Friday, 17 November 2017

Almonds are really super at busting bad cholesterol, so eat up

Researchers have recently confirmed the anti-cholesterol benefits of almonds.
Regular intake of a handful of almonds increased levels of mature HDL or “good cholesterol” particles, which are associated with cardiovascular health, by 19 per cent.
AUGUST 22, 2017
Almonds are really super at busting bad cholesterol, so eat up
Almonds, known to improve good cholesterol, are found to be great at removing bad cholesterol too.
According to a study published in the Journal Of Nutrition, almonds may not only increase blood levels of HDL (good cholesterol), but also boost the transport of bad blood cholesterol to the liver.
Previous studies have already shown that the small oleaginous fruit – which is not a true nut – has the capacity to reduce blood levels of LDL (bad cholesterol), which is associated with increased cardiovascular risk.
Over a period of six weeks, researchers at Pennsylvania State University monitored two groups of patients with high levels of bad cholesterol.
The first group of patients consumed 43g of almonds per day, the equivalent of a generous handful, whereas the members of the second group were given a banana muffin.
At the end of the end of each study period, the researchers measured the levels and functioning of HDL cholesterol in each participant.
Then they compared the results with blood counts established at the outset of the experiment.
The study highlighted a 19 per cent increase in mature HDL particles in members of the group taking almonds.
At the same time, participants whose weight was within normal ranges found their bodies’ ability to transport excess cholesterol to the liver improved by 6.4 per cent.

Almonds send more bad cholesterol to the liver to be removed from the body, and that is a great thing.

What’s mature HDL?

“HDL is very small when it gets released into circulation,” study author Dr Kris-Etherton said.
“It’s like a garbage bag that slowly gets bigger and more spherical as it gathers cholesterol from cells and tissues before depositing them in the liver to be broken down.”
On this journey, HDL particles grow bigger until they become mature.
Rich in magnesium (anti-spasmodic) and potassium (anti-fluid retention), almonds are a healthy and filling snack rich in fibre and protein.
A handful of ten almonds has approximately 100 calories. – AFP Relaxnews

Thursday, 16 November 2017

What’s up with gluten?

Many people believe that a gluten-free diet helps ease abdominal symptoms that have baffled doctors and researchers.

November 12, 2017

What’s up with gluten?
Food containing gluten include wheat, barley and rye.

There are no available statistics on the number of patients suffering from non-coeliac gluten sensitivity (NCGS) in Malaysia because there’s no such test currently to find out if someone is sensitive to gluten, said consultant gastroenterologist and physician Dr P. Shanthi.
“But it is real and there are papers published by the scientific community,” she said in an interview.
Food containing gluten include wheat, barley and rye.
Dr Shanthi said that currently, the only way of knowing if someone is sensitive to gluten is by putting them on a gluten-free diet and seeing if gastrointestinal symptoms resolve and then re-challenging them with gluten-containing food and looking for symptom recurrence.
She said that coeliac disease (CD), which is proven to be linked to gluten sensitivity, is rare in Malaysia, and it is believed that more people suffer from NCGS.
While there are no statistics on NCGS in Malaysia, Dr Shanthi said the prevalence of irritable bowel syndrome (IBS) varies from 10.9% to 15% (more than three million) of the population. An international journal quoted a global prevalence of 11.2%.
While not all IBS patients are sensitive to gluten, research has shown that certain patients with diarrhoea-predominant IBS may have gluten sensitivity, she said.
Consultant gastroenterologist and physician Dr P. Shanthi.
“Currently, patients with problematic IBS are prescribed the Fermentable Oligo- Di- Mono-saccharides and Polyols (Fodmaps) free diet because Fodmaps are found to cause bloating, diarrhoea and abdominal cramps in certain individuals,” she said.
Asked why food containing gluten are also listed in Fodmaps, Dr Shanthi said it was because of the starch found in wheat, which forms the biggest component in wheat flour (70-75%).
“The fructants in starch can cause IBS,” she said.
She said that for those with IBS and functional dyspepsia (a chronic disorder of sensation and movement [peristalsis] in the upper digestive tract), fruits with excess fructose and milk could pose an issue.
For instance, apples and pears are categorised as having “high fructose” but not bananas, she said.
Asked if those suffering from inflammatory bowel disease (IBD) – which include Crohn’s disease and ulcerative colitis – need to adhere to a gluten-free diet, she said they do not need to.
“But those with IBD and IBS can try the diet if it helps with their symptoms,” she said, adding that IBD patients still have to take a lot of medicines such as steroids and immosuppresants.
The other group of people who suffer from gluten-related disorders are those with wheat allergy, which could be detected by a blood test for IgE or skin prick test, according to Dr Shanthi.
When exposed to wheat products, they could suffer allergic reactions such as breathing difficulties, swelling or breaking out in rashes, she said.
None of the evidence thus far has convinced Dr Nazrul Neezam Nordin.
Paediatric gastroenterologist Dr Nazrul Neezam Nordin said there was insufficient evidence to suggest NCGS exists because the symptoms that NCGS patients say they suffer from such as headache, abdominal bloating and pains and diarrhoea are non-specific, which could be caused by anything and not necessarily gluten.
Patients could be getting bloating from being fructose intolerant or lactose intolerant, for instance, he said.
“So far, none of the evidence has convinced me. There isn’t enough strong evidence to back these claims,” he said, adding that it is also difficult to design a study to assess non-specific symptoms alleged to be caused by gluten sensitivity, contributing to scarcity of evidence.
To make things worse, there is also an absence of a reliable biological marker to confirm or exclude gluten sensitivity, he said.
Dr Nazrul said that the only gluten related disorder that has been clearly defined are CD and wheat allergy.
While he saw only one or two cases of CD as a paediatrician of 11 years in Malaysia, he saw many wheat allergy cases such as lip swelling, rashes and sometimes diarrhoea, which occur quickly after exposure to the allergen, he said.
But CD remains an important and common condition in other parts of the world, he said.
However, he pointed out that for children with recurrent abdominal pain, inflammatory bowel disease (IBD) is an important diagnosis to be excluded as the incidence is increasing at an alarming rate in Malaysia.
Irritable bowel syndrome is another important diagnosis and specific dietary intervention such as low Fodmaps diet and stress control are recommended as part of the management, he said, adding that IBS is a diagnosis of exclusion.
Dr Nazrul said it is not uncommon to see many people suffering from chronic pain such as headaches, body aches, back pains although scans do not show any problems. Hence IBS should not come as a surprise.
Dietitian Celeste Lau said CD patients have to be on gluten-free (GF) diet completely as even tiny amounts could trigger a severe reaction, while those with IBS and IBD do not need to avoid it unless they are sensitive to gluten.
For those without CD but have gluten sensitivity, they should also avoid gluten, she said.
Besides noodles, bread and cakes, food that people may not realise contain gluten are sausages (the wrap may have gluten), burgers (if added with in fillers), licorice, candies, marshmallows, milk pudding, custard (gelatin which may contain gluten), she said.
She also said that some rice and corn cereals may have been added with gluten too while fruit pie fillings and soy sauce too may contain gluten.
“While some experts say those sensitive to gluten can eat oats, others advise otherwise as oats could be exposed to cross-contamination unless certified otherwise,” she said.
Lau said that the GF diet may also help those with severe dermatitis herpetiformis, a skin manifestation of the body’s abnormal response to gluten. It often occurs with CD, but can occur alone without bowel damage.
GF food is not easily available in Malaysia, and those with a gluten issue should read food labels to avoid gluten, she said.
NCGS and coeliac patients also need to avoid food with “may contain gluten” labels because cross-contamination could occur in the manufacturing processes, she said.
She said that many patients had gone to her to see if a GF diet helps, and they include patients with eczema, IBS, IBD, food sensitivities, as well as parents with autistic children, and it worked for some, but not all.
Lau said some IBS and IBD patients could eat food with gluten while others could not, but most could tolerate a small amount.
Since the cause of IBS is unknown, gluten food could be omitted or reduced to see if there is any relief, she said, adding that those suffering from IBS need a low Fodmaps diet and should try and keep their stress levels down.
She said that probiotics may work for IBS patients, but not for IBD patients.
For confirmed IBD patients, they do not need to be on a GF diet unless they have discomfort with gluten, she said.
Lau said IBD patients have malabsorption and digestion problems and they have to go on a low residue diet or low fibre diet as too much fibre may trigger inflammation in their bodies.
“Depending on their tolerance level, they can still eat fruits, but with the skin removed. For vegetables, they can eat the leafy parts and less of the stalks,” she said.
For those with IBD or coeliac, they also suffer from malabsorption and weight gain problems and need a high protein and high-calorie diet such as meat, fish and chicken because they suffer from inflammation, said Lau.
“They also need supplementation with multivitamins. Their vitamins A, B, E may be low and they are prone to anaemia,” she said.

Wednesday, 15 November 2017

Vegetarianism and other dietary tales

Although most are comfortable with their vegetarian diets, there are some facts which are not always commonly known – and most vegetarian media do not even mention them, especially the “raw” or “paleo” diet media.
People on raw and paleo diets may be depriving themselves of 
mineral nutrients, simply by eating too many raw beans, seeds, 
nuts and wholegrains. – VisualHunt

And it is not the usual stuff about how vegetarian diets are deficient in nutrients which can only be found in meat and fish – many people simply may not know that several highly popular components of a vegetarian diet can actually result in a significant loss of nutrition, primarily by a chemical process called chelation (pronounced “key-lay-shun”).
Chelation prevents nutrients from being absorbed by the body because a chelating agent tightly binds its own molecules with metal ions, rendering the metals insoluble, inert and indigestible.
Not all chelating agents are bad; for example, sodium calcium edetate is used medically to treat lead and mercury poisoning.
A bit of bad news about beans, grains and nuts
The main dietary compound involved with chelation in humans is phosphorous-based phytic acid (also known as myo-inositol hexakisphosphate) – and salts of phytic acid are known as phytates.
Seeds use phytates as energy stores of phosphates to assist in germination and hence phytates are present in various concentrations in all seeds, grains and legumes used for human consumption.
Due to its undoubted ubiquity, chelation by phytates is generally not a major issue for most humans eating food based on plant seeds, though there are some possible exceptions.
By this I mean that there are significant differences in the levels of phytates in food and these levels are very dependent on the way the food has been prepared.
As an example, lentils which are cooked straight from the packet will have high concentrations of phytates whereas lentils soaked overnight before cooking will have much lower levels of phytates.
In short, wherever possible, always make sure that seeds are pre-soaked and on its way to germination before using them – the germination process greatly depletes phytates in seeds.
As such, people who need enhanced minerals should not eat excessive amounts of seeds which have not been pre-soaked or germinated – this applies to pregnant women, for example.
The chemical summary is that phytates are plant seed-based complex phosphorous compounds which have six sub-groups which bond fiercely with calcium, iron, manganese and zinc molecules, rendering these important metals insoluble and unavailable for digestion.
These minerals would probably be from foods ingested at the same time as phytates – plants do not tend to have them in large quantities. Minerals bound by phytates are excreted by the body as waste material.
It should be noted that phytates are not destroyed by cooking – and people on raw and paleo diets may inadvertently be depriving themselves of mineral nutrients, simply by eating too many raw beans, seeds and nuts. This may also apply to people eating a lot of wholegrain foods in general, such as wholemeal baked goods, oats, granola, muesli, et cetera.
Eating plants means more fibre
On the plus side, eating more plants and plant-based foods can increase the amount of dietary fibre, both soluble and insoluble. Fibre may be a significant contribution to the AHS-2 and EPIC-Oxford findings that vegetarian diets generally lead to lower rates of coronary heart disease (CHD).
A review of several studies by the BMJ in 2013 also concluded that the incidence of CHD is inversely related with the consumption of fibre – basically, eating more fibre reduces the likelihood of CHD while eating less fibre increases the chances of CHD.
The amplitude of this inverse correlation varies depending on which research papers are used but the overall relationship remains true across several large scale studies.
While this is good news, we might like to understand why this inverse relationship exists in the first place. Even if everybody has heard about how good fibre is for health, some may still not know the reasons WHY fibre is actually beneficial – and that may be because the two types of fibre work in different ways.
Soluble fibre and cholesterol
Soluble fibre is termed soluble because it can combine with water to form a gel. A common example is pectin in apples (which is also used to make jams). Soluble fibre appears to help reduce the amount of low-density lipoprotein (LDL) cholesterol circulating in the body by intervening in the intestines before the cholesterol is released into the bloodstream – this intervention is done by soluble fibre binding with cholesterol from digestive bile juices and ingested food and rendering such cholesterol into waste matter.
It seems that between 5 to 10g of soluble fibre can reduce LDL cholesterol by around 5%, though increasing the consumption of soluble fibre does not mean a corresponding decrease in LDL cholesterol as the relationship is not linear – therefore, perhaps an optimal level of soluble fibre consumption for people should be between 5 to 25g a day.
It should be added that LDL is not necessarily the prime cause of CHD but a stressful lifestyle which introduces arterial wall damage combined with LDL is definitely a significant risk factor for CHD. To understand this better, you may choose to read
Insoluble fibre and the one-eyed Irishman
Insoluble fibre is plant material which is impervious to water, such as cellulose or the bits of vegetables that you find a little stringy in the mouth.
To understand the function of insoluble fibre, we have to delve into the toilet habits of 20th century British sailors and African tribesmen and recount the work of an interesting one-eyed Irishman called Dr Denis Parsons Burkit.
While in Africa between 1966 and 1972, Burkit conducted curious experiments which noted that African tribesmen were producing between 2.5 to 4.5 times more faeces than British sailors on a regular basis.
This study was done initially to support his hypothesis that the health of people (as measured by the number of visits to hospitals) could be predicted by the frequency and quantity of their bowel movements – the less they pooped, the more sick they were likely to be.
His suspicions were also augmented by the introduction of refined flour (a food containing only a fifth of the fibre of unrefined flour) into the diets of British sailors – this helped to make the naval deposits hard and puny compared to the large soft poops from the Africans.
kale, vegetarian, vegetables, fibre
Eating more plant-based foods means a higher fibre intake, 
which in turn has shown to reduce incidences of coronary heart disease. – AP

An examination of the diets found that Africans ate much more fibre than British sailors and in general had notably healthier intestines.
Later it was established that much of the Africans’ diet was based on plants high in insoluble fibre. Analysing the ailments suffered by British sailors found that issues common with the sailors such as Irritable Bowel Syndrome (IBS), diverticulosis, haemorrhoids, colorectal cancers, et cetera, were absent from the Africans – and from his observations, Burkit proposed that insoluble fibre plays a significant part in maintaining the health of the human gastrointestinal system.
To this day, nobody has been able to challenge this assertion, though there have been disputes about Burkit’s original hypothesis about the numbers of hospital visits in relation to amounts of poop.
As for reasons why insoluble fibre has this beneficial effect, it may be the human digestive system had evolved to expect and handle the fibre load involved in digesting plant material. The human digestive system functions autonomously (ie. without conscious effort) and gut motility (stretching and contraction in the gut) is affected by the type and content of ingested food.
As such, the reduced amount of insoluble fibre in many modern diets would be alien, might not be tolerated so well intestinally and may therefore be a cause of at least some modern gastrointestinal issues.
Insoluble fibre is also high in plant oligosaccharides and these oligosaccharides are very often retained by the gut as food for intestinal microbiota – therefore insoluble fibre can also promote health of gut bacteria. Intestinal flora is very important for human health; as an example, much of the body’s defences against infection are based on the outputs from such flora. More recent research has indicated that gut microbiota may also be related to moods and mental health – this is a complex subject probably suited by another dedicated review.
There appears to be no upper limit to the amount of insoluble fibre which humans can consume – perhaps 30-50g a day should be adequate for most people. Any more may cause exuberant flatulence and require some people to always remain within a 10 metre range of a toilet facility. Nevertheless, it is quite plausible that insoluble fibre can also play a part in the reduction of gastrointestinal cancers (especially in women) as noted by the AHS-2 study.
At this point, it should be noted that both the AHS-2 and EPIC-Oxford dietary studies can also be regarded as proxies for research in dietary fibre, though they both actually did not initially record dietary fibre content in detail.
Subsequent analysis of both studies found that the US-based AHS-2 subjects ingested much more fibre as well as more antioxidants (as measured by Vitamin C content) than the UK EPIC-Oxford subjects.

Oats and bran are a good source of soluble fibre. – Marcoverch/VisualHunt
Fibre and/or antioxidants may therefore explain the major difference in mortality between vegetarian subjects compared to regular meat-eaters: AHS-2 found a 12% lower mortality rate for US vegetarians. However, EPIC-Oxford detected no significant differences across all categories for the UK, possibly due to the difference in dietary fibre.
Although one can think that “non-meat eaters” are automatically “vegetarians”, it is quite important to understand that the “vegetarians” in both studies included people who ate meat, dairy and/or fish occasionally – they are not studies of vegans or people who fastidiously avoid all non-plant proteins compared to meat-eaters.
If you take this view, then both studies can also be taken as proxy studies into the impact of eating less meat, simply by comparing the regular meat-eaters against the other categories which ate meat and/or dairy or fish only occasionally.
Viewed in this context, the AHS-2 research is particularly interesting as the irregular meat eaters seem to be more protected against early mortality and various diseases, especially CHD. But – why is this mortality pattern not observed in EPIC-Oxford?
An analysis of AHS-2 against EPIC-Oxford of ONLY the general meat eaters might help explain the difference in mortality rates (bearing in mind that correlation does not necessarily mean causation).
One striking difference is that Americans eat around 50% more meat per person compared to the United Kingdom, according to the FAO statistics for 2013.
There are many reasons why Americans eat so much more meat – partly it is a cultural issue, partly it is an economic issue as meat is comparatively cheap there due to generous subsidies (which can make various vegetables more expensive than meat).
Also, the US food industry appears to emphasise the nutritional importance of meat and downplays the fact that meat is not required every day. By this simple (and admittedly crudely inferential) analysis, the joint results do appear to indicate that a reduction in meat consumption does reduce mortality – people who ate around 50% more meat die 12% more often compared to people who ate less meat, even if they are all general meat eaters.
The next part will cover intestinal flora, how human mothers nourish the guts of their babies and why certain dietary issues may be attributed to the wrong sources.

Tuesday, 14 November 2017

Newly identified third type of diabetes is being wrongly diagnosed as type 2

Type 3c diabetes is quite common, but most doctors are missing it
Most people are familiar with type 1 and type 2 diabetes. Recently, though, a new type of diabetes has been identified: type 3c diabetes.
Type 1 diabetes is where the body’s immune system destroys the insulin-producing cells of the pancreas. It usually starts in childhood or early adulthood and almost always needs insulin treatment. Type 2 diabetes occurs when the pancreas can’t keep up with the insulin demand of the body. It is often associated with being overweight or obese and usually starts in middle or old age, although the age of onset is decreasing.
Type 3c diabetes is caused by damage to the pancreas from inflammation of the pancreas (pancreatitis), tumours of the pancreas, or pancreatic surgery. This type of damage to the pancreas not only impairs the organ’s ability to produce insulin but also to produce the proteins needed to digest food (digestive enzymes) and other hormones.
However, our latest study has revealed that most cases of type 3c diabetes are being wrongly diagnosed as type 2 diabetes. Only 3 per cent of the people in our sample (of more than two million) were correctly identified as having type 3c diabetes.
Small studies in specialist centres have found that most people with type 3c diabetes need insulin and, unlike with other diabetes types, can also benefit from taking digestive enzymes with food. These are taken as a tablet with meals and snacks.
Researchers and specialist doctors have recently become concerned that type 3c diabetes might be much more common than previously thought and that many cases are not being correctly identified. For this reason, we performed the first large-scale population study to try and find out how common type 3c diabetes is.
We also looked into how well people with this type of diabetes have their blood sugar controlled. To do this we analysed health records from more than two million people in England. The records used were taken from the Royal College of General Practitioners Research and Surveillance Database (RCGP RSC). This database, mainly used for flu surveillance, contains the anonymised healthcare records of people of all ages for a sample of GP practices spread out across England.
We looked for cases of diabetes occurring after conditions which had caused damage to the pancreas including pancreatitis, pancreatic cancer and tumours, and pancreatic surgery. These cases of diabetes are likely to be cases of type 3c diabetes. The proportion of people with diseases of the pancreas who go on to develop diabetes is not clear but it does not happen in all cases, and there may be a long delay before the onset of diabetes.
To our surprise, we found that in adults, type 3c diabetes was more common than type 1 diabetes. We found that 1 per cent of new cases of diabetes in adults were type 1 diabetes compared with 1.6 per cent for type 3c diabetes.
People with type 3c diabetes were twice as likely to have poor blood sugar control than those with type 2 diabetes. They were also five to 10 times more likely to need insulin, depending on their type of pancreas disease.
We found that the onset of type 3c diabetes could occur long after the onset of pancreas injury – in many cases more than a decade later. This long lag may be one of the reasons the two events are not often thought of as being linked, and the diagnosis of type 3c diabetes is being overlooked.
Correctly identifying the type of diabetes is important as it helps the selection of the correct treatment. Several drugs used for type 2 diabetes, such as gliclazide, may not be as effective in type 3c diabetes. Misdiagnosis, therefore, can waste time and money attempting ineffective treatments while exposing the patient to high blood sugar levels.
The ConversationOur findings highlight the urgent need for improved recognition and diagnosis of this surprisingly common type of diabetes.
Andrew McGovern is clinical researcher at the University of Surrey. This article was originally published on The Conversation (

Wednesday, 8 November 2017

Dark side of Chinese medicine injections

China is pushing for an overhaul of injectables based on traditional medicine, seeking to weed out unsafe products. 

Sunday, 5 Nov 2017
ON a winter morning in January 2012, farmer Wu Xiaoliang stopped by his local doctor to remedy a headache. At a small clinic near his village he received two injections made from traditional herbs.
Hours later, villagers saw him struggling to prop himself up on his moped as he drove home. By noon, he was dead.
What killed Wu, 37, was later described in an autopsy report as a “drug allergy.” But doctors couldn’t pinpoint what he was allergic to because the shots he was given contained dozens, if not hundreds, of different compounds extracted from two herbs.
For centuries, Chinese have bought plant and animal parts from traditional clinics, and boiled them into bitter soups to treat colds, strokes and even cancer. But the Chinese medicine sector has modernised along with the rest of the country, with local manufacturers turning age-old recipes into fast-acting injectable drugs.
Chinese medicine injections generated sales of US$13bil (RM55bil) last year, according to the research firm Forward Industries Institute.
Glass vials of injectable traditional Chinese medicine are arranged for a photograph at a pharmacy in Beijing, China, on Thursday, Oct. 12, 2017. For centuries, Chinese have bought plant and animal parts from traditional clinics, and boiled them into bitter soups to treat colds, strokes and even cancer. But the Chinese medicine sector has modernized along with the rest of the country, with local manufacturers turning age-old recipes into fast-acting injectable drugs. Photographer: Giulia Marchi/Bloomberg 
Yet, the industry’s ascent has also raised public health concerns. Over a hundred injections based on traditional recipes are sold in China these days, some without stringent human trials. Doctors often prescribe them in an array of untested combinations. Adverse reactions, from skin rashes to fatalities like Wu’s, doubled to about 133,000 last year from 2011, according to government data.
Having struggled for decades to rein in the sector, regulators have recently begun pushing for an overhaul of Chinese medicine injections, seeking to weed out unsafe and ineffective products. But the process could take up to a decade, given the complexity of these intravenous pharmaceuticals.
“For the majority of these chemicals, their properties and their safety to the human body are not properly evaluated and some of them are not even discovered yet,” said Justin Wu, associate dean at the department of medicine at the Chinese University of Hong Kong.
“If you just focus on this point, I don’t think traditional Chinese medicine injections can pass through any regulatory authority outside China.”
Manufacturers maintain their injections are safe and that the problems arise from incorrect use by doctors.
Still, due to the history of lax regulation, many injectables based on Chinese medicine haven’t been evaluated in strict scientific clinical trials.
Chinese medicine is based on centuries of practical experience. But it is traditionally taken orally, which gives the digestive system a chance to shield patients from harmful chemicals. Injecting the concoctions into the bloodstream can heighten side effects.
When China Shineway Pharmaceutical Group first registered its traditional medicine injections in the 1990s, no clinical studies were needed, said Chen Zhong, a vice president for R&D and quality at the company, which describes itself as the nation’s largest maker of these types of shots.
In recent years, Shineway has invested in post-market monitoring to track allergic reactions and has found its treatments highly safe, he said. But the drugs approved decades ago are still sold and haven’t had to undergo full-fledged testing in subsequent regulatory reforms, said Chen. Three stages of human trials were only required of therapies approved after 2008, he added.
Chen reckons less than 10% of the shots being sold by the traditional medicine industry have undergone this kind of stringent review. He compared the shortfall of scientific studies to skipped classes: “The lessons we missed before, we can make up from now on step by step.”
In developed countries like the United States, drugs must undergo several stages of review, often involving thousands of patients. China has instituted similar requirements for chemical medicines. But corrupt Chinese regulators in the early 2000s allowed thousands of therapies based on questionable data to be sold across the country, leaving a legacy of poorly tested treatments, the government has acknowledged.
“The safety problem of traditional Chinese medicine injections has always been rather serious,” Ke Sufang, an analyst at Shenzhen-based Forward Industries, said.
These are signs the sector is now drawing more scrutiny in Beijing. On Aug 29, the head of the China Food and Drug Administration, Bi Jingquan, declared that when traditional therapies are prepared with contemporary methods, the “results should be reported, reviewed and regulated as modern medicine.” They must show greater benefits than risks in clinical trials, he said.
In May, the agency pledged to reassess the quality of all marketed injections within the next decade, a push to advance a 2009 review of the Chinese industry that had made little headway.
Shineway’s ascent offers a window into the industry’s journey. The company, which started as a chemical drugmaker, developed 11 traditional injections between 1993 and 1995 to boost growth. They were seen as symbols of the modernisation of the ancient science.
“Clinical trials were needed for new drugs, but the requirements were very simple,” Chen said. And Shineway was copying existing products, so it didn’t have to do even the easier tests under the regulatory requirements of that time.
Drugmakers can charge more for injections because they require added production, according to Forward Industries.
Nowadays Shineway boasts US$160mil (RM678mil) in sales each year from injectables and a market value of about US$767mil (RM3.2bil). Its annual report states “evidence-based medical research is also being carried out.” Its top foreign investors as of mid-year included funds run by London-based Schroders and Norway’s Skagen. Skagen and Schroders didn’t comment.
Its competitor Livzon, which has a market value of US$5.1bil, (RM21bil) says injectable versions of traditional therapies act faster and help patients who can’t take drugs orally. The company said its main injectable, used by cancer patients, was registered in 1999 after three phases of clinical trials and was found safe with adverse reactions of less than 0.2% in a study.
Among other large players in the market are Wuzhou Zhongheng and Tianjin Chase Sun. Chinese medicine has inspired life-saving discoveries like artemisinin for malaria, which won a researcher from the country a Nobel Prize. The industry’s proponents argue Western drugs also have adverse effects, and traditional ones shouldn’t be discounted. The ancient formulas have been shown to be safe through their long history, said Wang Meng, a researcher at Tianjin University of Traditional Chinese Medicine.
Yet, the injectables business has introduced more complexity. Take a popular injection called Qingkailing, which Shineway and several other companies have approval to sell. Qingkailing logged the highest number of adverse reactions from 2011 to 2015, according to the China FDA, which didn’t list the manufacturers of the batches involved.
Shineway’s website says its version “relieves internal heat, reduces phlegm and promotes the restoration of consciousness.”
The product is safe and a monitoring programme found just 118 adverse events in 30,840 cases when it was used over five years, Chen said. The company says it’s the largest seller of the injection and borrowed the usage instructions directly from an ancient recipe. That, however, was intended for oral use.
Even though it wasn’t studied in late-stage trials, doctors prescribe Qingkailing for fevers, colds, comas and strokes “based on their own experiences,” Chen said. At the same time, he said that physicians who don’t follow the labelling are a major cause of adverse reactions.
Indeed, off-label use can be lethal. In February 2016, 24-year-old Yu Fu was given a mixture of Qingkailing and an anti-viral for a fever and died from an allergic reaction, according to a lawsuit filed by his family. A court ruled the clinic was “80% liable,” for mixing the drugs, blaming the rest on Yu’s own condition. Court documents didn’t list the manufacturer of either drug. The doctor at the clinic testified that he had followed standard practices.
In recent years, dozens of families have filed similar lawsuits in Chinese courts against hospitals and received compensation from them. Usually, the suits are against physicians and hospitals because it’s easier to sue a local entity instead of a faraway drug corporation, according to Huang Dongtao, a lawyer in northern China.
In February, the Chinese government restricted insurance reimbursements for 26 types of traditional medicine injections to larger hospitals, a bid to discourage use in clinics where emergency treatment for allergies isn’t available.
Shineway’s production of traditional Chinese medicine injections fell by about one third this year as those changes reduced usage, said Chen. Back in 2012, Wu Xiaoliang was given two kinds of herbal injections, neither of which required allergy tests or had warnings that they not be used in combination. Family members say that when he returned home after the injection he was nauseous and shivered although they piled blankets on him. By the time the ambulance arrived, his heart had stopped.
Wu’s family received 157,000 yuan (RM102,000) from the doctor who treated him after a medical review said the drugs weren’t used in violation of any rules but noted that the physician didn’t rinse the intravenous injection tube when switching medicines. The doctor “didn’t fully realise the risks of using Chinese medicine injections” the review said.

For his part, the physician maintained that he committed no error, and Wu’s death was an “unpredictable medical event.” — Bloomberg

Tuesday, 7 November 2017

Sugar, carbs and cancer links

In August of 2016, the New England Journal of Medicine published a striking report on cancer and body fat: Thirteen separate cancers can now be linked to being overweight or obese, among them a number of the most common and deadly cancers of all - colon, thyroid, ovarian, uterine, pancreatic and (in postmenopausal women) breast cancer.

November 2, 2017 by Sam Apple, Los Angeles Times


Earlier this month, a report from the Centers for Disease Control and Prevention added more detail: Approximately 631,000 Americans were diagnosed with a body fat-related  in 2014, accounting for 40 percent of all cancers diagnosed that year.
Increasingly, it seems not only that we are losing the war on cancer, but that we are losing it to what we eat and drink.
These new findings, while important, only tell us so much. The studies reflect whether someone is overweight upon being diagnosed with cancer, but they don't show that the excess weight is responsible for the cancer. They are best understood as a warning sign that something about what or how much we eat is intimately linked to cancer. But what?
The possibility that much of our cancer burden can be traced to diet isn't a new idea. In 1937, Frederick Hoffman, an actuary for the Prudential Life Insurance Co., devoted more than 700 pages to a review of all the medical thinking on the topic at the time. But with little in the way of evidence, Hoffman could only guess at which of the many theories might be correct. If we've made little progress since then in pinpointing specific foods that cause cancer, it's in large part because nutrition studies aren't well-suited to cracking the problem.
A cancer typically arises over years, or decades, making the type of study that might definitively establish cause and effect - an experiment in which people are randomly assigned to different diets - nearly impossible to carry out. The next-best option - observational studies that track what a specific group of individuals eats and which members of the group are later diagnosed with cancer - tends to generate as much confusion as knowledge. One day we read that a study has linked eating meat to cancer; a month later, a new headline declares the exact opposite.
And yet researchers have made progress in understanding the diet-cancer connection. The advances have emerged in the somewhat esoteric field of cancer metabolism, which investigates how cancer cells turn the nutrients we consume into fuel and building blocks for new cancer cells.
Largely ignored in the last decades of the 20th century, cancer metabolism has undergone a revival as researchers have come to appreciate that some of the most well-known cancer-causing genes, long feared for their role in allowing cancer cells to proliferate without restraint, have another, arguably even more fundamental role: allowing  to "eat" without restraint. This research may yield a blockbuster cancer treatment, but in the meantime it can provide us with something just as crucial - knowledge about how to prevent the disease in the first place.
Lewis Cantley, the director of the Cancer Center at Weill Cornell Medicine, has been at the forefront of the cancer metabolism revival. Cantley's best explanation for the obesity-cancer connection is that both conditions are also linked to elevated levels of the hormone insulin. His research has revealed how insulin drives cells to grow and take up glucose (blood sugar) by activating a series of genes, a pathway that has been implicated in most human cancers.
The problem isn't the presence of insulin in our blood. We all need insulin to live. But when insulin rises to abnormally high levels and remains elevated (a condition known as insulin resistance, common in obesity), it can promote the growth of tumors directly and indirectly. Too much insulin and many of our tissues are bombarded with more growth signals and more fuel than they would ever see under normal metabolic conditions. And because elevated insulin directs our bodies to store fat, it can also be linked to the various ways the fat tissue itself is thought to contribute to cancer.
Having recognized the risks of excess insulin-signaling, Cantley and other metabolism researchers are following the science to its logical conclusion: The danger may not be simply eating too much, as is commonly thought, but rather eating too much of the specific foods most likely to lead to elevated insulin levels - easily digestible carbohydrates in general, and sugar in particular.
This is not to say that all cancers are caused by too much  or that we should never eat sugar again. Michael Pollak, a metabolism researcher and director of cancer prevention at McGill University in Canada, says that the best approach to sugar is to think of it like a spice - something to occasionally sprinkle on foods, as opposed to an ingredient in nearly every meal and too many drinks.
Nutrition is an inherently messy science. But recent advances in  research are sending us an increasingly clear message about our diet. Winning the war on cancer may depend upon whether we're ready to hear it.

Monday, 6 November 2017

Researchers link Alzheimer’s gene to Type 3 diabetes

Researchers have known for several years that being overweight and having Type 2 diabetes can increase the risk of developing Alzheimer’s disease. But they’re now beginning to talk about another form of diabetes: Type 3 diabetes. This form of diabetes is associated with Alzheimer's disease.
October 25, 2017
Alzheimer's medical illustration of amyloid plaques
Type 3 diabetes occurs when neurons in the brain become unable to respond to insulin, which is essential for basic tasks, including memory and learning. Some researchers believe insulin deficiency is central to the cognitive decline of Alzheimer’s disease. Mayo Clinic’s Florida and Rochester campuses recently participated in a multi-institution clinical study, testing whether a new insulin nasal spray can improve Alzheimer’s symptoms. The results of that study are forthcoming.
But how is this tied to the Alzheimer’s gene APOE?
A new study from Guojun Bu, Ph.D., a Mayo Clinic neuroscientist and Mary Lowell Leary Professor of Medicine, found that the culprit is the variant of the Alzheimer’s gene known as APOE4. The team found that APOE4, which is present in approximately 20 percent of the general population and more than half of Alzheimer’s cases, is responsible for interrupting how the brain processes insulin. Mice with the APOE4 gene showed insulin impairment, particularly in old age. Also, a high-fat diet could accelerate the process in middle-aged mice with the gene. “The gene and the peripheral insulin resistance caused by the high-fat diet together induced insulin resistance in the brain,” Dr. Bu says. Their findings are published in Neuron.
Journalists: Broadcast-quality sound bites with Dr. Bu are in the downloads.
The team went on to describe how it all works in the neurons. They found that the APOE4 protein produced by the gene, can bind more aggressively to insulin receptors on the surfaces of neurons than its normal counterpart, APOE3. As if playing a game of musical chairs, the APOE4 protein outcompetes the normal protein and blocks the receptor. APOE4 goes on to do lasting damage to brain cells. After blocking the receptor, the sticky APOE4 protein begins to clump and become toxic. Further, once the protein enters the interior of the neuron, the clumps get trapped within the cell’s machinery, impeding the receptors from returning to the neuron surface to do their work. The insulin signal processing gets increasingly more impaired, starving brain cells.
“This study has furthered our understanding of the gene that’s the strongest genetic risk factor known for Alzheimer’s disease,” says Dr. Bu, who adds that, ultimately, the finding may personalize treatment for patients. “For instance, an insulin nasal spray or a similar treatment may be significantly more helpful for patients who don’t have the APOE4 gene. Patients who have the gene may need additional medications to help prevent cognitive decline.”
Co-first authors of this study are:
  • Na Zhao, M.D., Ph.D., Mayo Clinic
  • Chia-Chen Liu, Ph.D., Mayo Clinic
In addition to Dr. Bu, other researchers on the team include:
  • Alexandra Van Ingelgom
  • Yuka Martens, Ph.D., Mayo Clinic
  • Cynthia Linares, Mayo Clinic
  • Joshua Knight, Mayo Clinic
  • Patrick Sullivan, Ph.D., Duke University School of Medicine
  • Meghan Painter, Ph.D.

Tell me about… the different types of kidney transplants

Living donor kidney transplants offer better survival rates, and the kidneys start working immediately in the recipient’s body after transplantation compared to deceased donor kidneys. —

OCTOBER 26, 2017

Tell me about… the different types of kidney transplants

I was told that there are different types of kidney transplants. What types are there?

There’s one where the kidney comes from a donor who is already deceased. Usually, it is someone who has just recently died and has signed up for an organ donation programme. If this person has signed up, he or she will usually have an organ donor card. Alternatively, the family can also consent to it.

But the kidney is dead? What use is it to me then?

Actually, the kidney is not dead yet – even if the donor is medically dead. It still can be used and harvested. It is then stored on ice or connected to a machine that provides it oxygen and nutrition until it can be transplanted to a recipient. It is preferable that the donor and recipient be in the same area to ensure that the kidney does not spend too much time outside a living human body.

Is this type of transplant common?

Kidneys from deceased donors account for about two-thirds of kidney transplants. There is a very long waiting list for donor kidneys worldwide. Many patients with end-stage kidney failure have been on dialysis, waiting for a donor kidney. Many have died after a futile wait. And you can’t just accept any kidney from any deceased donor. It is like receiving donated blood. You have to have compatible blood types between the donor and the recipient.
Selena Gomez, kidney transplant, organ donation,
Gomez had a kidney transplant donated from her friend. The important thing is not being related, but having compatible blood and tissue typing. — AFP

Selena Gomez received a kidney from her best friend. I assume this is a living donor kidney transplant?

Yes. You only need one kidney to survive. The body has two because the other one is a backup. Based on this concept, a healthy person with two kidneys can donate a kidney to someone else. One-third of all kidney transplants are living donor transplants.

Is this a better option than a deceased donor transplant?

There are certain things that make live donor kidneys better. For example, you don’t have to wait months, or even years, waiting for a donor to die before you get your kidney. That way, your kidney function does not have to deteriorate further. You can then save a lot of money on months or years of dialysis fees. Living donor kidney transplants offer better survival rates. And living donor kidneys start working immediately in the recipient’s body after transplantation compared to deceased donor kidneys, which sometimes can have delayed function because they have been put on ice for a while.

Does the living donor have to be a sibling or a relative? Gomez got one from her friend, and they are not related, right?

Just as a deceased donor does not have to be related to you, a living donor does not have to be related to you either. The living donor can be your friend, neighbour, colleague or anyone you know from your circle of acquantainces. However, if you are genetically related – such as family members are – there is a higher chance of success. The important thing once again, is that you share compatible blood and tissue typing.
Dialysis, kidney transplant, organ donation,
Many patients with end-stage kidney failure have to go on dialysis, as seen in this filepic, while waiting for a donor kidney and many often die without getting a new kidney.

My sister wants to undergo a kidney transplant, and I am willing to donate. However, my blood type is not compatible with hers. She can’t find anyone else to donate, and she was told that the waiting list for deceased donors is several years. What can I do?

Even if the donor is not a complete match, there are ways to ensure success with additional medical suppression of the recipient’s immune system before and after the transplant surgery. This is to reduce the risk of rejection. There is such a thing as a paired donor programme. If your living donor is not compatible with you, your transplant centre can alert your donor to give to someone else compatible to his kidney, and you in turn will receive a compatible kidney from that recipient’s donor. It should be noted that a kidney transplant is not a cure to whatever disease you are having.

Is a kidney transplant a dangerous and very complicated procedure?

It is considered a major surgery, and like all surgeries, it has risks. But the benefits may far outweigh the risks, and that is the way you have to look at all surgeries and procedures. For example, during the surgery itself, you can get blood clots like deep vein thrombosis, bleeding, infections, leakages from tubes and rejection of the donated kidney. You can also get infections, or even cancer, from your new donated kidney if it has not been screened properly. In very rare cases, surgeries can be fatal. But like I said, all these are risks with any surgery. Later on, you have to go on lifelong immunosuppressive drugs to prevent your body from rejecting the new kidney. These come with a variety of side effects as well.