Monday, April 22, 2019

Review: The Role of Vitamin D and Lipoprotein Receptor-Related Protein in Amyloid Clearance and Brain Health

A review on the relationship between vitamin D and low-density lipoprotein receptor-related protein (LRP-1) has revealed that the two may work together to possibly clear amyloid-beta (Aβ), whose deposition is considered linked to the progression of neurological dysfunction.

LRP-1 is a large receptor present on the body’s cells and is widely expressed, or present in several tissues. It’s a member of the LDL receptor family, which plays various different roles related to enzyme activation, the entry of bacterial toxins and viruses into cells and the metabolism of proteins that transport and combine with fats in the blood.

But LRP-1 has also been identified as a Aβ scavenger receptor that can remove Aβ from the brain through the blood-brain barrier. However, its expression is decreased in patients with neurological dysfunction.

This review points to recent evidence that after supplementation with the active form of vitamin D, 1,25 (OH)2D3, LRP1 expression increases significantly both in-vivo and in-vitro. This is because so many vitamin D receptors are expressed in the brain.

Friday, April 19, 2019

Is it better to get nutrients from food or supplements?

Researchers have found that nutrients from food may be linked to lower risks of death, while excess intake of certain supplements may have the opposite effect.

Taking supplements leads to an increased level of total nutrient intake. Dietary supplements include vitamins, minerals, herbs, amino acids, and enzymes. Suppliers sell them in different forms, including tablets, capsules, powders, and liquids. Common dietary supplements include calcium, fish oil, and vitamin D.

According to the 2018 consumer survey conducted by the Council for Responsible Nutrition (CRN), consumer confidence in products and trust in the dietary supplement industry is strong among people in the U.S. The survey found that 75 percent of U.S. individuals take dietary supplements, as opposed to just 65 percent in 2009. "This year's data provide further evidence that dietary supplements are mainstays in modern day health and wellness regimens," explains Brian Wommack, the senior vice president of communications at the CRN. Vitamin and mineral supplements such as vitamin D and calcium remain the most popular types. However, the use of herbals and botanicals — especially turmeric — has significantly increased during the past 5 years.

The main reason that U.S. individuals take dietary supplements is overall health and wellness, according to the survey. Although many people use dietary supplements, a recent study found that multivitamins, vitamin D, calcium, and vitamin C showed no advantage or added risk in the prevention of cardiovascular disease or premature death. However, folic acid alone and B vitamins with folic acid may reduce the risk of heart disease. The team, from the Friedman School of Nutrition Science and Policy at Tufts University in Medford, MA, conducted a study to evaluate the association between dietary supplement use and all-cause mortality. The researchers have published their results in the journal Annals of Internal Medicine.

Wednesday, April 17, 2019

Wisdom Wednesday: Mineral Water versus Tap Water


Mineral water comes from underground reservoirs. Unlike regular drinking water, mineral water does not undergo chemical processing. As the name suggests, mineral water contains high quantities of minerals, especially magnesium, calcium, and sodium. But is mineral water better than regular water, and what are its benefits?

This article discusses some possible health benefits associated with drinking mineral water.

All living organisms need water to survive. Not only does water support essential physical functions, it also provides vital nutrients that the body does not produce on its own. While most people in the United States have access to clean drinking water, many people choose bottled mineral water for its perceived purity and potential health benefits.
How does mineral water compare with regular water? Based on the current evidence, the differences are not very significant. The water in household taps comes either from surface or underground sources.

In the U.S., tap water must meet the Safe Drinking Water Act standards established by the
Environmental Protection Agency (EPA). These regulations limit the number of contaminants present in water supplied to homes. Public water suppliers move water from its source to treatment plants, where it undergoes chemical disinfection. The clean water ultimately gets delivered to households through a system of underground pipes.

Monday, April 15, 2019

How to Understand Your Lab Results

A laboratory (lab) test is a procedure in which a health care provider takes a sample of your blood, urine, other bodily fluid, or body tissue to get information about your health. Some lab tests are used to help diagnose, screen, or monitor a specific disease or condition. Other tests provide more general information about your organs and body systems. Lab tests play an important role in your health care. But they don't provide a complete picture of your health. Your provider will likely include a physical exam, health history, and other tests and procedures to help guide diagnosis and treatment decisions.

Lab tests are used in many different ways. Your health care provider may order one or more lab tests to:
Diagnose or rule out a specific disease or condition

Screen - A screening test can show if you are at a higher risk for getting a specific disease. It can also find out if you have a disease, even if you have no symptoms.

Monitor a disease and/or treatment - If you've already been diagnosed with a disease, lab tests can show if your condition is getting better or worse. It can also show if your treatment is working.
Check your overall health - Lab tests are often included in a routine checkup.

Lab results are often shown as a set of numbers known as a reference range. A reference range may also be called "normal values." You may see something like this on your results: "normal: 77-99mg/dL". Reference ranges are based on the normal test results of a large group of healthy people. The range helps show what a typical normal result looks like. But not everyone is typical. Sometimes, healthy people get results outside the reference range, while people with health problems can have results in the normal range. If your results fall outside the reference range, or if you have symptoms despite a normal result, you will likely need more testing. Your lab results may also include one of these terms:
  • Negative or normal, which means the disease or substance being tested was not found
  • Positive or abnormal, which means the disease or substance was found
  • Inconclusive or uncertain, which means there wasn't enough information in the results to diagnose or rule out a disease. If you get an inconclusive result, you will probably get more tests. Tests that measure various organs and systems often give results as reference ranges, while tests that diagnose or rule out diseases often use the terms listed above.

Wednesday, April 10, 2019

Wisdom Wednesday: Metformin for Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis


Clinical Question
How effective is metformin in the treatment of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis?

Evidence-based Answer
Metformin does not seem to be an effective treatment for nonalcoholic steatohepatitis. There are no studies evaluating whether metformin improves long-term patient-oriented outcomes such as progression from NAFLD to nonalcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma, or death from liver failure. Metformin does not improve anatomic outcomes (histologic or ultrasound features of the liver) or biochemical outcomes (alanine transaminase [ALT] and aspartate transaminase [AST] levels, or insulin resistance) in adults. Metformin does not improve liver histologic or biochemical outcomes, or body mass index (BMI) in adults with nonalcoholic steatohepatitis. (Strength of Recommendation: C, based on a meta-analysis of randomized, controlled trials [RCTs] evaluating laboratory parameters.) Similarly, metformin does not improve histologic or biochemical outcomes, or BMI in children and adolescents with NAFLD. (Strength of Recommendation: C, based on RCTs evaluating laboratory parameters.)

Evidence Summary
Adults With NAFLD
No studies have evaluated patient-oriented outcomes of metformin therapy for NAFLD or nonalcoholic steatohepatitis. An RCT found no improvement in liver histology on biopsy.[1,2] Two placebo-controlled RCTs (N = 113) evaluating the effect of metformin (850 to 1,700 mg per day) on ALT and AST levels, insulin resistance, and BMI found no differences. One RCT (n = 48) found a small decrease in BMI. Another RCT (n = 2,153) found no improvement in ALT levels after treatment with metformin (850 mg twice per day) vs. placebo.[2]

Adults With Nonalcoholic Steatohepatitis
Two RCTs (N = 52) evaluating metformin (500 to 1,000 mg per day) in patients with nonalcoholic steatohepatitis found that it did not improve liver histology, ALT and AST levels, BMI, or insulin resistance.[1,3]

Children With NAFLD
Two RCTs (N = 172) evaluating metformin (1,000 to 1,500 mg per day) vs. placebo in children with obesity and NAFLD found no improvement in liver histology on biopsy, ALT and AST levels, BMI, or insulin resistance.[4,5] A smaller RCT (n = 50; mean age: 15 years) found that metformin (850 mg twice per day) improved ultrasound scores for fatty liver but did not improve ALT and AST levels.[6]

Recommendations From Others
An evidence-based guideline from the American Association for the Study of Liver Diseases, the American College of Gastroenterology, and the American Gastroenterological Association states that metformin has no significant effect on liver histology and is not recommended as a treatment for liver disease in adults with nonalcoholic steatohepatitis.[7]

Monday, April 8, 2019

How Sugary Drinks Fuel Cancer

Researchers acknowledge that obesity increases the risk of cancer, and some studies even consider the existence of a causal relationship between this metabolic condition and cancer.

One important factor that can lead to obesity is the high intake of sugar through the frequent consumption of processed foods and sugary beverages. However, so far, there has been limited research looking at the effects of sugar on tumor growth independently of obesity.
Now, a team of specialists from Baylor College of Medicine in Houston, TX and Weill Cornell Medicine in New York City, NY has collaborated with colleagues from other research institutions to identify a clear link between sugary drinks and the accelerated growth of tumors in colorectal cancer.

In the new study, the results of which appeared yesterday in the journal Science, the research team studied the effects of high-fructose corn syrup in mouse models of colorectal cancer.

The team opted for a solution of 25-percent high-fructose corn syrup because this is the type of sweetener that manufacturers most commonly used as an ingredient in popular soft drinks.

"The current thought is that sugar is harmful to our health mainly because consuming too much can lead to obesity," explains co-author Jihye Yun, who is an assistant professor of molecular and human genetics at Baylor College of Medicine. "We know that obesity increases the risk of many types of cancer, including colorectal cancer; however, we were uncertain whether a direct and causal link existed between sugar consumption and cancer."

The team conducted the research in mice with early-stage colorectal cancer in which they deleted a gene called "Apc." This gene encodes a protein with the same name, and its deletion simulated a mutation that characterizes fast-growing colon cancer in humans. "More than 90 percent of colorectal cancer patients have this type of Apc mutation," the researcher points out.

In the first stage of the study, the researchers allowed the mice to drink the sugary beverage freely. As a result, the rodents put on a lot of weight within just 1 month.

To determine whether or not the corn syrup would boost cancer growth independently of obesity, the team then decided to administer the sugary drink in a way that would allow the mice to ingest it without putting on weight. So, the researchers gave the mice the sugary drink orally through a specially designed syringe once a day for 2 months.

Following this 2-month intervention, the investigators observed that the rodents had not put on too much weight, but they had indeed developed larger, more advanced tumors than the rodents who had only received water.

Wednesday, April 3, 2019

Wisdom Wednesday: Continuing ARB Recalls Shake Up Hypertension, HF Care


Concerns over ongoing recalls of angiotensin II receptor blockers (ARBs) are forcing physicians and patients to choose between optimal treatments and rattling confidence in the safety of the generic drug supply itself.

"I see hypertension on a regular basis and on any given clinic day, four to five patients have either stopped their medicines or have considered stopping their medicines and a separate detailed conversation has to be put in place to try to convince them to continue," Keith Ferdinand, MD, Tulane University Heart and Vascular Institute, New Orleans, told theheart.org | Medscape Cardiology.

ARBs are recommended for the treatment of hypertension, heart failure, and chronic kidney disease, with more than 61 million prescriptions written for valsartan, losartan, and irbesartin in the United States in 2016, according to the federal ClinCalc DrugStats database.

Ongoing US Food and Drug Administration (FDA) recalls — all in generic ARB-containing products — began last July when the probable carcinogen N-nitrosodimethylamine (NDMA) was detected in the valsartan active pharmaceutical ingredient (API) supplied by Zhejiang Huahai Pharmaceuticals (ZHP), Linhai, China.

Within months, the rolling recalls had extended to irbesartan- and losartan-containing products. A second probable carcinogen, N-nitrosodiethylamine (NDEA), was identified last fall and a third, N-nitroso-N-methyl-4-aminobutyric acid (NMBA), only last month.