The Science of Niche Marketing

http://www.jpain.org/article/PIIS1526590011009333/abstract

Abstract

Paclitaxel often induces persistent painful neuropathy as its most common treatment-limiting side effect. Little is known concerning the underlying mechanisms. Given the prominent role of glial cells in many types of neuropathic pain, we investigated here the morphological and functional changes of spinal astrocytes and microglia in a rat model of paclitaxel-induced neuropathy. Immunohistochemistry, western blotting, and real-time polymerase chain reaction were performed with samples from 109 rats up to 28 days after paclitaxel treatment. Paclitaxel (2 mg/kg, i.p.) induced a rapid and persistent activation of spinal astrocytes assessed using glial fibrillary acidic protein, but not apparent activation of microglia assessed using OX42, Iba-1, and phosphorylated p38. In the context of astocyte activation, there was a significant downregulation of glial glutamate transporters GLAST and GLT-1 in spinal dorsal horn. The activation of spinal astrocytes by paclitaxel was not associated with expression of pro-inflammatory cytokines including tumor necrosis factor-α, interleukin-1β, or interleukin-6 in spinal dorsal horn. Systemic treatment with minocycline (50 mg/kg, i.p.) prevented activation of astrocytes and downregulation of glial glutamate transporters in spinal dorsal horn induced by paclitaxel. These data suggest the involvement of spinal astrocytes but not microglia in the pathogenesis of paclitaxel-induced neuropathy.

Perspective

Spinal astrocytes and/or glial glutamate transporters could be new therapeutic targets for paclitaxel-induced painful neuropathy.

http://www.diabetesincontrol.com/articles/diabetes-news/11547-almonds-can-improve-diabetes-control

Two new studies into the potential health benefits of eating almonds have supported evidence that they can help people with type 2 diabetes to maintain their blood glucose and cholesterol levels.…

One of the studies, published in the journal, Metabolism, showed that consuming an ounce of almonds straight before eating a high-starch meal brought a 30 per cent reduction in post-meal glucose levels for patients with type 2 diabetes, compared with a 7 per cent reduction for non-diabetics. In addition, after overnight fasting, patients with type 2 diabetes whose meal contained almonds had a lowering of blood sugar levels after their meal.

The effect of regular almond consumption on blood glucose levels for people with type 2 diabetes was also investigated, with the daily consumption of one ounce of almonds over a 12-week period being associated with a 4 per cent reduction in hemoglobin A1c (HbA1c) and the same reduction in body mass index (BMI).

The second study, which was published in Diabetes Care, revealed that nuts such as almonds could help to maintain healthy levels of blood glucose and cholesterol for both men and post-menopausal women who suffer from type 2 diabetes.

Karen Lapsley, chief science officer for the Almond Board of California, commented “Those with diabetes are faced with many challenges with their disease management, which is why we are always energized when new research is published that supports our understanding of almonds’ role in helping alleviate some of the difficulties.”

Diabetes UK, Diabetes Care, Oct. 2011

The United States of Diabetes: New report shows half the country could have diabetes or prediabetes at a cost of $3.35 trillion by 2020.…

More than 50 percent of Americans could have diabetes or prediabetes by 2020 at a cost of $3.35 trillion over the next decade if current trends continue, according to new analysis by UnitedHealth Group’s Center for Health Reform & Modernization, but there are also practical solutions for slowing the trend. See this week’s Tool for Your Practice.

New estimates show diabetes and prediabetes will account for an estimated 10 percent of total health care spending by the end of the decade at an annual cost of almost $500 billion — up from an estimated $194 billion this year.

The report, The United States of Diabetes: Challenges and Opportunities in the Decade Ahead, produced for November’s National Diabetes Awareness month, offers practical solutions that could improve health and life expectancy, while also saving up to $250 billion over the next 10 years, if programs to prevent and control diabetes are adopted broadly and scaled nationally. This figure includes $144 billion in potential savings to the federal government in Medicare, Medicaid and other public programs.

Key solution steps include lifestyle interventions to combat obesity and prevent prediabetes from becoming diabetes and medication control programs and lifestyle intervention strategies to help improve diabetes control.

“Our new research shows there is a diabetes time bomb ticking in America, but fortunately there are practical steps that can be taken now to defuse it,” said Simon Stevens, executive vice president, UnitedHealth Group, and chairman of the UnitedHealth Center for Health Reform & Modernization. “What is now needed is concerted, national, multi-stakeholder action. Making a major impact on the prediabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models. Done right, the human and economic benefits for the nation could be substantial.”

The annual health care costs in 2009 for a person with diagnosed diabetes averaged approximately $11,700 compared to an average of $4,400 for the remainder of the population, according to new data drawn from 10 million UnitedHealthcare members. The average cost climbs to $20,700 for a person with complications related to diabetes. The report also provides estimates on the prevalence and costs of diabetes based on health insurance status and payer, and evaluates the impact on worker productivity and costs to employers.

Diabetes currently affects about 27 million Americans and is one of the fastest-growing diseases in the nation. Another 67 million Americans are estimated to have prediabetes. There are often no symptoms, and many people do not even know they have the disease. In fact, more than 60 million Americans do not know that they have prediabetes. Experts predict that one out of three children born in the year 2000 will develop diabetes in their lifetimes, putting them at grave risk for heart and kidney disease, nerve damage, blindness and limb amputation.

Estimates in the report were calculated using the same model as the widely-cited 2007 study on the national cost burden of diabetes commissioned by the American Diabetes Association (ADA).

The report also focuses on obesity and its relationship to diabetes. Being overweight or obese is one of the primary risk factors for diabetes, and with more than two-thirds of American adults and 17 percent of children overweight or obese, the risk is clearly rising. In fact, over half of adults in the U.S. who are overweight or obese have either prediabetes or diabetes, and studies have shown that gaining just 11-16 pounds doubles the risk of type 2 diabetes and gaining 17-24 pounds nearly triples the risk.

“Because diabetes follows a progressive course, often starting with obesity and then moving to prediabetes, there are multiple opportunities to intervene early and prevent this devastating disease before it’s too late,” said Deneen Vojta, M.D., senior vice president of the UnitedHealth Center for Health Reform & Modernization, who helped develop UnitedHealth Group’s Diabetes Prevention and Control Alliance.

Here is a GREAT CHART to give patients to Reduce DB RISK!

Chung M et al. – Combined vitamin D and calcium supplementation can reduce fracture risk, but the effects may be smaller among community–dwelling older adults than among institutionalized elderly persons. Appropriate dose and dosing regimens, however, require further study. Evidence is not sufficiently robust to draw conclusions regarding the benefits or harms of vitamin D supplementation for the prevention of cancer.

Methods

• English–language studies identified from MEDLINE and the Cochrane Central Register of Controlled Trials through July 2011.
• Randomized, controlled trials (RCTs), prospective cohort studies, and nested case–control studies reporting incidence of or death from cancer and fracture outcomes.
• Multiple reviewers extracted details about participant characteristics, including baseline vitamin D status and use of supplements; details of statistical analyses, including adjustments for confounding; and methodological quality.
• Differences were resolved by consensus.
• 19 RCTs (3 for cancer and 16 for fracture outcomes) and 28 observational studies (for cancer outcomes) were analyzed.

Results

• Limited data from RCTs suggested that high–dose (1000 IU/d) vitamin D supplementation can reduce the risk for total cancer, and data from observational studies suggested that higher blood 25–hydroxyvitamin D (25–[OH]D) concentrations might be associated with increased risk for cancer.
• Mixed–effects dose–response meta–analyses showed that each 10–nmol/L increase in blood 25–(OH)D concentration was associated with a 6% (95% CI, 3% to 9%) reduced risk for colorectal cancer but no statistically significant dose–response relationships for prostate and breast cancer.
• Random–effects model meta–analysis showed that combined vitamin D and calcium supplementation reduced fracture risk (pooled relative risk, 0.88 [CI, 0.78 to 0.99]) in older adults, but the effects differed according to study setting: institution (relative risk, 0.71 [CI, 0.57 to 0.89]) versus community–dwelling (relative risk, 0.89 [CI, 0.76 to 1.04]).
• One RCT showed adverse outcomes associated with supplementation, including increased risk for renal and urinary tract stones.

www.concentrolabs.com

Two new studies into the potential health benefits of eating almonds have supported evidence that they can help people with type 2 diabetes to maintain their blood glucose and cholesterol levels.…

http://www.diabetesincontrol.com/articles/diabetes-news/11547-almonds-can-improve-diabetes-control

One of the studies, published in the journal, Metabolism, showed that consuming an ounce of almonds straight before eating a high-starch meal brought a 30 per cent reduction in post-meal glucose levels for patients with type 2 diabetes, compared with a 7 per cent reduction for non-diabetics. In addition, after overnight fasting, patients with type 2 diabetes whose meal contained almonds had a lowering of blood sugar levels after their meal.

The effect of regular almond consumption on blood glucose levels for people with type 2 diabetes was also investigated, with the daily consumption of one ounce of almonds over a 12-week period being associated with a 4 per cent reduction in hemoglobin A1c (HbA1c) and the same reduction in body mass index (BMI).

The second study, which was published in Diabetes Care, revealed that nuts such as almonds could help to maintain healthy levels of blood glucose and cholesterol for both men and post-menopausal women who suffer from type 2 diabetes.

Karen Lapsley, chief science officer for the Almond Board of California, commented “Those with diabetes are faced with many challenges with their disease management, which is why we are always energized when new research is published that supports our understanding of almonds’ role in helping alleviate some of the difficulties.”

Diabetes UK, Diabetes Care, Oct. 2011

Beta cell function can improve after just 12 weeks of weight loss in patients with type 2 diabetes.…

Hana Kahleova, MD, from the diabetes centre at the Institute for Clinical and Experimental Medicine in Prague, Czech Republic, reported that, for the first time, these changes have been shown to correlate with a decrease in pancreatic polypeptide.

Dana Dabelea, MD, PhD, associate professor at the Colorado School of Public Health in Aurora, and cochair of the session in which the research was presented stated that, “This is a novel suggestion of a mechanism through which weight loss might improve beta cell function. This is new, and it might help with therapeutic choices.”

The study involved 74 subjects with type 2 diabetes who were treated with oral hypoglycemic agents. Mean age was 56.6 years, mean body mass index was 35.8 kg/m², and mean glycated hemoglobin level was 7.7%. Subjects were prescribed 12 weeks of a weight-loss diet alone (a reduction of 500 kcal/day) followed by 12 weeks of the same diet but with aerobic exercise added.

At baseline, 12 weeks, and 24 weeks, insulin sensitivity was measured using a hyperinsulinemic isoglycemic clamp, plasma concentration of gastrointestinal peptides was measured during a fasting state and during clamp-induced hyperinsulinemia, beta cell function was assessed during standard meal tests, and the insulin secretory rate was calculated by C-peptide deconvolution.

In the cohort, mean weight loss was 5.0 kg (P = .001) after 12 weeks of dietary intervention; weight did not change significantly after the addition of exercise.

Both fasting and stimulated plasma glucose and insulin concentrations decreased in response to the diet. In the case of glucose, there was no change after the addition of exercise, but plasma insulin decreased further with exercise. Similarly, plasma concentrations of C-peptide decreased in response to the diet and further in response to exercise.

In addition, peripheral insulin sensitivity and insulin secretion increased, and glucose sensitivity of beta cells increased by 26% in response to the diet without a significant change after the addition of exercise.

They also observed a marked decrease in both fasting and hyperinsulinemic concentrations of pancreatic polypeptide in response to dietary intervention and there was no significant change in other gastrointestinal peptides.

Pancreatic polypeptide is a novel marker, and the authors are showing for the first time in the context of caloric restriction that a reduction in pancreatic polypeptide correlated with an improvement in beta cell function. The main point is that it showed an improvement in beta cell function following a guidelines-based diet. Preventing the decline of beta cell function is very valuable.

International Diabetes Federation (IDF) World Diabetes Congress 2011, Abstract O-0473, presented December 5, 2011

http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=11829&catid=1&Itemid=17

Middle aged women who consume large amounts of refined carbohydrates might offset their risk of type II diabetes by drinking a moderate amount of alcohol.…

Following more than 80,000 women over 26 years, researchers found that those who ate a diet high in refined carbohydrates had a 30% lower risk of developing diabetes than women with similar eating habits who didn’t drink alcohol.

Previous research has linked moderate drinking with lower diabetes risk, but the new study tried to determine why that might be by looking specifically at women with high-glycemic diets.

Senior author Dr. Frank Hu from the Harvard School of Public Health in Boston, Massachusetts stated that, “If you eat a high carb diet without drinking alcohol, your risk of developing diabetes is increased by 30%.” “However, if you eat a high carb diet, but (drink) a moderate amount of alcohol, the increased risk is reduced.”

Nearly half of the estimated 26 million American adults with diabetes are women, according to the Centers for Disease Control and Prevention.

The new published study doesn’t prove alcohol protects against diabetes. But Dr. Hu and his colleagues speculate that alcohol might affect release of insulin after a meal, blunting the blood-sugar spikes that promote diabetes.

They analyzed data on 82,000 women participating in the long-term Nurses’ Health Study. After 26 years of follow-up, 6,950 women, or about 9%, who were diabetes free at the outset had developed the condition. The researchers also examined participants’ diets, including alcohol, based on surveys taken every four years. And overall, the women who ate the most refined carbs, and a lot of meat, were at highest risk of developing diabetes. But within that group, moderate drinkers — those whose average alcohol intake was more than 15 g (about half an ounce) a day — had a 30% lower risk than women who didn’t drink at all.

Typically, the moderate drinkers imbibed 24 grams (0.8 ounce) of alcohol a day, which translates to about two drinks per week. Only a small fraction of the subjects were heavy drinkers (about two ounces per day or more), but heavy drinking was not linked with lowered diabetes risk.

Dr. Hu isn’t encouraging people to start drinking alcohol as a means of diabetes prevention, but he does think the study reveals an interesting interaction between alcohol and carbs.

“We still advocate a diet with reduced refined carbs,” he said. “And for people who drink, they should do so moderately.”

http://yourlife.usatoday.com/health/story/2011-11-01/Deaths-from-painkiller-overdose-triple-in-decade/51027242/1

The number of overdose deaths from powerful painkillers more than tripled over a decade, the government reported Tuesday — a trend the nation’s top health official called an epidemic, but one that can be stopped.

http://www.clinicaladvisor.com/us-rx-opioid-overdose-deaths-triple-over-decade/article/215868/

CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999—2008. MMWR.Nov. 1, 2011; 60:1-6.

http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=11642&catid=1&Itemid=17

For individuals with metabolic syndrome, physical activity is associated with a reduced risk of mortality from all causes and from cardiovascular causes….

Dorthe Stensvold, from the Norwegian University of Science and Technology in Trondheim, and colleagues investigated whether physical activity reduces mortality in 13,449 individuals with metabolic syndrome.

The participants were followed up for 10 years to assess cause-specific mortality and were divided into two groups according to age (younger than 65 years and older than 65 years). Data on physical activity were collected at baseline.

The investigators found that, for individuals younger than 65 years, metabolic syndrome was correlated with increased mortality from all causes (hazard ratio [HR], 1.35) and from cardiovascular causes (HR, 1.78), whereas no correlation was found among older participants. For both younger and older individuals with metabolic syndrome who reported a high level of physical activity at baseline, there was a reduced risk of all-cause mortality compared to those reporting no physical activity (HR, 0.52 and 0.59, respectively).

“We found that even a low level of physical activity was associated with a substantial mortality reduction compared to those who reported that they were physically inactive,” the authors write.

BMC Medicine Sept 29, 2011