Olympic Spirit?

As over 10,000 athletes from all over the world gather in London for the Games of the XXX Olympiad – better known as the 2012 Summer Olympic Games, and as spectators witness the amazing displays of athleticism,  SRxA’s Word on Health has been looking at the unhealthy history of the modern games.

Yes, today we’re talking doping.  The use of performance enhancing drugs has had a long history at the Olympic Games. Its origins can even be traced back to the Ancient Olympics. Athletes were also known to drink “magic” potions and eat exotic meats, such as lizard, to try and gain an athletic edge on their competition.

Back then, men were required to compete naked…but that’s a different story!

In the modern Olympic era, chemically enhancing one’s performance has evolved into a sophisticated science, but in the early years of the Modern Olympic movement the use of performance enhancing drugs was almost as crude as its ancient predecessors.

At the 1904 games in St Louis, Thomas Hicks, the winner of the men’s marathon was given  strychnine, eggs and brandy, before and even during the race.

This early example of “doping” certainly wasn’t the last. In 1957 a New England Journal of Medicine editorial commented on the dramatic improvements in performance at track and field events. The editorial considered the possible reasons for the recent epidemic of broken records.  It suggested that although training, diet antibiotics and motivation played a role, amphetamine use by athletes may be the main reason that otherwise unassailable records were being broken.

Performance enhancing drugs are not only a threat to the integrity of sport but can also have potentially fatal side effects. During a cycling event at the Rome Games of 1960, Danish cyclist Knud Enemark Jensen fell from his bicycle and later died. A coroner’s inquiry found that he was under the influence of amphetamines, which had caused him to lose consciousness during the race.

By the mid 1960s, sports federations were starting to ban the use of performance enhancing drugs, and the International Olympic Committee followed suit in 1967.

Despite this, each passing decade since has brought new scandals, new performance enhancing drugs, new testing methods and new methods to evade testing.

In 1984, the US Olympic Committee admitted that seven of its cyclists had received blood transfusions. Four years later, Canadian sprinter Ben Johnson was stripped of his gold medal from the Seoul Olympics when his urine samples were found to contain the anabolic steroid stanozolol.

Next came erythropoietin (EPO). The 1992 Games in Barcelona were even nicknamed the “Hematocrit Olympics.”

At the 2008 Games in Beijing the official slogan was “Zero Tolerance for Doping” . Even so, six athletes with positive specimens were ousted from the competition. Although this was far fewer than at previous games, it can’t be concluded that the prevalence of doping decreased as doping technology has become more sophisticated and athletes have turned to drugs that can’t be detected.

The list of drugs banned from the Olympicsis determined by the World Anti-Doping Agency. The banned substances and techniques include: androgensblood dopingpeptide hormonesstimulantsdiureticsnarcotics, and cannabinoids.

Both experts and cynics are already asking, will future athletes turn to gene therapy…or have they already started? One thing’s for sure, the Olympics will remain an object of fascination for all the right and the wrong reasons.

Apples, Pears & Risk of Death

Are you an apple or a pear? Could your big belly shorten your life?

Conventional wisdom tells us that the shape of our body and where we store fat can drastically alter our health outlook. For example, apple shapes – people who carry their weight around their middles – have long been thought to have a higher risk for heart disease and type 2 diabetes, when compared to the general population. But recent research suggests that this risk might be overstated and that excess fat anywhere on the body raises disease risk equally.

Body mass index (BMI), the most commonly accepted measure of obesity, has long been criticized because it doesn’t take into account body composition. Because it only uses height and weight, it can classify muscular people as overweight or obese.

So a father-son team of researchers from New York have come up a new tool – the A Body Shape Index (ABSI).

This formula takes into account waist circumference (WC), BMI, and height.

In a study of  more than 14,000 adults, above average ABSIs correlated with a higher risk of premature death — even when adjusted for risk factors like smoking, diabetes, hypertension, and cholesterol. Regardless of age, gender, BMI, and ethnicity, elevated death rates were found for both high and low BMIs and WCs.  This led the researchers to conclude that both measures are inaccurate for predicting premature death risk.

Measuring body dimensions is straightforward compared to other most medical tests, but it’s been challenging to link these with health,” says researcher Nir Krakauer, assistant professor in the department of civil engineering at the City College of New York.

The bottom line of all this?  It’s not just belly fat that can kill you, excess pounds anywhere can have an adverse effect on health.

However, before you throw in the towel or start ordering your coffin, other studies suggest you shouldn’t worry if have a bit of junk in the trunk!  According to new research from Oxford University, fat in the thighs and buttocks might actually help protect you from metabolic disease and a Danish study even found that people with thin thighs have a greater risk of premature death.

What’s your body shape, and how do you feel about it? We look forward to hearing from you.

Peanuts and Pregnancy

As we’ve discussed before, peanut allergies are on the rise. One study showed that the incidence of peanut allergy in children doubled between 1997 and 2002. Now, it seems researchers have discovered one of the reasons why.

A study of almost 62,000 mothers showed that the children of those who ate peanuts and tree nuts while pregnant were less likely to develop asthma or allergies than the kids whose mothers shunned nuts.

The results support the recent withdrawal of recommendations in both the US and the UK that pregnant women should avoid nuts because they might raise a child’s risk for allergies to the nuts.

There is little research on peanut eating during pregnancy and the subsequent risk for peanut allergy in her children yet the fear continues to lead many expectant mothers to steer clear of nuts.

So, researchers at the Centre for Fetal Programming at Statens Serum Institut in Copenhagen, wanted to take a more extensive look at nut exposure and the possible health outcomes in kids.

The mothers provided information about how often they ate peanuts and tree nuts, such as almonds and walnuts, during pregnancy.

At age 18 months, the researchers found, the kids whose mothers ate peanuts were less likely to have asthma.

Fifteen percent of kids whose moms ate peanuts more than once a week, had asthma compared to more than 17 percent of kids whose moms never ate peanuts.

When other asthma risk factors were taken into account, the researchers concluded that kids whose mothers ate peanuts regularly were 21% less likely to develop asthma.

At seven years old, this same group of kids was 34% less likely to have a diagnosis of asthma than kids whose moms had abstained from peanuts.

Similarly, mothers who ate tree nuts more than once a week had 18-month-olds who were 25% less likely to have asthma than the moms who avoided the nuts, although this difference appeared to fade as the kids reached seven years old.

Peanuts appeared to have no effect on whether kids developed nasal allergies, and the children of moms who frequently ate tree nuts were 20% less likely to have allergies.

Lead author, Ekaterina Maslova said the findings are further reassurance that moms-to-be don’t need to avoid peanuts and tree nuts, although the study doesn’t prove that nuts are actually protective against asthma and allergies.

Mahr, who is also chair of the section on allergy and immunology at the American Academy of Pediatrics, noted that interviewing people about what they eat can introduce some accuracy issues, but the findings are still interesting.

SRxA Advisor Todd Mahr, a pediatric allergist at Gundersen Lutheran Medical Center in La Crosse, Wisconsin, who was not involved in the study said “A take home from this would be if there’s no food allergy in your family, but there’s an asthma history in your family, maybe you might not want to avoid peanuts specifically.”

All of which is good news for moms with peanut butter cravings.

Egging on Allergies?

Friends, family, colleagues and regular readers of SRxA’s Word on Health already know about my egg allergy.  What they may not know about is my egg aversion.  Just typing the “e” word makes me queasy.  Thinking about eggs makes me cringe and actually seeing them, especially hard boiled, fills me with revulsion.

So, with some trepidation, I bring you this breaking health story.

According to a study just published in the New England Journal of Medicine by giving children with egg allergies increasingly higher doses of the very food they are allergic to researchers found they could eliminate or ease reactions in most of them.

The study conducted at Johns Hopkins Children’s Center and four other U.S. institutions treated 40 egg allergic children with escalating doses of eggs – an approach known as oral immunotherapy.

In the 10 month study, 40 children, aged 5 -18, received escalating doses of egg-white powder while 15 received a cornstarch placebo.  35 of the 40 children treated with egg immunotherapy experienced improvement. Five dropped out of the study, four of them due to allergic reactions. Eleven of the 35 patients experienced complete long-term elimination of egg-related allergic reactions. The rest of the children were able to tolerate higher doses of egg with only mild or no symptoms.

More than a quarter of the children in our study lost their egg allergies altogether, but we also saw dramatic improvements in those who didn’t, which in and of itself is an important therapeutic achievement,” says Robert Wood, M.D, director of allergy and immunology at Johns Hopkins Children’s Center. “These children went from having serious allergic reactions after a single bite of an egg-containing cookie to consuming eggs with minimal or no symptoms.”

This is important because it can protect against serious allergic reactions from accidental or incidental exposures and give patients and parents a peace of mind at restaurants, parties and other venues where food control is difficult or impossible.

But while this may be good news for the estimated 3% of U.S. with egg allergies, this blogger is not so sure she’d be a candidate.  The thought of having to eat escalating doses of the dreaded “e” word is more abhorrent to me than the thought of a future filled with quiche and ice cream!

On a more serious note, we’d also like to brings readers some sage advice from allergist David Amrol MD : “Although oral immunotherapy is our best chance for a food allergy cure, it is not ready for mainstream use until protocols are further refined. Patients who are not enrolled in clinical trials must continue to rely on allergen avoidance, patient education, and self-injectable epinephrine.”

i-Nhaler i-Mprovement?

Asthma is one of the world’s most common chronic diseases, affecting some 300 million people and almost 5 percent of the world’s population. It’s also the 5th most costly condition in the US  – an estimated at $56 billion annually. But as we’ve reported here previously, a significant number of people with asthma either don’t use their asthma medications or use them incorrectly.

Improving asthma control is known to reduce the cost of treating asthma by eliminating unnecessary hospitalizations, ED visits, and office visits. The additional cost of an uncontrolled asthma patient compared to a controlled asthma patient is estimated at $3,000-$4,000  per patient annually.

So, we were interested to learn last week that the FDA approved a sensorized asthma inhaler that can track usage and transmit the data to a smartphone and the web. The manufacturer – Asthmapolis will begin to market the asthma sensor and both English and Spanish language versions of the companion software in the US very soon.

Our mission is to make it easier for patients and their physicians to do a better job of managing asthma with less effort than traditionally required.” said David Van Sickle, co-founder and CEO of Asthmapolis.

The small and lightweight device attaches to the end of most inhalers, and the app tracks the time and location of each medication discharge and reminds patients to use it if they forget.

In clinical studies of the Asthmapolis system, uncontrolled asthma declined by 50%, and more than 70% of patients improved their level of control.  In addition it can identify trends in a patients asthma triggers and symptoms over time and provide patients with personalized education on how to improve their asthma.

Not only will the device talk directly to the patients, physicians and other health care providers will be able to identify, in near-real-time, patients with uncontrolled disease and attend to them before they suffer a severe exacerbation.

Despite all we know about asthma and how to treat it, the majority of patients still do not have the disease under control, and traditional approaches to self-management have been time-consuming and complicated,” said Inger Couture, chief regulatory officer of Asthmapolis. “The Asthmapolis technology makes it much easier to track symptoms and use of metered dose inhalers, allowing patients, their families and their doctors to gain a valuable new perspective on the disease.”

And that can only be a good thing.

It’s here! HIV Prevention in a Pill

An estimated 1.2 million Americans are currently living with HIV. Despite the availability of condoms and HIV education, the incidence rate has remained steady over the past two decades with approximately 50,000 new infections occurring each year. 23% of these new cases occur among women and 61% occur among men who have sex with men.

In the 80′s and early 90′s, HIV was viewed as a life-threatening disease. In some parts of the world, it still is. And while medical advances, along with the availability of 30 or so approved HIV drugs, mean its now a chronic disease, rather than a killer disease – what we’ve all been waiting for is a drug to prevent it.

Now, this week, after decades of anticipation, the FDA  approved Truvada – an HIV combination pill for pre-exposure prophylaxis.  Truvada is the first drug that has been approved to combat HIV among uninfected individuals who are believed to be at high risk of acquiring the virus. Analysts estimate that the drug will cost $450 a year in the U.S.

In a study sponsored by the National Institutes of Health, Truvada was shown to significantly reduce the risk of HIV infection in 42% of HIV-negative gay and bisexual men and transgender women. In another, the risk was lowered in 75% of heterosexual couples in which one partner was HIV positive and the other was not.

The data clearly demonstrate that Truvada, as pre-exposure prophylaxis, is effective at reducing the risk of HIV infection acquired through sexual exposure,” said Connie Celum, a professor of global health and medicine at the University of Washington and lead investigator of the second study.

As part of the approval, the FDA has stipulated that patients must test negative for HIV and that education guides must be distributed to healthcare providers and patients. And the manufacturer – Gilead must conduct a post-approval trial looking at levels of drug adherence, adverse events, resistance and pregnancy outcomes for women who become pregnant while taking Truvada.

The approval of Truvada comes after a long-running debate among AIDS activists. To some, FDA approval offers much-needed assistance in containing the disease. To others, it raises the possibility of creating resistant strains of HIV due to widespread use, just as we saw in the 1960’s with antibiotics, which would then undermine the effectiveness of Truvada.

While the approval may be a cause of celebration for many, some have blasted the decision. “The FDA’s approval of Gilead’s Truvada as a form of HIV prevention today without any requirement for HIV testing is completely reckless and a move that will ultimately set back years of HIV prevention efforts,” says AIDS Health Foundation president Michael Weinstein. “The FDA’s move today is negligence bordering on the equivalence of malpractice, which will sadly result in new infections, drug resistance and serious side effects among many, many people.”

So is this a watershed moment in the battle against HIV or not?  Let us know what you think.

Fighting flu in just two hours

As we approach midsummer, while most of us are enjoying days at the pool or beach and long evenings of grilling out, a few people have already begun the countdown to winter frosts and flu season.

For those in the latter group, SRxA’s Word on Health brings you good news!

Researchers from San Diego State University and Nebraska Medical Center have developed a synthetic protein known as EP67 that can fight off flu, in just two hours.

Until recently, EP67 had been used as an adjuvant for vaccines. When added to a vaccine, adjuvants help to activate the immune system. Which led scientists to wonder what effect the synthetic protein might have on its own?

Dr. Joy Phillips, lead author, said: “The flu virus is very sneaky and actively keeps the immune system from detecting it for a few days until you are getting symptoms. Our research showed that  introducing EP67 into the body within 24 hours of exposure to the flu virus caused the immune system to react almost immediately to the threat, well before your body normally would.”

EP67 is useful as a weapon against flu because it works on the immune system rather than the virus.  So it doesn’t matter which flu strain a patient becomes infected with.  If a new strain of flu or some other infectious disease appears, such as occurred with SARA and H1N1, EP67 could be useful as a tool even before the pathogen itself has been identified.

And even though this study concentrated on the benefits of EP67 for flu, researchers are hopeful that it might also be useful for combating other respiratory diseases and fungal infections.

Current tests are being done on laboratory animals, mainly mice, by infecting them with an influenza virus and then administering EP67 within 24 hours. They found that the treated mice did not get sick, while the untreated ones did.  Most mice infected with flu will lose approximately 20% of their body weight – this was the case with the untreated mice. The mice given EP67 lost just an average of 6%. Some mice were even given a lethal dose of flu virus, and then administered EP67 – none of them died.

All of this sounds so promising future studies are already planned to look at EP67’s effect on other pathogens and its functions within different types of body cells.

With this type of good news on the way, maybe we can all stop worrying about the winter and get back to enjoying summer before it’s gone!

Assault, Bath-Salts and Battery

Last month the internet was abuzz with the gruesome story of the nude face-eating cannibal zombie attack in Florida.

This month it’s the Pennsylvania mom, who attacked nurses and tried to bite a cop in a naked brawl, two days after giving birth.

For those readers who somehow missed these stories, allow us to summarize.

The first case happened on May 27th in Miami, Florida when a naked 31-year-old man tried to eat the face off of a complete stranger. He was largely successful in his efforts, mauling off 80% of his victim’s face. It was a gruesome spectacle that baffled police officers, ending with the attacker dead, and the victim virtually faceless. For those who witnessed this disturbing and puzzling attack, either first hand or through the media, it appeared as though the zombie apocalypse had begun.

The second, occurred on June 17, when a new mom stripped naked and repeatedly attacked staff and law enforcement officers on the maternity ward of Altoona Regional Hospital.

What links these two cases is not just the nudity and the biting – but also “bath salts”.  Bath salts are a relatively new group of designer drugs sold as tablets, capsules, or powder and purchased in places such as convenience stores and gas stations.

When the Miami mauling originally appeared in the news, the words “bath salts” were almost always included in the headlines, suggesting that dangerous or hallucinogenic drugs were the real culprits behind the attack. Subsequently, toxicology reports indicated that the only drugs the attacker had in his system at the time were traces of cannabis.

In the more recent case, it seems the woman had been smoking bath salts. After the attack, cops found a hollowed out pen covered with what they said looked like residue from smoking drugs, and  a silver disc containing a white powder that the attacker  identified as Disco – a street name for bath salts.

So what exactly are bath salts and why are they so dangerous?

First of all they are not the colored crystals you would add to your tub to promote a relaxing soak.  Although they sound innocent enough, they are in fact dangerous stimulants that mimic cocaine, LSD, methamphetamine, or ecstasy.

Between January and February 2011 alone there were over 250 calls to U.S. poison centers related to bath salts.

Given the recent surge of cases in which the use of these drugs has been associated with violent acts SRxA’s Word on Health believes it’s important to educate our readers. Society needs to understand bath salts before we can create an effective means of stopping or controlling their distribution, and providing treatment for those unfortunate enough to experience its effects.

Bath salts are produced from Methylenedioxypyrovalerone (MDPV), a psychoactive drug with stimulant properties first developed in 1969.  MDPV causes intense stimulation, euphoria, elevated mood, and a reportedly pleasurable “rush.” Increased heart rate and blood pressure, chest pain, hallucinations, paranoia, erratic behavior, inattention, lack of memory of substance use, and psychosis have also been observed.

Part of the appeal of using bath salts has been their relative availability and the difficulty in picking up its use on routine drug screens.

Bath salts have been packaged and labeled as “plant food” or “not for human consumption,” and product labels do not list the ingredients. Brand names include Blizzard, Black Rob Blue Silk, Charge+, Cloud 9Ivory Snow, Ivory Wave, Mad Cow, Magic, Maddie, Ocean Burst, Pure Ivory, Purple Wave, Snow Leopard, Stardust, Super Coke, Vanilla Sky, White Dove, White Knight and White Lightning.

On October 21, 2011, the US Drug Enforcement Administration issued a temporary one year ban on bath salts, classifying them as a schedule I substance – a status is reserved for those substances with a high potential for abuse.

On December 8, 2011, under the Synthetic Drug Control Act, the US House of Representatives voted to ban bath salts and a variety of other synthetic drugs which, until then, had been sold legally in stores.

The bottom line?

Bath salts are a relatively new drug, so it’s hard to know the full long-term effects, but they seem to have many similarities to methamphetamine. They can lead to emotional and physical “crash-like” feelings of depression, anxiety and intense cravings for more of the drug.  And since they contain amphetamine-like chemicals, bath salts will always carry the risk of stroke, heart attack and sudden death. While they may be still be legal in some countries, so is rat poison, and you probably wouldn’t want to ingest that either!

Diabetes Drug may Repair Injured Brains

Here’s a good brain teaser for a Wednesday.  What do an old diabetes drug, brain injury and Alzheimer’s Disease have in common?

Here’s some clues to help you solve the riddle.

(i)           Metformin is a widely used treatment for type II diabetes

(ii)          An increasing proportion of people with Alzheimer’s Disease also have diabetes

(iii)         Hyperinsulinemia (excess levels of insulin in the blood) may enhance the onset and progression of neurodegeneration

Have you solved it?  If so, congratulations!

If not, the answer, according to data just published in the journal Cell Stem Cell is that the former may hold the clue to treating the latter.

In other words, the study suggests that metformin, an anti-diabetes drug first discovered in the 1920’s, is able to help activate the mechanism that signals stem cells to generate brain cells.

Principal investigator, Freda Miller, a Professor from the Department of Molecular Genetics at the University of Toronto
says “If you could take stem cells that normally reside in our brains and somehow use drugs to recruit them into becoming appropriate neural cell types, then you may be able to promote repair and recovery in at least some of the many brain disorders and injuries for which we currently have no treatment.”

The research involved laboratory experiments using both mouse and human brain stem cells, as well as learning and memory tests performed on live mice given the drug.

Miller and her colleagues started by adding metformin to stem cells from the brains of mice, then repeated the experiment with human brain stem cells generated in the lab. In both cases, the stem cells gave rise to new brain cells.

They then tested the drug in lab mice and found that those given daily doses of metformin for two or three weeks had increased brain cell growth and outperformed rodents not given the drug in learning and memory tasks.

In the key experiment, mice were forced to learn the position of a platform hidden under the surface of a water-filled maze and then asked rapidly to learn a new position.

Mice were injected with either metformin or saline for 38 days. On days 22 through 38, they learned the initial position of the platform, which provided an escape from the water-filled maze.  Then the platform was moved to the opposite side of the maze, and the animals were asked again to learn its position. In both tasks, the mice learned the platform positions with equivalent speed.

But when they were put back in the maze – this time with the platform removed – control mice spent more time searching for it in the original position, while the metformin-treated animals preferentially looked in the new region.

The implication  is that metformin helped the mice form their new memories of the second platform position. Further analysis showed that their enhanced ability was paralleled by an increase in the number of  neurons.

In a separate study researchers have shown that metformin can increase lifespan and delay the onset of cognitive impairment in a mouse model of Huntington’s disease.

Taken together, these findings raise the possibility that metformin’s ability to enhance neurogenesis might have a positive impact in some nervous system disorders.

Miller’s team is already planning a pilot study to test metformin in young patients with acquired brain damage, either as result of treating a childhood brain tumor or from a traumatic head injury.

We will report back to you with results, as they are published.

Sweet Relief for Cough

If like millions of Americans you reach for drops or syrup at the first sign of a cough this post is for you. Until now, most cough experts were unsure if, and how, these popular remedies work.

However, new findings from the Monell Center –  a non-profit institute dedicated to research on the senses of taste and smell – may provide the answer.

It turns out that  both sucrose and menthol, ingredients used as flavorings in many of these preparations, can themselves, reduce coughing.

Cough is a vital protective reflex that clears the respiratory tract of threats from mechanical stimuli like food and chemical stimuli such as airborne toxins and pollutants. As such, cough is necessary to protect the lungs, and keep our airways clear.

Individuals with a weak cough reflex are at increased risk of pneumonia and of choking. Conversely, many acute and chronic conditions involve frequent coughing, leading to 30 million health care visits annually, with billions spent on over-the-counter medications and billions more lost due to reduced productivity,” said lead author, Paul Wise, PhD, a sensory psychologist at Monell.

However, many aspects of coughing remain poorly understood, including how chemicals act to trigger and modulate cough.

The study, published in Pulmonary Pharmacology and Therapeutics, involved 12 healthy young adults. Each participant  inhaled nebulized capsaicin, the burning ingredient in chili peppers which induces a cough. After each inhalation, the amount of capsaicin was doubled. This procedure continued until the subject coughed three times within 10 seconds. The capsaicin concentration that induced the three coughs was labeled as the individual’s cough threshold.

In some sessions, the subjects held either a very sweet sucrose or plain water in their mouths for three seconds, before spitting the liquid into a sink, and inhaling from the nebulizer.

In other sessions, subjects inhaled three breaths of either menthol-saturated air or clean air before each capsaicin inhalation. The menthol concentration was selected to approximate the cooling intensity of a menthol cigarette.

Both sucrose and menthol increased the amount of capsaicin needed to elicit a cough relative to plain water or clean air, respectively. Sucrose increased cough threshold by about 45%, while menthol increased it by approximately 25%.

This is the first study to empirically show that sweet taste reduces cough. This also is the first study to show that menthol alone can reduce coughing in response to a cough-eliciting agent,” said co author Paul Breslin, PhD.

The findings support the hypothesis that adding menthol to cigarettes may make it easier to begin smoking by suppressing the cough reflex, thus making the first cigarettes less distressing.

The researchers are planning further studies to explore the chemical elicitation of cough, along with the receptors and genes involved in this system.

In the meantime, it appears that sweet breath mints might be every bit as effective as cough drops… and possibly a whole lot cheaper.