Intermittent fasting: No advantage over conventional weight loss diets

Credit: CC0 Public Domain

Intermittent fasting leads to weight loss and promotes health. However, it is not superior to conventional calorie restriction diets, scientists from the German Cancer Research Center (DKFZ) and Heidelberg University Hospital report in a study called HELENA—the largest investigation on intermittent fasting to date. The scientists conclude that there are many paths leading to a healthier weight. They recommend that individuals find a diet plan that fits them best.

28 nov 2018--Feasting eight hours and then fasting the following 16 hours? Or is it even better to fast two whole days a week and then enjoy eating without regrets for the rest of the week? Intermittent fasting, also known as 16:8 diet or 5:2 diet, is trendy. Numerous popular self-help books on this topic promise weight loss without yo-yo effect, as well as sustained changes in metabolism and resulting health benefits. The German Nutrition Society (DGE), on the other hand, warns that intermittent fasting is not suitable for long-term weight regulation. In addition, according to DGE, there is not enough scientific evidence on the long-term effects of this dieting method.
"There are only a few smaller studies on intermittent fasting so far, but they have come up with strikingly positive effects for metabolic health," says DKFZ's Ruth Schübel. "This made us curious and we intended to find out whether these effects can also be proven in a larger patient group and over a prolonged period."
In collaboration with a team of DKFZ researchers and scientists from Heidelberg University Hospital, Schübel examined 150 overweight and obese study participants over one year as part of the HELENA study. At the start of the study, they were randomly classified in three groups: One-third followed a conventional calorie restriction diet that reduced daily calorie intake by 20 percent. The second group kept to a 5:2 dietary plan that also saved 20 percent of calorie intake over the whole week. The control group followed no specific diet plan but was advised, like all other participants, to eat a well-balanced diet as recommended by DGE. Following the actual dieting phase, the investigators documented the participants' weight and health status for another 38 weeks.
The result may be as surprising as it is sobering for all followers of intermittent fasting. The HELENA researchers found that improvements in health status were the same with both dietary methods. "In participants of both group, body weight and, along with it, visceral fat, or unhealthy belly fat, were lost and extra fat in the liver reduced," Schübel said.
The changes in body weight distribution in the study participants were exactly determined using special MRT imaging executed by Johanna Nattenmüller at Heidelberg University Hospital. The good news is: a small dieting success is already a big gain for health. Those who reduce their body weight by only five percent, lose about 20 percent of dangerous visceral fat and more than a third of fat in the liver—no matter which dietary method they have used.
The investigators also did not find any difference between the two dieting methods in any other metabolic values that were analyzed or biomarkers and gene activities under investigation.
Although the HELENA study does not confirm the euphoric expectations placed in intermittent fasting, it also shows that this method is not less beneficial than conventional weight loss diets. "In addition, for some people it seems to be easier to be very disciplined on two days instead of counting calories and limiting food every day," explained Tilman Kühn, leading scientist of the trial. "But in order to keep the new body weight, people must also permanently switch to a balanced diet following DGE recommendations," he added.
According to Kühn, the study results show that it is not primarily the dietary method that matters but that it is more important to decide on a method and then follow through with it. "The same evidence is also suggested in a current study comparing low-carb and low-fat diets, that is, reducing carbohydrates versus reducing fat intake while otherwise having a balanced diet," said Kühn. In this study, participants also achieved comparable results with both methods.
The scientists conclude that body and health will benefit from weight loss in any case, as long as it is achieved by a reliable dieting method and on the basis of a well-balanced diet.

More information: Ruth Schübel et al, Effects of intermittent and continuous calorie restriction on body weight and metabolism over 50 wk: a randomized controlled trial, The American Journal of Clinical Nutrition (2018). DOI: 10.1093/ajcn/nqy196


Provided by German Cancer Research Center

Building Bridges Across the Generational Divide

Despite all the hand-wringing about the graying of America, the needs and assets of older and younger people are complementary. The key is to overcome our habits of age segregation.

 

By Marc Freedman

25 nov 2018--It’s meant as a joke—and a provocation. In an edgy new get-out-the-vote ad aimed at young people, a half dozen senior citizens taunt the younger generation, calling themselves a “generation of doers” not “whiners.” “Everything’s fine the way it is,” says one of the seniors, as another chimes in, “Climate change? That’s a you problem. I’ll be dead soon.”

The ad recalls Groucho Marx’s famous quip about posterity: “Why should I care about posterity? What’s posterity ever done for me?” And it reinforces the too-common view of America’s older population as greedy geezers out for themselves, hogging a disproportionate share of society’s resources—a dyspeptic demographic foreshadowing the country’s gray dawn.

This much is true: We are careening toward a future with a lot more older people, and for a country that’s always thought of itself as young, it comes as a shock to the system. Next year, for the first time ever, there will be more Americans over 60 than under 18, a shift that will become even more pronounced in the coming decades. With that transformation to a more-old-than-young society comes the seeming prospect of scarcity, conflict and isolation. Many see a looming zero-sum fight between “kids and canes,” competing for diminishing resources in a society split along generational lines.

Without discounting these challenges, I believe there is reason for optimism and the possibility of a far better outcome—one that could help us to avoid conflict and solve problems such as child care and loneliness, while also generating a good deal of personal happiness along the way. The route to this more uplifting prospect is neither obscure nor abstract. It’s right in front of us, if we shift the lens from fiscal woes to emotional truths. The fact is, for all the hand-wringing about the graying of America, the needs and assets of the generations fit together like pieces of a jigsaw puzzle. Just ask any grandparent.

‘The two loneliest groups in the country, according to a 2018 survey, are younger people and older people, in that order.’

There is significant evidence from evolutionary anthropology and developmental psychology that old and young are built for each other. The old, as they move into the latter phases of life, are driven by a deep desire to be needed by the next generation and to nurture it; the young have a need to be nurtured. It’s a complementary relationship that goes back to the beginning of human history.

For many decades, anthropologists tried to understand why women typically lived so long beyond reproductive age. Men could continue reproducing late in life. But from a narrow evolutionary standpoint, postmenopausal women seemed superfluous—until a quarter-century ago, when anthropologist Kristen Hawkes of the University of Utah advanced the “grandmother hypothesis.’’ Based on her research studying hunter-gatherer tribes, Dr. Hawkes found that older women played a critical role gathering food and caring for their daughters’ children, thus enabling the longer gestational period that separates humans from most other species. If not for them, we likely wouldn’t have evolved in the way we did or ended up having such long life spans.

Alison Gopnik, a psychologist and philosopher at the University of California, Berkeley—and a regular contributor to these pages—believes that the evolutionary role of grandmothers in caring for children “may actually be the key to human nature.” Such support, she writes, allows for longer childhoods and more time to “grow large brains and to use those brains to learn about the world we live in.”

At Gorham House in Portland, Maine, a senior residence shares a site with a preschool. Youngsters visit the senior center’s living room to play with the residents, called “Grand Friends,” as seen here last week. Residents also visit the classroom to join in activities. PHOTO: JASON GROW FOR THE WALL STREET JOURNAL 

The Stanford psychologist Laura Carstensen, a leading scholar of longevity, comes to similar conclusions, arguing that older people are essential to younger ones and to the well-being of the whole species. As Prof. Carstensen sees it, elders are a potential “cavalry coming over the hill” for the next generation. They tend to feel a growing need for meaningful relationships as they realize that fewer days are ahead of them than behind. They have a deeply rooted instinct to connect in ways that flow down the generational chain. And they possess the virtues of age—patience, persistence and emotional regulation, among others—which are especially helpful in dealing with young people.

But what does all this mean for us today, when foraging for roots and herbs for grandchildren may not be the best use of elders’ time? How can we tap the vast and largely underused talent of the older population to support the next generation, not only within families but across the broader community? How might we adapt the grandmother hypothesis to modern family life?

Despite the powerful fit between the needs of older and younger people, such connections don’t develop easily today because we’ve done so much to thwart them. Over the past century we have undertaken a radical social experiment, transforming American society from one of the most age-integrated in the world to what is, arguably, the most age-segregated.

Historians report that, in the 19th century, there was little consciousness of chronological age in the U.S. Individuals rarely knew their own age or the age of others. Most Americans lived in multigenerational households, working a farmstead together. One-room schoolhouses might include students in their 20s and 30s, sometimes older. In his 1992 book “How Old Are You?,” the Brown University cultural historian Howard Chudacoff explained that America’s “institutions were not structured according to age-defined divisions, and its cultural norms did not strongly prescribe age-related behavior.”

If above chart does not appear, please click here.

Then industrialization and the assembly-line mentality intervened. Universal schooling gave rise to age-segregated institutions for primary and secondary education. Mandatory retirement and new policies such as Social Security—which set 65 as the definition of old age—accelerated the movement of older people out of the workplace. New institutions like nursing homes and senior centers, for all their advantages, further reinforced the new reality.

By the late 1940s, with lifespans lengthening, many older people felt excluded from much of American life and experienced a lack of purpose. UAW President Walter Reuther described retirees as “too old to work, too young to die.”

The market soon responded by inventing the retirement community, devoted to giving new direction to these “golden years.” The real-estate developer Del Webb, one-time owner of the New York Yankees, opened Sun City, the first large-scale retirement community, in the Arizona desert in 1960. It held out the promise of graying-as-playing, free from the noisy intrusions of the younger generation. On its opening weekend, 100,000 people flocked to the new town, producing the largest traffic jam in state history.

‘Intergenerational proximity has often brought with it not just support but a flowering of relationships.’

All of these developments have contributed to the unhappy situation that we face today: Young and old rarely encounter each other, ageism is on the rise, and public budgets are increasingly a battleground between clashing generational interests. Most telling perhaps is the fact that the two loneliest groups in the country are younger people and older people, in that order, according to a 2018 survey based on the UCLA Loneliness Scale and conducted by Ipsos for the health insurer Cigna.

Turning things around won’t happen simply or automatically, but there are emerging signs of hope and resilience. Innovators and entrepreneurs across the globe are working to reimagine modern daily life so that connections across generations happen more naturally and frequently.

Singapore offers a dramatic example. The city-state has launched a multibillion-dollar effort to create a “kampong for all ages,” embracing the Malay word for village in an effort to build “a cohesive society with intergenerational harmony.” To bring the generations together, officials are launching initiatives to have preschools share facilities with senior centers, recruit young people to teach technology to older people, and help organizations better use older volunteers. Since 2013 they’ve been building and promoting “3Gen flats,” designed for families to house grandparents and grandchildren under one roof. They’re also spending about $150 million to underwrite an innovation challenge to seek new ideas and research that promote productive aging.

If Singapore represents a grand plan, in the U.K. there’s the example of a charismatic Pied Piper. Two years ago, Financial Times columnist Lucy Kellaway, then 57, co-founded a group called Now Teach and then announced that she was leaving her job to become one of its recruits. She began training to become a math teacher in a low-income London school.

Rainbow Intergenerational Learning Center evolved from Miami seniors bringing their grandchildren to a Little Havana senior center. Now, seniors trained in early childhood education staff a Miami Beach location, where Emma Allen worked with preschooler Helena Nikolopoulos last week. PHOTO: SCOTT MCINTYRE FOR THE WALL STREET JOURNAL 

Ms. Kellaway challenged her readers over 50 to quit their jobs and join her. “Of the 35,000 who started teacher training in the U.K. last year, almost none of them—a mere 100—were over 55,” she wrote last year. “We were sure there were lots of fiftysomethings who wanted to teach.” In response to this challenge, a thousand older people applied for 47 slots, highlighting the longing of many older people to invest in the development of the next generation. Most, though not all, started as certified teachers this fall. Now Teach expanded beyond London this year and is training 80 new recruits. It has inspired other U.K. groups to try to develop new ways to tap older talent.

In the U.S., a number of entrepreneurs have been working for decades to bring the generations together, but only recently have they begun to find a small measure of philanthropic and government support.

In 2017, I visited Gorham House, a retirement and assisted living facility outside Portland, Maine, which was built around a preschool back in 1990. It turns out that the most coveted rooms for retirees are the ones nearest the children’s playground. The facility’s website proclaims to parents that Gorham’s early childhood program has a competitive advantage over other options: a built-in community of surrogate grandparents, whom Gorham calls “Grand Friends.” In Miami, a similar combination of activities evolved from a senior center to which grandparents often brought their grandchildren; it has become the home of Rainbow Intergenerational Child Care.

There are now more than 100 such “shared sites” in the U.S., pairing youths and elders for joint activities, according to a report published this year by the nonprofit group Generations United and the Eisner Foundation. An initiative launched at Ohio State in 2015, for instance, involves the university’s students in operating a program in Columbus that brings together preschoolers and seniors.

Higher education, long a bastion of age segregation, is also getting more direct intergenerational attention. Harvard, Stanford and the University of Minnesota have begun programs in the last decade aimed at helping people over 50 change careers or find fresh uses for their experiences in retirement. The older students take most classes alongside their younger counterparts, bringing real-life perspective to class discussions. Harvard calls it a “third stage of education.”

Other intergenerational efforts are aimed at promoting social and economic connections between young and old. In 2016, two recent graduates of the Massachusetts Institute of Technology began operating Nesterly, a start-up pairing older people who had room to spare in their homes with university students in need of reduced rent and able to do chores. The program, so far active just in Boston, is part of a pilot with the city’s government to provide affordable housing, help local homeowners and increase community stability. Last year in southern Oregon, Grandmas2Go launched with an initial cadre of 20 “Grandmas”—older people trained as coaches to help support struggling new parents and their babies. The program is in the process of going statewide.

Intergenerational proximity has often brought with it not just support but a flowering of relationships. In Cleveland, a senior living community called Judson Manor created an artist-in-residence program in 2010 providing free housing for graduate music students, who agree to perform for the residents and participate in meals and other activities. When one young violist living at Judson became engaged in 2014, she asked her 90-something neighbor to be part of the wedding party.

The reach of these various early efforts is modest, especially in relation to the scale of the social shift we’re facing. They underscore, however, the need to rethink how to live later life in ways that go with the grain of human development. Rather than trying so hard to be young, to cling to our faded youth, we need to be there for those who actually are young. To achieve this, we must be as creative at inventing institutions that bring Americans together as we have been over the past century in crafting ones that split us apart. Why not start our own equivalent of Singapore’s innovation challenge?

Making the most of the multigenerational world that’s already upon us is one of the surest routes to happiness in our longer lives. The psychiatrist George Vaillant, who led the landmark Harvard Study of Adult Development, tracking hundreds of men for decades, found that those in middle age or older who invest in nurturing the next generation are three times as likely to be happy as those who fail to do so. As he put it, “biology flows downhill.”

Of all the things that divide us, the gap between old and young is arguably the most bridgeable. Connecting across generations is not only pragmatic, it’s an essential part of the human experience and a key to the cycle of life. After all, the young will soon be the old—likely faster than they ever imagined.

—This essay is adapted from Mr. Freedman’s new book, “How to Live Forever: The Enduring Power of Connecting the Generations,” which will be published by Public Affairs on Nov. 20. He is the CEO and president of Encore.org.

Researchers develop new method to diagnose, monitor chronic wounds

Kyle Quinn in his lab at the University of Arkansas. Credit: University of Arkansas

Researchers at the University of Arkansas have developed a new approach to diagnosing and monitoring chronic skin wounds, such as diabetic foot ulcers and pressure wounds.
Chronic skin wounds affect more than 150 million people worldwide and cost approximately $25 billion in health care annually in the United States alone. These non-healing wounds are characterized by inflamed tissue, poor blood circulation, callus formation or infection.

25 nov 2018--Current clinical approaches for diagnosing and monitoring these wounds do not provide critical diagnostic information about how they develop or why they do not heal.
Kyle Quinn, assistant professor of biomedical engineering, and Jake Jones, a doctoral student in biomedical engineering, have identified how cell metabolism changes over time during the healing process of wounds, by using a powerful imaging system capable of measuring changes in cellular metabolism.
Quinn and Jones used a process called label-free multiphoton microscopy to view tissue in three dimensions at the cellular level and generate 3D maps of wound metabolism. Label-free means the tissue was not artificially labeled with a fluorescent molecule. Multiphoton microscopy can facilitate measurements of naturally occuring cell and tissue autofluorescence, which is the emission of light by molecules naturally present in cells and tissue when those molecules have absorbed light.
In this study, autofluorescence imaging of two molecules – nicotinamide adenine dinucleotide (NADH) and flavin adenine dinucleotide (FAD) – were used to monitor cell metabolism. This was accomplished through a measurement called an optical redox ratio, which quantifies the relative concentrations of NADH and FAD. The researchers monitored wound metabolism in mice over a period of 10 days.

Credit: University of Arkansas

"To our knowledge, this is the first study showing changes in the optical redox ratio of tissue within live animals imaged through repeated sessions," Quinn said. "We consider this a critical step in demonstrating the diagnostic potential of multiphoton microscopy for clinical wound care."

Complications associated with diabetes are a common cause of chronic wounds.  For this reason, Quinn and Jones's study included diabetic mice, in addition to healthy, control mice.
The researchers observed differences between diabetic and control mice during the rebuilding of wound tissue. Changes in the optical redox ratio and NADH fluorescence among the diabetic mice indicated that cells remained at the wound edge, growing and dividing, rather than migrating over the wound to restore the skin's protective barrier function.    
"The ability of multiphoton microscopy to non-invasively collect structural and metabolic data suggests that it might have broader applications for wound care and dermatology," said Quinn. "Providing quantitative metrics of cell function and wound composition has potential to supplement current standard of care and guide treatment options."
The study was published in Communications Biology.

More information: Jake D. Jones et al. In vivo multiphoton microscopy detects longitudinal metabolic changes associated with delayed skin wound healing, Communications Biology (2018). DOI: 10.1038/s42003-018-0206-4

Sugar-sweetened beverages are harmful to health and may be addictive, researchers suggest

Credit: CC0 Public Domain

Just as we might have guessed, those tasty, sugar-sweetened beverages that increase risk of diabetes and other chronic diseases may actually be addictive. Youth between 13 and 18 years of age who were deprived of sugary drinks for just three days reported headaches, cravings and other withdrawal symptoms, according to a University of California study with researchers from both the Davis and Berkeley campuses.
All 25 participants in this exploratory study reported normally consuming at least three sugar-sweetened beverages a day before the study and were told they were participating in a study exploring "how soda affects teenagers' health."

24 nov 2018--The youths reported the following specific symptoms during the three-day period of cessation from sugary drinks: increased headaches, decreased motivation to do work, lack of contentment and ability to concentrate, cravings for sugary drinks, and lower ratings of overall wellbeing.
The findings were published in an article, "Potentially addictive properties of sugar-sweetened beverages among adolescents," appearing in the journal Appetite.
"An abundance of research points to sugary drinks as contributing to a number of chronic diseases. Our findings—that these drinks may have addictive properties—make their ubiquitous availability and advertising to youth even more concerning for public health," said Jennifer Falbe, assistant professor in the Department of Human Ecology in the College of Agricultural and Environmental Sciences at UC Davis and the lead author of the article.
The teens, all overweight, were instructed to consume their normal beverages for five days, then, for three days afterward, to consume only water or plain milk. They were reimbursed for travel and received up to $160 for participation.
Participants, a diverse population living in and around the San Francisco Bay Area, kept beverage journals and reported in to researchers several times during the study. Three quarters of the participants were female. They also submitted saliva samples to test for caffeine intake, which could affect results. Most of the participants were not high caffeine consumers before the study, reducing the likelihood that participants were just suffering from caffeine withdrawal, an established disorder, rather than also reduced sugar intake.
Among nine participants, there were some lapses in compliance, usually due to drinking flavored milk instead of plain milk.
The study noted that results were consistent with previous research that has reported the addictive potential for sugar, a relatively new but burgeoning area with parallels to substance abuse. Additionally, researchers said, the study was needed because sugar-sweetened beverage consumption by teens had increased five-fold since the 1950s, and adolescence is a time for increased susceptibility to addiction. Young people, the report said, consume the largest amounts of sugary beverages and have experienced the greatest relative gains in obesity in the past several decades.
The study may have important implications for public health and should be repeated with a larger sample, the researchers said.
"These results, combined with present and future corroborating evidence, could inform clinical practice around helping adolescents reduce sugar-sweetened beverage intake, have important implications for messaging in public health campaigns, and inform the need for efforts to reduce sugar-sweetened-beverage advertising to youth and those drinks' availability in and around schools," the report concluded.

More information: Jennifer Falbe et al. Potentially addictive properties of sugar-sweetened beverages among adolescents, Appetite (2018). DOI: 10.1016/j.appet.2018.10.032


Provided by UC Davis

A programme of personalised physical exercise reverses functional decline in the over-75s

Credit: CC0 Public Domain

A programme of personalised physical exercise implemented over a three-year period and involving 370 people over the age of 75 admitted to the Geriatric Service of the Hospital Complex of Navarre (CHN) has turned out to be "safe and effective" in reversing the functional deterioration associated with hospitalisation to which patients in this age group are subjected. Other aspects such as cognitive status and life quality also benefitted.

24 nov 2018--This is the conclusion of a research project coordinated by Nicolás Martínez-Velilla and Mikel Izquierdo-Redín, researchers at Navarrabiomed, the biomedical research centre of the Government of Navarre and the Public University of Navarre (NUP/UPNA); its results have just been published in the Journal of the American Medical Association (JAMA Internal Medicine).
These findings open up the possibility of medical hospitalisation units changing their traditional paradigm to focus on functional status as a clinical sign that may be negatively affected by traditional hospitalisation classically based on bed rest.

Programme of physical exercise involving strength, balance and walking

Subjects participated in a controlled, personalised programme of strength, balance and walking exercises adapted to their abilities, even during the acute phase of their diseases. Depending on the status of each patient, training intensity ranging between 30 percent and 60 percent of their muscular capacity was specified, so they did leg and arm exercises. These sessions lasted 20 minutes twice a day (morning and afternoon), for between five and seven consecutive days (including weekends and public holidays) under the individual supervision of experts in the field of physical exercise for the elderly.
The programme of physical activity adapted from the VIVIfrail training programme was adapted to the clinical circumstances of each patient; it was found to be "a significant support in preventing frailty, a factor in eliminating complications linked to passive stay in hospital and a means of motivation for overcoming disease," according to Nicolás Martínez-Velilla and Mikel Izquierdo.
"Our study shows that intervention involving, innovative, personalised multicomponent physical exercise that includes moderate intensity endurance training over a very short period of time, five days on average, has a significant benefit on routine care and may help to reverse the functional and cognitive deterioration associated with the hospitalisation of the elderly," said the NUP/UPNA professor.
The results of the study show that when discharged from hospital, the group that had participated in the prescribed programme of exercise achieved, in comparison with those who had not done it, a total of 2.2 points above the average on a maximum score of 12 in the SPPB (Short Physical Performance Battery) functional assessment tool, which measures balance, walking speed and leg strength, and 6.9 points above the average score in the Barthel Functional Index for Activities of Daily Living, which has a maximum score of 100 points. These results are particularly important, as there is scientific consensus that regards a one-point increase on the SPPB scale and five on the Barthel scale as clinically significant.
In comparison with the interventions carried out with patients that fit this profile, this constitutes significant progress in dealing with functional aspects when abandoning hospitalisation models that encourage the bed rest and sendentarism of the patient. "Until now, no one had suggested that patients of this type (elderly people with a range of diseases) could benefit in just five days from a personalised exercise programme far removed from the usual message of 'get up and walk along the corridor a little' or 'rest in bed or in an armchair,'" explained the head of the Geriatric Service at the CHN.
Significant benefits of the intervention from the cognitive and life quality perspective were also found. The above-mentioned improvements were achieved without any side effects or increase in hospital stay, as the researchers point out in their article.
"Nevertheless, this intervention did not change the rate of re-admittance or mortality three months later. In such an elderly population as those in the study and with a theoretically short life expectancy following hospitalisation, the aim of our intervention was not to increase the quantity but the quality of life," said Nicolás Martínez-Velilla.
"Sometimes, we believe that improvements in technologies or the latest innovative treatment can provide all the solutions for our problems, but we are not aware that disability generated by hospitalisation may exert a greater impact than the very disease that prompted admittance in the first place. In this respect the hugely positive effect that physical exercise can have on disease prevention and treatment is reiterated," added Mikel Izquierdo.

More information: Nicolás Martínez-Velilla et al. Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization, JAMA Internal Medicine (2018). DOI: 10.1001/jamainternmed.2018.4869


Provided by Elhuyar Fundazioa

Gene testing doesn't add much information for antidepressant or antipsychotic prescribing

Pharmacogenetic tests are marketed as an aid to psychiatrists in selecting the antidepressant or antipsychotic medication that will work best in individual patients, based on their genetic makeup. But for most patients, these pharmacogenetic tests don't provide much useful information, beyond a basic understanding of how antidepressant and antipsychotic drugs are metabolized, suggests a study in the Journal of Psychiatric Practice.

Knowing the drug metabolism generally leads to the same conclusion as gene tests, according to the new research by Matthew Macaluso, DO, and Sheldon Preskorn, MD, of University of Kansas Medical Center, Wichita.

Knowing How Drugs Are Metabolized Predicts Which Will Be in the 'Green Bin'

The researchers analyzed their experience with 19 patients with major depressive disorder who had not had a good response to previous antidepressant treatment. All patients underwent one type of pharmacogenetic test. These tests are marketed as "decision support tools" to aid in choosing and selecting the dose of antidepressant and antipsychotic drugs, based on genetic factors affecting blood levels of specific medications.
The test used in the study sorts drugs into red, yellow, and green "bins," based on genes for certain enzymes involved in drug metabolism (cytochrome P450, or CYP enzymes) and how drugs are metabolized. Drs. Macaluso and Preskorn hypothesized that knowing the metabolic pathways for antidepressant and antipsychotic drugs would allow them to accurately predict which drugs would be sorted into the red, yellow, and green bins.
Two of the 22 antidepressants tested were sorted into the "green bin" for more than 90 percent of patients. Another eight antidepressants were "almost never" in the green bin—about ten percent of the time or less. Of the 16 antipsychotic drugs tested, four were "virtually always" and two were "almost never" in the green bin.
Medications that were more dependent on CYP enzymes for their metabolism generally appeared in the yellow and red bins. Drugs that were metabolized by the liver and those with a "narrow therapeutic index" requiring monitoring of blood drug levels were more likely to fall into the red bin versus the yellow bin.
Drugs that were almost always in the green bin tended to be newer medications that were not dependent on oxidative metabolism for their clearance. "Given these results, one could predict which drugs are found in the 'green bin' more than 90 percent of the time of the time simply on the basis of knowledge of their oxidative drug metabolism without knowing the results of the patient's genetic testing," the researchers write.
Drs. Macaluso and Preskorn suggest an alternative approach to antidepressant and antipsychotic prescribing, using information on metabolic pathways to choose a drug with a lower risk of variation in blood levels. The authors believe this method "may be more cost effective than genetic testing and may perhaps also be more practical." The cost of pharmacogenetic testing is approximately $300.
In a previous article in Journal of Psychiatric Practice, Dr. Preskorn reviewed issues related to the use of new laboratory tests for psychiatry. He comments, "The value of pharmacogenetic tests in psychiatry is a major topic amongst clinicians today because the sales forces marketing them are pervasive, potent, and—unlike pharmaceutical companies—not regulated." His review raises questions about the types of evidence put forth to support the value of testing, and notes the lack of regulation over the pharmacogenetic testing industry.
"Although pharmacogenetic testing will almost undoubtedly prove critical in customizing treatment in psychiatry, the critical question is whether that time is now," Drs. Macaluso and Preskorn write. Based on their new findings, they add: "Pharmacogenetic testing in terms of guiding the selection of specific antidepressant and antipsychotic medications may not yet have reached the threshold of clinical utility."

More information: "Knowledge of the Pharmacology of Antidepressants and Antipsychotics Yields Results Comparable With Pharmacogenetic Testing", journals.lww.com/practicalpsyc … tidepressants.6.aspx


Provided by Wolters Kluwer Health

Gratitude is good—even if it doesn't always feel like it

You've probably heard that gratitude is good for you. A mountain of scientific research backs up that idea. People who take time to reflect on the good things in their lives report higher life satisfaction levels, are often less materialistic, and even seem to bounce back more quickly from illnesses.

22 nov 2018--Those inward reflections, however, can have a decidedly different impact when expressed to others, says Sonja Lyubomirsky, a professor of psychology and researcher of human happiness at UC Riverside.
So before you find yourself holding forth this Thanksgiving about the profound gratitude you feel for those gathered around the table, pause to make sure your declaration won't cause a bad case of heartburn.
Grand gestures—like reading aloud a letter of appreciation to a loved one—can leave the person on the receiving end feeling guilty and obliged to reciprocate, Lyubomirsky says. Instead of feeling grateful, the receiver is focused on not having an equal gift in kind.
"Demonstrating gratitude can make someone feel indebted to you, when previously they did not feel that way," she says. "Instead of feeling grateful for someone's thoughtful expression of thanks, we can instead feel like we owe them or we feel guilty that we haven't reciprocated an act of kindness or affection."

Learning how to be gracious to those who helped you

It can also be tricky sometimes when children articulate how much they value the help of their parents.
"When you express gratitude to a parent, it's like you're implying that they had an alternative," Lyubomirsky says. "It's like saying, 'you didn't have to support or be kind to your child, but you chose to do it.' This can be perceived as almost insulting."
Sincere feelings of gratitude towards others often demand that you take stock of your own life. For bootstrappers, who often believe that their successes are due exclusively to their own hard work, that can mean swallowing the hard reality that their accomplishments were achieved with help. Coming to that truth can be awkward and uncomfortable. Once someone realizes that they've never given thanks to their benefactors, they might they feel shame for having needed help in the first place, and guilty that they never expressed gratitude.
"Of course, being humbled or feeling embarrassed about having needed help in the first place isn't at all a bad thing, but it certainly can feel bad in the moment," says Lyubomirsky.
"You want to make your benefactor proud. You want to make sure that their efforts towards your success were worthwhile. It can be painful, but eventually expressing gratitude can lead to something good."

The many benefits of gratitude

None of this is to say that expressions of gratitude should be avoided altogether, of course.
"There is a whole range of benefits of practicing gratitude," says Jason Marsh of the Greater Good Science Center at UC Berkeley. "One of the general findings coming out of recent research is that gratitude is strongly linked to higher levels of life satisfaction. Practicing gratitude encourages you to take stock and recognize both momentary good things and experiences, as well as appreciate more global benefits and gifts in your life that you might otherwise take for granted."
"Along with that, there's also evidence that practicing gratitude helps people bounce back from stressors and illness. More grateful people are less likely to get sick," says Marsh.
Gratitude also seems to help counter or reduce materialism—something to keep in mind as consumer culture kicks into high gear for the holidays. There's even research that supports the idea that increased gratitude can motivate us to be better people.
The bottom line: While the benefits of gratitude are numerous, it should be practiced thoughtfully. So before you stand up and wing a heartfelt toast this holiday, take a moment to make sure that you're giving thanks in a way that uplifts those you care about. That is, after all, what the holiday is all about.


Provided by University of California - Riverside

Dementia study first in a series on health needs and challenges of LGBTQ seniors

In the first paper to emerge from a series of research projects aimed at understanding the health needs of older adults who identify as lesbian, gay, bisexual, transgender and queer (LGBTQ), Jason Flatt of the Institute for Health & Aging at the UC San Francisco School of Nursing found that nearly 25 percent of the LGBT adults aged 50 and older in his study had subjective cognitive decline, a potential indicator of a future Alzheimer's diagnosis. According to the Alzheimer's Association, only 10 percent of the overall population of the United States aged 65 and older has Alzheimer's dementia.

21 nov 2018--The disparity not only invites further questions about how the incidence and prevalence rates of dementia among LGBTQ adults compare with those in other populations and why they may differ, but it also speaks to the importance of the entire body of research that Flatt is pursuing.

An Understudied Population

According to the American Psychological Association, 2.4 million people over age 65 in the U.S. identify as LGBT. In this community, the common challenges of aging are often compounded by health disparities that can arise in connection with decades of discrimination. The disparities include reduced access to health care, minority stress and lack of social support. Through his diverse and expanding research program, Flatt is uncovering new insights about this understudied population to better understand its challenges and needs.
Flatt's interest in the health of older people began in high school, when he volunteered as a social activity coordinator for assisted living and skilled nursing facilities. The experience stayed with him through college and during his master of public health (MPH) degree program at the University of South Carolina. When he decided to get his Ph.D. degree in behavioral and community health sciences at the University of Pittsburgh Graduate School of Public Health, he did some soul-searching. "I asked myself what was the most rewarding thing I'd done so far, what would I like to do for a living, and it was working with older people," he says. "I decided to try to see what was important about the social lives of older adults. Could we use [an understanding of that] to either prevent or help people compensate when they're having challenges due to dementia?"
An invitation to join the faculty at UCSF offered him an opportunity to hone his focus. "I thought about what was unique about San Francisco and where there were opportunities to contribute," he says. As he began volunteering with organizations serving the city's LGBTQ community, he recognized that there was a paucity of research on the challenges of dementia in this population and decided he could help change that.

Investigating Dementia Risk in LGBTQ Elders

To that end, Flatt is using a career development award from the National Institute on Aging to jump-start his investigation of the epidemiology of dementia among LGBTQ elders. His study is the first to address the issue, investigating whether there are unique risk or protective factors in this group.
He and his collaborators – including Associate Dean for Research Julene Johnson – are using medical records from a large data set held at Kaiser Permanente Northern California's Research Program on Genes, Environment and Health (RPGEH). The records allow him to follow more than 4,000 participants identifying as lesbian, gay or bisexual from the time they enter the health system and compare them with other participants to investigate the factors that affect dementia risk. (Transgender individuals aren't part of the study at this point.) The data set offers a unique opportunity to get longitudinal data on this group, Flatt says, because RPGEH began recording data on the cohort in 1996 and started asking participants about sexual orientation in 2007, making it one of the earliest large research programs to do so.
Flatt is primarily pursuing two overlapping research questions: Are sexual minorities at higher or lower risk for developing dementia? And how does sexual minority status affect outcomes for elders living with dementia?
"We know that [sexual minorities] are at higher risk for health conditions like depression, heart disease and risky health behaviors like tobacco use, which are potential risk factors for dementia," says Flatt. "What's unique about [the LGBTQ community] is that, in some ways, they can't rely on the same social support structures that other elders do. They're often not married or partnered, they're less likely to have children, and they're more likely to live alone. We know that those are risk factors for [poor outcomes for people with] dementia."
Flatt and his co-investigators' first paper, published in the Journal of Alzheimer's Disease, has begun to tease out answers to the first question, but Flatt hopes to publish many more papers that emerge from this data set. "It's very basic descriptive data," he says. "Our first step is to describe and look at the strengths and weaknesses for this community, and how they relate to the risks related to Alzheimer's." As associations between those strengths and weaknesses and Alzheimer's risk emerge from the research, Flatt says, the next step is to develop programs and interventions both to help people reduce their risk for developing dementia and to help those who do develop it better cope with their condition.
In a separate but related project, Flatt is a collaborator on the UCSF PRIDE Study, a landmark investigation of LGBTQ health that uses mobile phone technology to connect with LGBTQ adults across the U.S. to study factors related to health over time. Flatt is specifically looking at the over-50 cohort in the study group to examine health disparities and to quantify strengths and weaknesses related to aging in the LGBTQ community.

Inclusive and Affordable Housing's Effect on Health

Another of Flatt's research projects looks at the impact of inclusive and affordable housing on the health of LGBT older adults. With funding from UCSF's Resource Allocation Program (RAP), Flatt and his co-investigators – Leslie Dubbin, of the School of Nursing, Meredith Greene and Madeline Deutsch, of the School of Medicine, and Karyn Skultety, executive director of San Francisco's Openhouse, a nonprofit organization that provides housing and a range of supportive services and community programs for LGBTQ seniors – are following LGBTQ participants in San Francisco's affordable housing lottery for the next year to see how receiving or not receiving housing affects their health and quality of life. He was also recently contacted by SAGE, a national organization that advocates for services for LGBT seniors, to include two new housing sites in New York City in his study. This will result in evaluating the impact of 307 new LGBT-inclusive and affordable apartments on the health of LGBT seniors in San Francisco and New York.
Research suggests that housing status is linked to health outcomes, and LGBTQ seniors face increased challenges finding stable housing due to a number of factors, including discrimination, lack of social and family support and chronic health problems like testing positive for human immunodeficiency virus (HIV). A related concern is that LGBT seniors who can't find welcoming, age-appropriate housing will be forced into long-term care facilities, where they may face discrimination, leading to adverse health outcomes and poor quality of life.
A 2010 report from Justice in Aging, a national organization that fights poverty among older adults, found that a majority of LGBT seniors surveyed were afraid it would be unsafe for them to be "out" in a long-term care facility. The report also recorded 853 incidences of mistreatment, including harassment and neglect by long-term care facility staff, reported by LGBT seniors or their family, friends or other advocates.
Flatt's study will look at whether receiving affordable, LGBTQ-friendly housing is associated with decreased health care utilization among seniors, which would suggest improved health. Because some of the lottery units are designated for people who have been chronically homeless or are living with HIV, Flatt says, he would not be surprised to see initial utilization go up as those individuals transition to stable housing and can begin to focus on health issues. He hopes his study will show whether, over time, emergency department visits and inpatient hospital stays will decrease as these issues are addressed and stably housed participants are better able to manage chronic health conditions.
Flatt's work with Openhouse has led to another project he's excited about – one that takes him back to his roots working with seniors in assisted living. Openhouse and its partner On Lok, a nonprofit senior care organization, have invited Flatt and his research team to do a needs assessment for a new "LGBT-welcoming" high-rise building for low-income seniors in San Francisco. The team is working with community members to look at the need for all-inclusive health care for the building's residents.
The project appeals to Flatt's passion for working directly with members of the community and giving back to the people who have inspired and fueled his research career. "I'm interested in more participatory approaches [to research], and this is true community-participatory work," he says.
He sees such work as well suited to addressing the unique health challenges and needs of LGBTQ seniors. Those needs are only beginning to be quantified and described, but Flatt is hopeful that greater awareness of the challenges that face this community will spur more research.

More information: Jason D. Flatt et al. Correlates of Subjective Cognitive Decline in Lesbian, Gay, Bisexual, and Transgender Older Adults, Journal of Alzheimer's Disease (2018). DOI: 10.3233/JAD-171061


Provided by University of California, San Francisco

Scalpel-free surgery enhances quality of life for Parkinson's patients, study finds

The improvement in a patient's hand tremor is checked during a focused ultrasound procedure. Credit: Harry Moxley | University of Virginia Health System

A high-tech form of brain surgery that replaces scalpels with sound waves improved quality of life for people with Parkinson's disease that has resisted other forms of treatment, a new study has found. Further, the University of Virginia School of Medicine researchers conclude their study offers "comprehensive evidence of safety" in terms of the approach's effect on mood, behavior and cognitive ability, areas largely neglected in previous research.

18 nov 2018--"In our initial study that looked at the outcomes of focused ultrasound surgery in Parkinson's disease, we primarily described post-operative improvements in motor symptoms, specifically tremor," said Scott Sperling, PsyD, a clinical neuropsychologist at UVA. "In this study, we extended these initial results and showed that focused ultrasound thalamotomy is not only safe from a cognitive and mood perspective, but that patients who underwent surgery realized significant and sustained benefits in terms of functional disability and overall quality of life."

Focused Ultrasound and Parkinson's Disease

Focused ultrasound, as the procedure is known, has already been approved by the federal Food and Drug Administration for the treatment of essential tremor, the most common movement disorder. That approval came after a pioneering international study led by UVA neurosurgeon Jeff Elias, MD. He and his colleagues have since demonstrated the technology's potential in reducing tremor in people with drug-resistant Parkinson's disease. The goal is to use focused sound waves to interrupt the faulty brain circuits responsible for the uncontrollable shaking associated with the disease.
The new study looked at the effects on 27 adults, all with severe Parkinson's tremor that had not responded to previous treatment. The study participants were initially divided into two groups. Twenty received the procedure, while seven received a fake procedure, to serve as a control group. (The seven in the control group were later offered the opportunity to receive the real procedure, and all but one did.)
After receiving the procedure, study participants reported improved quality of life at both three months and 12 months. "After surgery, patients experienced significant improvements in multiple aspects of quality of life, including their ability to perform simple daily tasks, emotional well-being and the sense of stigma they experienced due to their tremor," Sperling said. "Our results suggest that post-operative improvements in tremor lead to very meaningful improvements in day-to-day functioning and, subsequently, to better overall quality of life."

University of Virginia Health System neurosurgeon Jeff Elias, MD, is seen in front of the MRI used to "see" inside patients' brains during focused ultrasound surgery. The MRI imaging helps him target just the right spot to disrupt faulty brain circuits that cause tremor. Credit: University of Virginia Health System

The Effects on Mood and Memory


The study was notable for its in-depth examination of the psychological and cognitive effects of the procedure, areas that have received relatively little attention in previous research.
The researchers found that mood and cognition, and the ability to go about daily life, ultimately had more effect on participants' assessment of their overall quality of life than did their tremor severity or the amount of tremor improvement seen after the procedure.
"A person's perception of their quality of life is shaped in many different ways," Sperling said. "Mood and behavioral symptoms, such as depression, anxiety and apathy, often have a greater impact on quality of life than the measurable severity of one's tremor."
The only cognitive declines seen in participants followed through the study were in how quickly they were able to name colors and think of and speak words. The cause of this was unclear, though the researchers suggested this could be a result of the natural progression of Parkinson's. (Focused ultrasound is being tested to address the tremor associated with the disease, not its other symptoms.)
The researchers noted that their study was limited by its small size and the fact that participants' medication dosing varied, among other factors.
To become available as a treatment for medication-resistant Parkinson's, the approach would need approval from the FDA. UVA's new research is an important step in that process.
The researchers have published their findings in the scientific journal Neurology.

More information: Scott A. Sperling et al, Focused ultrasound thalamotomy in Parkinson disease, Neurology (2018). DOI: 10.1212/WNL.0000000000006279


Provided by University of Virginia

Exercise is medicine, and doctors are starting to prescribe it

Exercise is an effective medicine for many patients dealing with heart disease, dementia, depression, stroke and cancer. Credit: Shutterstock

There is a movement afoot (pun intended) to get more people exercising by involving their family doctors.
In the United Kingdom, the government recently released Moving Medicine —an online resource to help doctors talk to their patients about the importance of exercise in relation to conditions as diverse as cancer and dementia. This is a welcome initiative given that physical inactivity is the fourth leading cause of death in the world, according to the World Health Organization.

17 nov 2018--The benefits of exercise have been proven over and over again: Exercise reduces risk of depression, type 2 diabetes, heart disease, stroke and many cancers, and prevents early death.
If it was a pill, exercise would be a trillion-dollar money-maker prescribed to everyone.
Exercise as a therapy is mentioned in almost all prevention and treatment guidelines, which are written by doctors themselves. Still, most patients never hear their doctor talk about it. And fewer than one in four Canadians meet current guidelines for physical activity, which recommend that people participate in moderate (such as brisk walking) and vigorous (such as jogging, swimming or running) activity for at least 150 minutes per week.
Part of the reason is that most doctors in practice today received little, if any, training on the role of exercise in managing disease. Years ago I taught a 30-minute lecture on the topic at a Canadian medical school and this was all the students got over their four-year program.
This is about to change.

Free gym prescriptions

In recent years, Canadian medical schools—such as the Cumming School of Medicine at the University of Calgary—have revised their curricula to incorporate aspects of exercise in the prevention and treatment of disease.
This is one part of growing initiatives like Exercise is Medicine that advocate for the role of exercise and encourage doctors to prescribe it.
Similarly, the Prescription to Get Active program in Alberta allows doctors to prescribe free 30-day gym memberships to patients.
A grassroots program called Walk with a Doc has local doctors walking with their patients. The program was begun by Dr. David Sabgir, a cardiologist in Columbus, Ohio, who was frustrated with his inability to affect behaviour change in the clinical setting and invited his patients to go for a walk with him in a local park one Saturday morning. More than 100 people showed up, and there are now 400 chapters worldwide.
There have also been calls for exercise to be considered a vital sign, much like blood pressure and heart rate. Health insurance provider Kaiser Permanente requires doctors in the United States to record how much physical activity a patient does.
Patients who receive exercise prescriptions and counselling from their doctors are more likely to be active, so these initiatives are a good start.
More needs to be done, however, when only one-third of doctors talk to their patients about exercise.

Reactionary health-care system

Not surprisingly, doctors who exercise themselves are more likely to counsel their patients about physical activity. Therefore, targeting doctors to be more active may provide a substantial population effect.
At the same time, doctors say they need more and better training with respect to the benefits of exercise and how to counsel patients.
The need for this change in approaching health and disease comes from two key realizations. One is that there are a growing number of people with preventable chronic illness, and our health-care system is not adequately prepared to deal with all these patients.
Our system is reactionary; it is designed to wait until someone has a disease instead of preventing it. But chronic illnesses are not like diseases of old. They cannot be cured, although many can be prevented. Exercise is increasingly recognized as important to this change.

Exercise for cancer care

Second, we have greater knowledge about the benefits of exercise in treating disease in addition to preventing it. Exercise is used for cardiac rehabilitation, after a heart attack.
Exercise works as well as drugs that lower cholesterol and blood pressure in preventing early death. And diabetics who exercise require less medication to manage their blood sugar.
Even in treating cancer, exercise can reduce the side-effects of treatment, such as anxiety, depression and fatigue. This has prompted the Clinical Oncology Society of Australia to release a position statement recommending exercise as part of regular cancer care. It is believed to be the first of its kind in the world, but hopefully not the last.
Doctors would benefit from additional incentives such as specific billing codes that allow for prescribing of exercise as well as more continuing medical education sessions on how to do so.
Educating current and future doctors that exercise is as good, if not better, than many medications will be essential to prevent the increasing burden of chronic illnesses.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Provided by The Conversation

Six surprising drug interactions you should know about

Mixing certain antibiotics and alcohol can leave you feeling nauseous. Credit: metamorworks/Shutterstock

As the UK population grows older, more and more people are using a combination of drugs to treat multiple conditions. This can lead to interactions and side effects that we all need to be aware of. Not only can drugs interact with each other, they can also interact with food and drink, as well as popular herbal remedies.Here are some of the most noteworthy to give you an overview of the combinations to be wary of.

1. Statins and grapefruit juice

17 nov 2018--Many people are prescribed drugs from the statin family to prevent heart attacks and strokes. Statins are the mainstay of cholesterol management but are not free from drug and food interactions. One particularly important interaction to note is that of certain statins with grapefruit juice.
People who have been told that they have high cholesterol often make lifestyle changes, which may involve increasing the amount of fruit and vegetables in their diet. Although this is encouraged, it's important to be aware that grapefruit juice can slow down the breakdown of statins in the body, thereby increasing their presence in the blood, resulting in more side effects.

2. Warfarin and green leafy vegetables

Warfarin, a drug used to prevent and treat blood clots, is commonly prescribed in the UK. People taking warfarin need to go for regular blood tests to make sure that they are taking the right dose to treat their particular condition. An interaction of note with this drug is that with vitamin K.
Supplements and foods that contain vitamin K, such as green leafy vegetables and green tea, can reduce the effect of warfarin by speeding up its removal from the body, meaning that those taking it may suffer serious consequences, including an increased risk of strokes or deep vein thrombosis. You should let your prescriber know if you are making any changes to your diet so that your dose of warfarin can be adjusted accordingly.

3. Antidepressants and ibuprofen

Taking a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as citalopram, alongside anti-inflammatory painkillers, such as ibuprofen, can increase the risk of internal bleeding. This is usually associated with the stomach and symptoms can include dark stools, stomach cramps, feeling tired, blood in vomit and feeling faint or dizzy.
This side effect can be avoided by taking a stomach protecting drug, such as lansoprazole. It's important to note, however, that certain other stomach protecting drugs may also interact with antidepressants, so it's important to choose wisely.

4. Metronidazole and alcohol

Metronidazole is a commonly prescribed antibiotic, particularly for dental infections. Although your pharmacist may often encourage you not to drink alcohol while taking prescribed medication, this advice is particularly important with metronidazole.
Drinking alcohol while on metronidazole can lead to severe nausea and vomiting. Not only should you avoid alcohol while taking metronidazole, you should wait for at least two days after your course has finished. This is to make sure that all of the drug has left your body.

5. St John's Wort and the contraceptive pill

St John's Wort is a popular herbal remedy, used to treat the symptoms of mild depression. Some people assume that because it is a herbal remedy, it must be harmless. Quite the opposite.
St John's Wort is an example of an enzyme inducer, a substance that speeds up the breakdown of another substance. By encouraging the breakdown of the other drug at a faster rate than normal, this means that the other drug becomes less effective.
While St John's Wort can have this effect on many drugs, one of particular note is the contraceptive pill. St John's Wort decreases the effectiveness of the pill, increasing the chance that the person taking the pill will become pregnant.
The interaction is so severe that the UK's Medicines and Healthcare products Regulatory Agency has advised that the combination of St John's Wort and the combined hormonal contraceptive pillshould be avoided altogether.

6. Calcium supplements and other medications

As we get older, our bones become weaker, so many people are prescribed calcium and vitamin D supplements to strengthen their bones and prevent fractures. While these products benefit many, it is important to understand that they may affect how the body absorbs other drugs. These include drugs to prevent malaria, certain antibiotics and those used to treat an underactive thyroid.
For most drugs, this interaction can be overcome by leaving time between taking the calcium product and the other drug. A gap of between two and six hours between taking calcium and other drugs is usually enough.
It is very important that if you are taking any of the drugs mentioned in this article that you do not stop taking any of them until you have consulted with your doctor. Any sudden changes to medication may have more severe consequences than any of the interactions listed in this article.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Provided by The Conversation

Going for a checkup? You may be screened for alcohol use

Credit: CC0 Public Domain

Here's to your health. Screening and counseling for unhealthy alcohol use could become part of a standard doctor's visit, according to the United States Preventive Services Task Force. The organization, funded and staffed by the U.S. Department of Health and Human Services, published its recommendation in the medical journal JAMA.

16 nov 2018--The United States Preventive Services Task Force "recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use," according to the report. The organization didn't conclude such a screening was necessary for underage drinkers.
According to the abstract at the start of the report, an estimated 88,000 alcohol-attributed deaths occurred annually between 2006 and 2010 in the U.S. That number includes "acute conditions" such as car accidents and "chronic conditions" such as liver disease.
The report cites statistics from the National Institute on Alcohol Abuse and Alcoholism to define "risky use" of alcohol as exceeding the recommended limits of four drinks per day or 14 drinks per week for healthy adult men aged 21 to 64. For women, "risky" drinking is defined as three drinks per day or seven drinks per week. That standard also applied to men 65 or older.
A standard drink, according to the study, is defined as a 12-ounce beer (5 percent alcohol), a 5-ounce wine (12 percent alcohol) or 1.5 ounces of liquor (40 percent alcohol).

New guidelines for early detection and treatment of sarcopenia

Newcastle University experts are chairing a national session on new guidelines for the early detection and treatment of sarcopenia—a loss of muscle strength that affects many older people in the UK.
It is estimated that hundreds of thousands of older people live with the condition in the UK, and identification and treatment is a major challenge for modern medicine.
Now new guidelines for early detection and treatment of sarcopenia will be launched in the UK on Friday (November 16) at the British Geriatrics Society Autumn Meeting in London.

Newcastle experts' role

16 nov 2018--Professors Avan Sayer and Miles Witham, from the NIHR Newcastle Biomedical Research Centre, at Newcastle University and Newcastle Hospitals, UK, will chair a session that outlines the process of creating the guidelines with the European Working Group on Sarcopenia in Older People (EWGSOP).
Professor Alfonso Cruz-Jentoft, Director of the Geriatric Department of the Hospital Universitario Ramón y Cajal in Madrid, and lead author of the new guidelines, will discuss the recommendations as part of the session.
Professor Avan Sayer, Director of the NIHR Newcastle Biomedical Research Centre, was a member of the Working Group.
She said: "These guidelines are an update of the previous ones published in 2010 and will provide a step change in how we both recognise and manage sarcopenia.
"They will underpin the growing research activity in this area as well as support the development of new clinical services for older people.
"We are keen to get this message out as widely as possible to patients and the public where sarcopenia is not so well known."
The new consensus is endorsed by a number of international Societies, including the European Geriatric Medicine Society, the European Society for Clinical Nutrition, the European Society for Clinical and Economic Aspects of Osteoporosis Osteoarthritis and Musculoskeletal Diseases, the International Osteoporosis Foundation and International Association of Gerontology and Geriatrics for the European Region.

Sarcopenia research

Studies have shown that sarcopenia increases risk of falls and fractures, impairs ability to perform activities of daily living, lowers quality of life, leads to loss of independence, and is associated with increased mortality rates.
In financial terms, sarcopenia is costly to healthcare systems as among older adults who are hospitalised, those with sarcopenia on admission are five times more likely to have higher hospital costs.
There are a number of important changes to the guidance from 2010, including an easier way to screen for sarcopenia risk using a simple questionnaire, a systematic way to make the sarcopenia diagnosis, and suggestions for practical tools and tests at each step. The new consensus also underscores the importance of poor physical function as a "red flag" for severe sarcopenia.
The new consensus also highlights areas requiring further research, such as the underlying mechanisms of the disease remain poorly understood.
There may be multiple types of sarcopenia, driven by different underlying risk factors or diseases. The new guidance attempts an important next step in classifying sarcopenia into primary and secondary forms, which should accelerate research in this area.
Professors Sayer and Witham's work at Newcastle University and the NIHR Newcastle Biomedical Research Centre harnesses scientific expertise, input from patients, the public and industry, in order to improve the diagnosis, treatment and prevention of ageing syndromes, including sarcopenia. Their work seeks to understand why muscle becomes weaker with age, identify ways to prevent or reverse sarcopenia, and then test these potential treatments in clinical trials.
Professor Alfonso Cruz-Jentoft said: "There is no doubt that sarcopenia is now well established as an important area of research activity, both within geriatric medicine and increasingly in organ specialities, such as cardiology, respiratory medicine, and oncology.
"Will this research activity translate into clinical activity focused on sarcopenia, as we would like to see? For this to happen, sarcopenia has to be routinely detected and addressed in clinical practice.
"Diagnosing sarcopenia will have to lead to treatment strategies that would otherwise not be triggered as part of current care. The treatments proven to work so far—resistance training and nutrition intervention—are not unique to sarcopenia and are already indicated for the related syndrome of frailty.
"It may be that for sarcopenia to find a place in daily geriatric medicine practice—and in general medical care—we must wait for specific, effective treatments that merit spending time and effort on making the diagnosis of sarcopenia. As research progresses towards that goal, these new guidelines are an important next step on the road."
Read the Age and Ageing paper Sarcopenia: revised European consensus on definition and diagnosis
These new guidelines are an update to the previously published Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People published in Age and Ageing in 2010.


Provided by Newcastle University