Day: 12/22/2022
Fecal Transplant Failed to Boost Effects of Bariatric Surgery
No impact on weight loss or metabolism compared with placebo, small study found
Fecal microbiota transplantation (FMT) had no effect on weight loss, body composition, or metabolic markers in obese individuals who underwent bariatric surgery, said authors of a small clinical trial.
In 41 adults with severe obesity, total weight loss at 12 months post-surgery was not significantly different in those who received FMT beforehand compared with those who received a placebo transplant (25.3% vs 25.2%, P=0.99), Perttu Lahtinen, MD, of Päijät-Häme Central Hospital in Lahti, Finland, and colleagues reported in JAMA Network Openopens in a new tab or window.
Both groups experienced similar reductions in body-mass index (BMI), high-density lipoprotein cholesterol, triglycerides, fasting glucose, and other metabolic markers. Furthermore, quality-of-life assessments did not differ significantly between the two groups, the study found.
A previous studyopens in a new tab or window in mice suggested FMT might be effective in treating obesity, the researchers noted. “The intestinal microbiota has aroused interest as a potential target for the treatment of obesity. Most patients with severe obesity harbor an intestinal microbiota with decreased bacterial diversity and microbial gene richness compared with healthy controls.”
“Our study provides further evidence that FMT alone is not sufficient to decrease body weight in humans. However, FMT may exert a transient effect on more delicate markers of metabolism,” the team added.
The randomized, double-blind, placebo-controlled trial included 41 adults with a mean BMI of 42.5. Their mean age was 48.7, and nearly three-quarters (71%) were women. Twenty-one patients received FMT from a lean donor, and 20 received a placebo transplant of their own fecal microbiota — both groups by gastroscopy into the duodenum.
The fecal transplants were obtained from two lean individuals with healthy lifestyles: a donor in their 40s who practiced long-distance training (BMI <20), and another in their 50s who was an organic gardener (BMI <25). Both donors were omnivores; were generally healthy, without diagnosed chronic diseases or medications; and had not used antibiotics within the preceding 12 months.
The transplants were conducted 6 months before the patients underwent bariatric surgery with laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy. The main outcome was weight reduction measured as the percentage of total weight loss. Secondary outcomes included changes in body composition, lipid levels, and glucose control.
Assessments of body composition 12 months after surgery did not differ significantly between the two groups:
- Reduction in mean BMI: 10.4 in the FMT group, 10.15 in the placebo group
- Decrease in mean fat content: 8.8% in the FMT group, 7.6% in the placebo group
- Decrease in mean visceral fat content: 6.9% in the FMT group, 5.3% in the placebo group
- Decrease in mean muscle mass: 8.0 kg in the FMT group, 9.9 kg in the placebo group
Previous studies of FMT in obese individuals also reported minimal effects on body weight, Lahtinen and co-authors noted, adding, however, that some of these studies reported slight improvements in insulin sensitivity, abdominal adiposity, and lipid metabolism.
For example, a randomized, placebo-controlled clinical trialopens in a new tab or window that included obese adolescents ages 14 to 18 reported significant changes in the android-to-gynoid fat ratio in the FMT versus the placebo group at 26 weeks (−0.029, 95% CI −0.049 to −0.008). The intervention in this study was a single course of oral encapsulated fecal microbiome from healthy lean donors of the same sex or saline placebo.
A chief limitation of the current study was the small sample size, which may have been inadequate to show small differences in weight loss related to FMT, the researchers noted. “In the absence of published data, our estimation of the treatment effect was optimistic, and, thus, the number of patients was tuned to detect only clear differences between the groups.”
“Limited numbers of patients may generate a type II error,” the team explained, “and we were unable to determine whether a much larger sample size would have yielded any differences between the groups according to these results.”
Dementia Risk Higher in People With Earlier Signs of Psychological Distress
Stress, exhaustion symptoms linked with increased dementia risk years later
Dementia risk was higher in people who had signs of psychological distress earlier in life, a cohort study in Finland found.
In more than 67,000 people with an average age of 45, self-reported distress symptoms — notably, stress, and exhaustion — were associated with a 17% to 24% increased risk of dementia over a 25-year follow-up period, reported Sonja Sulkava MD, PhD, of the Finnish Institute for Health and Welfare in Helsinki, and co-authors.
These self-reported symptoms were tied to an 8% to 12% increase in lifetime dementia after accounting for the competing risk of death, which was more common than dementia over time, Sulkava and colleagues wrote in JAMA Network Openopens in a new tab or window.
“Our study suggests symptoms of psychological distress like exhaustion, depressive mood, and the experience of stress are risk factors for dementia, and not only prodromal symptoms of underlying dementia disorder,” Sulkava wrote in an email to MedPage Today.
“Previous studies have shown an association between symptoms of psychological distress and dementia, but the nature of the association is still unclear,” Sulkava wrote. “We clarified that connection using a large population data set with 10 to 45 years of follow-up and careful modeling of death for other causes.”
The study used data from 67,688 people who completed National FINRISK Study surveys between 1972 and 2007. Participants self-reported symptoms of psychological distress in the prior month, including whether they experienced stress more than other people and whether they experienced depressive mood, exhaustion, and nervousness often, sometimes, or never. The cohort was linked to the Finnish Health Register for dementia and mortality data.
About half (51.7%) of participants were women. Baseline ages ranged from 25 to 74 years, with a mean age of 45.4. Findings were adjusted for age, sex, baseline year, follow-up time, educational level, BMI, smoking, diabetes, systolic blood pressure, cholesterol, and physical activity.
Over a mean follow-up of 25.4 years, 7,935 participants received a diagnosis of dementia. The competing risk of death was more common, occurring in 19,647 people.
In a Poisson cause-specific model, exhaustion was linked with subsequent all-cause dementia (incidence rate ratio [IRR] 1.17, 95% CI 1.08-1.26), as was stress (IRR 1.24, 95% CI 1.11-1.38). These relationships remained significant in sensitivity analyses.
A subdistribution hazard model that estimated the effect on cumulative incidence also showed exhaustion (HR 1.08, 95% CI 1.01-1.17) and stress (HR 1.12, 95% CI 1.00-1.25) were linked with dementia risk over time. In contrast, depressive mood (HR 1.08, 95% CI 0.98-1.20) did not show a statistically significant association.
The study of psychological distress and brain health is “far from being incisive,” noted Yoram Barak, MD, MHA, psychiatrist of the University of Otago in Dunedin, New Zealand, in an accompanying editorialopens in a new tab or window.
This “sophisticated analysis” adds “an important facet to the field by accounting for competing risk of death,” Barak observed. “This should become a standard when researching these questions.”
But relying on survey questions about experiences in the previous month may negate the possibility of understanding how stress may be a causative agent in dementia, since no information about lifelong traits or clinically diagnosed anxiety or depression was collected, Barak pointed out.
“We need to advance the field farther by creatively studying lifelong patterns of emotional states and relationships,” he wrote. “Life trajectories of individuals and couples will teach us more about stress, distress, tensity, neuroticism, and dementia.”
While the study questions on psychological distress do not form a validated multi-item questionnaire, the one-item measures for different symptoms of psychological distress correlate significantly, Sulkava and colleagues noted.
The research had other limitations, they acknowledged. Data about traumatic brain injury, hearing impairment, and low social contact — three known dementia risk factors — were not available. In addition, participants with missing covariate information had more risk factors for dementia or mortality.
It’s a TNF Inhibitor! It’s a Steroid! It’s Two (Potential) RA Drugs in One!
Hints in mid-stage trial that novel conjugate will surpass adalimumab in efficacy
A novel drug conjugate combining steroidal and tumor necrosis factor (TNF) inhibitor activity appeared highly effective in a phase IIa trial as a treatment for rheumatoid arthritis (RA).
Patients with active RA assigned to the product, called ABBV-3373, showed responses after 12 weeks that were at least as good as seen with the leading approved TNF inhibitor, adalimumab (Humira), according to Frank Buttgereit, MD, of Charité University Medicine in Berlin, and colleagues.
With changes in the 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) as the primary outcome, scores declined 2.65 points among 31 patients receiving ABBV-3373, compared with a decrease of 2.13 points in a historical cohort of 242 adalimumab-treatment patients (P=0.02), the researchers reported in Arthritis & Rheumatologyopens in a new tab or window.
Another 17 patients in the trial were randomized to adalimumab, and this group showed a mean decline in DAS28-CRP of 2.51 points, which did not differ significantly from the ABBV-3373 group.
Buttgereit and colleagues estimated from these data that ABBV-3373 had a probability of superiority over adalimumab of 79.3%-99.5%.
The most notable safety finding with the novel intravenous agent was one case of anaphylactic shock. Following this incident, investigators increased the infusion duration from 3 minutes to 15-30 minutes, with no more anaphylaxis cases occurring.
Both ABBV-3373 and adalimumab are AbbVie products, and the latter serves as the new agent’s anti-TNF backbone. The steroidal activity comes from “a proprietary glucocorticoid receptor modulator,” Buttgereit and colleagues explained.
The idea, they added, is that the combined molecule will gravitate selectively to activated immune cells expressing TNF, “thus increasing overall efficacy, while minimizing systemic exposure to the [steroidal component].” It’s hoped that this mechanism will cut incidence of the adverse effects known to come with long-term steroid treatment, while improving on adalimumab’s efficacy; the phase IIa trial was conceived to prove the conceptopens in a new tab or window.
To be eligible, patients needed DAS28-CRP scores of at least 3.2 plus at least four swollen and at least four tender joints, indicating moderate-to-severe disease activity, despite taking maximal doses of methotrexate. Past use of biologic or other targeted RA drugs was an exclusion.
ABBV-3373 was given at 100 mg IV along with subcutaneous placebo every other week; the adalimumab control group received IV placebo plus 80 mg of the active drug by subcutaneous injection every other week. Methotrexate was continued in both groups. The historical adalimumab-treated cohort was drawn from three prior trials involving the same dosage and with DAS28-CRP scores available.
Outcome measures included other DAS28-based values, ACR50 response rates (50% decline in symptoms by American College of Rheumatology criteria), physician and patient global RA assessments, and overall health status. The trial also included a 12-week extension, during which the ABBV-3373 group was switched to placebo while those assigned to adalimumab continued with it.
Mean patient age was about 52, and three-quarters were women. DAS28-CRP values at baseline averaged 5.6 in the two randomized arms and 6.5 for the historical controls. Other indicators all confirmed that the patients had moderate to severe symptoms.
Although changes in DAS28-CRP showed rough equivalence and potential superiority for ABBV-3373 versus adalimumab, ACR50 responses did not. Some 65% of patients assigned to adalimumab reached this benchmark at week 12 compared with 52% of the ABBV-3373 group (P not reported). Other secondary outcomes, though, did indicate comparable efficacy with the two agents.
Efficacy was generally maintained in both groups during the extension period as evaluated with DAS28-CRP and most other outcome measures.
Safety findings couldn’t be definitive with only 48 participants in the study. Other than the anaphylactic reaction, however, no major safety issues emerged in the trial. Overall adverse events were less common with ABBV-3373 than with adalimumab (37% of patients vs 75% through week 24) and only one very mild case of liver enzyme elevation (alkaline phosphatase more than 1.5 times the upper limit of normal) was seen with the novel agent. Two serious infections were observed in the ABBV-3373 group, with none in the adalimumab arm. One patient in each group quit the study because of adverse events.
Despite the favorable results, this is probably the end of the line for ABBV-3373 because, as Buttgereit and colleagues noted, AbbVie has since developed a “slightly modified” version called ABBV-154 that is suitable for subcutaneous injection. Phase II studies with this improved product are now underway in RAopens in a new tab or window, polymyalgia rheumaticaopens in a new tab or window, and Crohn’s diseaseopens in a new tab or window. Results could begin to appear as soon as next year.
Childhood Obesity Crisis Leads CDC to Expand BMI Charts
Charts now extend to a BMI of 60
The CDC released new extended BMI-for-age growth chartsopens in a new tab or window on Thursday to include children and adolescents with severe obesity.
Charts now extend to a BMI of 60, and severe obesity is defined as 120% of the 95th percentile, to reflect the higher prevalence of obesity among kids and teens, rates of which have tripled over the past three decadesopens in a new tab or window.
These new curves were added to the pre-existing 2000 CDC BMI-for-age growth charts, which stopped at a BMI of 37, with separate charts for males and females ages 2 to 20. Otherwise, the charts remain unchanged.
“As a clinician, I encourage healthcare providers to use the extended growth charts as a tool when working with children and adolescents with severe obesity,” said Karen Hacker, MD, MPH, director of the CDC’s National Center for Chronic Disease Prevention and Health Promotion.
“Intervening early is critical to improving the health of our children as they grow into adults. Prior to today’s release, the growth charts did not extend high enough to plot BMI for the increasing number of children with severe obesity,” Hacker explained in a statement. “The new growth charts coupled with high-quality treatment can help optimize care for children with severe obesity.”
Prior to this change, the BMI-for-age curves stopped at the 97th percentile owing to the fact that there were too few young people with these very high BMI values. With obesity rates drastically increasing over the past few decades — more than 4.5 million children and adolescents had severe obesity in 2018 — the CDC made the call to extend the charts.
The 2000 CDC growth charts were created based on national survey data from children and adolescents from 1963 to 1980, long before the uptick in pediatric obesity. The newly added percentiles are based on data for children with obesity from 1998 through 2016.
The CDC also released extended BMI z-score charts associated with the extended percentiles.
“With very high BMI values above the extended 99th percentile, the z-score may be an easier number for clinicians, patients, and families to understand,” the CDC’s guide on the extended growth charts noted.
“For example, the value of z-score=1 is nearly equivalent to the 85th percentile — the threshold for overweight status. A z-score of 4 is equivalent to the extended 99.9th percentile, but z-scores of 4 and 1 may be easier to convey to patients and families compared to extended 99.9th and 85th percentiles.”
In order to help healthcare professionals with these revised calculations, the CDC is referring to its SAS programopens in a new tab or window to crunch the percentiles and z-scores for a child’s sex and age for BMI, weight, height, and head circumference.
Other than this change, the CDC said that there are no plans to completely overhaul the growth charts with current data because it would skew the charts, essentially normalizing obesity.
“Using a new 95th percentile to define obesity would lead to some children being below the 95th percentile who were above using the 2000 charts,” the agency noted.
“As an example, during 2017-March 2020, 19.7% of U.S. children and adolescents were above the 95th percentile of the 2000 CDC BMI-for-age growth charts and had obesity. If the charts were updated to include only these children, 5%, not 19.7%, would be above the 95th percentile.”
What Is Brain Fog? Neurology in the ED; What CSF Tau Biomarkers Show
News and commentary from the world of neurology and neuroscience
Researchers studied over 700 first-person descriptions of brain fogopens in a new tab or window on social media to better understand its phenomenology. (Journal of Neurology, Neurosurgery, and Psychiatry)
A combination of guanfacine and the supplement N-acetylcysteineopens in a new tab or window appeared to help eight people with long COVID brain fog symptoms. (Neuroimmunology Reports)
Amyloid PET changes were similar between people with autosomal dominant Alzheimer’s disease and Down syndrome.opens in a new tab or window (Lancet Neurology)
The most common neurologic complaints seen in emergency departmentsopens in a new tab or window included headache, vertigo or dizziness, and general weakness, with a serious condition suspected in 10.1% of patients. (JAMA Neurology)
Anti-dementia drugs, including acetylcholinesterase inhibitors and memantine, were tied to shorter hospital stays and decreased mortality risk in people who had dementia with Lewy bodiesopens in a new tab or window. (PLoS Medicine)
Soluble phosphorylated tau (p-tau) biomarkers in cerebrospinal fluidopens in a new tab or window were more closely associated with cerebral amyloid-beta than with tau tangles, data from two observational cohorts showed. (JAMA Neurology)
Policy makers and funders need to support more inclusive research opens in a new tab or windowif the burden of dementia is to be tackled effectively, the editors of Lancet Neurology argued.
Starting disease-modifying treatment earlier was associated with better patient-reported physical symptomsopens in a new tab or window in multiple sclerosis, but not overall quality of life. (Journal of Neurology, Neurosurgery, and Psychiatry)
Satralizumab (Enspryng) reduced the risk of relapse in patients with aquaporin-4-immunoglobulin G-seropositive (AQP4-IgG+) neuromyelitis optica spectrum disorderopens in a new tab or window beyond the first 96 weeks of treatment, open-label extension data showed. (Neurology: Neuroimmunology & Neuroinflammation)
Long COVID Contributed to Thousands of Deaths, CDC Says
Death certificate records mentioned long COVID as early as April 2020
Long COVID played a role in more than 3,500 deaths in the U.S. since the start of the pandemic, according to data from the CDC’s National Center for Health Statistics (NCHS).
Death certificate records from January 2020 through June 2022 showed that long COVID contributed to 3,544 deaths, based on ICD-10 codes for COVID-19 as well as text referring to long COVID, reported Farida B. Ahmad, MPH, a health scientist at the NCHS, and colleagues.
Older adults had the highest percentage of deaths involving long COVID, including people 85 and older (28.1% of deaths), 75 to 84 years old (28.8%), and 65 to 74 years old (21.5%), they noted in Vital Statistics Rapid Releaseopens in a new tab or window.
The death rate was higher among men versus women (51.5% vs 48.5%), and highest among American Indian and Alaska Native people (14.8 per 1 million) and lowest among Asian people (1.5 per 1 million).
The first recorded death certificate with a mention of long COVID occurred in April 2020, and the highest number of deaths with long COVID occurred in February 2022 (n=393).
The percentage of COVID-19 deaths with long COVID peaked in June 2021 (1.2%) and April 2022 (3.8%). Both peaks coincided with periods of decreasing numbers of COVID deaths, the researchers noted.
“The main finding is that there are deaths with long COVID,” Ahmad told MedPage Today. “This report is our first time looking at long COVID deaths using Vital Statistics data, so we haven’t looked at the data in this lens.”
The most commonly mentioned term on death certificates with long COVID was “post COVID,” which was mentioned in 89.6% of long COVID-related deaths.
Other key search terms included “chronic COVID,” “long COVID,” “long haul COVID,” “long hauler COVID,” “post-acute sequelae of COVID-19,” “post-acute sequelae SARS-CoV-2 infection,” “PASC,” and “post COVID syndrome.”
Ahmad noted that long COVID was not a well-known term for most of 2020, which made it difficult to accurately review death certificates. She explained that they did not use search terms that could misidentify the cause of death, such as “history of COVID,” which might refer to a prior COVID infection but not a true link between death and long COVID.
“We certainly have standardized guidance about what should be written on the death certificate and how, but with something like long COVID, I mean even clinically it’s hard to define and diagnose, then you get to how to write that on the death certificate or how to determine if it played a role in the death,” Ahmad said. “A lot of this is subjective to the doctor who’s writing it.”
That subjectivity, she added, could mean that the number of deaths is very likely underestimated in this report. She also noted that this report is based on provisional data that are subject to change, which could lead to an increase in the total number of deaths attributed to long COVID.
“There’s possible underestimates because we can only count the data that we have,” Ahmad said. “So if it’s not written on the death certificate, we don’t have a way of quantifying it.”
The evidence of any death records mentioning long COVID is particularly noteworthy, noted Arch Mainous, PhD, of the University of Florida in Gainesville.
“The fact that people were dying and you were finding mentions in the death certificate of people saying long COVID, or chronic COVID, or long hauler COVID, was actually quite surprising to me,” Mainous told MedPage Today. “Early on, people [thought] that someone had COVID, they recovered from COVID, and the severe outcome wasn’t really linked, so the fact that you have thousands of deaths that were linked [to long COVID] is pretty amazing.”
However, he noted that many people are still not taking long COVID seriously enough, both as a health concern and as a potentially deadly condition. He emphasized that healthcare providers should focus more on the possibility that long COVID is affecting their patients and possibly contributing to their deaths.
“The data they had access to is good, but I think it’s definitely limited,” Mainous said. “The recording of the death certificate including long COVID has to have people who are sensitized to be looking for it, and those people are going to have to be thinking of it when somebody dies of a stroke.”
This report is just the beginning of research into long COVID as a cause of death in the U.S., Ahmad noted. She urged healthcare providers to remember this when considering possible causes of death in the future.
“Providers [should] keep in mind how they’re diagnosing and recording post-COVID conditions, especially in the death certificate, so that it can be picked up,” Ahmad said. “If the information is in the death certificate, we can identify those deaths.”
For this analysis, Ahmad and colleagues reviewed final and provisional National Vital Statistics System death certificate data for deaths that occurred in the U.S. from January 2020 through June 2022. They used the cause-of-death code U07.1, the ICD-10 code for COVID-19, to count deaths, as well as the previously mentioned keywords.
3 Wild Herbs For Lucid Dreaming
Do you remember what you dreamt about last night? How about the night before?
For thousands of years, we humans have placed a ton of value on the content of these bedtime reveries, deriving inner wisdom and even premonitions from them. Dreaming feels like a birthright, an extra sense that allows us to process both rationally and spiritually while our body rests up.
They are one of behavioral science’s biggest mysteries, with no agreed-upon theory of their origin and specific purpose. For some, dreams occur nightly, but others never experience them at all.
One thing is for sure – many who don’t dream wish they did.
Since I was young, I’ve had them on a regular basis, but have always known there were deeper places to go in this state of consciousness. The quest for many is to achieve the lucid dream, or “knowing we’re dreaming” inside the dream.
The lucid dreamers I know are able to navigate their dreamscape with an awakened mind, asking characters they come across pretty insightful questions about their life path. They can run, jump, and fly at will, gaining profound inner wisdom from the experience.
If you would like to dream more at night, and perhaps experience the mysterious lucid dream, there are three wild herbs that have been used throughout time to accomplish just that.
The herbs below are all 100% legal, and easy to get ahold of. However, please do your own research before trying any of them – herbs are medicine and they should be treated with proper caution. These plants each have a variety of other medicinal uses, but we’re focusing solely on their dream-enhancing effects.
Wild Asparagus Root –Asparagus racemosus
The Chinese word for wild asparagus root is Tian Men Dong – or heavenly spirit herb. For millennia, it’s been cherished by shamans, monks, and yogis for its heart-opening effects.
Also known as “The Flying Herb”, it’s believed that wild asparagus root helps one fly through the universe at night, achieving magnificent dreams. The wisdom schools of ancient China placed much value on dream work, namely lucid dreaming.
In Chinese folk medicine, it is believed that this particular herb has a direct and positive effect on the heart energy, dissolving the dualities that come with our physical incarnation – black and white, left and right, inside and out. This allows our consciousness to blossom into infinite space while we sleep.
Preparation: the best way to use wild asparagus for this particular purpose, is to brew a tea of either the fresh or dried root. Keep in mind that a tea from the fresh root will be much more potent.
Valerian Root – Valeriana officinalis
This herb has been used in folk medicine for centuries as a calming aid, muscle relaxant, and to promote deep sleep. Because lucid dreaming usually requires a heightened state of slumber, it has become a commonly reported side effect of valerian root.
Many also report that valerian greatly improves the ability to remember their dreams. Robert Monroe, a famed specialist in Out Of Body Experiences, once said “Most of us dream, and those who don’t simply are not remembering them.”
Imagine an herb that not only promotes deep states of sleep that are fertile ground for vivid dreams, but also boosts our ability to remember what happened the morning after. Valerian might be just that.
Warning: Because there isn’t enough information available regarding its effects during pregnancy, women who are expecting are better off avoiding it altogether.
Keep in mind: If you already experience extreme dream states, you might think twice before trying valerian. It can intensify your nocturnal adventures quite a bit – which is wonderful when you’re having a good dream, but not-so-great if you’re having a nightmare.
Preparation: Valerian is most commonly brewed in a tea, but be careful to use water that is hot, but not boiling, in order to preserve the delicate oils in the root. Some also prepare a tincture from the dried or fresh root (this can usually be found at health food stores).
Mugwort – Artemisia vulgaris
Very common throughout the Americas, Europe and Asia, mugwort has a rich history of use, both as a medicinal and metaphysical ally. In the middle ages, it was known as Cingulum Sancti Johannis, because Saint John the Baptist famously wore a belt of it whenever he traveled through the woods. It is referenced often in Celtic and Norse mythology as a magical plant that can ward off evil, and was hung in doorways and burnt as incense to clear stagnant air and prevent illness.
Mugwort is known as “Molush” by the Chumash Indians of California, and its Paiute name translates literally to “Dream Plant”. It’s often smoked in indigenous ceremonies, and interestingly, is also hailed by various tribes for its power to ward off evil, bad spirits, and disease.
Known for its dream-enhancing effects, many report that it magnifies the brilliance of color and overall duration of their mid-slumber journeys. On a personal note, I’ve had some lovely experiences with this one 
Mugwort grows just about everywhere. You’ll often find it underfoot, whether in the woods or walking through an overgrown urban environment. Is it sheer chance that this sacred herb that reportedly heightens consciousness is sprouting up all around us?
Preparation: Like the two plants mentioned above, Mugwort is quite often taken as a tea, but can also be smoked in a pipe. The leaves of the Mugwort plant are what contain the active chemical constituents.
I wish you wonderful and wisdom-packed journeys tonight, and many nights thereafter. Remember, like any good herbalist, we each need to do careful research on the medicinals we choose to work with – this is a central pillar of the plant path.
Everyone deserves to dream
Which are the latest medical advances to cure or treat type 2 diabetes?
More than 420 million people in the world have diabetes, a number that is likely to double in the next 20 years, according to the World Health Organization (WHO). Faced with this reality, in recent times, treatments have been developed that allow a substantial improvement in the quality of life of those who suffer from this disease.
Dr. Isabel Errázuriz, a diabetologist at Clínica Alemana, explains that worldwide “it is projected that in 2022, cases of type 1 diabetes will be double those of the year 2000, due to the increase in autoimmune diseases in general and because the best treatment with insulin has significantly prolonged the lives of these patients.”
She adds that type 2 diabetes has also increased dramatically due to the rise in obesity and poor eating habits, and due to a longer life expectancy, since this pathology is more prevalent in the elderly.
Although there is still no curative treatment, in recent years there have been different advances in the management of this disease:
- Drugs: thanks to bioengineering, new insulins have been developed that reduce hypoglycemia (low blood sugar) in some people. In addition, other hormones involved in the metabolism of carbohydrates have been discovered. Other medications that act at the level of the kidney, inducing glucose loss through the urine, are also being used. Its use can be associated with weight loss and cardiovascular protection.
- Continuous subcutaneous insulin infuser (insulin pump): it is a device that, through a flexible catheter, administers this hormone in the subcutaneous tissue, in a programmed manner. This has made it possible, especially in patients with type 1 diabetes, to make eating and physical activity schedules more flexible, allowing them to improve their quality of life.
- Surgeries: Currently, there are surgical procedures, such as gastric bypass and vertical sleeve gastrectomy, that have been shown to be an effective treatment for type 2 diabetes in patients who meet certain criteria.
- Research: There are many ongoing studies to develop new drugs and devices that are not yet on the market. Among them, a transdermal patch stands out that is capable of infusing insulin through microneedles according to the level of blood glucose.
Diabetes research is one of the areas that has given the most positive news in recent years with new treatments that have radically changed the prognosis of the disease, to the point that experts explain that not only are patient tests being transformed , but rather lead to a 180 degree turn in their quality of life.
These are drugs that allow a personalized treatment of the disease, going to the source of the problem and with added effects in terms of spectacular weight loss and cardiovascular protection.
Diabetes is now recognized as an epidemic and a serious health problem. It is calculated, according to data provided by Cristóbal Morales, endocrinologist and specialist in cardiometabolic health, diabetes and obesity at the Virgen Macarena University Hospital and Vithas Hospital in Seville, that 14% of the population has diabetes, a disease that leads to an increase in morbidity and mortality, fundamentally due to cardiovascular pathology, and that can generate a wide range of complications.
However, one of the biggest problems in dealing with this pandemic is that it is a silent killer, in the case of type 2 diabetes, in the sense that it takes time to show symptoms and often when it does, the disease is already advanced and has been able to do damage to multiple organs, according to Dr. Morales.
Given this scenario, one of the main challenges is to try to correct underdiagnosis, given that it is estimated that 30% of the population could present a prediabetic state or undiagnosed onset diabetes.
What’s more, actually the course of the illness changes fundamentally relying upon the second where the finding is made, which is the reason early identification is a key goal. “One of the angles most worries us; the second where the patient’s most memorable interview with his wellbeing group happens marks the forecast of the infection, “makes sense of this subject matter expert.
Also, it is that type 2 diabetes requires some investment to show manifest side effects however it creates miniature and macrovascular entanglements in the body, cautions Francisco Merino, top of the Endocrinology and Sustenance administration at La Fe College Clinic, in Valencia, thus that exceptionally realistic name with which she is depicted as the quiet adversary.
true revolution
Early diagnosis is important because today there is a wide arsenal of pharmacological treatments that have meant “a real revolution” in the approach to the disease, as both experts agree. In few diseases has research been so successful.
In summary, the keys to these new treatments that allow us to speak of a paradigm shift in the approach to the disease are:
Specificity based on the pathophysiology of diabetes, that is, the original problem and the patient’s phenotype.
The effectiveness in weight loss.
The powerful cardioprotective effect.
This allows us to speak of a “personalized medicine” derived from:
Treatments that can be individualized.
Used since the beginning.
preventively.
Dr. Cristóbal Morales is categorical in pointing out that the current pharmacological panorama has nothing to do with that of a few years ago, “when we had little more than three drugs, in most cases we were late and almost always followed failure . Pharmacological innovation in diabetes has led to a real revolution that allows us to speak of a paradigm shift”.
The two new therapeutic groups are:
GLP-1 receptor agonists: Also called incretin mimetics, they copy or mimic the action of GLP-1 produced by the human body. “These are treatments that go to the origin of the problem in a very effective way,” summarizes Dr. Morales. They are injectable drugs, currently available in presentations for weekly administration and that are very effective in terms of:
Weightloss.
Metabolic and glucose control without hypoglycemia.
Cardiovascular protection and very significant decrease in the risk of atherosclerotic events
In this group of drugs there has also been significant innovation in the last year, points out Francisco Merino, with the availability of the first GLP-1 receptor agonist that is administered orally, through a tablet that is taken by the mornings on an empty stomach, which is a step forward when the puncture may represent some kind of problem. “It makes treatment easier for the patient and the doctor because the training needs are much lower,” says this expert.
And the American Diabetes Association recommends the use of these drugs from the start, regardless of the levels of glycosylated hemoglobin, if the patient has atherosclerotic disease, indicates Cristóbal Morales.
iSGLT2 inhibitors: they are antihyperglycemic drugs, administered orally that have shown potent effects in terms of:
Glycemic and metabolic control.
Renal and cardiovascular protection, with a decrease in both the risk of coronary ischemia and heart failure, as well as cerebrovascular disease.
Weight loss.
With both groups we are managing to reduce morbidity and mortality, which is the objective of any treatment, and all of this results in a very important improvement in the patient’s quality of life”, indicates Dr. Merino.
And, in fact, dual GLP-1 receptor agonists are already under investigation that act on this receptor and also on GIP, that is, they have a dual action on two receptors and are also showing excellent results in controlling diabetes and in reducing obesity, with a very powerful effect on weight loss that can reach figures of 15 or 16%, that is, similar or close to those achieved with endoscopic techniques, specifies Cristóbal Morales.
Even those known as triagonists that act on GLP-1, GIP and glucagon are already under development, also with spectacular initial results in glycemic control and weight loss.
These drugs have been added to the classic treatment with metformin and must always be accompanied by changes in lifestyle, with special emphasis on diet and physical exercise. On the other hand, the arsenal is completed with insulin treatments, when these pharmacological treatments do not achieve the expected results.
Delay the need for insulinization
Francisco Merino highlights the importance and efficacy of diabetes treatments to delay the need for insulinization in type 2 diabetes, a requirement that is becoming less and less. Currently, it is estimated that between 15 and 20% of patients with type 2 diabetes must resort to insulin. “And we anticipate that in the future this number will go down.” And that is the goal because insulin is an anabolic hormone that facilitates weight gain and presents a risk of complications due to hypoglycemia, “undesirable effects, especially in older patients.”
Telemonitoring
At the same time as the pharmacological novelties, the use of technology for painless interstitial glucose measurement, according to Cristóbal Morales, such as FreestyleLibre, has been “a great disruptive advance since it allows a better quality of life and better glycemic control, avoiding hypoglycemia.” at the same time that it allows the development of telemedicine through its glucose telemonitoring program”.
Source: Quora
New Behavioral Vaccines Raise Unsettling Questions
Government and drug makers are looking to treat drug addiction with vaccines
New vaccines may block the brains of drug users from getting high from their favorite drug, but that scenario raises other concerns.
In its 2016 to 2020 strategic plan, the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), promoted the promise of “anti-addiction vaccines aimed at eliciting antibodies that block the effects of a specific drug.”
Certainly addiction is a huge problem, with opioid addiction leading the way, taking more than 140 American lives per day, in part because lethal fentanyl is being peddled. Addiction to other drugs, including meth and, of course, alcohol, also has tragic and often deadly consequences.
The quest for an anti-addiction vaccine began in earnest when Drs. Nora D. Volkow, NIDA director, and Francis S. Collins, then-NIH director, called on scientists and industry to help develop vaccines specific against opioids in a New England Journal of Medicine Special Report in 2017. The quest for such treatments continues.
How exactly do anti-addiction vaccines work? According to Chemical and Engineering News, in the case of heroin, the vaccine “would stimulate a person’s immune system to produce antibodies that bind to heroin. The antibodies would block the drug from crossing the bloodstream into the brain, stopping the person from experiencing a high and preventing a relapse.”
In short, these antibodies “would shut down the narcotic before it could take root in the body, or in the brain,” according to The New York Times.
Limits to Behavioral Vaccines
While many medical voices salute such vaccines and hope that they become available, others are more skeptical. Some point out that, like the alcoholism treatment Antabuse (disulfiram), which causes a person to get sick if they imbibe, a vaccine requires motivation on the part of the addicted person—they have to want to stop.
An anti-addiction vaccine will likely require continued motivation, such as a potential anti-cocaine vaccine discussed in the journal Clinical Pharmacology & Therapeutics, which might require “six additional boosters given as one every 3 months,” to produce “a period of protection lasting 2 years.”
If the addict craves the escape the high provides and isn’t ready to face the world without it, a vaccine is only part of the solution. The addict could just find a different drug.
And there are other challenges. Addicts might simply use more of a drug to override the vaccine effects, Angela Garcia wrote in the Los Angeles Times. The vaccines may even be forced on addicts or their children, Garcia said, a concern echoed in the BMJ’s Journal of Medical Ethics.
Many critics of the vaccine are uncomfortable with the biological approach to addiction embraced by NIDA, which can overlook the root cause of the addiction, which often comes back to previous trauma.
NIDA sees the problem in less personal terms.
“We have identified many of the biological and environmental factors [of addiction] and are beginning to search for the genetic variations that contribute to the development and progression of the disease,” Volkow, NIDA’s director, said in 2007.
A flier promoting Volkow’s presentation to the Commonwealth Club of California in 2013 reads that she believes “that all addictions can be eliminated if the brain’s receptors can be controlled.” Some regard such remarks as Orwellian or disturbingly similar to the more subtle dystopia envisioned in “Brave New World.”
If addiction can be solved in the brain, what other socially undesirable diseases may we be inclined to treat? And after COVID-19, what penalties might an individual face if he or she refuses?
Addiction Isn’t Just a Brain State Say Experts
NIDA’s “brain disease” model not only enriches psychiatric drugmakers and Big Pharma, but it ignores all the societal reasons for drug addiction.
“Even the most effective anti-addiction vaccine can’t cure the underlying factors that make people prone to using drugs, including poverty, violence and lack of opportunity,” Garcia wrote. “[The] underlying issues of addiction causality, including inequality, hopelessness, and the human desire for pleasure, cannot be addressed by a vaccine alone.”
Certainly drug addiction has features of a social disease, and the areas where it’s concentrated reveal something about our broader culture and the daily conditions in which people find themselves. People don’t seek the escape of drugs or alcohol for no reason at all, and some do become addicted. Nor should we ignore the fact that even as lawsuits against opioid makers and sellers have proceeded, the opioid treatment drug Suboxone was a top seller in 2018 with sales of $859 million.
Drug addiction can clearly be a drug industry profit center.
Treating addiction as a brain disease has other risks, according to an editorial in the journal Addiction. It can deemphasize social and psychological influences.
“Depicting addiction as a ‘brain disease’ could privilege the development and use of expensive and sometimes risky medical interventions, such as drug vaccines and deep brain stimulation, to the neglect of proven social policies,” the editorial reads. “The idea that addiction is a ‘brain disease’ might also lend itself to the view that we should identify the minority of people who are most susceptible and subject them to individually focused preventive measures (e.g. vaccines) rather than using strategies that target the entire population.”
Another issue that The Epoch Times recently covered is the positive effects that a sense of free will and self-efficacy exert on many, perhaps most health conditions, versus the feeling that nothing can be done.
Several studies have indicated that a person’s sense of self-efficacy—that they have the ability to affect the course of their life through their own choices—is an important factor in recovering from addiction.
If addicts believe a medical professional or injection can cure their addiction, it further removes their sense of self-control and could lead to unintended consequences.
Research published in the journal Culture, Medicine, and Psychiatry in 2021 concurs about the problem of addicts abdicating personal responsibility.
“While NIDA’s neurobiological understanding of addiction has been crucial in advancing pharmacotherapeutic interventions and advocacy for people experiencing problematic substance use, it can nevertheless be internalized by people such as Vivian [a cited case] who understand their chronic relapse as ‘just part of being an addict,’” the article reads.
Like other voices, the article in Culture, Medicine, and Psychiatry notes that epidemics of drug use aren’t uniformly found among different groups of people and can be linked to “chronic experiences of dispossession and postindustrial decline and dislocation.”
On a brighter note, the researchers noted that NIDA may be enlarging its very limited brain-and-vaccine model of addiction and integrating social and environmental factors into a more “biopsychosocial model” that recognizes the “complex interactions between biology, behavior, and environment.”
“Anti-addiction vaccines aren’t intended to be used on their own, nor would they work that way,” an article posted by the Texas Addiction Treatment Centers reads. “They are designed to be a part of a comprehensive treatment plan that incorporates other evidence-based treatment methods and behavioral therapies like cognitive behavioral therapy, 12-step therapy, or individual and group counseling sessions.”
Will Anti-Addiction Vaccines Take Off?
So far, human trials with vaccines against nicotine and cocaine in 2008 were failures, Ivan Montoya of NIDA said in 2018. This didn’t bode well for newer vaccines.
But if anti-addiction vaccines succeed, another issue may arise. The COVID-19 vaccines have revealed a lack of firewalls between government officials and industry. Volkow has personally collaborated with five pharmaceutical companies in research that seeks to help translate “basic information … into Food and Drug Administration–approved treatments.” This appears to be a serious conflict of interest. While faith-based and 12-step recovery programs are free, the search for high-tech treatments such as anti-addiction vaccines promises lucrative windfalls to drugmakers, which should be concerning to us all.
And given that the current opioid crisis can be directly linked to the misleading claims of drug makers when they marketed those products and the continued over-prescription of those products, the fact that this massive social epidemic could become a major source of profit for some of the same companies is unethical, to say the least.
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