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6 June 2009

Message from Dr Lau: Book Update

Final thoughts…

Today, I realize that I could be a writer; and a fairly good one at that. I can best express my feelings through writing. I write not only for personal satisfaction, but also to help my patients.

Therefore my writing has a concrete purpose. It gives me the maximum satisfaction. And the fodder for my writing comes from reading.

I am a voracious reader of books, magazines, journals; whatever I can lay my hands or eyes on.

In a manner, there is a strong connect between my writing and reading habit. The inspiration to write is usually derived from whatever literature I may have happed to read at a particular time. This also reminds me of Newton’s Third law of Motion: Every action has an equal and opposite reaction. So, if there is some input in the form of reading, at some point of time there also has to be some output in the form of writing. Perhaps that’s the reason why all great novelists and authors invariably have a reading habit.

What fuels their active churnings are not just their thoughts but also the ideas they randomly picked from other people, which in my case happen to be my patients. Reading, observing and interacting with my patients are a cycle through which most of my learning evolves.

Because of the skills I have gained though my observations, reading and writing, I am able to bring more confidence and trust into my relationship with my patients. It improves my skills as a doctor and I am able to connect better with my patients. Eventually, it makes me feel more alive. I feel worthy of learning and doing more.

Omega fatty acid balance can alter immunity and gene expression

For the past century, changes in the Western diet have altered the consumption of omega-6 fatty acids (w6, found in meat and vegetable oils) compared with omega-3 fatty acids (w3, found in flax and fish oil). Many studies seem to indicate this shift has brought about an increased risk of inflammation (associated with autoimmunity and allergy), and now using a controlled diet study with human volunteers, researchers may have teased out a biological basis for these reported changes.

Anthropological evidence suggests that human ancestors maintained a 2:1 w6/w3 ratio for much of history, but in Western countries today the ratio has spiked to as high as 10:1. Since these omega fatty acids can be converted into inflammatory molecules, this dietary change is believed to also disrupt the proper balance of pro- and anti- inflammatory agents, resulting in increased systemic inflammation and a higher incidence of problems including asthma, allergies, diabetes, and arthritis.

Floyd Chilton and colleagues wanted to examine whether theses fatty acids might have other effects, and developed a dietary intervention strategy in which 27 healthy humans were fed a controlled diet mimicking the w6/w3 ratios of early humans over 5 weeks. They then looked at the gene levels of immune signals and cytokines (protein immune messengers), that impact autoimmunity and allergy in blood cells and found that many key signaling genes that promote inflammation were markedly reduced compared to a normal diet, including a signaling gene for a protein called PI3K, a critical early step in autoimmune and allergic inflammation responses.

This study demonstrates, for the first time in humans, that large changes in gene expression are likely an important mechanism by which these omega fatty acids exert their potent clinical effects.

Tomato pill 'beats heart disease'

Scientists say a natural supplement made from tomatoes, taken daily, can stave off heart disease and strokes.
The tomato pill contains an active ingredient from the Mediterranean diet - lycopene - that blocks "bad" LDL cholesterol that can clog the arteries.
Ateronon, made by a biotechnology spin-out company of Cambridge University, is being launched as a dietary supplement and will be sold on the high street.
Experts said more trials were needed to see how effective the treatment is.

Preliminary trials involving around 150 people with heart disease indicate that Ateronon can reduce the oxidation of harmful fats in the blood to almost zero within eight weeks, a meeting of the British Cardiovascular Society will be told at Ateronon's launch on Monday.

Our advice to heart disease patients or those at high risk is to rely on proven medications prescribed by their doctor, and aim to get the benefits of a Mediterranean diet by eating plenty of fresh fruit and veg
Professor Peter Weissberg of the British Heart Foundation
Neuroscientist Peter Kirkpatrick, who will lead a further research project at Addenbrooke's Hospital in Cambridge on behalf of Cambridge Theranostics Ltd, said the supplement could be much more effective than statin drugs that are currently used by doctors to treat high cholesterol.
But Professor Peter Weissberg of the British Heart Foundation said: "As always, we caution people to wait for any new drug or modified 'natural' product to be clinically proven to offer benefits before taking it.
"It will take some time, and several clinical trials, to provide such evidence for Ateronon.
"In the meantime, our advice to heart disease patients or those at high risk is to rely on proven medications prescribed by their doctor, and aim to get the benefits of a Mediterranean diet by eating plenty of fresh fruit and veg."
He said the British Heart Foundation had supported some of the basic science at Cambridge University underpinning the development of the product.
Professor Anthony Leeds, trustee of the cholesterol charity Heart UK, said: "The new lycopene product Ateronon represents an entirely new approach to the treatment of high blood cholesterol and opens up the exciting possibility."
He said the preliminary findings were "very promising".
Lycopene is an antioxidant contained in the skin of tomatoes which gives them their red colour. But lycopene ingested in its natural form is poorly absorbed.
Ateronon contains a refined, more readily absorbed version of lycopene that was originally developed by Nestle.
Dr Peter Coleman of The Stroke Association said: "We know that diets rich in antioxidants are beneficial in reducing the plaque build up and welcome the findings of this research."

Exercise more, not less, to ease aching back

People with lower back pain are better off exercising more, not less.
A University of Alberta study of 240 men and women with chronic lower-back pain showed that those who exercised four days a week had a better quality of life, 28 per cent less pain and 36 per cent less disability, while those who hit the gym only two or three days a week did not show the same level of change.

"While it could be assumed that someone with back pain should not be exercising frequently, our findings show that working with weights four days a week provides the greatest amount of pain relief and quality of life," said Robert Kell, lead author of the study and an assistant professor of exercise physiology at the University of Alberta, Augustana Campus.

About 80 per cent of North Americans suffer from lower back pain.

Kell presented some of the findings May 30 at the American College of Sports Medicine conference in Seattle, Wash.

In the study, groups of 60 men and women with chronically sore lower backs each exercised with weights in two, three or four-day weekly programs, or not at all. Their progress was measured over 16 weeks. The level of pain decreased by 28 per cent in programs that included exercise four days a week, by 18 per cent three days a week and by 14 per cent two days a week. The quality of life, defined as general physical and mental well-being, rose by 28 per cent, 22 per cent and 16 per cent respectively.

3 June 2009

K for Kartilage? New health areas for vitamin K

Vitamin K has been linked to bone, heart, and even prostate health, but could joint health and cartilage be next on the horizon for the unKnown vitamin? Stephen Daniells talks to Prof Cees Vermeer from VitaK, about raising awareness on vitamin K, dietary intakes, and new applications.

Speaking at Vitafoods 2009 in Geneva about vitamin K, Prof Vermeer said that he could imagine vitamin K benefits extending beyond cardiovascular and bone health, to joint health.

“All diseases of the cartilage – I could imagine that these would benefit from vitamin K2.”

Awareness of vitamin K, from green vegetables, the fermented soy product natto, cheese, or supplements, is increasing, albeit from a very small base.

“In the Western world our problem is that almost the only source is cheese,” said Prof Vermeer. “Cheese is fat, animal fat, saturated fat, it is not so healthy. So [vitamin K] is combined with not so healthy food, and that is why I recommend people take curd… or take natto, and if you don’t like both, then take pills.”

Vitamin D may help prevent knee osteoarthritis

NEW YORK (Reuters Health) - Low levels of vitamin D are associated with the loss of cartilage in the knee joint of older individuals, researchers in Australia report.

"Cartilage loss is the hallmark of osteoarthritis," Dr. Changhai Ding told Reuters Health. By the time patients reach the point of needing knee replacement, 60 percent of cartilage has been lost, he said.

However, "achieving vitamin D sufficiency in osteoarthritis patients could significantly delay total knee replacement," said Ding, at the Menzies Research Institute in Tasmania.

In a study, Ding and colleagues found "osteoarthritis patients with vitamin D sufficiency have approximately 1.5 percent less loss of knee cartilage per year than patients with vitamin D deficiency," said Ding.

The investigators measured levels of vitamin D in blood samples and knee cartilage volume on X-rays from 880 men and women who were 51 to 79 years old. The team then took similar measurements again almost 3 years later among 353 of the study participants, the researchers report in the journal Arthritis & Rheumatism.

Overall, 58 percent of these subjects showed changes in knee cartilage indicating worsening osteoarthritis between the first and second measurements, and half reported knee pain.

Both at the beginning of the study enrollment and at follow up, men and women with vitamin D deficiency had lower knee cartilage volume and were more likely to experience knee pain.

Ding's team concludes that vitamin D plays an important role in cartilage changes, and that vitamin D deficiency may predict knee cartilage loss over time.

The researchers call for further research to see if vitamin D supplementation can delay the progression of knee osteoarthritis and the need for total knee replacement in osteoarthritis patients.

SOURCE: Arthritis & Rheumatism, May 2009