Monday, March 31, 2008

Bill and Melinda Gates Foundation Backs $100 Million Global Health Initiative

Dr. Tadataka Yamada, M.D., president of the Global Health Program of the Bill and Melinda Gates Foundation, Seattle, has issued a challenge for researchers across the globe to find bold new ways to remedy global health issues. Dr. Yamada writes - “I must confess to having learned the hard way that embracing new thinking, as difficult as it may be, is crucial for the advancement of science and medicine. He provides an example: When two scientists from Australia came along and argued that it was actually a bacterium, Helicobacter pylori that produced ulcers, [rather than gastric acid] those of us in the "Acid Mafia" rejected their claims out of hand. The scientists had to actually drink the bacteria then treat themselves with antibiotics in order to prove the results of their research; they later earned the 2005 Nobel Prize.

Dr. Yamada, with financial support from the Bill and Melinda Gates Foundation, is launching the “Grand Challenges in Global Health” Web site on March 31.

The impetus follows another failure to produce a vaccine against HIV. Dr. Yamada recognizes that there is no way to progress unless new, even “bold and seemingly wacky” approaches to global health are proposed. The huge undertaking carries known financial risk, but it seems our inability to find global health solutions is far more risky.

The initial four areas of focus will include preventing infectious disease, new drugs to treat resistant infection, HIV treatment and cure, and understanding latent tuberculosis. Dr. Yamada is looking for innovative ideas from all disciplines, not just “anointed experts”. He calls traditional peer review, “peerless", and suggests great minds are ignored because of the "process" that can inhibit new ideas and approaches to health care.

One hundred million dollars will fund new and innovative research projects over a period of five years. The only criterion for inclusion is creative thinking - $100,000 grants will provide support for each idea. A two-page application is required, making the submission process fairly easy. The decision for grants will be determined within ninety days, following review by a team of creative advisors and scientists. New challenges will emerge bi-annually, following the initial May 30 deadline.

Dr. Yamada acknowledges that many of these projects will fail, but the Foundation stands ready to provide full support to those that do succeed. He points out “if we are not willing to take risks and fail often, we will miss many opportunities to capture novel approaches that can transform a field.”

Personally, I am excited about the adventure. This sort of freethinking is a breath of fresh air. It seems we've been on a merry-go-round of cause and side effect. Dr. Yamada is correct when he says – “it takes humility to let go of old concepts and familiar methods. “ It is a sentiment that we should always keep close. It's entirely possible that we’ve become stagnant and a bit too comfortable with thinking 'inside the box'.

Read my article on Antibiotic Resistance @ Her Active Life

Sunday, March 30, 2008

FDA Warns Against "Blue Steel" and "Hero" Supplements for Erectile Dysfunction.

The FDA has issued a warning against the use of "Blue Steel" and "Hero" dietary supplements, currently sold online for erectile dysfunction. The warning stems from the unapproved ingredients that have been found in the pills that may dangerously lower blood pressure and are not disclosed on the product label.

The undisclosed chemicals are similar to the active ingredient in Viagra, and may cause a dangerous interaction with prescription medications. Blue Steel and Hero are being marketed as “all natural”, raising concerns that patients who take prescription nitrates will purchase the supplements unsuspectingly. Most people with erectile dysfunction have diabetes or heart disease, and products marketed as "all naural" are likely to be viewed as safe and effective.

Healthcare professionals or anyone who has used the product and had an adverse event are encouraged to report it to the FDA's MedWatch program by phone at 800-FDA-1088, or go to the FDA's website to file a report.

If you have erectile dysfunctiion, please speak with your doctor to obtain and FDA approved treatment or prescription. The FDA is considering regulatory action to protect consumers from purchasing illegal products via the Internet.

Erectile dysfunction is a common problem and the causes are varied. Most men who experience erection problems are already in poor health. Evaluation of the cause is mandatory to properly target the treatment, something that should not be taken lightly. For an overview of erectile dysfunction, including treatment options, please visit the Cleveland Clinic's Department of Urology and Internal Medicine website.

Source: News release, FDA ◦

Coronary Artery Calcium Score Shown to Predict Heart Disease in Minorities

Doctors can now utilize coronary artery calcium (CAC) scoring to predict the incidence of coronary heart disease in Blacks, Hispanics and Chinese. Dr. Robert Detrano (University of California, Irvine) and colleagues are the first to study the relationship between coronary calcium and the incidence of heart attack in the various ethnic groups. The findings are presented following a 3.8-year analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) study. Dr. Detrano says that because coronary calcification is less prevalent in these ethnic groups, it may be more significant. He stresses that the test is equally predictive in whites and minority groups.

Another name for coronary artery calcium scoring is cardiac CT – a computerized scan that takes pictures of the heart to detect the presence of calcium that is not normally present in the blood vessels. The test is not widely utilized, because the information provided is somewhat vague,especially for those with known heart disease, but for patients who have low to moderate risk for heart attack, it may yield some useful information. Calcium is present in the coronary arteries even in the absence of coronary artery disease that causes obstruction to blood flow to the heart. Cardiac CT, or CAC cannot precisely define the percentage of blockage that is present in the coronary arteries.

The test is also considered expensive. According to Dr. Detrano, “Cost is one of the problems with this test. Of a scan that costs $600, $400 will be marketing costs. So whether or not you agree that this test is useful, it's beyond the means of many individuals and many societies". However, the results will further Dr.Detrano's studies in China.

Experts believe that calcium scoring should be used cautiously, cost aside. The study should not lead practitioners to order calcium scoring tests for everyone. However, Dr. Detrano says "The results prove that coronary-calcium detection is a strong predictor of heart attack and disease for African Americans, Hispanics, and Chinese Americans and whites.

The test is non-invasive and still less costly than a cardiac catheterization, leading many patients to request it from their physician. A combination of coronary artery calcium scoring, complete history and physical exam, cholesterol profile and other heart testing should still be used to absolutely define your risk for coronary artery disease. The MESA study provides clarification for physicians regarding the accuracy of CAC in non-white populations, a variable that was not previously known.

Ref: March 27, 2008, New England Journal of Medicine. ◦

Tuesday, March 25, 2008

New Findings Shows Tighter Blood Sugar Control May Reduce Diabetic Stroke Risk

According to a recent study, diabetics may face a significant increase for the risk of ischemic stroke when blood sugar levels are even slightly above target. These new findings indicate that more aggressive approaches may be warranted to control fasting blood sugars in the diabetic population.

Included in the research were 3298 diabetic participants, without prior incidence of stroke, from an urban community that included multiple ethnic groups. Of these, 338 had elevated blood sugar levels; 572 participants reported a history of diabetes. The mean age was 59 to 79 years and included three groups: those with fasting blood sugar levels greater than 126 ml/dL who had diabetes; less than 126 ml/dL with diabetes; no diabetes.

Follow up was done via telephone over a period of six years - there were 190 ischemic strokes and 585 vascular events. The group whose fasting glucose remained at target showed no increased risk of stroke. The results indicate that stricter guidelines may significantly reduce the risk of stroke in diabetics.

Past studies have not directly addressed the risk of stroke among diabetics, though we have known that diabetics carry twice the risk of developing heart disease. This study showed that even when fasting blood sugars remained at 126 ml/dL, the risk outcome was the same when compared to those with fasting glucose levels of 159mg/dL.

According to Bernadette Boden-Albala, MPH, DrPH, from the Columbia University College of Physicians and Surgeons, the Mailman School of Public Health, in New York, NY, "There is insufficient randomized trial data to support evidence-based recommendations for tight control of fasting blood glucose (FBG) among diabetics in primary stroke prevention. Ongoing rigorous clinical trials such as ACCORD [Action to Control Cardiovascular Risk in Diabetes], a study of over 10,000 adults with diabetes, will ultimately provide conclusive evidence regarding the importance of glycemic control in preventing macrovascular disease including ischemic stroke."

Proper control of blood sugar is not always easy. According to the American Diabetes Association, 14.6 million people have diagnosed diabetes and 2 million adolescents have pre-diabetes. "The prevalence of diabetes is at least 2 to 4 times higher among non-Hispanic Black, Hispanic/Latino American, American Indian, and Asian/Pacific Islander women than among non-Hispanic white women." In addition, it's estimated that 33% of the population has undiagnosed diabetes.

If you think you may have diabetes, take the diabetic risk test. Visit the National Diabetes Association for more information on what you can do to prevent or control diabetes.

Ref: Diabetes Care. Published online March 13, 2008.

Saturday, March 15, 2008

Focus on Calorie Restriction - from the “Heart of Women’s Health”

According to a presentation from the Second Annual “Heart of Women’s Health”, a low fat diet is still the best for prevention of heart disease, but in the past instructions for a low fat diet neglected to include emphasis on calorie restriction. It seems we’ve cut the fat, but started eating more carbohydrates, resulting in weight gain, higher triglyceride levels and low HDL levels – all of which are bad for heart health.

The news comes from the American College of Cardiology per Dr. Katherine Tuttle, MD, FASN, FACP. Speaking on the CardioSource Video Network, Dr. Tuttle says that recommending a low fat diet simply is not enough. She points out that “we have to become much more aware of calorie control, portion control, and normal body weight”. The problem she says is “overeating”.

In order to maintain good heart health, the focus must remain not only on the type and amounts of food we eat. Dr. Tuttle also discusses the importance of physical activity and exercise, making the message loud and clear that there is no one thing that can protect us from the ravages of poor cardiovascular health.

Consumer advocacy groups, with support from the American College of Cardiology, are also voicing their disdain for processed foods with high sodium content - an issue that greatly needs to be addressed. Dr. Tuttle, who is a Nephrologist by training, is very concerned about hypertension. She says that “even people who want to follow diets don’t have foods that they can choose that are low in salt” and she strongly supports the notion that societal and cultural changes are needed to allow people to make healthy dietary choices. She points out that poor eating is not just a medical problem – it is a social and cultural problem that cannot be addressed at medical conferences alone.

For healthy adults, a high protein, low carbohydrate diet is recommended for weight control and cardiovascular health. Due to the high incidence of obesity, many people have undiagnosed diabetes, hypertension and kidney disease. Those who think they are healthy simply are not. Medical screening before going on a diet would be ideal, but this is something that is not routinely performed. The problem is that many health issues appear over time, making prudence the safest approach to weight loss and good overall health. Dr. Tuttle's best advice for safety is “not too much of anything”. Moderation is still the best recipe for a healthy lifestyle.

Now if we can just get those “biggie”, “supersized” portions out of our sight, perhaps we’d have a fighting chance.


Friday, March 14, 2008

Magnesium Rich Foods Cuts Risk of Stroke in Male Smokers by 15%

According to a new study, male smokers can reduce their risk of cerebral infarction, or stroke, by 15% by increasing dietary intake of magnesium rich foods. The most significant effect was found in men younger than age 60. Magnesium intake has also been found to reduce blood pressure, leading researchers to speculate that dietary intake of foods rich in minerals such as magnesium may be associated with good blood pressure control, though the exact mechanism for stroke risk reduction is not entirely clear.

Finnish men who smoked more than five cigarettes a day were enrolled in the study after providing complete dietary information, and included 26,566 participants, aged 50 to 69 years The average follow up time was 13.6 years. The men who consumed at least 589 mg/day of dietary magnesium daily were found to have a significantly lower risk of ischemic stroke than those who consumed the average amount of 373 mg/day.

To clarify further, strokes are caused either by ischemia (lack of blood flow), or hemorrhage. This study, led by Susanna C. Larsson, PhD, at the Karolinska Institute in Stockholm, Sweden, found that magnesium intake did not influence the incidence of strokes cause by hemorrhage. Dr. Larsson writes: "An inverse association between magnesium intake and cerebral infarction is biologically plausible. In addition to lowering blood pressure, magnesium may influence cholesterol concentration or the body's use of insulin to turn glucose into energy. Either of these mechanisms would affect the risk for cerebral infarction but not hemorrhage.”

It’s important to recognize the role that nutrient rich foods have on our overall health. Foods that are rich in magnesium include black beans, whole grain cereals, spinach and whole wheat bread.

Food sources of magnesium
• Cashews, dry roasted, 1 oz: 73 mg.
• 1 Cup cooked spinach: 157 mg
• Baked potato with skin, medium sized: 55mg.
• Medium sized banana: 34 mg.
• 100 percent Bran, 1 oz: 134 mg.
• Roasted almonds, 1 oz: 86 mg.
• 1 Cup black beans: 120 mg.
• 1 Cup raw broccoli: 22 mg.

Make an effort to stop smoking, of course, but if you’ve tried and are still struggling, consider the results of this study and increase your dietary intake of magnesium. Better health is a fine goal for today. We’ll deal with tomorrow in about 24 hours, okay?

Ref: Arch Intern Med. 2008;168:459-465. ◦

Wednesday, March 5, 2008

HEPA Filters in the Home Found to Significantly Improve Overall Health

Bad eating and inactivity are known contributors to vascular disease, or endothelial dysfunction. When you factor in an unhealthy environment and genetics, the odds of developing diseases of the blood vessels exacerbates.

A recent study has found that using a HEPA filter in the home significantly lowered the biomarkers that lead to vascular and microvascular disease in healthy older adults.

The study participants all lived in highly trafficked areas and were between 60 and 75 years old. All were in relatively good health. Inflammatory markers were measured after two 48 hr. exposures to indoor air filtration; improvement in endothelial function was an impressive 8.1%. Now researchers are wondering what improvement might be seen for those who already have diabetes and vascular disease.

Dr Steffen Loft (University of Aarhus, Denmark) and colleagues published the study in the February 15, 2008 issue of the American Journal of Respiratory and Critical Care Medicine. Dr. Loft says, “I think this improvement is something like what you might expect from a well-working drug. A lot of research suggests that particles from outdoor air affect vascular function, especially at high doses. We wanted to see whether the concentration of airborne particles in a regular, normal home would be sufficient to cause similar effects, so we removed them, and indeed we found they had [adverse] effects."

Normal vascular function is necessary for overall health and well being. The integrity of our blood vessels protects us from atherosclerosis (hardening of the arteries), stroke, heart attack, high blood pressure and diabetes. Once endothelial function is compromised things obviously only get worse, making this study especially noteworthy. Finding ways to improve health, without, or as an adjunct to medications, is always welcoming.

It is mentioned in the study that the type of HEPA filtration system used is pretty expensive. Nevertheless, Dr. Loft is seeking funding to study the technology in patients who are already at high risk.

Does anyone see the benefit of focusing on the quality of our air to improve health and well being? Maybe it’s just too late or too massive an undertaking. Sometimes I think we’re on a merry-go-round. It’s like taking a plow horse to the Kentucky Derby. ◦

Monday, March 3, 2008

Smoking Marijuana May Increase Risk of Dying After a Heart Attack

A recent study shows that smoking marijuana after a heart attack may cause death. The study was spawned after it was found that oral doses of marijuana stopped atherosclerosis in mice. The goal was to see what effect marijuana has on people with existing heart disease and what, if any cardiovascular risks it poses. The results showed that you are three times more likely to die from the effects of marijuana post heart attack.

Lead investigator Dr Kenneth Mukamal (Beth Israel Deaconess Medical Center, Boston, MA), points out that "for all the thousands and thousands of studies we've done on people who have had heart attacks, virtually nobody asks them about their marijuana use. Every single study asks people if they smoke, if they drink alcohol, but we never ask about marijuana."

The study group was small, and Dr. Mukamal suggests that more studies are needed to precisely identify the cardiovascular risks associated with marijuana use. Past studies have shown the possibility of adverse effects in older adults and those with coronary artery disease. Marijuana increases heart rate and exposes the body to increased levels of carbon monoxide, both of which are undesirable under any circumstances, let alone in the presence of heart disease.

The study, though not definitive, provides hints that perhaps drinking a glass of red wine might be more beneficial for stress relief following a heart attack - but please get your doctor’s permission first.

This study was published in the March 2008 issue of the American Heart Journal. ◦