Found! Fat’s “Master Switch”

Now if only we could find a way to switch it off!

In a breakthrough discovery that has all of us here at Word on Health really excited, scientists have found that a gene that acts as a master switch controlling other genes found in fat tissue.

The study published in Nature Genetics could help to target metabolic diseases such as  obesity, heart disease and diabetes.  More than half a billion people, or one in 10 adults worldwide, are obese. These numbers have doubled since the 1980s as the obesity epidemic has spilled over from wealthy into poorer nations and the trend is expected to continue.

In the United States, obesity-related diseases already account for nearly 10% of medical spending – an estimated $147 billion a year.

Type 2 diabetes, which is often linked to poor diet and lack of exercise, is also reaching epidemic levels worldwide as rates of obesity rise.

The London based research team analyzed more than 20,000 genes in fat samples taken from under the skin of 800 British female twin volunteers. They found the KLF14 gene acts as a master switch to control genes in fat tissues. They confirmed their findings in fat samples from a separate group of people from Iceland.

Genes found to be controlled by KLF14 are linked to a range of metabolic traits, including body mass index, obesity, cholesterol, insulin and glucose levels.

This is the first major study that shows how small changes in one master regulator gene can cause a cascade of other metabolic effects in other genes,” said lead investigator Tim Spector of King’s College London.

The team are now working hard to see how they can use this information to improve treatment of obesity and obesity-related diseases.

As always we’ll be watching, waiting and writing as soon as we hear more.

Pretty Shoes Lead to Pretty Ugly Feet

 With Memorial day weekend upon us, it’s time to start thinking about our summer wardrobe.  And where better to start than with shoes? While we could blog about shoes all day, we’re reminded that this is Word on Health!

With that said…according to a recent study, 39% of women say they wear high heels every day, and 75% of those women have foot problems.  Hardly a  shocker! Just about any poll of our colleagues or friends could have told us that.

Most women accept shoe-related foot pain as a viable alternative to wearing flats.  Bunionsarthritic and hammer toescalluses, and plantar warts are just the price to be paid for great looking gams and killer heels.

Many women wear shoes to work every day that look great but they are simply too small,” said Dr. Pedro Cosculluela, an orthopedic surgeon with The Methodist Hospital in Houston. “The biggest problems we encounter are related to the height of the heel and/or the narrowness of the toe box.”

Poor fit can lead to toe deformities such as bunions.  “As the deformity worsens, the big toe loses its ability to properly carry the load, which can lead to increased pressure along two through five. This can, in turn, lead to pain and cause hammertoes and cross-over toe deformities,” Cosculluela said.

High heels also bend the toes up and can move padding under the knuckles of the foot further down, exposing more bone to the bottom of the shoes, causing a great deal of pain. Frequent use of high heels is also associated with the development of tight calf muscles which can lead to other painful foot problems such as plantar fasciitisflat feet and Achilles tendonitis.

However, there is hope, even for the shamelessly shoe addicted.  Apparently all women need to do is a simple test before they buy to find out if those “must have” shoes will fit:

Take a pen and draw around your bare foot, then put the shoe over the drawing. If your toes stick out of the shoe, they are too small. In which case, you might want to try a bigger pair that will cause you less discomfort.

To see if this works, I just took my very own “footprint” down to my shoe closet. Out of the, well let’s just say, several pairs hiding away in there, only two would have passed the test.  And yes, you’ve guessed it- they’re the “sensible” ones that I never wear.

Do you sacrifice comfort for glamour? Or are you firmly in the flat camp?  Let us know.

Watching What You Eat

In case you hadn’t noticed, the world did not come to an end on May 21st.  Most of us, so we’re told, were not eaten by zombies. However, we did learn of one 6-year-old boy who nearly lost his life because of something someone else ate.

No, we’re not making this up.  In fact, this story comes from the highly respected New England Journal of Medicine, no less. The article reveals that the boy suffered a severe allergic reaction following a blood transfusion from people that had consumed peanuts in the hours before donating their blood.

Dr. Johannes Jacobs, one of the study coauthors, described how three of the five blood donors in this case reported eating peanuts on the evening before they gave blood. It had been a Sunday evening, the night of a big soccer game, and the three donors had been snacking on peanuts as they watched TV.

The boy who received the nut-tainted blood was being treated for acute lymphoblastic leukemia.  During a platelet transfusion he experienced an anaphylactic reaction in which he developed a rash, angioedema, hypotension, and difficult breathing.  Fortunately doctors recognized his symptoms and treated him with epinephrine (adrenaline) and he recovered within 30 minutes.

The patient’s mother stated that her son had had a similar reaction after eating peanuts at the age of 1 year. Since that time, peanuts had been excluded from his diet.

The authors of the report say the boy experienced an allergic reaction because peanuts contain a protein known as Ara h2, which is extremely resistant to digestion and can stay in the blood for up to 24 hours. While such a scenario had been presented as a theoretical possibility in the past, this is the first clinical report of this phenomenon.

Speaking exclusively to Word on Health, Dan A. Waxman MD, President of America’s Blood Centers said “Donor screening measures are quite effective in terms of detecting infectious agents and donor questionnaires tell us if donors need to be excluded because of medicines they are taking such as aspirin or antibiotics.  But, when it comes to what they’ve eaten, we really don’t ask”.

According to the latest Food Allergy Guidelines,  peanut allergies are known to affect about somewhere between 0.6 and 6% of the population.

While the researchers involved with this study are not recommending that blood donors avoid all foods known to be associated with systemic allergic reactions, they caution that more research must be done to determine the level of risk.

In the meantime, SRxA’s Word on Health suggests it may be time to adapt the phrase “Think before you drink, before you drive” to “Think what you ate before you donate.”

Sorry! We Zoned-Out on the Zombies

Happy Monday to all our Word on Health readers.  We’re so glad you survived the May 21st doomsday, doubly so, as we completely neglected to cover last weeks CDC advisory, telling you how to prepare.

Even though the immediate danger appears to have passed, in the event the next TV evangelist is more successful with their end-of-the-world predictions, we want to make sure you’re ready.

The agency’s guidance on how to handle a zombie apocalypse certainly makes more interesting reading than their traditional instructions on how to prepare for Tsunamis, Terrorist Attacks and Plague.

Keep plenty of food and water on hand, plus of course duct tape. Lot’s and lot’s of duct tape! Additionally, they advise keeping a copy of your birth certificate in your emergency kit.  Great advice – we certainly wouldn’t want to be unprepared for a presidential run in a post-apocalyptic world!

CDC also recommends stocking up on household bleach and soap. We’re not sure if that’s to ward off the zombies or to ensure we’re clean before they eat us.  Either way, we’re thinking of substituting these items with wine and chocolate. Not even oblivion can be that bad after wine and chocolate.  And just in case we do survive, our emergency kit will include a TIVO player or two to ensure we don’t miss the final few Oprah shows.

What would be in your emergency kit? Send us your comments and let’s start a thread.

And if you’re not reading this because zombies have already attacked your neighborhood, we apologize for the inconvenience.

Men’s Stress Levels Improve When Wives Work More

Warning this blog post may contain material offensive to feminists, metrosexuals, stay-at-home dads, busy working moms, and well, just about everyone!

It seems it’s not enough for couples to relax together at the end of the day for them to be happy and healthy.   According to a new study published in the Journal of Family Psychology, men find it easier to chill if their wives are still busy, while women prefer hands on help from their men!

Neither sex it seems is happy.  The results paint a pretty pessimistic picture of marriage, relationships and gender equality.  Researchers from the USC Psychology Department learned that the actions of one spouse can affect the stress levels of the partner.

By measuring cortisol levels as a marker of stress, they found that womens’ stress levels improve if their husbands chip in with the housework.  In contrast, husbands were less stressed when they had more leisure time … but only if their wives spent less time in leisure.

Observers monitored husbands and wives and recorded >5,000 unique entries about their activities. The descriptions were then classified under 13 different categories, which include housework, leisure, child care, personal time, paid work at home and communication.  The results confirmed that wives were generally doing twice as much housework as husbands and that husbands had more leisure time.

Lead author, Darby Saxbe noted, “Your biological adaptation to stress looks healthier when your partner has to suffer the consequences. The result shows that the way couples spend time at home – not just the way you spend time, but the way your partner spends time as well – has real implications for long-term health.”

Cortisol levels can affect sleep, weight gain, burnout and weakened immune resistance.

One of Saxbe’s earlier studies focused on marital relationships, stress and work. Her research found that more happily married women showed healthier cortisol patterns, while women who reported marital dissatisfaction had flatter cortisol profiles, which have been associated with chronic stress. Men’s marital satisfaction ratings, on the other hand, weren’t connected to their cortisol patterns.

The quality of relationships make a big difference in a person’s health,” Saxbe said. “Dividing up your housework fairly with your partner may be as important as eating your vegetables.”

SRxA’s Word on Health adds, “Amen to that!!!”

The Doctor Will See You All Now!

Overcrowded waiting room and endless wait times may soon  be a thing of the past. At least for patients with Parkinson’s disease.

According to a  study published in the online issue of Neurology, group appointments may be feasible for patients with Parkinson’s disease. Group visits  allow patients more time with their doctor, provide more opportunity for disease management education and allow patients and their caregivers to share their experiences and learn from one another

The study compared patients who received normal care from their physician with patients who had underwent group visits. The “normal care” group had 30-minute appointments with their physicians every three to six months. Group visits lasted 90 minutes and were held every three months and included introductions, updates from patients, and an educational session on a topic chosen by the participants. Time was allotted for questions from patients or caregivers, and individual 10-minute appointments with the physician were scheduled for before or after the group visit for individual concerns.

Of the 30 study participants, 90% completed the 12 month study, along with 93% of the 27 participating caregivers. At the end of the study, there was no difference between those receiving normal care and those participating in the group visits in how they rated their overall quality of life.

Participants were also asked whether they preferred the group visits or usual care. Of those receiving group visits two thirds said they preferred them. Among the normal care group, opinions were roughly divided.

While both support groups and traditional visits have clear benefits, a survey of people with Parkinson’s showed that they desire more information for them and their caregivers about their disease,” said study author E. Ray Dorsey, MD, MBA, of Johns Hopkins University School of Medicine.

Group visits can give physicians the opportunity to observe their patients for a longer period of time and appreciate disease characteristics such as fluctuations in their symptoms and daytime sleepiness that may not readily be appreciated during a routine 20- to 30-minute office visit.  However, they may also pose logistical issues, such as scheduling difficulties and the need for a large room. Additionally, there is a potential risk that the lack of a one-on-one examination could lead physicians to miss subtle problems and also some concerns about patient confidentiality.

Perhaps what is needed is a hybrid model – where patients alternate between group and individual appointments.

Have you experienced a group appointment?  Would you be willing to have a group appointment? Please share your thoughts with us.

Multitasking as a Diagnostic Tool?

Here at Word on Health we’re used to doing a million things at once. So over the years, we’ve  heard most of the multitasking jokes. Admittedly we’ve chuckled at the male definition known as chewing gum and breaking wind at the same time.  We’ve even been known to smile when men ask, “if women are so good at multitasking why can’t they have sex and a headache at the same time?”

However, it turns out that it’s no laughing matter.

Scientists hope to use a simple multitasking challenge – walking and thinking at the same time –  to quickly screen individuals who may have suffered brain injuries. According to researchers at the Georgia Tech Research Institute (GTRI) asking an individual to walk a short distance while saying the months of the year in reverse order, can determine if that person is impaired and possibly suffering from a concussion.

This simple test involving radar, which could be performed on the sideline of a sporting event or on a battlefield, has the potential to help coaches and commanders decide if athletes and soldiers are ready to engage in activity again.

When a person with a concussion performs cognitive and motor skill tasks simultaneously, they have a different gait pattern than a healthy individual, and we can identify those anomalies in a person’s walk with radar,” said GTRI research engineer Jennifer Palmer.

More than 1 million concussions and other mild traumatic brain injuries are reported each year in the United States.  Catching them right after they happen can improve treatment and prevent further injury or other long-term health issues. Diagnosing concussion can be difficult, though, because the symptoms are not always easily visible or detectable, even though they last for weeks or months following the incident.

While methods exist for detecting concussion, most focus purely on cognitive impairment and do not assess accompanying motor skill deterioration.

Details of GTRI’s technique, which simultaneously examines a person’s cognitive and motor skills, were presented on April 26 at the SPIE Defense, Security and Sensing conference in Orlando. Using radar for gait analysis would be faster and less intrusive than existing techniques. The assessment would be done with radar systems similar to those used by police for measuring the speed of vehicles.

The GTRI research team compared how 10 healthy individuals walked normally and when impaired. For the impairment scenario, individuals wore goggles that simulated alcohol impairment. Past research has shown that concussion impairment is equivalent to having a blood alcohol level of 0.05%.

Each individual performed four 30-second walking tasks: a normal walk, walk while saying the months of the year in reverse order, walk while wearing the goggles, and walk while wearing the goggles and performing the cognitive task. For each task, the subjects walked away from the radar system, turned around and walked back toward the radar system.

By looking for differences in the gait patterns of normal and impaired individuals, researchers found that healthy individuals could be distinguished from impaired individuals wearing the goggles. Healthy individuals demonstrated a more periodic gait with regular and higher velocity foot kicks and faster torso and head movement than impaired individuals when completing a cognitive task.

The results also indicated that if no cognitive task was performed, a healthy individual’s gait pattern was not statistically different when wearing and not wearing the goggles.

We found that we needed to examine a person’s physical and mental capabilities at the same time to see a change in gait and detect impairment,” said research engineer Kristin Bing. “It’s easy for a person to concentrate on one task, but when that person has to multitask we can begin to discriminate between someone who is impaired and someone who is not.”

In the future, the researchers plan to reduce the size of the system so that it becomes more practical to use.

Although approval from the Food and Drug Administration will be required before this system can be used to diagnose concussion, seems this multitasking tool is no joke.

Dozing Off or Going Off Line?

If, like us, you’ve ever “misplaced” your keys or stuck the milk in the cupboard and the cereal in the refrigerator, we have good news for you. According to new research, chances are you’re not going mad, or showing signs of early Alzheimer’s – your brain may simply have been taking a nap!

The study published this week in Nature suggests that certain napping neurons in an otherwise awake brain may be responsible for the attention lapses, poor judgment, mistake-proneness and irritability that we’ve all experienced when we haven’t had enough sleep.

Doctors at the University of Wisconsin-Madison say they have found that some nerve cells in a sleep-deprived, yet awake, brain can briefly go “off line,” into a sleep-like state, while the rest of the brain appears awake.

Even before you feel fatigued, there are signs in the brain that you should stop certain activities that may require alertness,” says Dr. Chiara Cirelli, Professor of Psychiatry at the School of Medicine and Public Health. “Specific groups of neurons may be falling asleep, with negative consequences on performance.”

Until now, scientists thought that sleep deprivation generally affected the entire brain. EEGs typically show network brain-wave patterns typical of either being asleep or awake.  Micro sleep, a term used to describe momentary periods of sleep that can occur at any time, typically without significant warning was thought to be the most likely cause of accidents due to falling asleep at the wheel while driving.

But the new research found that even before that stage, brains are already showing sleep-like activity that impairs them.  In the current study, researchers inserted probes into the brains of freely-behaving rats. After the rats were kept awake for prolonged periods, the probes showed areas of “local sleep” despite the animals’ appearance of being awake and active.
And there were behavioral consequences to the local sleep episodes. When they kept the rats up beyond their bedtime, the rats started to make mistakes. When challenged to do a tricky task, such as reaching with one paw to get a sugar pellet, they began to drop the pellets or miss in reaching for them, indicating that a few neurons might have gone off line.

This activity happened in few cells,” Cirelli adds. “Out of 20 neurons we monitored in one experiment, 18 stayed awake. From the other two, there were signs of sleep—brief periods of activity alternating with periods of silence.”

So, the next time you do something dumb, don’t blame yourself, just tell people your brain was off-line!

Less May be More in the Management of Depression

A national study just published in the American Journal of Psychiatry says taking two medications for depression does not speed up recovery.

Although previous studies have suggested that combination therapy may be more effective than monotherapy, researchers at UT Southwestern Medical Center have now shown this is not the case. The condition, which affects approximately 19 million Americans each year, is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a long period of time. While the exact cause of depression is not known many researchers believe it is caused by chemical imbalances in the brain, which may be hereditary or caused by events in a person’s life.

The Combining Medication to Enhance Depression Outcomes, studied 665 patients aged 18-75 with major depressive disorder. It randomized patients into 3 groups who were then prescribed FDA approved antidepressant medications.

After 12 weeks of treatment, remission rates were similar across the three groups: 39%, 39% and 38%, respectively. Response rates were  about 52% in all three groups. After seven months of treatment, remission and response rates across the three groups remained similar, but side effects were more frequent in the third group.

These results show that, “Clinicians should not rush to prescribe combinations of antidepressant medications as first-line treatment for patients with major depressive disorder,” said Dr. Madhukar H. Trivedi, Principal Investigator of the study  and Professor of Psychiatry and Chief of the Division of Mood Disorders at UT Southwestern.The clinical implications are very clear – the extra cost and burden of two medications is not worthwhile as a first treatment step,” he concluded.

The next step is to study biological markers of depression to see if it is possible to predict response to antidepressant medication and, thus, improve overall outcomes.

All Aboard for the Doctor on Board

How many of you have been settled, albeit uncomfortably, at 30,000 feet enjoying a movie or hastily putting the finishing touches to the PowerPoint presentation you are due to give in a couple of hours when you hear a familiar chime, followed by the flight attendant asking: “Is there a medical professional on board this aircraft?” Every year, more than 500 million people travel by air in the U.S. Not surprising then, that medical emergencies aboard aircrafts occur.  In fact, an estimated 1:10-40,000 passengers will experience one. With commercial air traffic increasing, these emergencies are expected to become more frequent, especially as the percentage of older people increases. Although flight attendants are required to undergo initial and recurrent training on aviation medicine, first aid, CPR and automated external defibrillator (AED) usage every 12–24 months, EMTs, paramedics and other medical professionals are still called upon to provide assessment and treatment of passengers who become ill in flight. Now, two U.S. physicians from Boston’s Beth Israel Deaconess Medical Center have called for a standardization of the processes and the equipment for dealing with in-flight medical emergencies. Within the current issue of the Journal of the American Medical Association, Melissa Mattison, MD and Mark Zeidel, MD, note that the kinds of approaches that have improved flight safety have not been extended to providing optimal care for passengers who become acutely ill while on board airplanes. Each airline has its own reporting system and protocol. And while emergency medical kits are mandated to contain medications and equipment, actual kits vary by airline. As a result, paramedics and physicians responding to emergencies can face a broad array of challenges including cramped physical space, emergency kits whose contents are unfamiliar, inadequate, and poorly organized, and flight crews unaware of how best to assist the physicians. Mattison and Zeidel offer a four-step plan to improve the treatment of passengers who become ill in-flight:

  • A standardized recording system for all in-flight medical emergencies, with mandatory reporting of each incident to the National Transportation Safety Board. This approach should include a systematic debriefing of anyone directly involved with the in-flight medical emergency.
  • Airlines should create a standard emergency medical kit with identical elements available in identical locations on every flight.
  • Enhanced and standardized training for flight attendants, including the clear obligation that a single flight attendant is assigned during emergencies and stay nearby until the patient is safe.
  • Standardized flight crew communication with ground-to-air medical support available on all flights when there are no health care professionals available.

As both a frequent flyer and paramedic, I applaud the authors for this long overdue common sense approach. Have you ever helped with an in-flight emergency or perhaps been the victim of one?  If so, SRxA’s Word on Health would love to hear from you.