Jan
    03
    2004

    Old-Fashioned Fish Oil Boosts Heart Health

    You do not need to spoil your appetite with the thought of swallowing cod liver oil, but see yourself enjoy a piece of salmon instead. Dr. Jehangir N Din and collegues published an article entitled “Omega 3 fatty acids and cardiovascular disease—fishing for a natural treatment” in the first January edition of the British Medical Journal (BMJ 2004;328:30-35,January 3, 2004). These cardiology researchers from the University of Edinburgh/England have reviewed all of the recent medical literature regarding the beneficial effects of omega-3-fatty acids on heart disease. The following are some facts they found.

    The interesting story regarding the omega-3-fatty acids, which have anti-inflammatory qualities, is that they balance the detrimental effects of the omega-6-fatty acids, which lead to inflammation not only in joints, but also in blood vessels. In the standard North American and European foods the omega-6-fatty acids are overconsumed. To counter the bad effects of the omega-6-fatty acids, more omega-3-fatty acids need to be ingested.

    Old-Fashioned Fish Oil Boosts Heart Health

    Old-Fashioned Fish Oil Boosts Heart Health

    So, what should we consume in terms of omega-3-fatty acids? The American Heart Association made the recommendations in the second table below.

    Current consumption of omega-3-fatty acids in North America and Europe is low. Recently an expert US panel of nutritionists determined that the US consumption per day is about 0.1 to 0.2 grams per day and should be 0.65 grams per day as a minimum according to the recommendations by the American Heart Association.

    Facts regarding omega-3-fatty acids:
    Omega-3-fatty acids from fish and fish oils protect against heart disease
    Following heart attacks fish oil is helpful in preventing more heart attacks
    Hardening of arteries stops when fish oil or fish is eaten regularly
    Rapid response critics pointed out that exercise is as important as fish oil
    Trials with fish oil showed reduction in death rates from strokes and heart attacks from between 15% and 29% over 2 to 3.5 years (several studies)
    The beneficial effects are due to a combination of stabilizing irregular heart beats, preventing clots, countering hardening of arteries, countering inflammation, improving function of lining of arteries, lowering of triglycerides (bad fatty acids) and lowering of blood pressure

    The authors of this paper from England disagree and state that at least 1 gram per day would be needed to lower the heart attack risk to the low levels in Asia. The British Nutrition Foundation has recommended to use 1.2 grams of omega-3-fatty acids per day.

    Fish or fish oil capsules as a protective effect on blood vessels*
    Patients without documented coronary heart disease: Eat a variety of (preferably oily) fish at least twice weekly. Include oils and foods rich in inolenic acid
    Patients with documented coronary heart disease: Consume 1 g of eicosapentanoic and docosahexanoic acid daily, preferably from oily fish. Supplements could be considered in consultation with a doctor
    Patients with hypertriglyceridemia: Take 2-4 g of eicosapentanoic acid and docosahexanoic acid daily, provided as capsules under a doctor’s care
    *As recommended by American Heart Association 

    How does that translate into how much fish you would have to eat to get about 1 gram of omega-3-fatty acids per day? To make things simpler I have categorized fish and seafood in the table below based on the data from this article into low, medium and high marine derived omega-3-acid foods. You obviously need to eat more of the low category seafood to achieve 1 gram of omega-3-fatty acid than of the high category seafood.

    How much fish and seafood you need to eat to get 1 gram of omega-3-fatty acids…
    Concentration of omega-3-fatty acids in seafood: Type of fish and seafood consumed:
    Low (eat 1 lbs) Catfish, Haddock
    Medium (eat 1/3 -1/2 lbs) Tuna, Halibut, Oyster, Cod, Flounder, Sole
    High (eat 2 or 3oz.) Atlantic salmon, Sardines, Rainbow trout, Atlantic herring, Mackerel

    Before you overindulge in seafood from the low and medium category, check with your doctor first whether you are allowed so much protein. Some people have protein restrictions due to poor kidney function or because of gout. The authors of this study stated that you should eat a seafood meal with 1 gram of omega-3-fatty acid twice per week. Other sources of omega-3-fatty acids (=alpha-linolenic acid) are plant products such as soy beans,flaxseed, walnuts and rapeseed oil. In Asia fish and soy bean products are consumed in much bigger quantities than in the US.

    Last edited December 8, 2012

    Jan
    03
    2004

    China Blows Alarm Whistle On Smoking

    The risks of smoking are being addressed in China, where roughly 300 million people or one quarter of the population are puffing away. The number is rising by about 3 million new smokers each year, and according to statistics of the WHO 700,000 die each year from smoking.

    In November of 2003 China joined the Framework Convention on Tobacco Control (FCTC), a subsidiary of the World Health Organization. As a member China is now obliged to tighten restrictions on cigarette marketing and consumption.
    Due to an economic boom in the country foreign tobacco giants are putting their hope into this rising market, as revenue has decreased elsewhere in the world. So far tobacco taxes, which are collected from the 1.7 trillion cigarettes sold in China amount to 8 billion $US or one tenth of government revenue. In the wake of SARS, however, the realization has come to the forefront, that health care cost have a severe impact on the economy of a country. Despite the seemingly enticing short-term gain from tobacco tax revenue, short cuts in health care can economically damage a country in the long run.

    Health officials will have a battle with their counterparts in finance, when it comes to implementing tobacco control. In some areas of the country the sale of tobacco products to children has been banned and an attempt has been made to restrict cigarette commercials.

    China Blows Alarm Whistle On Smoking

    Quit smoking!

    Powerful tobacco lobby groups actively undermine these efforts.
    It is encouraging to see at least a beginning of public education about the risks of smoking. However, in a nation where cigarette manufacturing and consumption are the highest worldwide, it will be a long and arduous journey to clear the air to better health.

    Based on The Lancet 363, No. 9402 (Jan. 3, 2004)

    Last edited December 8, 2012

    Jan
    01
    2004

    Flu Season Not Over Yet

    Influenza type A is the cause of many flu epidemics including the one that recently affected the northern hemisphere. It is known to change its surface characteristics from time to time. This has occurred in the southern hemisphere (Australia and New Zealand) during the summer of 2003 and the same new type has caused the recent epidemic in Canada, the US and Europe.

    Prior strains of flu viruses in recent years were variants of the Panama strain, that’s why the infection specialists decided in the beginning of 2003 to suggest a Panama strain type vaccine to be used for protection for this flu winter season. However, 70% of the cases tested in Canada by the end of November turned out to be influenza type A/Fujian,full name A/Fujian/411/2002(H3N2), different from type A/Panama, full name A/Panama/2007/99(H3N2), according to Dr. Theresa Tam. She is a specialist in the division of respiratory diseases at the Health Canada Centre for Infectious Disease Prevention and Control. Similar observations regarding a shift from the type a/Panama to the type A/Fujian strain of the flu virus has also been reported in the US and in Europe. It appears that those who have been vaccinated with the type A/Panama vaccine have had partial protection from this new flu as some of the flu virus characterisitics (e.g. the H3N2 determinants) are the same.

    Dr. Tam mentioned that the recent deaths in children from the flu in the US, England and Canada would likely be explained by the fact that in the last 3 years there have not been any H3 type flus and the flus that did circulate were relatively mild. This means that children have not developed enough background resistance to fight a flu when it comes. Most adults have background resistance, but older people are loosing some of the resistance due to aging. Dr. Tam explained that not too many children have had the flu vaccination. One would expect that children are most vulnerable for the flu and this explains why these deaths would have occurred.

    Flu Season Not Over Yet

    Flu Season Not Over Yet

    Production of flu vaccines that protect from flus: One of the problems with getting the best match for an upcoming flu season is the lag period between the decision to produce a certain type of flu vaccine and the mass production of the vaccine to serve a world population. This can take 6 to 8 months. A new technique of vaccine production is being investigated, called “reverse genetics”, where the lag period may only be a few weeks.

    Dr. Webster, an infectious disease specialist at the St. Jude Children’s Research Hospital in Memphis, has produced a vaccine with this method against an avian flu with the characteristics H5N1(different from the others mentioned above). This is an older flu transmitted by birds that has resurfaced earlier in 2003 again. However, this vaccine that has been produced in cell culture and not in egg cultures, has only been tested in animal models, not in humans yet. Both Dr. Webster and Dr. Tam agree that human trials under FDA guidelines are needed to test these newer vaccines utilizing reverse genetics. Regulatory and patent issues need to be settled for this to happen.

    Use of antiviral drugs: Another issue is that type A influenza can be treated with antiviral antibiotics, but every flu season these types of drugs tend to run short. Each country should have a national stockpile of these antiviral drugs (such as Tamiflu) so that enough stock is available in case of a serious epidemic where the vaccine may not fit the flu strain that comes around. This is not happening at the present.

    What is needed is that international discussions take place through the Global Health Security Network (right now consisting of the G7 countries and Mexico), Dr.Tam said.

    Conclusion: The flu season has started early this season. Many people have died because of a lack of vaccination. Some of those who were vaccinated against the flu may have caught the flu as the fit this year with regard to the vaccine was not the best. However, they likely survived the flu, whereas those who did not have the vaccine were more likely to have experienced the flu more severely and some of these have died. It is not too late to get the flu vaccine before the spring season. Typically there is another peak of the flu between February and April.

    Based in part on The Medical Post, Dec.9, 2003 (p.1 and 73).

    Last edited December 8, 2012

    Dec
    01
    2003

    Bystanders Become Lifesavers: Immediate CPR Improves Survival

    Cardio-pulmonary resuscitation (=CPR) is known to save lives, but it has been known for some time that it has to be applied as early as possible to save lives on the longterm. In a recent study in Ottawa/Ont., which was published recently in the medical journal Circulation, the OPALS study checked out survival data.

    OPALS is an acronym for Ontario Prehospital Advanced Life Support Study. One of the lead authors, Dr. Ian Stiell, emphasized that CPR done by bystanders (such as immediate family members) right in the beginning of a cardiac arrest will double the probability of having a survivor with quality of life that is very good.

    Here are some detailed figures from that study. Only 14% to 15% of patients who suddenly collapse and are in need of CPR actually receive CPR. There were 8,091 cases of cardiac arrest that occurred between 1995 and 2000 in Ontario. Only 5.2% (418 patients) survived until the time of discharge from the hospital. 4% (324 patients) survived until the timeline of 1 year after the event. Of these the researchers were able to interview 268 survivors.

    Bystanders Become Lifesavers. Immediate CPR Improves Survival

    CPR saves lives

    The following are a few observations from the OPALS study:

    1. 85% of cardiac arrests happen at home.

    2. 43% of cases are witnessed by bystanders, so if they all would know CPR about 3-times more unconscious patients could receive CPR (14% to 15% times 3 equals about 43%).

    3. 65% of cardiac arrests in the OPALS study occurred in men. The authors recommended that women over 40 should get trained in CPR.

    4. Women usually play a more pivotal role in taking care of elderly parents, of their spouse and of children, which puts them more likely into a situation where bystander CPR is required.

    5. Family members of heart attack survivors should be encouraged to take a CPR course as the probability of a cardiac arrest is higher in these patients.

    6. All 4 links to successful resuscitation are important: CPR by a bystander; defibrillation; rapid access to care; early advanced cardiac life support.

    7. Contrary to rumors the long term outlook of successfully resuscitated patients is good and after 1 year the survivors have a quality of life as good as their healthy peers. However, without CPR initially the quality of life is only half as good as those who had someone provide CPR on them. The authors found it difficult to dispel some of the misconception surrounding CPR. Some of the myths are the notions that a person could do some harm by administering CPR or not performing CPR it correctly. They said it is important to be decisive and administer CPR to an unconscious person and call for an ambulance.

    Summary: The OPALS study re-emphasized the importance for everybody to learn CPR. You never know when you need this skill. The more people know it, the more lives will be saved.

    Here is a link to the University School of Medicine site entitled “Learn CPR – you can do it!

    Last edited December 8, 2012

    Dec
    01
    2003

    Fat Cells Secrete Hormones That Raise Blood Pressure

    Fat cells are known to secrete a number of substances that affect the lining of the arteries and that are also known to be associated with the metabolic syndrome. One of the observations that physicians were aware of for some time is that aldosterone, a hormone from the adrenal glands, is often elevated in patients with high blood pressure and obesity or people who are overweight.

    Dr. Ehrhart-Bornstein and her group from the University Medical Center, Heinrich Heine University of Düsseldorf in Germany investigated this interaction between fat cell metabolites and the cells of the adrenal cortex in more detail. They used a tissue culture model with human adrenocortical cells (NCI-H295R). To their surprise they found two separate hormone factors that were produced by fat cells and that showed in the tissue culture system a 7-fold increase in aldosterone hormone release. As aldosterone is a mineralocorticoid hormone they called these new releasing hormones mineralocorticoid-releasing factors. Further characterization of these factors demonstrated that one was of a higher molecular structure and was heat-sensitive, the other one was smaller in size and was more heat resistant. Each factor alone lost much of the aldosterone releasing activity, but when recombined they had 93% of the original action. Synthesis of messenger RNA inside the adrenocortical cells was stimulated by a factor of 10-fold from the action of the mineralocorticoid-releasing factors. Other hormones were also somewhat stimulated such as release of cortisol by a 3-fold increase and DHEA by a 1.5-fold increase. Other known substances from fat cells were entirely ineffective in this testing system.

    Fat Cells Secrete Hormones That Raise Blood Pressure

    Adipose cells secreting aldosterone releasing factor

    When asked how this new research might fit in with the observation that loss of fat through calorie restriction has a beneficial effect on high blood pressure, the authors commented that with less fat storage in fat cells during weight loss the production of mineralocorticoid-releasing factors would go down significantly and aldosterone would be released at a much lower rate thus decreasing blood pressure through the aldosterone/angiotensin/renin mechanism.

    Nov. 12, 2003 paper on which this write-up is based: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC283571/

    Last edited October 26, 2014

    Dec
    01
    2003

    New Cholesterol-Lowering Drug Reduces Inflammatory Marker

    With newer knowledge about the process of hardening of the arteries from the ongoing Framingham study it is not surprising that the drug companies are shifting the development of cholesterol-lowering drugs to those substances that will reduce inflammation of the arteries as well. In previous issues of the health newsletter I summarized a paper that was published on the importance of the C-reactive protein (also called CRP) in connection with the diagnosis of heart attacks and strokes. I also reviewed an article that pointed out that both CRP and LDL cholesterol are important in determining who is at risk for developing a heart attack or stroke.

    In a press release to Reuters on Nov. 13, 2003 Merck & Co. Inc. and Schering-Plough Corp. announced that ezetimib (Zetia), a new cholesterol-lowering drug that is marketed by both companies, was found by their researchers to lower C-reactive protein (CRP) significantly. At the annual meeting of the American Heart Association in Orlando/Fla. these researchers presented a clinical trial showing that ezetimib when used in combination with small amounts of simvastatin (Zocor) lowered CRP by 33%. However, simvastatin alone lowered CRP only by 14.3%. Dr. Christie Ballantyne, a Baylor College cardiologist, pointed out that this new finding was very important. It was important, because it shows that these drugs do not only lower LDL cholesterol, which according to the Framingham study is a known risk factor for heart attacks and strokes. In addition it has now also been proven to lower CRP significantly at the same time, which is another known inflammatory component produced by the blood vessels also associated with heart attacks and strokes.

    New Cholesterol-Lowering Drug Reduces Inflammatory Marker

    New Cholesterol-Lowering Drug Reduces Inflammatory Marker

    Merck and Schering-Plough are now developing a new formulation containing both of these medications as one pill (Vytorin). This has the advantage to lower the risk on liver cells of Zocor by being able to lower the dose in the pill. The Zocor component will mainly lower the LDL cholesterol in the blood (and the CRP somewhat as well) and the Zetia component will provide the beneficial effect of the CRP lowering (anti-inflammatory component and LDL lowering). There is another advantage of this combination: Zetia works by inhibiting absorption of cholesterol by the gut, Zocor works by inhibiting cholesterol synthesis in the liver cells. Whenever the mechanism of action is different two drugs in combination are usually better tolerated than if both would work through the same mechanism. However, the companies pointed out that more research and clinical trials are needed to check out side-effects of Zetia before it would be submitted to the FDA for approval for general prescription by physicians.

    P.S. on Oct. 31, 2012: Read the following article about Zetia and Vytorin (the combination pill): http://www.nytimes.com/2008/01/14/business/14cnd-drug.html?_r=0

    Links regarding further information about heart disease (Net Health Book).

    Last edited December 9, 2012

    Dec
    01
    2003

    Help For Patients With Iron Overload

    Patients who are born with an inborn enzyme defect that leads to iron overload (hemochromatosis) and others with secondary hemochromatosis due to sickle cell anemia will benefit from new research by Dr. Gavin Oudit, Dr. Peter Backx, Dr. Peter Liu and others. The researchers at the University of Toronto and Toronto General Hospital have published their findings in the Sept. 15 issue of Nature Medicine.

    In animal experiments they found that the same calcium channels that transport calcium to vital organs are also the channels through which poisonous levels of iron are introduced with iron overload disease. In both animal experiments and in the clinical situation, human iron overload affects mainly the pancreas, the heart muscle and the pituitary gland. The authors of this study found that in hemochromatosis patients the calcium channel blockers, such as amlodipine (Norvasc), verapamil or diltiazem will stop the accumulation of toxic levels of iron in these organs.

    Dr. Peter Backx, professor of physiology and medicine at U of T in the Heart & Stroke/Richard Lewar Centre of Excellence and senior author of the paper, explained that more detailed research determined that the L-type calcium channels that play a role in the normal calcium transport across the cell membrane are the same channels that allow the iron molecules into the heart muscle cells and into the cells of the other organs that get damaged with hemochromatosis. By using calcium channel blockers, heart drugs that are already on the market, it is possible to prevent accumulation of iron to the point of toxic levels. Up to now the only approach to therapy was to remove excessive iron from the body by expensive iron chelation medication that had to be given intravenously.

    Help For Patients With Iron Overload

    Further clinical trials on a larger patient population are necessary to determine who will benefit most from this approach of treating iron overload conditions with calcium channel blockers and what dosage to take. Dr. Peter Liu is another senior author regarding this study and is a cardiologist at the Toronto General Hospital and director of the Heart & Stroke/Richard Lewar Centre of Excellence and professor of medicine and physiology at U of T. He stated that this alternative therapy for heart failure from iron overload cardiomyopathy will likely open the doors for those patients worldwide who could not afford to have expensive chelation done, which is presently the only treatment method to remove the excessive iron. People of North American, European, Mediterranean or Asian descent are more prone to genetic hemochromatosis, thalassemia and sickle cell anemia that can all lead to iron overload requiring this type of therapy.

    Last edited December 9, 2012

    Dec
    01
    2003

    New Tumor Marker For Prostate Cancer Detected

    According to an upcoming article in the December 15th issue of Cancer (Cancer 2003;98) a research group from the Harvard Medical School, Boston, under Dr. Brian Liu describes a micro-dissection method where prostatic tissue from 17 suspected cancer patients were examined with a spectroscopic method for a new protein marker, the cellular protein PCa-24). This was found to be positive in 16 of the 17 samples. In contrast, 12 patients with benign prostatic hyperplasia (also known as BPH or “benign prostatic hypertrophy”) showed no trace of this prostate cancer specific protein. As this protein is located inside the prostate cancer cell (it is a cellular protein), one has to obtain a tissue sample through a prostate biopsy. The group under Dr. Liu achieved this through laser capture micro-dissection  Proteomics, which is the method that was used to characterize the prostate cancer specific protein (PCa-24), is briefly discussed under this link, but it is not necessary to understand all of the ramifications of these methods. What is important regarding the work by the group under Dr. Liu is to note that there is now a very reliable method available to distinguish between the harmless BPH condition and the deadly prostate cancer condition, which requires invasive therapy such as a radical prostatectomy. Both of these conditions can produce high prostate specific antigen (PSA) that can be detected in the blood. Dr. Liu’s group plans to develop antibodies to the PCa-24 protein so that eventually there will be a more specific blood test available that could be used in patients with high PSA levels to distinguish between benign and cancerous prostate conditions. In the future the physician might use the cheaper PSA screening test to screen for prostate abnormalities and use the more expensive antibody test against the PCa-24 protein that is being developed to determine whether or not prostate cancer might be the underlying cause.

    New Tumor Marker For Prostate Cancer Detected

    New Tumor Marker For Prostate Cancer Detected

    Dr. Liu also wants to develop a high resolution body scan where in the case of metastatic prostate cancer the cancer cells would be located exactly where they are with a new imaging technique. These would have a high probability of being specific for prostate cancer, as the antibodies would be highly specific against the prostate cancer protein. Here is a link to the Net Health Book’s chapter on prostate cancer.

    Last edited December 9, 2012

    Nov
    01
    2003

    Growth Factor In Breast Milk A Key In Protecting Infants From Asthma

    It has been known for some time that breast milk plays a preventative role in infants. It transmits antibodies and protects from viral illnesses, but it also prevents the infant from developing asthma. Dr. Anne L. Wright, from the University of Arizona in Tucson, and colleagues published a study of 243 infants/mothers in the October issue of the Journal of Allergy and Clinical Immunology (J Allergy Clin Immunol 2003;112:723-728).

    They measured cytokines and growth factors in breast milk and examined the infants paying particular attention to wheezing as a symptom of asthma. One of the cytokines, called transforming growth factor (TGF)-beta1, was inversely related to the amount of wheezing in the infants. In other words, the higher the level of this growth factor was in breast milk, the more protected from asthma the infant was. This was a highly significant correlation. After 3 months of being fed with breast milk with the highest level of TGF-beta1 the infants’ asthma rate was reduced by 78% compared to the rate of asthma found in infants fed only short-term with low level TGF-beta1 breast milk.

    In their future research the investigators intend to investigate the effects of these breast milk cytokines on the cells, which form the lining of the airways, the immune system and the cells lining the gut in infants. There is already preliminary data to suggest cytokines play an important role in stabilizing these cells.

    Growth Factor In Breast Milk A Key In Protecting Infants From Asthma

    Breastfeeding prevents asthma

    Here is a link to a chapter on asthma from the Net Health Book.

    Last edited October 26, 2014

    Nov
    01
    2003

    Stroke Risk Increases With Carotid Artery Disease

    An important study about the risk of strokes and mini-strokes (called”transient ischemic attacks”) was published in the Oct. 27 edition of the Archives of Internal Medicine. Dr. Daniel J. Bertges and his group followed 1,004 patients between 1988 and 1997 with ultrasound studies of the carotid arteries (carotid artery duplex ultrasound scans). The studies took place at the Pittsburgh Veterans Affairs Medical Center/University of Pittsburgh School of Medicine. Patients were followed with regard to events such as strokes on the side of where the narrowed carotid artery was.

    Reversible mini-strokes (medically correct term:”transient ischemic attack” or TIA) were also registered. A total of 1,701 narrowed arteries (called “stenotic arteries”) were found with this ultrasound method. All of the patients initially had no symptoms of the carotid artery stenosis (no dizziness, no fainting, no absence spells or symptoms of TIA or stroke). In 75% of the patients the carotid stenotic lesions were less than 50% meaning that the carotid artery blood flow was acceptable.

    Here are some of the risks as the study went on over the years: both TIA and CVA risk in a given patient occurred at a rate of 3.3% per year. Regarding a specific involved artery the risk of developing a TIA as a result of this was 2% per year and the risk to develop a stroke was 2.1% per year. The investigators found that two main factors determined the ultimate progression into a TIA or a stroke and they were as follows. First, if the artery was severely stenosed at the outset, the probability was high that this would progress and be the cause of a stroke. Secondly, the degree of progression when checked with a follow-up duplex ultrasound was another important factor in terms of leading to a subsequent TIA or stroke.

    Stroke Risk Increases With Carotid Artery Disease

    Carotid artery clot can cause stroke

    The composite risk of developing either a TIA or a stroke with a worsening stenotic carotid artery lesion was 1.68-fold. To develop a stroke alone in this scenario the risk was 1.78-fold. Clinical risk factors were of no help in predicting which cases would go on to develop TIA’s or strokes. However, the finding of further progression of a stenotic carotid artery lesion documented on serial duplex ultrasound studies was highly significant.

    The authors concluded that there is value in doing serial carotid artery duplex scan studies in the same patient to screen for progressing stenotic lesions in the carotid arteries. When a stenotic lesion is significant enough or progressing fast, intervention by a cardiovascular surgeon with carotid endarterectomy can be done to prevent a stroke or TIA.

    Here is a link to a chapter on strokes from the Net Health Book.

    Last edited October 26, 2014