Archive for August, 2011

What is Diabetes

Monday, August 29th, 2011

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.
Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge.

Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.
Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity.

Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.

Until recently, this type of diabetes was seen only in adults but it is now also occurring in children.
Gestational diabetes is hyperglycaemia with onset or first recognition during pregnancy.

Symptoms of gestational diabetes are similar to Type 2 diabetes. Gestational diabetes is most often diagnosed through prenatal screening, rather than reported symptoms.

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG)
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable.

What are common consequences of diabetes?
Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

Diabetes increases the risk of heart disease and stroke. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke).
Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation.
Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment.
Diabetes is among the leading causes of kidney failure. 10-20% of people with diabetes die of kidney failure.
Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50% of people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands.

Biological mechanism of antidepressant effect of omega-3 fatty acids: how does fish oil act as a ‘mind-body interface’? Neurosignals.

Thursday, August 18th, 2011

Biological mechanism of antidepressant effect of omega-3 fatty acids: how does fish oil act as a ‘mind-body interface’? Neurosignals. 2009;17(2):144-52.
The unsatisfactory results of monoamine-based antidepressant therapy and the high occurrence of somatic symptoms and physical illness in patients with depression imply that the serotonin hypothesis is insufficient to approach the aetiology of depression. Depressive disorders with somatic presentation are the most common form of depression. Somatization, the bodily symptoms without organic explanation, is similar to cytokine-induced sickness behaviour.

Based on recent evidence, omega-3 polyunsaturated fatty acids (n-3 PUFAs, or n-3 fatty acids) are enlightening a promising path to discover the unsolved of depression, sickness behaviour and to link the connection of mind and body.

The PUFAs are classified into n-3 (or omega-3) and n-6 (or omega-6) groups. Eicosapentaenoic acid and docosahexaenoic acid, the major bioactive components of n-3 PUFAs, are not efficiently synthesized in humans and should therefore be obtained directly from the diet, particularly by consuming fish.
Eicosapentaenoic acid is important in balancing the immune function and physical health by reducing membrane arachidonic acid (an n-6 PUFA) and prostaglandin E(2) synthesis, which might be linked to the somatic manifestations and physical comorbidity in depression.
The role of n-3 PUFAs in immunity and mood function supports the promising hypothesis of psychoneuroimmunology of depression and provides an excellent interface between body and mind.

This review is to provide an overview of the evidence about the role of n-3 PUFAs in depression and its common comorbid physical conditions and to propose mechanisms by which they may modulate molecular and cellular functions.
(Synapses and inflammatory/anti-inflam ratios)

Omega 3 essential fatty acid EPA and Psychological Distress In Women

Thursday, August 18th, 2011

Lucas M, Asselin G, Mérette C, et al. Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women. Am J Clin Nutr.
BACKGROUND: Psychological distress (PD) and depressive symptoms are commonly observed during menopausal transition. Studies suggest that omega-3 (n-3) fatty acids may help alleviate depression.

OBJECTIVE: The objective was to compare enriched ethyl-eicosapentaenoic acid (E-EPA) supplementation with placebo for the treatment of PD and depressive symptoms in middle-aged women.

DESIGN: Women with moderate-to-severe PD (n = 120) were randomly assigned to receive 1.05 g E-EPA/d plus 0.15 g ethyl-docosahexaenoic acid/d (n = 59) or placebo (n = 61) for 8 wk. The main outcomes were 8-wk changes in PD scores [Psychological General Well-Being Schedule (PGWB)] and depressive scales [20-item Hopkins Symptom Checklist Depression Scale (HSCL-D-20) and the 21-item Hamilton Depression Rating Scale (HAM-D-21)].

RESULTS: At baseline, women with PD were mildly to moderately depressed, and 24% met the major depressive episode (MDE) criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. After 8 wk, outcomes improved in both groups, but no significant differences were noted between them. Stratification analyses for MDE diagnosis at baseline indicated that differences in adjusted 8-wk changes between the E-EPA group without MDE (n = 46) and the placebo group (n = 45) were 8.0 (95% CI: 0.6, 15.3; P = 0.034) for the PGWB, -0.2 (95% CI: -0.01, -0.4; P = 0.040) for the HSCL-D-20, and -2.7 (95% CI: -0.3, -5.1; P = 0.030) for the HAM-D-21. Differences in adjusted 8-wk changes between the E-EPA group with MDE (n = 13) and the placebo group (n = 16) were not significant.

CONCLUSIONS: To our knowledge, this is the first trial of n-3 supplementation in the treatment of PD and depressive symptoms in middle-aged women. In women with PD without MDE at baseline, the 8-wk changes in PD and depressive scales improved significantly more with E-EPA than with placebo.

Omega-3 Fatty Acids For Neuropathic Pain

Thursday, August 18th, 2011

OBJECTIVE:
The aim of this case series study was to investigate and report on patients with neuropathic pain who responded to treatment with omega-3 fatty acids.

METHODS:
Methods: Five patients with different underlying diagnoses including cervical radiculopathy, thoracic outlet syndrome, fibromyalgia, carpal tunnel syndrome, burn injury were treated with high oral doses of omega 3 fish oil (varying from 2400-7200 mg/day of EPA-DHA). Outcome measures were obtained pretreatment and posttreatment. These included validated surveys (short-form McGill Pain questionnaire, DN4 neuropathic pain scale, Pain Detect Questionnaire), objective clinical tools (Jamar grip strength, Lafayette dynamometry, tender point algometry) and EMG Nerve Conduction studies.

RESULTS:
These patients had clinically significant pain reduction, improved function as documented with both subjective and objective outcome measures up to as much as 19 months after treatment initiation. No serious adverse effects were reported.

CONCLUSIONS:
This first-ever reported case series suggests that omega-3 fatty acids may be of benefit in the management of patients with neuropathic pain. Further investigations with randomized controlled trials in a more specific neuropathic pain population would be warranted.

Omega-3 Essential Fatty Acid EPA May Benefit Cancer Patients Undergoing Surgery, Study by NYU Researcher Finds

Tuesday, August 16th, 2011

Omega-3 Fatty Acids May Benefit Cancer Patients Undergoing Surgery, Study by NYU Researcher Finds

research published in the Annals of Surgery points to a potentially significant advance in the treatment of patients undergoing major cancer surgery. A randomized controlled trial showed that oral nutritional supplements with omega-3 fatty acids resulted in the preservation of muscle mass in patients undergoing surgery for esophageal cancer, a procedure normally associated with significant weight loss and quality-of-life issues.

The lead investigators of the study were John V. Reynolds, professor of surgery at Trinity College Dublin, and Aoife Ryan, assistant professor of nutrition at New York University’s Steinhardt School of Culture, Education, and Human Development*.

Omega 3 fats are essential fats found naturally in oily fish. Recently food manufacturers have begun to add omega 3 to foods such as yogurt, milk, juice, eggs, and infant formula in light of a body of scientific evidence which suggests that they reduce cardiovascular disease risk, reduce blood pressure, reduce clot formations, and reduce certain types of fat in the blood.

Given these health benefits, the researchers were interested to see whether omega 3 supplements could reduce post-operative weight loss among esophageal cancer patients. Previous studies had found that nutritional supplements containing one form of omega 3 fat, eicosapentaenoic acid (EPA), significantly reduced weight loss among inoperable cancer patients. Researchers hypothesized that a nutritional supplement rich in calories and a high dose of EPA would stem the debilitating weight loss seen in patients following esophageal surgery.

In a double-blinded randomized control trial, the gold standard in medical research, patients awaiting esophagectomy surgery were randomly assigned to treatment and control groups. While both groups received a 240ml nutritional supplement twice daily starting five days before surgery (which was identical in calories, protein, micronutrients, and flavor), patients in the treatment group received an enriched formula with omega 3 (2.2 gram EPA/day).

Immediately following surgery, the supplement was given through a feeding tube for 14 days while patients recovered in hospital. Once patients could resume oral feeding, they continued drinking the supplement until 21 days post surgery.

The researchers, working at St. James Hospital and Trinity College Dublin, found that patients given the standard feed (without EPA) suffered clinically severe weight loss post-surgery which was all muscle mass, while patients in the treatment group maintained all aspects of their body composition following surgery. Omega-3 fed patients also had better immune function, lower risk of fever post op, and significantly reduced levels of inflammatory markers in their blood.

“The results are intriguing, no previous study of nutritional support in the peri-operative period has revealed such a benefit,” said Ryan.

An accompanying editorial in the journal noted that Ryan’s study “is a significant step forward” in the management of patients undergoing surgery for esophageal and perhaps other complex cancers. “[Omega 3 based nutrition] should no longer be a surgeon’s preference, but the standard of expected norm for the practice of elected complex GI cancer surgery.”

Using specialized nutritional feeds with a highly purified form of EPA, the researchers were able to administer a dose of omega 3 that was much higher than that typically found in food. They noted that treatment with omega 3 enriched supplement is only slightly more expensive than traditional nutritional therapy, and previous studies have yielded significant cost-savings in the form of fewer complications following surgery using immuno-nutrition feeds similar to this.

“Initial treatments like this may be cost-effective for our cash-strapped health care system,” said Ryan.

Commenting on the study Reynolds noted “omega 3 enriched-nutrition appears to prevent the loss of muscle mass by modulating the body’s inflammatory response following surgery. Future studies on the health benefits of EPA supplements in cancer patients should be conducted to determine whether such approaches improve quality of life, reduce complications, and improve patient outcomes, not only after surgery but also through long and complex treatment programs which may include chemotherapy and radiation therapy in addition to surgery. We can speculate moreover that the findings of the study are not unique to cancer and that potential benefits should be explored in trial in patients following major non-cancer surgery, such as liver transplantation, cardiac surgery, and neurosurgery.”

Omega-3 research sheds light on inflammation trigger

Tuesday, August 16th, 2011

BBSRC-funded scientists at the University of Birmingham have discovered a previously unknown step in early inflammation which is controlled by omega –3 and omega –6 fatty acids, potentially leading to clarification around conflicting health and diet advice on these two essential nutrients.

Dr Ed Rainger, from the Centre for Cardiovascular Sciences at the University, has discovered that a key product in the metabolism of omega –6 fatty acids is an essential signal for neutrophils (white blood cells that form an essential part of the immune system) to cross the endothelium, the thin layer of cells that line the interior surface of blood vessels, to work on inflammation.

Dr Rainger says the findings of the study, funded by BBSRC and the British Heart Foundation, will open up new possibilities: “The identification of these novel mechanisms by which inflammation is regulated may allow us to develop new therapies to intervene when the process of inflammation becomes pathological rather than physiological.”

These latest discoveries bolster the evidence that fish oils have anti-inflammatory effects in addition to other health benefits. Dr Rainger and his team have revealed new steps in the body’s response to tackling inflammation which researchers hope will lead to designing potential new drugs to tackle severe and chronic disease such as rheumatoid arthritis.

The team also found that the migration of neutrophils could be blocked by the increased levels of omega -3 generated after the endothelial cells had been supplemented with this omega –3 fatty acid.

Dr Rainger and his team conducted the study using a realistic, flow based system that models the process of inflammation at the interface of the circulating blood and inflamed tissue. They were then able to observe the effects of physiological levels of omega –3 and omega –6 fatty acids on the process of recruiting inflammatory blood cells such as neutrophils into the tissue. This process is regulated by endothelial cells lining the blood vessels.

Dr Ed Rainger, said: “Our findings are very significant. They support the idea that omega–6 fatty acids are pro-inflammatory – that they are required to sustain a normal inflammatory response without which we would be prone to serious infection and tissue damage.”

Conversely, Dr Rainger has uncovered mechanistic evidence that supports the anti-inflammatory role of omega -3 fatty acids: “We’ve all heard about the health benefits of eating oily fish, and its beneficial effects on cardiovascular health, possibly due to their anti inflammatory properties, yet little is known about the normal cellular mechanisms by which omega –3 fatty acids produce their protective effects.”

Nutritionists believe that imbalances in omega –3 and –6 – may explain the rise of diseases such as asthma, coronary heart disease, cancers, autoimmunity and neurodegenerative diseases, all of which are believed to stem from inflammation in the body.

Paper: Fatty acids and Inflammation: novel interactions reveal a new step in neutrophil recruitment is published in PLoS Biology on 25 August.

Eicosapentaenoic Acid – EPA Omega 3 essential fatty acid

Thursday, August 11th, 2011

Eicosapentaenoic Acid – EPA Omega 3 essential fatty acid

Important polyunsaturated fatty acid found in fish oils. It serves as the precursor for the prostaglandin-3 and thromboxane-3 families. A diet rich in eicosapentaenoic acid lowers serum lipid concentration, reduces incidence of cardiovascular disorders, prevents platelet aggregation, and inhibits arachidonic acid conversion into the thromboxane-2 and prostaglandin-2 families. EPA is considered to be the most powerful anti inflammatory and is the key essential fatty acid with regards mental health disorders such as depression , bi polar , schizophrenia .

Omega 3 and renal function in adults

Thursday, August 11th, 2011

Omega-3 essential fatty acid and renal function in older adults.
Lauretani F, Maggio M, Pizzarelli F, Michelassi S, Ruggiero C, Ceda GP, Bandinelli S, Ferrucci L.
Source

Geriatric Unit, Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy. flauretani@ao.pr.it
Abstract

Chronic kidney disease (CKD) is a major public health problem and can result in end-stage renal disease with need for dialysis or transplantation. In Europe up to 12% of the adult population had some renal impairment, while in the United States the end stage of CKD has increased dramatically from 209.000 in 1991 to 472.000 in 2004. Diabetes and hypertension are major causes of kidney pathology. Infection, particularly ascending infection, is more common with increasing age, as both immune function declines and associated pathology predisposing to infection, such as obstructive uropathy, becomes more common. Most pathological changes in the kidney appear to be initiated by oxidative stress, followed by an inflammatory reaction. Oxidative stress results from an imbalance between free radicals and their detoxification by endogenous and exogenous scavengers, including polyunsaturated fatty acids (PUFA) Omega 3 fatty acids EPA and DHA . Recent studies showed that omega3 essential fatty acid EPA and DHA supplementation slowed the rate of loss of renal function in patients with IgA nephropathy. Then, studies of omega-3 supplementation in dialysis patients describe salutary effects on triglyceride levels and dialysis access patency. We examined the relationship between total plasma PUFA levels and change in creatinine clearance over a three-year follow-up in the older persons enrolled in the InCHIANTI study, a population-based epidemiology study conducted in Tuscany, Italy. This study showed that older adults with low total plasma PUFA omega 3 essential fatty acid levels have a greater decline in creatinine clearance over three years of follow-up. These findings suggest that a higher dietary intake of omega 3 essential fatty acids EPA and DHA may be protective against progression to chronic kidney disease.

Omega-3 EPA DHA essential fatty acid for Bipolar Disorder: Meta-Analyses of Use in Mania and Bipolar Depression

Thursday, August 11th, 2011

Omega-3 for Bipolar Disorder: Meta-Analyses of Use in Mania and Bipolar Depression

Jerome Sarris, PhD, MHSc; David Mischoulon, MD, PhD; and Isaac Schweitzer, MD

J Clin Psychiatry
10.4088/JCP.10r06710
Copyright 2011 Physicians Postgraduate Press, Inc.

Objective: Studies using augmentation of pharmacotherapies with omega-3 in bipolar disorder have been conducted; however, to date a specific meta-analysis in this area has not been published. Thus, we present the significant findings from meta-analyses of omega-3 in the treatment of bipolar depression and bipolar mania.

Data Sources: PubMed, CINAHL, Web of Science, and Cochrane Library databases were searched for clinical trials up to September 1, 2010, using the search terms bipolar disorder OR bipolar depression OR bipolar mania OR mania OR hypomania OR cyclothymia with the search terms omega 3 OR essential fatty acids OR polyunsaturated fatty acids OR DHA OR EPA OR fish oil OR flax oil. Clinical trial registries and gray literature (published or unpublished data not readily accessible via main databases) were also searched.

Data Selection: The analysis included randomized controlled studies 4 weeks or longer, with a sample size > 10, written in English, using omega-3 for diagnosed bipolar depression or mania. No criteria were set for age, gender, or ethnicity.

Data Extraction: A random-effects model was used. The model analyzed the standard mean difference between treatment and placebo between baseline and endpoint, combining the effect size (Hedges g) data. Funnel plot and heterogeneity analyses (I2) were also performed.

Data Synthesis: The findings of 5 pooled datasets (n = 291) on the outcome of bipolar depression revealed a significant effect in favor of omega-3 (P = .029), with a moderate effect size of 0.34. On the outcome of mania, 5 pooled datasets (n = 291) revealed a nonsignificant effect in favor of omega-3 (P = .099), with an effect size of 0.20. Minor heterogeneity between studies on the outcome of bipolar depression was found (I2 = 30%; P = .213), which was not present on the outcome of bipolar mania (I2 = 0%; P = .98). Funnel plot symmetry suggested no significant likelihood of publication bias. Meta-regression analysis between sample size and effect size, however, revealed that studies with smaller sample sizes had larger effect sizes (P = .05).

Conclusions: The meta-analytic findings provide strong evidence that bipolar depressive symptoms may be improved by adjunctive use of omega-3. The evidence, however, does not support its adjunctive use in attenuating mania.

J Clin Psychiatry

Submitted: November 10, 2010; accepted December 13, 2010.

Online ahead of print: August 12, 2011 (doi:10.4088/JCP.10r06710).

A diet high in Essential Fatty Acids Omega 3 EPA and DHA during pregnancy reduce risk of Cancer

Thursday, August 4th, 2011

Researchers have suggested that if an expectant mother increases her consumption of foods high in omega3 essential fatty acids EPA /DHA or nutrients during her pregnancy, she can potentially reduce the risk of breast cancer in her female offspring.

The research delves into breast cancer risk reductions attributed to the fetus when the mother, while pregnant, increases omega 3 essential fatty acids EPA and DHA within her diet or consumes dietary methyl nutrients (methionine, choline, folate and vitamin B12). Some findings hypothesize that these diet augmentations may even prevent breast cancer from ever developing in the offspring.

The study looked at 45 pregnant rats and randomized them into two groups: one to receive a control and the other to be fed a methyl-supplemented diet. Once the pups were born, they were separated into three additional groups depending on the feeding regime of their mother. When the female pups reached a specific age, they were exposed to a chemical that induced breast cancer and researchers charted when the first tumour appeared and measured all tumour sizes and volumes.

Results demonstrated that the offspring from the methyl-supplemented diet group showed a decrease in tumour incidence and growth when compared to the control group. Also, they had fewer tumours and fewer tumours that multiplied.

“The conclusions of this study suggest that we may be able to prevent the development of breast cancer in daughters of women at risk for breast cancer by supplementing the mother’s diet during pregnancy,” said Dr. Chung Park, North Dakota State University. Essential Fatty Acid Omega 3 EPA has been shown to inhibit tumour development / growth in adult subjects

The research was presented at the Era of Hope conference, a scientific meeting hosted by the Department of Defense Breast Cancer Research Program (BCRP).

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