Lancet

EU-approved ‘safe’ air pollution levels causing early deaths.

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Published time: December 09, 2013 14:08
Edited time: December 10, 2013 08:37

General view of the Origny sugar factory in Sainte-Benoite near Saint-Quentin. (AFP Photo / Philippe Huguen)General view of the Origny sugar factory in Sainte-Benoite near Saint-Quentin. (AFP Photo / Philippe Huguen)

Air pollution in the European Union is causing premature deaths even when levels meet quality guidelines, a report has shown. Even in areas where pollution was much lower than the limit, scientists found there is a higher-than-normal risk of death.

The study, published the British Medical Association’s journal The Lancet, found that Europeans who have had prolonged exposure to pollution from industrial activities or road traffic have a higher chance of premature death. The increased risk to a person’s health is linked to tiny particles of soot and dust than can get lodged in the lungs and cause respiratory illnesses.

The study, carried out by Utrecht University in the Netherlands, found the particles measure 2.5 microns or 2.5 millionth of a meter. Exposure for “up to a few months” to particles of 2.5 microns can increase the risk of premature death.

“Although this does not seem to be much, you have to keep in mind that everybody is exposed to some level of air pollution and that it is not a voluntary exposure, in contrast to, for example, smoking,” scientist Rob Beelen, who led the study, told AFP.

The findings of the study echo the results of similar investigations carried out in North America and China.

“Our findings support health impact assessments of fine particles in Europe which were previously based almost entirely on North American studies,” Beelen said.

As part of the study the researchers drew on 22 previously published studies that documented the health of 367,000 people in 13 countries in Western Europe over 14 years. Beelen and his team then traveled to the areas where the participants lived and took traffic pollution readings that they used to calculate how much pollution local residents were exposed to.

 

AFP Photo / Frederick FlorinDuring the investigation, 29,000 of the 367,000 participants recruited in 1990 died. In order to increase accuracy, investigations also took into account such factors as physical exercise, body mass, education and smoking habits. 

European Union guidelines set the maximum exposure to particles of 25 micrograms per cubic meter. Beelen says the results of this study are evidence the EU needs to reset its safety limits to 10 micrograms per cubic meter.

“Despite major improvements in air quality in the past 50 years, the data from Beelen and his colleagues’ report draw attention to the continuing effects of air pollution on health,” Jeremy Langrish and Nicholas Mills, of the University of Edinburgh, told the Medical Press.

In China a red alert was issued for poor air quality was issued Thursday after pollution reached hazardous levels. The coastal city of Qingdao recorded PM2.5 Air Quality Index levels of over 300, while Nanjing saw a reading of 354 on Wednesday, according to local news portal news.longhoo.net.

In light of the dangerous levels of pollution the Chinese government is considering the practice of ‘cloud seeding’ to clear toxic fog in the country. According to a document released by the China Meteorological Administration, from 2015 local meteorological authorities will be permitted to use cloud seeding to disperse pollution.

The World Health Organization has classified outdoor pollution as one of the principal causes of cancer and estimates around 3.2 million people die every year globally as a result of prolonged exposure.

Ibuprofen Kills Thousands Each Year, So What Is The Alternative?

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A recent Reuters’ article opened with the following stunning sentence:

“Long-term high-dose use of painkillers such as ibuprofen or diclofenac is ‘equally hazardous’ in terms of heart attack risk as use of the drug Vioxx, which was withdrawn due to its potential dangers, researchers said.”  

The 2004 Vioxx recall, as you may remember, was spurred by the nearly 30,000 excess cases of heart attacks and sudden cardiac deaths caused by the drug between 1999-2003. Despite the fact that scientific research had accumulated as early as 2000 linking Vioxx to increased heart attacks and strokes, the drug’s manufacturer Merck, and the FDA, remained silent as the death toll steadily increased.

Ibuprofen Kills Thousands Each Year, So What Is The Alternative?

The Reuters report focused on new research published in Lancet indicating the risk of heart attack increases as much as a third and the risk of heart failure doubles among heavier users of NSAID drugs.

INFLAMED: Our Default Bodily State

Why are so many folks taking NSAID drugs like ibuprofen anyway?

Pain and unhealthy levels of inflammation are fast becoming default bodily states in the industrialized world. While in most cases we can adjust the underlying pro-inflammatory conditions by altering our diet, and reducing stress and environmental chemical exposures, these approaches take time, discipline and energy, and sometimes we just want the pain to stop now. In those often compulsive moments we find ourselves popping an over-the-counter pill to kill the pain.

The problem with this approach is that, if we do it often enough, we may kill ourselves along with the pain…

Ibuprofen really is a perfect example of this. As mentioned above, this petrochemical-derivative has been linked to significantly increased risk of heart attack and increased cardiacand all-cause mortality (when combined with aspirin), with over two dozen serious adverse health effects, including:

  1. Anemia[1]
  2. DNA Damage[2]
  3. Hearing Loss[3]
  4. Hypertension[4]
  5. Influenza Mortality[5]
  6. Miscarriage[6]

Ibuprofen is, in fact, not unique in elevating cardiovascular disease risk and/or mortality. The entire category of non-steroidal anti-inflammatory drugs (NSAIDs) appears to have this under-recognized dark side; cardiovascular disease and cardiac mortality score highest on the list of over 100 unintended adverse health effects associated with their use. See also our analysis of the rarely acknowledged dark side to aspirin: The Evidence Against Aspirin And For Natural Alternatives.

So, what does one do? Pain is pain. Whether it happens to you, or you witness it in another (which can be worse), finding relief is a top priority.

Ibuprofen Kills More Than Pain, So What Is The Alternative?

Research on Natural Alternatives To Ibuprofen

Here is some evidence-based research on alternatives to ibuprofen, sourced from the National Library of Medicine:

  1. Ginger – A 2009 study found that ginger capsules (250 mg, four times daily) were as effective as the drugs mefenamic acid and ibuprofen for relieving pain in women associated with their menstrual cycle (primary dysmenorrhea). [7]
  2. Topical Arnica – A 2007 human study found that topical treatment with arnica was as effective as ibuprofen for hand osteoarthritis, but with lower incidence of side effects.[8]
  3. Combination: Astaxanthin, Ginkgo biloba and Vitamin C – A 2011 animal study found this combination to be equal to or better than ibuprofen for reducing asthma-associated respiratory inflammation.[9]
  4. Chinese Skullcap (baicalin) – A 2003 animal study found that a compound in Chinese skullcap known as baicalin was equipotent to ibuprofen in reducing pain.[10]
  5. Omega-3 fatty acids: A 2006 human study found that omega-3 fatty acids (between 1200-2400 mg daily) were as effective as ibuprofen in reducing arthritis pain, but with the added benefit of having less side effects.[11]
  6. Panax Ginseng – A 2008 animal study found that panax ginseng had analgesic and anti-inflammatory activity similar to ibuprofen, indicating its possible anti-rheumatoid arthritis properties.[12]
  7. St. John’s Wort – A 2004 animal study found that St. John’s wort was twice as effective as ibuprofen as a pain-killer.[13]
  8. Anthrocyanins from Sweet Cherries & Raspberries – A 2001 study cell study found that anthrocyanins extracted from raspberries and sweet cherries were as effective as ibuprofen and naproxen at suppressing the inflammation-associated enzyme known as cyclooxygenase-1 and 2.[14]
  9. Holy Basil – A 2000 study found that holy basil contains compounds with anti-inflammatory activity comparable to ibuprofen, naproxen and aspirin.[15]
  10. Olive Oil (oleocanthal) – a compound found within olive oil known as oleocanthal has been shown to have anti-inflammatory properties similar to ibuprofen.[16]
  11. There are, of course, hundreds of additional substances which have been studied for their pain-killing and/or anti-inflammatory effects, and there are also aromatherapeutic approachesthat do not require the ingestion of anything at all, but there is also a danger here. When we think of taking an alternative pain-killer to ibuprofen, we are still thinking within the palliative, allopathic medical model: suppress the symptom, and go on about our business. It would behoove us to look deeper into what is causing our pain. And when possible, remove the cause(s). And that often requires a dramatic dietary shift away from pro-inflammatory foods, many of which most Westerners still consider absolutely delightful, e.g. wheat, dairy,nighshade vegetables and even wheat-free grains, etc.

    [1] Direct cytotoxicity of non-steroidal anti-inflammatory drugs in acidic media: model study on human erythrocytes with DIDS-inhibited anion exchanger. Pharmazie. 2002 Dec;57(12):848-51. PMID: 12561250

    [2] Genotoxicity of ibuprofen in mouse bone marrow cells in vivo. Drug Chem Toxicol. 2012 Jan 27. Epub 2012 Jan 27. PMID: 22283434

    [3] Analgesic use and the risk of hearing loss in men. Am J Med. 2010 Mar;123(3):231-7. PMID: 20193831

    [4] Effect on blood pressure of lumiracoxib versus ibuprofen in patients with osteoarthritis and controlled hypertension: a randomized trial. J Hypertens. 2008 Aug;26(8):1695-702. PMID: 18622250

    [5] The effect on mortality of antipyretics in the treatment of influenza infection: systematic review and meta-analysis. J R Soc Med. 2010 Oct;103(10):403-11. PMID: 20929891

    [6]  Taking non-aspirin NSAIDs in early pregnancy doubles risk of miscarriage, study shows. BMJ. 2011 ;343:d5769. Epub 2011 Sep 9. PMID: 21908536

    [7] Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea. J Altern Complement Med. 2009 Feb 13. PMID: 19216660

    [8] Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomised, double-blind study. Rheumatol Int. 2007 Apr;27(6):585-91. Epub 2007 Feb 22. PMID: 17318618

    [9] Summative interaction between astaxanthin, Ginkgo biloba extract (EGb761) and vitamin C in suppression of respiratory inflammation: a comparison with ibuprofen. Phytother Res. 2011 Jan;25(1):128-36. PMID: 20632299

    [10] The antiinflammatory and analgesic effects of baicalin in carrageenan-evoked thermal hyperalgesia. Anesth Analg. 2003 Dec;97(6):1724-9. PMID: 14633550

    [11] Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31. PMID:16531187

    [12] Potential analgesic and anti-inflammatory activities of Panax ginseng head butanolic fraction in animals. Food Chem Toxicol. 2008 Dec;46(12):3749-52. Epub 2008 Oct 1. PMID:18930781

    [13] Antinociceptive activity of methanolic extracts of St. John’s Wort (Hypericum perforatum) preparation. Pak J Pharm Sci. 2004 Jul;17(2):13-9. PMID: 16414593

    [14] Cyclooxygenase inhibitory and antioxidant cyanidin glycosides in cherries and berries. Phytomedicine. 2001 Sep;8(5):362-9. PMID: 11695879

    [15] Antioxidant and cyclooxygenase inhibitory phenolic compounds from Ocimum sanctum Linn. Phytomedicine. 2000 Mar;7(1):7-13. PMID: 10782484

    [16] Molecular mechanisms of inflammation. Anti-inflammatory benefits of virgin olive oil and the phenolic compound oleocanthal. Curr Pharm Des. 2011 ;17(8):754-68. PMID:21443487

     

‘Sugar gel’ helps premature babies.

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A dose of sugar given as a gel rubbed into the inside of the cheek is a cheap and effective way to protect premature babies against brain damage, say experts.

premature baby

Dangerously low blood sugar affects about one in 10 babies born too early. Untreated, it can cause permanent harm.

Researchers from New Zealand tested the gel therapy in 242 babies under their care and, based on the results, say it should now be a first-line treatment.

Their work is published in The Lancet.

Sugar dose

Dextrose gel treatment costs just over £1 per baby and is simpler to administer than glucose via a drip, say Prof Jane Harding and her team at the University of Auckland.

“Start Quote

This is a cost effective treatment and could reduce admissions to intensive care services which are already working at high capacity levels”

Andy Cole Bliss

Current treatment typically involves extra feeding and repeated blood tests to measure blood sugar levels.

But many babies are admitted to intensive care and given intravenous glucose because their blood sugar remains low – a condition doctors call hypoglycaemia.

The study assessed whether treatment with dextrose gel was more effective than feeding alone at reversing hypoglycaemia.

Neil Marlow, from the Institute for Women’s Health at University College London, said that although dextrose gel had fallen into disuse, these findings suggested it should be resurrected as a treatment.

We now had high-quality evidence that it was of value, he said.

Andy Cole, chief executive of premature baby charity Bliss, said: “This is a very interesting piece of new research and we always welcome anything that has the potential to improve outcomes for babies born premature or sick.

“This is a cost-effective treatment and could reduce admissions to intensive care services, which are already working at high capacity levels.

“While the early results of this research show benefits to babies born with low blood sugars, it is clear there is more research to be done to implement this treatment.”

Scan predicts heart attack risk

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A new way of scanning the heart can identify those who may be at high risk of a heart attack, early tests suggest.

It can identify dangerous plaques in the arteries which nourish the heart. If a fatty plaque ruptures, it can lead to a clot, blocking the flow of blood.

Scientists at the University of Edinburgh said an effective tool for predicting a heart attack would make a “massive difference” to patients.

Experts said it was an exciting start.

More than 100,000 people have a heart attack in the UK each year and disease of the arteries around the heart is the leading cause of death in the world.

Light up

The researchers used a radioactive tracer which can seek out active and dangerous plaques. This was combined with high resolution images of the heart and blood vessels.

The overall effect is a detailed picture of the heart with the danger zones clearly highlighted. The technology is already used to detect tumours in cancer patients.

The first tests of the technique for danger spots in the heart were on 40 patients who had recently had a heart attack.

The scan highlighted the plaque which caused the heart attack in 37 of the patients according to a study published in the Lancet medical journal.

It is the first time a scan has been able to identify danger zones but further tests are needed to see if detecting dangerous plaques before, rather than after, a heart attack has the potential to save lives.

“I suspect not all plaques detected will cause a heart attack, but it could be useful for identifying high risk patients who need aggressive therapy,” cardiologist Dr Marc Dweck told the BBC.

This could include drugs such as statins or aspirin, drastic lifestyle change or even inserting stents into the arteries to keep them open.

Scan
The scan shows a cross-section of the heart and the high risk plaque in orange

‘Massive difference’

The researchers will look at high risk patients, including those about to have surgery, to see if the scan can save lives.

Dr Dweck said if this scan or similar ones proved successful it would make a “massive difference”.

He said: “Heart attacks are the biggest killer in the Western world and there is no prior warning, the first time people know about heart disease is when they have a heart attack.

“If we can treat and stabilise the plaques then we might be able to prevent heart attacks and stop people dying.”

Prof Peter Weissberg, the medical director of the British Heart Foundation, said: “Being able to identify dangerous fatty plaques likely to cause a heart attack is something that conventional heart tests can’t do.

“This research suggests that PET-CT scanning may provide an answer – identifying ‘ticking time bomb’ patients at risk of a heart attack.

“We now need to confirm these findings, and then understand how best to use new tests like this in the clinic to benefit heart patients.”

Prof Andrew Morris, the chief scientist for health in Scotland, said: “These are exciting data – being able to prospectively identify patients at the highest risk of a heart attack and provide treatment to prevent this would be a significant step forward.”

Hopes of hepatitis C cure raised after antiviral drug treatment success.

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Sofosbuvir and ledipasvir stop virus replicating in 97% of patients in study reported in the Lancet journal

Hepatitis C virus seen through an electron microscope. Photograph: UIG/Getty

Scientists have reported the successful eradication of hepatitis C in patients using two new antiviral drugs, raising hopes of a possible cure.

In the trial, the virus was eliminated from almost all the patients involved, including those who had not previously responded to existing drugs.

Hepatitis C is caused by a virus that spreads via bodily fluids and ends up damaging the liver. Unlike other forms of hepatitis, there is no vaccine and the only treatments include powerful combinations of drugs known as interferons and protease inhibitors. But the treatments have many side-effects, are complex to administer and, in the common type of hepatitis C known as genotype 1, the drugs do not work. If an infection cannot be cured, it can lead to liver cancer.

The new treatment, reported in medical journal the Lancet on Tuesday , consists of the experimental drugs sofosbuvir and ledipasvir. In the trial, 100 patients with genotype 1 hepatitis C were split into groups and given the drugs in a single pill for either eight or 12 weeks. Forty of the participants had previously failed to respond to drugs and half of this group had cirrhotic livers.

After 12 weeks, 97% of the participants had what scientists called a “sustained virological response”, which meant that the hepatitis C virus was not replicating inside them. The patients suffered varying amounts of side-effects, including nausea, anaemia, respiratory tract infections and headaches, but none were considered to be serious.

Professor Eric Lawitz of the University of Texas, who led the study, said the results offered hope to people currently without treatment options: “The results of this trial suggest that the fixed-dose combination of sofosbuvir and ledipasvir could offer patients a short, all-oral treatment that might be highly effective and safe in patients who tend not to respond well to existing therapies, including individuals with cirrhosis, or black race, resistant strains of the virus.”

Charles Gore, chief executive of the Hepatitis C Trust, said the new drug combination was great news. “We were concerned that those with advanced hepatitis C would remain difficult to treat, but these new direct antivirals are incredibly potent. The results suggest that even the most difficult to treat people will in fact be extremely treatable. It now looks as if almost no one will be excluded from benefiting from treatment, which is an incredible achievement.

“There are a number of exciting new drugs on the horizon. However, of the 215,000 people estimated to be living with the virus in the UK, less than half have been diagnosed. In England, only 3% of hepatitis C patients receive treatment each year. There is no point having these treatments if we can’t use them, so we must ensure that we diagnose more people who can avail of them.”

In 2010, a total of 7,834 new hepatitis C cases were reported in England, though the true figure is probably much higher. Rates of infection are greater in people of African descent than in other ethnic groups.

The virus is present in the blood and, to a much lesser extent, the saliva and semen or vaginal fluid of an infected person.

It is most likely to be transmitted through blood-to-blood contact. Intravenous drug users who share their needles are known to be especially vulnerable.

Professor Margaret Hellard of the Burnet Institute in Melbourne, Australia, who co-authored a linked comment on the research published in the Lancet, said: “As a proof of concept study, [this] demonstrates very high response rates, regardless of the presence of cirrhosis, prior treatment failure, or [resistant] genotype.”

She cautioned, however, that the study was small, based at a single location and only had a short follow-up, which she said raised concerns about how representative the sample was and whether early clinical trial results could be generalised to real-world settings. “Whilst giving cause for optimism, the full implications of these results need to be tempered for now,” she wrote.

Tuberculosis: Test Speeds Diagnosis, Time to Treatment.

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The Xpert MTB/RIF (Cepheid) test improved tuberculosis (TB) diagnosis and reduced time to treatment, but not long-term TB-related morbidity, according to the results of a multicenter, randomized, controlled trial.

“Despite already being rolled-out in many countries, our study is the first to look at the feasibility of the Xpert test in a real-life clinical setting in southern Africa,” lead author Keertan Dheda, MBBcH, from the Department of Medicine, University of Cape Town, South Africa, said in a news release. The study results were published online October 28 in the Lancet.

The researchers enrolled adult patients with symptoms suggestive of active TB at 5 primary care facilities in South Africa, Zimbabwe, Zambia, and Tanzania. They randomly assigned patients to either Xpert MTB/RIF testing, performed at the clinic by a nurse who received 1 day of training, or to sputum smear microscopy. On the basis of local World Health Organization–compliant guidelines, participants with a negative test result were managed empirically.

The main study endpoint, analyzed by intention to treat, was TB-related morbidity, measured with the TB score and Karnofsky performance score at 2 months and 6 months after randomization in culture-positive patients who had started anti-TB treatment.

Of 758 assigned patients to smear microscopy between April 12, 2011, and March 30, 2012, 182 were culture positive, as were 185 of 744 patients assigned to Xpert MTB/RIF. Among culture-positive patients, median TB score and median Karnofsky performance score in culture-positive patients did not differ between groups at 2 or at 6 months.

Diagnostic Performance of Point-of-Care MTB/RIF

Compared with microscopy, point-of-care MTB/RIF had higher sensitivity (83% vs 50%; P = .0001), but similar specificity (95% vs 96%; P = .25). Compared with laboratory-based MTB/RIF, point-of-care MTB/RIF had similar sensitivity (83%; P = .99), but higher specificity (92%; P = .0173).

Of 744 tests with point-of-care MTB/RIF, 34 (5%) failed, as did 82 (6%) of 1411 with laboratory-based MTB/RIF (P = .22). More patients in the MTB/RIF group than in the microscopy group had a same-day diagnosis (24% vs 13%; P < .0001) and same-day treatment initiation (23% vs 15%; P = .0002).

Because of the lower dropout rate, more culture-positive patients in the MTB/RIF group were receiving treatment by study end (8% untreated in the MTB/RIF group vs 15% in the microscopy group; P = .0302). By day 56, however, the proportions of all patients receiving treatment were similar (43% vs 42%, respectively; P = .6408).

“Although earlier diagnosis by the Xpert test did not reduce overall severity of TB-related illness, and moreover did not reduce the overall number TB cases treated over the course of the study, it has substantial benefits over smear microscopy including improved rates of same-day diagnosis and reducing treatment drop-out,” Dr. Dheda said in the release.

Cost-Effectiveness May Be a Concern

Limitations of this study include about 20% loss to follow-up of patients with culture-confirmed TB, mostly resulting from staffing problems at 1 site, and possible lack of generalizability to seriously ill patients or those with extrapulmonary TB.

“Whilst Xpert may not be the ideal point of care TB test in particularly poorly resourced settings, in countries like South Africa where the clinic infrastructure is relatively good, rates of drug-resistant TB are high, and patient drop-out are significant problems, within clinic placement of Xpert in TB hotspots might be appropriate and enable earlier diagnosis of drug-resistant TB thus likely reducing community-based transmission,” Dr. Dheda noted. “Nevertheless, prevention of TB and adherence to TB treatment is critical and remains a major priority.”

In an accompanying comment, Christian Wejse, MD, PhD, associate professor, GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Denmark, wonders about the cost-effectiveness of Xpert testing.

“At a cassette cost of US$10 (reduced price for low-resource settings), testing large numbers of people with suspected tuberculosis will put substantial pressure on already resource-limited tuberculosis programmes in which the drugs for treatment might not always be available,” Dr. Wejse writes. “Hence, the provocative question raised by this study is whether tuberculosis elimination is most likely to be advanced by distributing GeneXpert machines to all peripheral health facilities in the world, or by investing the same amount in ensuring that health facilities have the set-up available in this study—ie, well trained and paid staff, electricity, and reagents.”

Tuberculosis: Test Speeds Diagnosis, Time to Treatment.

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The Xpert MTB/RIF (Cepheid) test improved tuberculosis (TB) diagnosis and reduced time to treatment, but not long-term TB-related morbidity, according to the results of a multicenter, randomized, controlled trial.

“Despite already being rolled-out in many countries, our study is the first to look at the feasibility of the Xpert test in a real-life clinical setting in southern Africa,” lead author Keertan Dheda, MBBcH, from the Department of Medicine, University of Cape Town, South Africa, said in a news release. The study results were published online October 28 in the Lancet.

The researchers enrolled adult patients with symptoms suggestive of active TB at 5 primary care facilities in South Africa, Zimbabwe, Zambia, and Tanzania. They randomly assigned patients to either Xpert MTB/RIF testing, performed at the clinic by a nurse who received 1 day of training, or to sputum smear microscopy. On the basis of local World Health Organization–compliant guidelines, participants with a negative test result were managed empirically.

The main study endpoint, analyzed by intention to treat, was TB-related morbidity, measured with the TB score and Karnofsky performance score at 2 months and 6 months after randomization in culture-positive patients who had started anti-TB treatment.

Of 758 assigned patients to smear microscopy between April 12, 2011, and March 30, 2012, 182 were culture positive, as were 185 of 744 patients assigned to Xpert MTB/RIF. Among culture-positive patients, median TB score and median Karnofsky performance score in culture-positive patients did not differ between groups at 2 or at 6 months.

Diagnostic Performance of Point-of-Care MTB/RIF

Compared with microscopy, point-of-care MTB/RIF had higher sensitivity (83% vs 50%; P = .0001), but similar specificity (95% vs 96%; P = .25). Compared with laboratory-based MTB/RIF, point-of-care MTB/RIF had similar sensitivity (83%; P = .99), but higher specificity (92%; P = .0173).

Of 744 tests with point-of-care MTB/RIF, 34 (5%) failed, as did 82 (6%) of 1411 with laboratory-based MTB/RIF (P = .22). More patients in the MTB/RIF group than in the microscopy group had a same-day diagnosis (24% vs 13%; P < .0001) and same-day treatment initiation (23% vs 15%; P = .0002).

Because of the lower dropout rate, more culture-positive patients in the MTB/RIF group were receiving treatment by study end (8% untreated in the MTB/RIF group vs 15% in the microscopy group; P = .0302). By day 56, however, the proportions of all patients receiving treatment were similar (43% vs 42%, respectively; P = .6408).

“Although earlier diagnosis by the Xpert test did not reduce overall severity of TB-related illness, and moreover did not reduce the overall number TB cases treated over the course of the study, it has substantial benefits over smear microscopy including improved rates of same-day diagnosis and reducing treatment drop-out,” Dr. Dheda said in the release.

Cost-Effectiveness May Be a Concern

Limitations of this study include about 20% loss to follow-up of patients with culture-confirmed TB, mostly resulting from staffing problems at 1 site, and possible lack of generalizability to seriously ill patients or those with extrapulmonary TB.

“Whilst Xpert may not be the ideal point of care TB test in particularly poorly resourced settings, in countries like South Africa where the clinic infrastructure is relatively good, rates of drug-resistant TB are high, and patient drop-out are significant problems, within clinic placement of Xpert in TB hotspots might be appropriate and enable earlier diagnosis of drug-resistant TB thus likely reducing community-based transmission,” Dr. Dheda noted. “Nevertheless, prevention of TB and adherence to TB treatment is critical and remains a major priority.”

In an accompanying comment, Christian Wejse, MD, PhD, associate professor, GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Denmark, wonders about the cost-effectiveness of Xpert testing.

“At a cassette cost of US$10 (reduced price for low-resource settings), testing large numbers of people with suspected tuberculosis will put substantial pressure on already resource-limited tuberculosis programmes in which the drugs for treatment might not always be available,” Dr. Wejse writes. “Hence, the provocative question raised by this study is whether tuberculosis elimination is most likely to be advanced by distributing GeneXpert machines to all peripheral health facilities in the world, or by investing the same amount in ensuring that health facilities have the set-up available in this study—ie, well trained and paid staff, electricity, and reagents.”

Source: Lancet

Talking therapy ‘eases hypochondria’

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An anxious patient
Health anxiety can cause terrible suffering

Cognitive behavioural therapy is more effective than standard care for people with hypochondria or health anxiety, say researchers writing in The Lancet.

In their study, 14% of patients given CBT regained normal anxiety levels against 7% given the usual care of basic reassurance.

It said nurses could easily be trained to offer the psychological therapy.

Between 10% and 20% of hospital patients are thought to worry obsessively about their health.

“Start Quote

Health anxiety is costly for healthcare providers and an effective treatment could potentially save money”

Prof Peter Tyrer Imperial College London

Previous studies have shown that CBT, which aims to change thought patterns and behaviour, is an effective treatment for other anxiety disorders.

But there is a shortage of specialists trained to deliver CBT, and as a result waiting lists can be long.

In this study, 219 people with health anxiety received an average of six sessions of cognitive behavioural therapy while 225 received reassurance and support, which is standard.

After periods of six months and 12 months, patients in the CBT group showed “significantly greater improvement in self-rated anxiety and depression symptoms” compared with standard care, the study showed.

There was also a particularly noticeable reduction in health anxiety in the CBT group straight after treatment began.

The therapy was delivered by non-CBT experts who had been trained in only two workshops.

Study author Prof Peter Tyrer, head of the Centre for Mental Health at Imperial College London, said the results showed that hypochondria could be successfully treated, in a “relatively cheap” way, by general nurses with minimal training in a hospital setting.

WHAT IS CBT?

Cognitive behavioural therapy is:

  • a way of talking about how you think about yourself, the world and other people
  • how what you do affects your thoughts and feelings

CBT can help you to change how you think (cognitive) and what you do (behaviour).

Unlike some other talking treatments, it focuses on the “here and now” instead of the causes of distress or past symptoms.

Reducing the anxiety levels of 14% of the CBT group might not seem a high figure, he said, but these were often people with serious problems who had sometimes spent thousands of pounds on private health assessments because of fears about their health.

“Health anxiety is costly for healthcare providers and an effective treatment could potentially save money by reducing the need for unnecessary tests and emergency hospital admissions,” Prof Tyrer said.

Writing about the study in The Lancet, Chris Williams from the University of Glasgow and Allan House from the University of Leeds, said the findings were “intriguing” but translating them into services was “problematic”.

They also questioned the cost-effectiveness of screening patients for health anxiety and CBT.

They wrote: “Health anxiety is only one of the problems noted in medical outpatients – depression, hazardous alcohol use, poor treatment adherence, and other forms of medically unexplained presentation all press for recognition and intervention.

“To develop multiple parallel services makes no sense, especially since the common emotional disorders overlap substantially.”

But Prof Tyrer said health anxiety was a hidden epidemic that required the correct treatment, not just reassurance.

Vitamin D pills’ effect on healthy bones queried.

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Supplements

Healthy adults do not need to take vitamin D supplements, suggests a study in The Lancet which found they had no beneficial effect on bone density, a sign of osteoporosis.

But experts say many other factors could be at play and people should not stop taking supplements.

University of Auckland researchers analysed 23 studies involving more than 4,000 healthy people.

The UK government recommends children and over-65s take a daily supplement.

The New Zealand research team conducted a meta-analysis of all randomised trials examining the effects of vitamin D supplementation on bone mineral density in healthy adults up to July 2012.

The supplements were taken for an average of two years by the study participants.

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I’m not surprised they didn’t find any evidence of the effects of vitamin D on bone density because there are so many other factors involved…”

Dr Laura Tripkovic University of Surrey

Bone mineral density is a measure of bone strength and measures the amount of bone mineral present at different sites in the body. It is often seen as an indicator for the risk of osteoporosis, which can lead to an increased risk of fracture.

The trials took place in a number of different countries including the UK, the US, Australia, Holland, Finland and Norway.

Although the results did not identify any benefits for people who took vitamin D, they did find a small but statistically significant increase in bone density at the neck of the femur near the hip joint.

According to the authors, this effect is unlikely to be clinically significant.

Free up resources

Prof Ian Reid, lead study author, from the University of Auckland, said the findings showed that healthy adults did not need to take vitamin D supplements.

“Our data suggest that the targeting of low-dose vitamin D supplements only to individuals who are likely to be deficient could free up substantial resources that could be better used elsewhere in healthcare.”

Writing about the study in The Lancet, Clifford J Rosen from the Maine Medical Research Institute agrees that science’s understanding of vitamin D supports the findings for healthy adults, but not for everyone.

“Supplementation to prevent osteoporosis in healthy adults is not warranted. However, maintenance of vitamin D stores in the elderly combined with sufficient dietary calcium intake remains an effective approach for prevention of hip fractures.”

The Department of Health currently recommends that a daily supplement of vitamin D of 10 micrograms (0.01mg) should be taken by pregnant and breastfeeding women and people over 65, while babies aged six months to five years should take vitamin drops containing 7 to 8.5 micrograms (0.007-0.0085mg) per day.

Additional factors

Dr Laura Tripkovic, research fellow in the department of nutritional sciences at the University of Surrey, said the study was important but very specific.

“I’m not surprised they didn’t find any evidence of the effects of vitamin D on bone density because there are so many other factors involved in osteoporosis, like genes, diet and environment.

“To pin it all on vitamin D… it’s difficult to do that.”

Dr Tripkovic said it was no good taking vitamin D supplements if people didn’t also maintain a healthy, balanced diet containing calcium and take plenty of exercise.

She said most healthy people should be able to absorb enough vitamin D naturally, through sunshine and diet.

“But if people are worried about their vitamin D levels then a multi-vitamin tablet would do. If you have bone pain and muscle aches then you should go and see your GP and discuss it.”

We get most of our vitamin D from sunlight on our skin, but it is also found in certain foods like oily fish, eggs and breakfast cereals.

However, taking too much vitamin D in the form of supplements can be harmful because calcium can build up and damage the kidneys.

Experts advise taking no more than 25 micrograms (0.025mg) a day.

The UK guidance is currently being reviewed.

Veggie-Heavy Stress Reduction Regimen Shown to Modify Cell Aging

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Story at-a-glance

  • New research showed that eating a diet rich in vegetables while exercising and managing stress may modify cell aging and potentially help you live longer
  • Choosing a diet that encourages proper levels of leptin and insulin in your body, and thereby proper genetic expression, is likely the most powerful anti-aging diet there is
  • For most people, avoiding sugar, fructose, grains and processed foods while eating low-to-moderate protein and as much high-quality healthful fat as you want (saturated and monounsaturated) will optimize your general health and longevity
  • Exercise and regular stress reduction round out a simple anti-aging lifestyle plan.

Stress ManagementStress Management

The last time you went to your physician, did he or she ask you about your diet, your exercise habits or your methods of stress reduction? These should be a key point of discussion, as research continues to pour in about their importance to human health, disease prevention and increased lifespan.

Recently, a small study published in the Lancet once again confirmed that eating a diet rich in vegetables while exercising and managing stress may modify cell aging and potentially help you live longer.1

It’s not rocket science… the old adage ‘you are what you eat’ really is true, and combined with other healthy lifestyle factors is the best ‘fountain of youth’ currently known to humankind.

A Healthy Lifestyle Is Your Ticket to a Long Life

You’ve certainly heard about the importance of a healthy lifestyle before, but it deserves repeating because it truly is the closest thing to a magic ‘pill’ for life extension that you can find. In the latest study, men followed a healthy lifestyle, which consisted of:

  1. Eating a mostly whole-food, vegetable-rich diet (with few refined carbohydrates)
  2. Walking for 30 minutes six days a week
  3. 60 minutes of daily stress management (mostly yoga and meditation)
  4. A 60-minute support group session once a week

After five years, men in the healthy lifestyle group had an increase in telomere (the ends of your chromosomes) length compared to the control group. It has been suggested, not without controversy, that increasing telomere length slows down or even reverses aging.

However, it may be possible that the modifications in cell aging being attributed to telomere length increases may actually be a byproduct of healthy genetic expression gained by eating a whole-food, low-sugar diet.

Dr. Ron Rosedale Explains Telomere Science…

Dr. Ron Rosedale, M.D. is widely considered to be one of the leading anti-aging doctors in the US, and as such is highly qualified to discuss the complex issues behind using telomere length as an indicator of lifespan. There are numerous problems with the theory, including that fewer than 1 percent of people have the telomerase enzyme necessary to increase their chromosome’s telomere length.

Further, many cells, such as liver and kidney cells can’t lengthen telomeres, while cancer cells can increase telomere length. As Dr. Rosedale said:2

“The fact that telomeres shorten may actually allow us to live longer, as it may reduce the risk of cancer. The good news is that the telomeres in almost all the cells other than WBCs and stem cells do not increase, for if they did, dying of cancer would be all but certain.”

It may very well be that controlling telomere length specific to different diseases and cells may be a powerful way to improve health. But right now, we just don’t know enough about it to be certain. And it might be that the association between increased lifespan and telomere length is simply a correlation, not a cause. Dr. Rosedale explained:

“A major mistake made so frequently in medicine… is the confusion and interchange between correlation and cause. An example is the consistent reference to cholesterol being a cause of heart disease, when in fact it is an association, and even a weak one at that.

…Getting wrinkles is far more correlated, and is therefore a far better biomarker for aging than telomere length, however undergoing a dermabrasion is not likely to extend lifespan. Once again, it is science 101 to not confuse correlation with cause.

It could very well be, and in fact is likely, that reduced telomere length is a byproduct of the cell damage and turnover associated with aging, rather than a prime cause of it, though it likely does have some adverse repercussions especially to the immune system and possibly stem cells.”

How the Foods You Eat Impact Your Lifespan

So what does all of this mean for you, and, importantly, what does it have to do with the foods you choose to eat? Choosing a diet that encourages proper level of leptin and insulin in your body, and thereby proper genetic expression, is likely the most powerful anti-aging diet there is – and may also be involved, or at the very least associated, with the length of your telomeres, although this is only beginning to be explored. Dr. Rosedale continued:

“Life is dependent on the coordination of its constituent parts. This is especially true pertaining to the length of telomeres of the various cells and organs to maintain health but prevent a high risk of cancer.

…we are 15 trillion cells and 90 trillion bacteria that must work harmoniously as one for us to be healthy and remain alive. This requires an intricate orchestration of communication between the different parts. 

That includes the genes, telomeres, and telomerase. It is where, when, and how much they are played, like the keys of a piano playing an infinite variety of music from the same keys, that determine who we are, diabetic or not, and if we stay alive or die.

What we do want to do is slow down the reduction in the length of our telomeres in an organ and tissue-specific manner that can be orchestrated only through proper genetic expression. Leptin and insulin are among the most, if not the most powerful influences of this. And these in turn are controlled by what you eat.”

Insulin and Leptin Resistance: How These Disease-Causing States Happen

Leptin is a hormone that plays a key role in regulating your energy intake and energy expenditure. It may be one of the most important hormones in your body as it can determine your health and lifespan. Insulin is another, and  work in tandem with leptin. Both insulin and leptin resistance are associated with obesity, and impairment of their ability to transfer the information to receptors is the true foundational core of most all chronic degenerative diseases.

Your fat, by way of leptin, tells your brain whether you should be hungry, eat and make more fat, whether you should reproduce, or (partly by controlling insulin) whether to engage in maintenance and repair. In short, leptin is the way that your fat stores speak to your brain to let your brain know how much energy is available and, very importantly, what to do with it.

Therefore, leptin may be on top of the food chain in metabolic importance and relevance to disease. You become leptin-resistant by the same general mechanism that you become insulin-resistant – by continuous overexposure to high levels of the hormone. This happens when you eat a diet that is high in sugar (particularly fructose), grains, and processed foods. The same type of diet that will also increase inflammation in your body – as the sugar gets metabolized in your fat cells, the fat releases surges in leptin.

Over time, if your leptin receptors are exposed to excessive leptin, they will develop resistance, just as your insulin receptors can develop resistance to insulin. The best way to reestablish proper leptin (and insulin) signaling is to prevent those surges, and the only known way to do that is via diet. As such, diet can have a more profound effect on your health than any other known modality of medical treatment.

Eat This Way to Maximize Your Healthy Lifespan Potential

A strategic whole food diet, as detailed in my free nutrition plan, that emphasizes good fats and avoids blood sugar spikes coupled with targeted supplements will enhance insulin and leptin sensitivity so that your brain can once again hear the feedback signals from these hormones. The vegetable-rich, low-refined-carbs diet described in the featured study likely also played a role in enhancing the study participants’ insulin and leptin sensitivity (although this wasn’t measured), and perhaps this was involved in the changes in telomere length, as Dr. Rosedale’s theory seems to support. To reverse insulin and leptin resistance:

  • Avoid sugar, fructose, grains and processed foods
  • Eat a healthful diet of whole foods, ideally organic, and replace the grain carbs with:
    • No-to-low sugar and grain carbs
    • Low-to-moderate amount of protein
    • As much high-quality healthful fat as you want (saturated and monounsaturated). Most people need upwards of50-70 percent fats in their diet for optimal health. Good sources include coconut and coconut oil, avocados, butter, nuts, and animal fats. Also take a high-quality source of animal-based omega-3 fat, such as krill oil.

Remember Exercise and Stress Management, Too

Remember, about 80 percent of the health benefits you reap from a healthy lifestyle comes from your diet, and the remaining 20 percent from exercise – but it’s a very important 20 percent, as it acts in tandem with and boosts the benefits derived from a proper diet. Exercise is also one of the fastest and most powerful ways to lower your insulin and leptin resistance. For maximum benefits, you’ll want to make sure to include high-intensity interval training (HIIT), which has been found to help slow down aging.

Of course, the connections between stress and physical health are undeniable, as well, with chronic stress linked to lowered immune system function, heightened inflammatory response, altered hormonal balance and more. Energy psychology techniques such as the Emotional Freedom Technique (EFT) can be very effective by helping you to actuallyreprogram your body’s reactions to the unavoidable stressors of everyday life.

Exercising regularly, getting enough sleep, and meditation are also important “release valves” that can help you manage your stress. Together with a healthful diet and exercise, stress management makes up the ‘third Musketeer’ that is essential to leading a long, vital life.