic whites and non-Hispanic blacks.

3. Women as a group were poorer in blood pressure controlling than men.

4. People above the age of 60 had a much higher rate of uncontrolled blood pressure as well.

The study concluded that by concentrating campaigns and efforts on these four target groups significant gains could be made in terms of control of blood pressure, reduction of strokes, heart attacks and kidney damage.

Here are some links regarding high blood pressure and prevention of strokes and heart attacks to various chapters of my nethealthbook.com:

High blood pressure link.

Heart attack link.

Stroke link.

Food And Mood

"Food affects your mood" is the heading of an article by Dr.Susan Biali (practising family physician with a degree in dietetics) in the June 24, 2003 edition of The Medical Post (page 24). According to her there is good evidence in the medical literature to indicate that a number of biologically active brain hormones depend on what we eat. There are 5 major items that she pointed out, which I summarized below in tabular form.

The medical literature points to the importance of these various food factors to allow us to have a balanced brain metabolism. When these ingredients are present our mood is more likely to be normal with more resilience to depression.

The literature centers around various population groups in comparison with the North American population. For instance, in an article of the Dec. 2000 issue of Psychiatric Clinics of North America a study was reported that found that Taiwanese and Chinese people consume a lot more omega-3 fatty acid rich foods such as fish than North Americans.

In the same study the rate of major depression was found to be 10-times more frequent in North Americans and the investigators felt that this was so because of the brain hormone stabilizing effect of the omega-3 fatty acids. Other researchers suggest that chronic stress might lead to a depletion of omega-3 fatty acids in the brain through an oxydation process, which eventually results in depression.

Several nutritional factors appear to have caused deficiency states of essential brain nutrients, one being the junk foods like candy bars, French fries, hamburgers etc. leading to a dysbalance of the omega-6 fatty acid to omega-3 fatty acid ratio. Another factor is the increase of consumption of highly refined carbohydrates (sugar and starch), often also called high glycemic foods. This is known to lead to the metabolic syndrome, also called syndrome of insulin resistance. Finally many people still have too much fat in their diets with a high amount of hydrogenated vegetable oils (see link). It is also important to note that folate, Vit. B6 and Vit.B12 are required for prevention of hardening of the arteries by lowering homocysteine levels.

So what is "brain food" ? Dr. Biali pointed out in her article that it is always best to start with a low fat, well balanced food plan where junk foods are avoided and where vegetables and fruit provide the low to medium glycemic index carbohydrates. Fish should be eaten at least three times per week to provide the brain with the essential omega-3 fatty acids.

It is probably not recommendable to take tryptophan as a supplement: in 1989 several fatalities occurred from impurities in commercial tryptophan and many researchers are concerned about dysbalancing the network of brain hormones by giving an overdose of only one amino acid, but not giving enough of the others. It is much safer to simply eat enough protein (meat, soy protein, milk products) and the body can pick and choose what it needs in terms of amino acids including tryptophan. With folates one needs to be careful not to exceed 0.8 mg per day as with mega-doses of folate in the 15 mg range toxic symptoms of vivid dreams, disturbed sleep patterns and even occasional seizures developped. A good multivitamin supplement will not only provide the right folate dose, but also Vit. B12, which is also needed to prevent depression.

Obesity And Metabolic Syndrome

In the June 10, 2003 edition, following page24, of The Medical Post there was a minisymposium on obesity and the metabolic syndrome (also known as the "syndrome of hyperinsulinism").

Four specialists had a discussion about this topic: Dr. Ehud Ur (endocrinologist, Dalhousie University, Halifax, N.S., Canada), Dr. Robert Dent (Director of the Weight Management Clinic, Ottawa Hospital, Ont.), Dr. Dominique Garrel (Director of Department of Nutrition and endocrinologist, University of Montreal, Quebec), and Dr. Arya Sharma (Prof. of Medicine, McMaster University, Hamilton, Ont.).

Introduction:

Obesity is now a health threat that about 25% of the North American population is suffering from. There is still a lot of discussion what the exact criteria should be, but the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) has simplified the detection of the metabolic syndrome.

The experts agree that when three or more of the criteria mentioned in this table are positive the person would be considered to have metabolic syndrome.

There is a wide age-related variety: in one study only 7% had metabolic syndrome in the age group of 20 to 29. The same study found 40% of study participants had the metabolic syndrome in the age group of 70 years and older. It is thought that too many calories coupled with too little activity over a longer period of time, perhaps coupled in some people with a genetic tendency to develop metabolic syndrome, leads to an accumulation of abdominal (so-called"visceral") fat.

Because fat cells have their own hormone systems (leptins etc.) there is a change of metabolism including an elevation of the insulin level with associated loss of "insulin sensitivity". So, the more obese a person becomes, the less effective insulin becomes in transporting blood sugar through cell walls. At the same time the liver metabolism is changing with the good cholesterol (HDL) being less produced and the bad cholesterol (LDL) being overproduced. The liver will produce a different mix of coagulation factors, which leads to a tendency to form clots in the veins of the legs and in the lungs. As the pancreatic capacity for insulin production gets exhausted over a period of time, the patient eventually develops type 2 diabetes mellitus. Due to the risk of the coronary arteries clogging up with the cholesterol changes and the accelerated hardening of arteries from diabetes, the risk for getting severe heart attacks in obese people with the metabolic syndrome when compared to a normal weight population is about 4-fold.

Treatment of metabolic syndrome:

The experts agreed that a reduction of only 5% to 10% of the body weight through a sensible combination of a mild exercise program (e.g. walking 30 to 45 minutes every day) and a calorie reduced food intake will make a significant difference in terms of normalization of the body chemistry. It is my estimate that perhaps 70% to 90% of all cases of obesity and metabolic syndrome can be treated this way.

However, the remaining cases should continue to see their physician and be followed like the doctor would follow someone who has high blood pressure. There are two types of medications available and they have nothing to do with the Phen-Fen diet pills from not too long ago that were found to cause pulmonary hypertension. These new diet pills are fairly safe and show weight loss results provided the patient co-operates with regard to a modified to low fat diet and some degree of regular exercise.

1. Sibutramine (brand name: Meridia) is a specific brain hormone inhibitor in the area where the appetite zone is located (serotonine and norepinephrine reuptake inhibitor). This medication helps the patient by experiencing satiety sooner so that the patient does not feel deprived despite less calorie consumption.

It is the medication of choice for those who tend to eat a lot. Like with other anti-depressants side-effects are a dry mouth, heart rate increases and sleep loss (insomnia).

2. Orlistat (brand name: Xenical) inhibits fat uptake at the level of the gastrointestinal wall (gastrointestinal lipase inhibitor). This leads to an inhibition of fat absorption by about 30%. The patient needs to keep the fat intake down to about 2 oz. (=60 gm) per day. If the patient consumes more fat, the side-effect of orlistat will be flatulence, abdominal cramps and diarrhea. If the patient is on a strict low fat diet, there would not be enough fat in the gut for the medication to be effective.

At this point it is not known how long the patient should be on such weight loss medication, if this was the chosen route. The experts felt that 1 year would be reasonable, but that the patient should be observed by the treating physician and it may be necessary after some intermission to go for another year of therapy all the way attempting to permanently change eating and exercise habits as an ongoing maintenance program.

Here is a link to another reference about the metabolic syndrome (syndrome of insulin resistance).

Beware Of Binges

In the June 16, 2003 issue of Time (page 73) an article appeared under the heading "Summertime booze". A study from the Buffalo University showed that women, in particular, have to be conscious that drinking 3 or 4 drinks at one time on the weekend is not the same as drinking the same 3 to 4 drinks over the course of one week.

A study looking at the frequency of breast cancer in relation to drinking patterns found that the binge drinking women had a 80% higher breast cancer risk than the controls who drank 3 to 4 drinks at a time (but only one drink per day). Jo Freudenheim, the epidemiologist involved in this study, suggested that perhaps with the binge drinking alcohol's toxic potential for breast cancer cells had been reached whereas with one drink at a time over one week this level was never encountered.

In another study from the Buffalo University liver toxicity as a result of alcohol exposure was examined. These researchers used blood tests to measure liver enzymes, which were leaking from the liver cells as a result of the toxic effect of alcohol. Both men and women were tested and various drinking patterns were also studied. Men who drink several drinks daily had the highest liver enzyme counts (reflecting the toxic effect of alcohol on the liver). However, women who drink only on weekends had even higher counts of the liver enzymes than men! Women who drank on an empty stomach had much higher liver enzymes in these studies than men where this effect did not show (with men it did not matter whether they drank with food or on an empty stomach).
The researchers concluded that binge drinking appears to affect women more than men. Generally speaking the higher the amount of alcohol consumed, the more toxic the effects on body cells and on the liver. Moderation may be in order.

Comments: These type of studies are particularly important in view of the fact of marketing techniques of the wine industry. Wine and alcoholic beverages are being protrayed as being a good source of bioflavonoids that are lowering cholesterol and would prevent or postpone heart attacks. Some of the data on cancer indicates that for ovarian cancer and colorectal cancer there may not be a safe low dose as even one drink per day can have a measurable effect on cancer risk. On the other hand, bioflavonoids are abundantly present in raw vegetables and fruit, so there is no panic about not getting enough heart attack preventing foods. Finally, a bit of common sense does not harm: alcohol is a cell toxin, so it should be diluted (nothing stronger than wine) and if you desire a drink, use it in moderation.