WASHINGTON - When Shakespeare called sleep the "chief nourisher of life's feast," he may have been well ahead of his time, medically at least. Researchers at the University of Chicago Medical Center report that disrupting sleep damages the body's ability to regulate blood sugar levels, potentially raising the risk of developing type 2 diabetes.
More than 18 million Americans have diabetes and the most common form is type 2, in which the body either becomes resistant to insulin or doesn't produce enough of it to regulate sugar in the bloodstream.
In a small experiment, researchers led by Dr. Esra Tasali, an assistant professor of medicine, found that disrupting the deepest sleep periods of volunteers rapidly resulted in reduction in their ability to regulate blood-sugar levels.
The findings are reported in Monday's online edition of Proceedings of the National Academy of Sciences.
The researchers studied the sleep patterns of nine volunteers, five men and four women, all of normal weight, in good health and aged 20 to 31.
Normal sleep is divided into several stages, with the so-called slow-wave sleep considered the deepest.
Whenever the volunteers went into slow-wave sleep the researchers made noise — enough to disturb the sleep though not to fully awaken them.
After just three days the ability of the volunteers to regulate blood sugar was reduced by 25 percent, the researchers reported.
Earlier studies have indicated that lack of sleep can reduce the ability to regulate sugar, and this report adds evidence that poor sleep quality is also a diabetes risk.
"This decrease in slow-wave sleep resembles the changes in sleep patterns caused by 40 years of aging," Tasali said in a statement. Young adults spend 80 to 100 minutes per night in slow-wave sleep, while people over age 60 generally have less than 20 minutes. "In this experiment," she said, "we gave people in their 20s the sleep of those in their 60s."
"Since reduced amounts of deep sleep are typical of aging and of common obesity-related sleep disorders, such as obstructive sleep apnea, these results suggest that strategies to improve sleep quality, as well as quantity, may help to prevent or delay the onset of type 2 diabetes in populations at risk," said co-author Dr. Eve Van Cauter, a professor of medicine.
___
On the Net:
Proceedings of the National Academy of Sciences: http://www.pnas.org
Monday, December 31, 2007
Wednesday, December 26, 2007
Experts update "food pyramid" for older adults
NEW YORK (Reuters Health) - A nearly decade-old food guide pyramid for older adults has gotten a makeover to make it more user-friendly and to emphasize the special dietary needs of people older than 70.
Published in the January issue of the Journal of Nutrition, the Modified MyPyramid for Older Adults stresses that older people should be careful to get enough fiber, calcium and vitamins D and B-12. It also emphasizes the importance of regular exercise and adequate fluid intake.
Researchers at Tufts University in Boston originally developed the food pyramid for older adults in 1999. They revamped it in response to changes made to the federal government's general Food Guide Pyramid -- which, along with a new look for the pyramid itself, includes an online component where people can calculate their personal dietary needs based on factors like age, weight and exercise levels.
Since older Americans are typically not as Web-savvy as younger generations, the Tufts researchers created a new version of their food pyramid that contains more graphics and underscores the importance of certain nutrients for older adults.
For example, a flag at the top of the pyramid reminds older people that they may need to take supplements of calcium, vitamin D and vitamin B-12 in addition to what they get from food.
"Adults over the age of 70 have unique dietary needs," Dr. Alice H. Lichtenstein, the lead author of the report, said in a statement.
Older adults' calorie needs usually decline because they are less physically active than they once were, Lichtenstein explained. As they eat less food, it becomes even more important to choose nutrient-rich fare, like fruits, vegetables, low-fat dairy and high-fiber whole grains.
The new pyramid points out that packaged versions of fruits and vegetables -- frozen vegetables and canned or dried fruit, for instance -- might be good alternatives to fresh varieties for some older adults.
"These choices are easier to prepare and have a longer shelf life, minimizing waste," Lichtenstein explained. "Such factors are important to consider when arthritis kicks in or dark, cold days mean it is less likely someone will go out to replenish their refrigerator stores."
At the base of the pyramid are graphics showing physical activities that many older adults can perform -- such as walking, swimming and yard work.
"Regular physical activity is linked to reduced risk of chronic disease and lower body weights," Lichtenstein said. "Government statistics indicate that obesity in adults 70 years and older has been increasing, physical activity is one way to avoid weight gain in later years and its adverse consequences."
SOURCE: Journal of Nutrition, January 2008.
Published in the January issue of the Journal of Nutrition, the Modified MyPyramid for Older Adults stresses that older people should be careful to get enough fiber, calcium and vitamins D and B-12. It also emphasizes the importance of regular exercise and adequate fluid intake.
Researchers at Tufts University in Boston originally developed the food pyramid for older adults in 1999. They revamped it in response to changes made to the federal government's general Food Guide Pyramid -- which, along with a new look for the pyramid itself, includes an online component where people can calculate their personal dietary needs based on factors like age, weight and exercise levels.
Since older Americans are typically not as Web-savvy as younger generations, the Tufts researchers created a new version of their food pyramid that contains more graphics and underscores the importance of certain nutrients for older adults.
For example, a flag at the top of the pyramid reminds older people that they may need to take supplements of calcium, vitamin D and vitamin B-12 in addition to what they get from food.
"Adults over the age of 70 have unique dietary needs," Dr. Alice H. Lichtenstein, the lead author of the report, said in a statement.
Older adults' calorie needs usually decline because they are less physically active than they once were, Lichtenstein explained. As they eat less food, it becomes even more important to choose nutrient-rich fare, like fruits, vegetables, low-fat dairy and high-fiber whole grains.
The new pyramid points out that packaged versions of fruits and vegetables -- frozen vegetables and canned or dried fruit, for instance -- might be good alternatives to fresh varieties for some older adults.
"These choices are easier to prepare and have a longer shelf life, minimizing waste," Lichtenstein explained. "Such factors are important to consider when arthritis kicks in or dark, cold days mean it is less likely someone will go out to replenish their refrigerator stores."
At the base of the pyramid are graphics showing physical activities that many older adults can perform -- such as walking, swimming and yard work.
"Regular physical activity is linked to reduced risk of chronic disease and lower body weights," Lichtenstein said. "Government statistics indicate that obesity in adults 70 years and older has been increasing, physical activity is one way to avoid weight gain in later years and its adverse consequences."
SOURCE: Journal of Nutrition, January 2008.
Tuesday, December 25, 2007
Post-Holiday Letdown Can Be Avoided
TUESDAY, Dec. 25 (HealthDay News) -- Eating a balanced diet and staying active are key to beating the blues this holiday season, say mental health experts.
According to Malone, there are a few things people can do to avoid post-holiday letdown:
Eat a balanced diet, which results in more energy and an improved sense of wellbeing. Cut back on caffeine if you are having trouble sleeping and cut back on the festive cocktails.
Go for a walk. Physical activity helps you lose weight and improves your mood. If the winter weather looks foreboding, work out inside. Take advantage of New Year's specials to join a gym or your fellow post-holiday shoppers walking the outer edge of the mall.
Talk about it. According to Malone, sharing your troubles with someone else can be a relief, and they may be able to offer another perspective that could help you.
If these steps don't help ease the blues away, consider talking to a physician.
The symptoms of depression include a persistent sad or "empty" mood; sleeping too little or too much; weight loss or weight gain; loss of interest in once-enjoyed activities; restlessness; difficulty concentrating; tiredness; and thoughts of death or suicide.
More information
To learn more about coping with the holiday blues, visit the American Psychological Association.
According to Malone, there are a few things people can do to avoid post-holiday letdown:
Eat a balanced diet, which results in more energy and an improved sense of wellbeing. Cut back on caffeine if you are having trouble sleeping and cut back on the festive cocktails.
Go for a walk. Physical activity helps you lose weight and improves your mood. If the winter weather looks foreboding, work out inside. Take advantage of New Year's specials to join a gym or your fellow post-holiday shoppers walking the outer edge of the mall.
Talk about it. According to Malone, sharing your troubles with someone else can be a relief, and they may be able to offer another perspective that could help you.
If these steps don't help ease the blues away, consider talking to a physician.
The symptoms of depression include a persistent sad or "empty" mood; sleeping too little or too much; weight loss or weight gain; loss of interest in once-enjoyed activities; restlessness; difficulty concentrating; tiredness; and thoughts of death or suicide.
More information
To learn more about coping with the holiday blues, visit the American Psychological Association.
Thursday, December 13, 2007
Fewer breast patients may need chemo
SAN ANTONIO - Thousands of breast cancer patients each year could be spared chemotherapy or get gentler versions of it without harming their odds of beating the disease, new research suggests.
One study found that certain women did better — were less likely to die or have a relapse — if given a less harsh drug than Adriamycin, a mainstay of treatment for decades.
Another study found that a gene test can help predict whether some women need chemo at all — even among those whose cancer has spread to their lymph nodes, which typically brings full treatment now.
The findings are sure to speed the growing trend away from chemo for many breast cancer patients and targeting it to a smaller group of women who truly need it, doctors said Thursday at the San Antonio Breast Cancer Symposium, where the studies were reported.
"We are backing off on chemotherapy and using chemotherapy more selectively" in certain women, said Dr. Eric Winer of the Dana-Farber Cancer Institute in Boston.
The gene test in particular "will start changing practice nearly immediately," said Dr. Peter Ravdin of the University of Texas M.D. Anderson Cancer Center in Houston. "The results are compelling that this test ... helps select patients who will most benefit from chemotherapy."
Breast cancer is the most common major cancer in American women. More than 178,000 new cases are expected this year. Most are helped to grow by estrogen, and hormone-blocking medicines like tamoxifen are used to treat those.
Chemo usually is added if the disease has spread to lymph nodes — a situation faced by about 45,000 U.S. women each year. Doctors know that chemo won't help most of these women, but they have had no good way to tell who can safely skip its cost and misery.
Here's where Oncotype DX, a test that measures the activity of 21 genes and gives a score to predict a woman's risk of recurrence, comes in. Doctors have used it for several years to guide treatment for certain women with early breast cancers, especially those that not spread.
The new study, led by Dr. Kathy Albain of Loyola University in Chicago, looked at whether it accurately predicted chemo's benefit in 367 women whose hormone-driven cancer had spread to lymph nodes.
A decade after these women were treated, those who had low scores on the gene test were found to have had no benefit from chemo. Conversely, chemo did a lot of good for those with high scores.
Because 40 percent of the women scored low, it means that as many as 18,000 women each year might safely skip chemo.
The National Cancer Institute and the test's maker, Genomic Health of Redwood City, Calif., sponsored the study. Albain, Winer and Ravdin have consulted or been paid speakers for the company in the past.
Dr. Kelly Marcom, a Duke University cancer expert with no ties to the company, said the test would give valuable information to guide treatment for more patients in the future. He has used it on about 50 women in the last year.
"I've had it cut both ways" — ruling chemo in and out, Marcom said.
The test is expensive — $3,400 — though many insurers are paying for it because it can avoid even more costly chemo.
Albain plans to discuss using it with Andrea DeRosier, a 49-year-old health care administrator from suburban Chicago whose cancer has spread to a single lymph node.
When a surgeon said she likely would need chemo, "I remember thinking, 'Oh, that's terrible,'" DeRosier said. "I want whatever protocol is going to keep me alive," but not futile treatment, she said.
Chemo's side effects are getting greater attention. One drug commonly used for early breast cancer — doxorubicin, sold as Adriamycin and generic brands — is known to cut the risk of having a recurrence or dying, but raises the risk of heart problems and even leukemia.
Dr. Stephen Jones of Baylor-Sammons Cancer Center tested using Taxotere, a drug not linked to heart problems, in its place in more than 1,000 women with early breast cancer. After seven years, 87 percent of those given Taxotere survived, compared with 82 percent of those given Adriamycin. In addition, those given Taxotere were less likely to have had a recurrence.
The study was sponsored by Taxotere's maker, Sanofi-Aventis SA, a French company with U.S. offices in Bridgewater, N.J. Jones consults for the company.
A study in the New England Journal of Medicine in October showed that another drug, Taxol, does not work for the most common form of breast cancer.
These new studies should lead to less use of chemo, but there has been "intense" pushback from doctors, who fear giving up on a treatment that might help some patients, said Barbara Brenner, head of the advocacy group Breast Cancer Action.
"It's very hard to turn a ship like this," she said. "Adding things never takes much, but removing things takes a mountain of data from the medical community."
___
On the Net:
Breast cancer meeting: http://www.sabcs.org
National Cancer Institute: http://www.cancer.gov
One study found that certain women did better — were less likely to die or have a relapse — if given a less harsh drug than Adriamycin, a mainstay of treatment for decades.
Another study found that a gene test can help predict whether some women need chemo at all — even among those whose cancer has spread to their lymph nodes, which typically brings full treatment now.
The findings are sure to speed the growing trend away from chemo for many breast cancer patients and targeting it to a smaller group of women who truly need it, doctors said Thursday at the San Antonio Breast Cancer Symposium, where the studies were reported.
"We are backing off on chemotherapy and using chemotherapy more selectively" in certain women, said Dr. Eric Winer of the Dana-Farber Cancer Institute in Boston.
The gene test in particular "will start changing practice nearly immediately," said Dr. Peter Ravdin of the University of Texas M.D. Anderson Cancer Center in Houston. "The results are compelling that this test ... helps select patients who will most benefit from chemotherapy."
Breast cancer is the most common major cancer in American women. More than 178,000 new cases are expected this year. Most are helped to grow by estrogen, and hormone-blocking medicines like tamoxifen are used to treat those.
Chemo usually is added if the disease has spread to lymph nodes — a situation faced by about 45,000 U.S. women each year. Doctors know that chemo won't help most of these women, but they have had no good way to tell who can safely skip its cost and misery.
Here's where Oncotype DX, a test that measures the activity of 21 genes and gives a score to predict a woman's risk of recurrence, comes in. Doctors have used it for several years to guide treatment for certain women with early breast cancers, especially those that not spread.
The new study, led by Dr. Kathy Albain of Loyola University in Chicago, looked at whether it accurately predicted chemo's benefit in 367 women whose hormone-driven cancer had spread to lymph nodes.
A decade after these women were treated, those who had low scores on the gene test were found to have had no benefit from chemo. Conversely, chemo did a lot of good for those with high scores.
Because 40 percent of the women scored low, it means that as many as 18,000 women each year might safely skip chemo.
The National Cancer Institute and the test's maker, Genomic Health of Redwood City, Calif., sponsored the study. Albain, Winer and Ravdin have consulted or been paid speakers for the company in the past.
Dr. Kelly Marcom, a Duke University cancer expert with no ties to the company, said the test would give valuable information to guide treatment for more patients in the future. He has used it on about 50 women in the last year.
"I've had it cut both ways" — ruling chemo in and out, Marcom said.
The test is expensive — $3,400 — though many insurers are paying for it because it can avoid even more costly chemo.
Albain plans to discuss using it with Andrea DeRosier, a 49-year-old health care administrator from suburban Chicago whose cancer has spread to a single lymph node.
When a surgeon said she likely would need chemo, "I remember thinking, 'Oh, that's terrible,'" DeRosier said. "I want whatever protocol is going to keep me alive," but not futile treatment, she said.
Chemo's side effects are getting greater attention. One drug commonly used for early breast cancer — doxorubicin, sold as Adriamycin and generic brands — is known to cut the risk of having a recurrence or dying, but raises the risk of heart problems and even leukemia.
Dr. Stephen Jones of Baylor-Sammons Cancer Center tested using Taxotere, a drug not linked to heart problems, in its place in more than 1,000 women with early breast cancer. After seven years, 87 percent of those given Taxotere survived, compared with 82 percent of those given Adriamycin. In addition, those given Taxotere were less likely to have had a recurrence.
The study was sponsored by Taxotere's maker, Sanofi-Aventis SA, a French company with U.S. offices in Bridgewater, N.J. Jones consults for the company.
A study in the New England Journal of Medicine in October showed that another drug, Taxol, does not work for the most common form of breast cancer.
These new studies should lead to less use of chemo, but there has been "intense" pushback from doctors, who fear giving up on a treatment that might help some patients, said Barbara Brenner, head of the advocacy group Breast Cancer Action.
"It's very hard to turn a ship like this," she said. "Adding things never takes much, but removing things takes a mountain of data from the medical community."
___
On the Net:
Breast cancer meeting: http://www.sabcs.org
National Cancer Institute: http://www.cancer.gov
Monday, December 10, 2007
Mediterranean diet lengthens Americans' lives
NEW YORK (Reuters Health) - Eating the Mediterranean way could help you live longer, according to the first study to look at how the dietary pattern relates to mortality in a US population.
Men whose diets were closest to the Mediterranean ideal were 21 percent less likely to die over five years than men whose diets were least Mediterranean-like. Similar results were seen in women.
"These results provide strong evidence for a beneficial effect of higher conformity with the Mediterranean dietary pattern on risk of death from all causes, including deaths due to cardiovascular disease and cancer, in a US population," Dr. Panagiota N. Mitrou of the University of Cambridge in the UK and colleagues conclude.
A number of studies have linked the Mediterranean diet, which is rich in fish, fruits and vegetables and nuts and low in dairy foods and red meat, to health benefits, the researchers note in the Archives of Internal Medicine.
They looked at diet and mortality in 380,296 men and women, 50 to 71 years old, who were participating in the National Institutes of Health-AARP Diet and Health Study.
For both men and women, the researchers found, the risk of death from any cause over the five-year follow-up period was lower for those with the most Mediterranean-like diets. Deaths from cancer or cardiovascular disease were also significantly lower in this group.
The benefit was especially strong in smokers who were not overweight, who nearly halved their risk of death if they closely followed the Mediterranean diet pattern. Smokers may have had the most to gain from the antioxidant and blood fat-lowering effects of Mediterranean-style eating, Mitrou and colleagues suggest.
SOURCE: Archives of Internal Medicine, December 10/24, 2007.
Men whose diets were closest to the Mediterranean ideal were 21 percent less likely to die over five years than men whose diets were least Mediterranean-like. Similar results were seen in women.
"These results provide strong evidence for a beneficial effect of higher conformity with the Mediterranean dietary pattern on risk of death from all causes, including deaths due to cardiovascular disease and cancer, in a US population," Dr. Panagiota N. Mitrou of the University of Cambridge in the UK and colleagues conclude.
A number of studies have linked the Mediterranean diet, which is rich in fish, fruits and vegetables and nuts and low in dairy foods and red meat, to health benefits, the researchers note in the Archives of Internal Medicine.
They looked at diet and mortality in 380,296 men and women, 50 to 71 years old, who were participating in the National Institutes of Health-AARP Diet and Health Study.
For both men and women, the researchers found, the risk of death from any cause over the five-year follow-up period was lower for those with the most Mediterranean-like diets. Deaths from cancer or cardiovascular disease were also significantly lower in this group.
The benefit was especially strong in smokers who were not overweight, who nearly halved their risk of death if they closely followed the Mediterranean diet pattern. Smokers may have had the most to gain from the antioxidant and blood fat-lowering effects of Mediterranean-style eating, Mitrou and colleagues suggest.
SOURCE: Archives of Internal Medicine, December 10/24, 2007.
Sunday, December 2, 2007
Avandia may raise osteoporosis risk
WASHINGTON - The popular diabetes drug marketed as Avandia may increase bone thinning, a discovery that could help explain why diabetics can have an increased risk of fractures.
New research raises the possibility that long-term treatment with rosiglitazone, as Avandia is also called, could lead to osteoporosis. The diabetes drug is used to improved response to insulin.
While bones seem solid, they constantly are being broken down and rebuilt by the body. Researchers found that in mice, the drug increased the activity of the cells that degrade bones, according to a report in this week's online issue of Nature Medicine.
Avandia recently was labeled with warnings about the risk of heart failure in some patients. GlaxoSmithKline, which markets the drug, already has acknowledged that a study found a higher risk of fractures among women who take the drug. But this report is the first to attempt to explain the link between the drug and fractures.
The finding "has led to a better understanding of the challenges associated with long-term treatment of patients with Type II diabetes," said Ronald M. Evans of the Salk Institute for Biological Studies in La Jolla, Calif., lead author of the report.
"It also provides a basis for the development of a 'next generation' of drug that can specifically dial out this side effect and a new insight into a previously unrecognized aspect of bone physiology that has important medical consequences," he said in an interview via e-mail.
Nearly 21 million people in the United States have diabetes. Rosiglitazone is widely used in people with Type II, or adult onset diabetes, the most common form of the disease.
Evans said the discovery was fortuitous. Researchers were looking at different aspects of the diabetic mice and did not realize they would be able to change the bone-removing activity.
The assumption had been that more brittle bones in diabetics were the result of a reduced bone-building activity, not increased bone removal.
"Considering the widespread use of these drugs and the known action in people it is surprising that such a key observation had been missed," he said.
"The long-term use of rosiglitazone should be cautious in patients with higher risk of fractures such as older women," he added. Using it in combination with anti-osteoporosis drugs could be beneficial, he said.
The research was funded by the Howard Hughes Medical Institute and the National Institutes of Health.
___
On the Net:
Nature Medicine: http://www.nature.com/naturemedicine
Avandia: http://www.avandia.com/
Food and Drug Administration background on rosiglitazone: http://tinyurl.com/33kkbs
New research raises the possibility that long-term treatment with rosiglitazone, as Avandia is also called, could lead to osteoporosis. The diabetes drug is used to improved response to insulin.
While bones seem solid, they constantly are being broken down and rebuilt by the body. Researchers found that in mice, the drug increased the activity of the cells that degrade bones, according to a report in this week's online issue of Nature Medicine.
Avandia recently was labeled with warnings about the risk of heart failure in some patients. GlaxoSmithKline, which markets the drug, already has acknowledged that a study found a higher risk of fractures among women who take the drug. But this report is the first to attempt to explain the link between the drug and fractures.
The finding "has led to a better understanding of the challenges associated with long-term treatment of patients with Type II diabetes," said Ronald M. Evans of the Salk Institute for Biological Studies in La Jolla, Calif., lead author of the report.
"It also provides a basis for the development of a 'next generation' of drug that can specifically dial out this side effect and a new insight into a previously unrecognized aspect of bone physiology that has important medical consequences," he said in an interview via e-mail.
Nearly 21 million people in the United States have diabetes. Rosiglitazone is widely used in people with Type II, or adult onset diabetes, the most common form of the disease.
Evans said the discovery was fortuitous. Researchers were looking at different aspects of the diabetic mice and did not realize they would be able to change the bone-removing activity.
The assumption had been that more brittle bones in diabetics were the result of a reduced bone-building activity, not increased bone removal.
"Considering the widespread use of these drugs and the known action in people it is surprising that such a key observation had been missed," he said.
"The long-term use of rosiglitazone should be cautious in patients with higher risk of fractures such as older women," he added. Using it in combination with anti-osteoporosis drugs could be beneficial, he said.
The research was funded by the Howard Hughes Medical Institute and the National Institutes of Health.
___
On the Net:
Nature Medicine: http://www.nature.com/naturemedicine
Avandia: http://www.avandia.com/
Food and Drug Administration background on rosiglitazone: http://tinyurl.com/33kkbs
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