Hearing is acute

walked into local opticians to sort my new glasses and was persuaded to take a free hearing test by a trained audiologist! Test lasted 20 minutes. Result: my hearing is 'acute' and within 5decibels of the average of 18-25 years.

Whatever that means.

Anti-fat pill could help keep the weight off

reposted from: http://www.newscientist.com/article/dn16148-antifat-pill-could-help-keep-the-weight-off.html?DCMP=OTC-rss&nsref=online-news

• 17:00 26 November 2008 by Ewen Callaway

A pill might replace that third helping of turkey at future Thanksgiving and Christmas dinners. A newly-discovered chemical found naturally in our body blocks hunger and weight gain.

Mice and rats - and presumably humans - produce the chemical after eating a fatty meal. When researchers gave the rodents an extra dose, they ate less and shed weight, with no ill effects.

If similar tests in larger animals pan out, humans will be next, says Gerald Shulman, a molecular biologist at Yale University in New Haven, Connecticut whose team discovered this new role for the molecule, called

N-acylphosphatidylethanolamine (NAPE).

"We have this epidemic of obesity and we have very few agents that are able to effectively treat obesity," he says. "We'd be quite interested in trying a clinical trial to see if giving this back would reduce food intake in humans."

More, gimme more

Fatty foods, be they milkshake, French fry or Big Mac, have long confounded researchers seeking to explain how our body determines when it has had enough. Levels of fatty acids - the building blocks of junk foods - actually fall when people gorge on greasy foods, only to increase with hunger.

This peculiar behaviour prompted Shulman, Yale biologist Matthew Gillum and their colleagues to scour blood for compounds that shot up after a fatty meal.

NAPE fit the bill. Fatty acids in food get converted to NAPE in the gut before heading to the bloodstream.

From there, the chemical races into the brain's appetite centre, in the hypothalamus, and shuts down neurons involved in signalling hunger,

Shulman's team found.

Post-prandial nap

This explains why mice and rats injected with natural levels of NAPE act like they've gorged. They show little interest in stuffing their faces, and the normally athletic animals give in to languor.

"It's kind of like a siesta response. After an animal eats a heavy meal, it wants to sit in the corner and nap," Shulman says.

After five days on NAPE, rats ate 30% less food and lost a quarter of their weight.

Rodents that didn't get NAPE actually gained a little flab. Shulman's team didn't notice any other permanent behavioural changes in the NAPE-fed mice.

Problems controlling production of the chemical could underlie diseases like obesity and diabetes, Shulman suggests.

When their mice gorged on fatty foods for more than a month, NAPE levels in their blood no longer waxed and waned with each meal, but extra NAPE still suppressed their appetites.

Obesity pill?

It's too early to tell whether giving humans NAPE will offer the same benefits. Humans produce the molecules, and Shulman's team is now working to determine how they track with fatty food intake.

"I think they made a good case that [NAPE] should be considered among the factors the body uses to regulate food intake," says Michael Schwartz, an endocrinologist at the University of Washington in Seattle. "It does raise the possibility that this could be a new approach to treatment, but we know really little."

The molecular intricacies of NAPE's appetite-sapping effects have yet to be ironed out, and problems could emerge if the chemical does more than curb appetite. "It's hard to target the brain in a way that doesn't have side effects," says Schwartz.

Matthias Tschöp, an obesity researcher at the University of Cincinnati, says understanding how NAPE affects our appetite for fat would hopefully lead to new drugs that muzzle hunger, without eliminating it.

Journal reference: Cell (DOI: 10.1016/j.cell.2008.10.043)

Crabsallover Blood Pressure

123/81 today as measured by nurse 'Very Good'. Blood test for total cholesterol, HDL, triglycerdies and CRP (C-Reactive Protein). Cardiac specialist nurse Sue Morse said 'she never heard of CRP test'.

from http://crabsalloverhealth.blogspot.com/2008/11/statin-use-may-benefit-healthy.html

We randomly assigned 17,802 apparently healthy men and women with low-density lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and

high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher

to rosuvastatin, 20 mg daily, or placebo and followed them for the occurrence of the combined primary end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes,

Normal levels of cholesterol and high levels of CRP were associated with increased health when statins were taken.

Preventive medicine

reposted from:http://www.bbc.co.uk/health/health_over_50/issues_care.shtml

Many GP surgeries run a variety of preventive medicine clinics. Their aim is to assess your general health and your risk of a variety of diseases common in old age, and to give advice on how to prevent them.

The checks may include:

• Weight and body mass index (BMI) assessment
• Blood pressure
• Eye check for signs of diabetes, glaucoma and high blood pressure
• Cholesterol levels and electrocardiogram (ECG) to assess your risk of heart disease
• Urine and blood sugar measurement to test for diabetes, along with liver and kidney function blood tests
• Breast examination and advice on self-examination
• Cervical smear to detect pre-cancerous changes
• Examination or scan for ovarian cysts
• Prostate assessment and advice
• Testicular examination
• Chest x-ray
• DEXA scans to assess your risk of osteoporosis

Take away restaurants promise to lower salt

21/11/2008

Key points

• Fast food restaurants have committed to lowering their levels of salt and fat
• Eating too much salt raises your blood pressure. People should eat no more than 6 grams of salt a day to avoid high blood pressure
• High blood pressure causes strokes and heart attacks
• Eating too much saturated and trans fats clogs up your arteries with cholesterol and raises your risk of strokes and heart attacks
• Lowering salt and fat in fast food meals will help in the fight against strokes and heart disease caused by high blood pressure and high cholesterol

Six of Britain’s biggest fast-food restaurants have committed to making their burgers and sandwiches more healthy.

Burger King, KFC, McDonald’s, Nando’s, Subway and Wimpy have promised to lower the salt and saturated or trans fats in their meals to make them more heart and blood pressure friendly.

more info

High blood pressure - a global problem

reposted from: http://www.bpassoc.org.uk/mediacentre/Bloodpressurenews/Highbloodpressure-aglobalproblem

30/06/2008

New research published in The Lancet has found that

high blood pressure causes at least 7.6 million premature deaths worldwide - about 13.5% of the global total.

According to researchers, that means that almost one in five premature deaths each year are caused by high blood pressure and the problem is fast becoming a global epidemic.

Mike Rich, Executive Director of the Blood Pressure Association said: "This research rightly shows the size of the global problem with 7.6 million deaths attributed to high blood pressure annually.

The majority of the burden of high blood pressure is clearly being felt in the developing world and it is vital that something is done about it, but it is also clear that the UK picture is nothing to be proud of.

"Even with the availability of effective blood pressure lowering medicines and knowledge of the lifestyle changes that will reduce hypertension, the UK is still failing to effectively reduce blood pressure related disease.

"Every day there are 350 preventable strokes or heart attacks in the UK due to high blood pressure. This research highlights the continuing need for us to help the 16 million people in the UK who have high blood pressure, including the third who do not even know they have it."

References: C Laws, S Vander Hoorn, A Rodgers, for the International Society of Hypertension. ‘Global burden of blood-pressure related disease, 2001’, The Lancet. Friday 2 May 2008.

myths about the "developing world. Life expectancy and health

reposted from:HASSERS via TED.

You've never seen data presented like this. With the drama and urgency of a sportscaster, statistics guru Hans Rosling debunks myths about the so-called "developing world." Peter Snow eat your heart out!

Shilpa Bhardwaj – November 11 2008 said " I have never been so impressed with a presentation of stats. This was outstanding. A wide-eyed jaw-dropped thunderbolt-struck ovation to Hans Rosling".

New Crabsallover Weight Target

Among male participants who had never smoked, Pischon found the risk of death was lowest at:

1. BMI of 24.5 (crabsallover: 156 pounds (11st 2 pounds))
   
2. 85cm (33.4") waist circumference
3. 0.88 waist to hip ratio (equiv. 96cm hip (37.8") circum.)
   

These are my new goals (see November 2008 Health Strategy - right column).

New weight loss per week target: 0.7 pounds (was 0.8 pounds). 40 week diet completed target: 4th May 2009 to 156 pounds.

To save lives, we have to change attitudes to organ donation

Comments (31)

• Editorial
• guardian.co.uk, Sunday November 16 2008 00.01 GMT
• The Observer, Sunday November 16 2008
• Article history

The Organ Donation Taskforce will tomorrow present the findings of its year-long review into the system that finds organs for would-be transplant patients. It will reject the most radical option - switching from the current system by which people 'opt in' to the register of willing donors, to one of 'presumed consent', where anyone unhappy with the idea of their organs being used can freely 'opt out' of the register.

Some 1,000 people die every year in Britain for want of donors.

Waiting lists are growing. The Observer has campaigned for the law to be changed to introduce 'presumed consent' as the most effective way to save lives.

For the taskforce to reject this approach is deeply regrettable. It is a disappointment to patients awaiting surgery and to many doctors who are frustrated that the current system stops them carrying out life-saving operations. That frustration is shared by the government's own Chief Medical Officer, Sir Liam Donaldson, who has backed the Observer campaign.

Why has the taskforce concluded otherwise? Not all medics are comfortable with presumed consent. Some worry it would affect their relationship with critically ill patients, who might fear their treatment was compromised by a hospital's interest in their organs, should they die.

The taskforce also believes that the public is not ready for presumed consent. This is a strange argument since no concerted attempt has been made to explain the idea. A sensible debate has not properly begun. The taskforce recommends instead recruitment of more co-ordinators to work in hospitals, encouraging patients and bereaved families to donate, an approach modelled on the system in Spain, which has the world's highest rate of donation.

But Spain also has presumed consent. Transplant coordinators there work within a culture less inhibited by stigma around the subject. It is the assumption that donation is normal that gives doctors the confidence to discuss it with patients without fear of seeming insensitive or ghoulish. That is the sort of culture change we need in Britain, and that is why the case must still be made.

Presumed consent is not the state assuming ownership of our organs. It is a way for society to show collective compassion to people in desperate need. It is, as Sir Liam Donaldson says, a matter of 'solidarity, generosity and humanity'.

A local solution to obesity

• Comment is free

Obesity should be tackled at a local level, with health boards empowered to find the right solutions for their areas

Comments (29)

• Norman Lamb
• guardian.co.uk, Tuesday November 11 2008 15.00 GMT
• Article history

Although action is long overdue, the government is right to be looking for fresh thinking on how we can tackle what is undoubtedly our greatest public health challenge. Last year the parliamentary public accounts committee accused the government of "dithering and confusion", so I welcome this new focus. My frustration and fear is that dictating strategy so much from the centre, handing money down from Whitehall to the select few, will not deliver the sort of change required.

First, why is action necessary? If current trends continue, 40% of Britons will be obese by 2025. Even today, over a third of children who leave primary school are overweight.

This problem is starting early and a recent study by the Department of Health showed that nine out of 10 parents were unaware that their children were overweight.

A Foresight report last year estimated that by 2050 obesity would cost the NHS £50bn a year.

Whichever way you look at it, obesity has the potential to crush the life out of the NHS. But far more importantly, the health consequences for individuals are disastrous. Just look at the increasing incidence of diabetes. The potential also for increasing rates of heart disease, arthritis and some cancers is frightening.

As our society has got richer it has also got fatter. But the troubling paradox is that the most deprived communities also have the highest levels of obesity. The Foresight report warned of a "polarisation of the population, into the junk food eating, less-educated poor and functional food eating, better-informed higher classes". In the poorest areas of the country, access to healthy foods and exercise facilities is more difficult.

So what needs to happen? I certainly accept the case for the government piloting fresh ideas. Redesigning our towns and cities to encourage walking and cycling is the right thing to do. And I am very much in favour of exploring whether incentives can work to empower people to make informed choices.

Those who condemn this as yet another example of the nanny state have got it wrong. The state should be acting as enabler. There is a common interest here for both the state and citizens: reducing inequalities, controlling health costs and encouraging people to stay healthy. But for this to work, we have to move away from the dependency culture which exists in this country where, for any initiative to happen, it requires a hand-out from central government.

The Liberal Democrats' vision is of a radical shift of power away from Whitehall to local communities – locally elected health boards working with local government, integrating health and social care, addressing the health needs of their area. Along with democratic accountability to the communities they serve, health boards would also have the power to raise funds locally, with a commensurate reduction in national taxation.

We raise more of our taxes centrally than any other country in Europe apart from Malta. With that power, local health boards and local authorities could be free to innovate, to determine what is right for their area – and to find ways of reducing healthcare costs in the longer term.

A scheme they may choose to follow is one that has been introduced in Nova Scotia with strong public support. There, families get a tax-back payment if their children enrol in sports or activity clubs. A similar incentive payment could be made to those on benefits. In other countries, where healthcare is funded through insurance, providers have found that offering incentives – in the form of reduced premiums – to participate in screening, health risk assessments and physical activity reduces claims. In other words, this approach keeps people healthier and cuts cost. Surely there are positive lessons to learn here for a tax funded system.

I give the government credit for, at last, initiating some action. But please don't believe that what we have heard so far will make a dramatic difference.

healthy people avoid high blood pressure & control weight by short bursts of high intensity exercise

source: http://www.bpassoc.org.uk/mediacentre/Bloodpressurenews/Stoppinghighbloodpressureischildsplay

Preventing high blood pressure is child's play
04/11/2008

Research from Wales suggests that healthy people may be able to avoid high blood pressure, and control their weight, by short bursts of high intensity exercise - much like the way children play in a playground. For example,

the researchers believe that six short, sharp sprints of 30 seconds three times a week could be as beneficial as jogging or cycling for 45 minutes five times a week.

However, high intensity activity is not recommended for people with high blood pressure because it may raise their blood pressure to a dangerously high level. If you have high blood pressure and want to lower it, 30 minutes of moderate intensity exercises such as cycling, swimming or brisk walking five times a week is still the best choice.

Key points

Key points about exercise and high blood pressure:

• Being active helps to keep our heart and arteries flexible and efficient - lowering our blood pressure and our risk of a heart attack or stroke
• The UK Government recommends that everyone takes 30 minutes of moderate intensity exercise (dancing, digging or brisk housework) five times a week to look after their heart
• This research suggests that people who do not have high blood pressure could benefit from short, sharp bursts of high intensity activity
• People who have high blood pressure should avoid high intensity exercises because it may raise their blood pressure to dangerous high levels
• To lower pre-existing high blood pressure, following the Government's advice is the best established option

What did the research find?

Because only 29% of adults in Wales reach the Government's advice of 30 minutes of moderate intensity exercise five times a week, researchers wanted to see if other, quicker forms of exercise could be as beneficial.

The scientists, from the University of Glamorgan, looked at people's exercise patterns over a number of years and compared short high-intensity sprints to moderate intensity activities such as jogging or cycling.

They found that healthy people who sprinted had the same health benefits as those undertaking endurance activities.

According to their study,

the researchers believe that six short sprints of 30-60 metres (that last up to 30 seconds) with a four minute rest period in between each sprint, is beneficial.

What do the findings mean?

If you do not have high blood pressure and wish to prevent it:
This research suggests that building in short, high-intensity activities and exercises into your day may help to keep your weight down and keep your arteries and heart in good condition.

If you have high blood pressure and wish to lower it:
This research may not be useful for you. High-intensity exercises will raise your already-raised blood pressure even higher and this may be dangerous for you. For this reason, it would be best to continue to follow the UK Government's advice of 30 minutes of moderate-intensity exercise five times a week to benefit your heart and lower your blood pressure.

More from BBC Wales

Regret original peer reviewed research not found by crabsallover.

Statin use 'may benefit healthy'

Statins are widely prescribed on the NHS

Guidelines on who is eligible for statins may need to be widened after an international trial found benefits in "healthy" adults, experts say.

The study of 17,800 men and women with normal cholesterol levels found rosuvastatin cut deaths from heart attacks and strokes.
Currently statins are offered to people with a moderate to high risk of a cardiovascular "event".
The results are published in the New England Journal of Medicine Published at www.nejm.org November 9, 2008 (10.1056/NEJMoa0807646)

The patients in the trial, funded by AstraZeneca, had cholesterol levels below those usually indicating a need for treatment and had no other signs of heart disease.

These are people who have an intermediate risk and you wouldn't normally prescribe statins for them in the UK Dr Terry McCormack,

But they did have increased levels of a C-reactive protein, which indicates inflammation in the body and is believed to be a marker of future cardiovascular events.

After an average follow-up of two years, 20mg a day of rosuvastatin was found to have cut cholesterol by 50% and C-reactive protein by 37%.
Overall, the chance of a heart attack, stroke, hospital admission for chest pain or death from cardiovascular disease was cut by 44%, researchers said.

A reduction was even seen in those with the lowest chance of a cardiovascular event over the next decade, they said.

Researchers found a higher incidence of physician-reported diabetes in the statin group but could not explain it as blood glucose levels were similar between those taking rosuvastatin and those taking a dummy pill.
Guidelines
Statins are already prescribed to millions of adults in the UK.
The UK's National Institute of Clinical and Health Excellence (NICE)recommends doctors carry out a risk calculation based on an individual's blood pressure, cholesterol, weight and other risk factors, such as whether or not they smoke.
Those with a 20% risk of a heart attack or stroke in the next 10 years should be prescribed a daily dose of simvastatin - the cheapest of the statin class.

Dr Terry McCormack, a GP in Whitby, North Yorkshire, and ex-chairman of the Primary Care Cardiovascular Society, said the results were "astonishing" and much stronger than he would have expected.

He added that NICE should redo their cost-effectiveness calculation on the basis of the latest figures.

"These are people who have an intermediate risk and you wouldn't normally prescribe statins for them in the UK," he said.
"It opens up a whole new debate and the trial probably raises more questions than it answers."

Professor Peter Sever, an expert in clinical pharmacology at Imperial College in London, said

the results backed other studies which had shown statins had the same proportional benefit however low an individual's cholesterol.

But he added:

"The thing to remember is that the 20% threshold is arbitrary - it is essentially based on economic issues.

"Most nations have a finite pot and if you're going to treat everyone with a 10% risk, that's billions of pounds extra and somewhere along the line someone else is going to miss out."

Dr Alan McDougall, from AstraZeneca, said there was "no question" the trial would raise some important issues about statin use but that they would recommend doctors still follow existing guidance.
NICE is due to consult on plans to review their statin guidance shortly.

Abstract
Background Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein predict cardiovascular events. Since statins lower levels of high-sensitivity C-reactive protein as well as cholesterol, we hypothesized that people with elevated high-sensitivity C-reactive protein levels but without hyperlipidemia might benefit from statin treatment.
Methods We randomly assigned 17,802 apparently healthy men and women with low-density lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher to rosuvastatin, 20 mg daily, or placebo and followed them for the occurrence of the combined primary end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes.
Results The trial was stopped after a median follow-up of 1.9 years (maximum, 5.0). Rosuvastatin reduced LDL cholesterol levels by 50% and high-sensitivity C-reactive protein levels by 37%. The rates of the primary end point were 0.77 and 1.36 per 100 person-years of follow-up in the rosuvastatin and placebo groups, respectively (hazard ratio for rosuvastatin, 0.56; 95% confidence interval [CI], 0.46 to 0.69; P<0.00001),> rates of 0.17 and 0.37 for myocardial infarction (hazard ratio, 0.46; 95% CI, 0.30 to 0.70; P=0.0002), 0.18 and 0.34 for stroke (hazard ratio, 0.52; 95% CI, 0.34 to 0.79; P=0.002), 0.41 and 0.77 for revascularization or unstable angina (hazard ratio, 0.53; 95% CI, 0.40 to 0.70; P<0.00001),> the combined end point of myocardial infarction, stroke, or death from cardiovascular causes (hazard ratio, 0.53; 95% CI, 0.40 to 0.69; P<0.00001),> any cause (hazard ratio, 0.80; 95% CI, 0.67 to 0.97; P=0.02). Consistent effects were observed in all subgroups evaluated. The rosuvastatin group did not have a significant increase in myopathy or cancer but did have a higher incidence of physician-reported diabetes.
Conclusions In this trial of apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events. (ClinicalTrials.gov number, NCT00239681 [ClinicalTrials.gov] .)

Current treatment algorithms for the prevention of myocardial infarction, stroke, and death from cardiovascular causes recommend statin therapy for patients with established vascular disease, diabetes, and overt hyperlipidemia.^1,2

However, half of all myocardial infarctions and strokes occur among apparently healthy men and women with levels of low-density lipoprotein (LDL) cholesterol that are below currently recommended thresholds for treatment.

Measurement of high-sensitivity C-reactive protein, an inflammatory biomarker that independently predicts future vascular events, improves global classification of risk, regardless of the LDL cholesterol level.^{3,4,5,6,7,8,9} We have previously shown that statin therapy reduces high-sensitivity C-reactive protein levels^10,11 and that among healthy persons,¹² patients with stable coronary disease,¹³ and those with the acute coronary syndrome,^14,15,16 the magnitude of the benefit associated with statin therapy correlates in part with the achieved high-sensitivity C-reactive protein level. To date, however, no prospective outcome trial has directly addressed the question of whether apparently healthy persons with levels of LDL cholesterol below current treatment thresholds but with elevated levels of high-sensitivity C-reactive protein might benefit from statin therapy. The primary objective of the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) was to investigate whether treatment with rosuvastatin, 20 mg daily, as compared with placebo, would decrease the rate of first major cardiovascular events.

Study Population
As described in detail elsewhere,^17,18 men 50 years of age or older and women 60 years of age or older were eligible for the trial if they did not have a history of cardiovascular disease and if, at the initial screening visit, they had an LDL cholesterol level of less than 130 mg per deciliter (3.4 mmol per liter) and a high-sensitivity C-reactive protein level of 2.0 mg per liter or more. Other requirements for inclusion were a willingness to participate for the duration of the trial, provision of written informed consent, and a triglyceride level of less than 500 mg per deciliter (5.6 mmol per liter).

Results
Between February 4, 2003, and December 15, 2006, a total of 89,890 people were screened for enrollment. Of these, 72,088 were ineligible, including 37,611 (52.2%) with LDL cholesterol levels of 130 mg per deciliter or more and an additional 25,993 (36.1%) with high-sensitivity C-reactive protein levels of less than 2.0 mg per liter. Other reasons for exclusion are presented in Fig. 1 in the Supplementary Appendix. A total of 17,802 people were randomly assigned to a study group.

Potential limitations of our study merit consideration.

First, we did not include people with low levels of high-sensitivity C-reactive protein in our trial,

since our hypothesis-generating analysis of high-sensitivity C-reactive protein in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS)¹² showed extremely low event rates and no evidence that statin therapy lowered vascular risk among persons who had neither hyperlipidemia nor elevated high-sensitivity C-reactive protein levels. Thus, a trial of statin therapy involving people with both low cholesterol and low high-sensitivity C-reactive protein levels would have been not only infeasible in terms of statistical power and sample size but also highly unlikely to show a benefit.

Function C-Reactive Protein

CRP is a member of the class of acute phase reactants as its levels rise dramatically during inflammatory processes occurring in the body. This increment is due to a rise in the plasma concentration of IL-6, which is produced predominantly by macrophages^[1] as well as adipocytes.^[2] Interleukin-6 (IL-6) is an interleukin that acts as both a pro-inflammatory and anti-inflammatory cytokine.
CRP binds to phosphocholine on microbes. It is thought to assist in complement binding to foreign and damaged cells and enhances phagocytosis by macrophages, which express a receptor for CRP. It is also believed to play an important role in innate immunity, as an early defense system against infections.

last week i've gained weight! So I'm adding 'target' weights to my Hackers Diet. Today 8th November was 169 pounds (actual weight). My target is 169 pounds for next 3 days, then 168 for 4 days, 167 for 4 days, 166 for 4 days. If I can achieve these targets I will again reach my target weight loss yellow line (0.8 pounds /week loss). So over the next 2 weeks I'm targeting to lose 1 and a half pounds per week or 750 cals/day deficit.

Steep target!


Update 1st December: - the goal posts were shifted - target was 0.8 pounds per week changed to 0.66 pounds per week (2 pounds every 3 weeks).

When it's best to do nothing - Prostate cancer

If we knew which prostate tumours will not kill, men could avoid risky treatment
Sometimes, the best way to deal with cancer is to leave well alone. Tests for specific gene mutations promise not only to turn many deadly cancers into diseases that people can live with, they could also help to address another problem: the harm done by needlessly treating tumours that are never going to kill.
Take prostate cancer. The number of reported cases in the US jumped sharply after the introduction in 1986 of a blood test for a protein called the prostate specific antigen, or PSA (see graph). While death rates have fallen somewhat, the decline began too quickly to be clearly attributable to screening; it seems likely that it was more to do with improved treatments for tumours that have spread around the body.
PSA screening is not even specific for cancer, as levels of the protein are also elevated in men with benign enlargement of the prostate. The main reason for its failure to put a big dent in the death rate, though, is that most prostate tumours grow relatively slowly. Combined with the fact that men with prostate cancer are usually elderly, this means that many more with the disease die from other causes than die from it.
Still, in line with the received wisdom that early detection has to be a good thing, men with elevated PSA are given biopsies to look for cancerous cells. If these are found - and the tumour doesn't seem to have spread beyond the prostate gland itself - the most common treatments are radiation therapy or surgical removal of the gland.
While this intervention may prevent thousands of deaths from aggressive forms of the disease, the gains come at a huge cost. Aside from the billions of dollars spent on screening and treatment each year, surgical removal frequently leaves men impotent or incontinent. "What we really have now is a problem of over-treating people," says John Semmes of the Eastern Virginia Medical School in Norfolk.
No wonder, then, that this August the US Preventive Services Task Force recommended against PSA screening in men over 75. For younger men, it concluded that there was not enough evidence to urge for or against.
What's needed is some way to tell the difference between slow-growing tumours and life-threatening ones. Among the most promising candidates is a test for a genetic mutation that fuses a "promoter" sequence called TMPRSS2, which boosts gene activity, with a gene called ERG. Prostate cancer cells with this mutation respond to male hormones by becoming more invasive.
Ventana Medical Systems of Tucson, Arizona, is now developing a test for the TMPRSS2-ERG mutation in biopsied tissues, while Gen-Probe, based in San Diego, California, hopes to detect the RNA copies of this and other dangerous mutations in urine. Such tests could spare many men from unnecessary treatments, costs and stress.
Peter Aldhous

Run Moores Valley - Ringwood, 5000m

3.1 miles, 5000m, 40 minutes run with Jazzie at lunch. @ 4.5mph

Prostate Cancer

Last night I went for a curry with John H who I've known for fifty years. At 82, he was diagnosed with Prostate Cancer earlier this year. Treatment is with 'hormonal injections' to control his PSA levels. He's had a negative test in a body scanner for bone cancer.

John H mentioned that high PSA (Prostrate Specific Antigen) (wikipedia) levels can be an indicator of Prostate Cancer. "All men over 50 in USA know about these figures" said John. A month ago we heard that our good friend Jonathan Fs' father, in his mid 70s, has prostate cancer.

• source: CancerResearchUK
• Prostate cancer is the most common cancer in men in the UK. A quarter of all new cases of cancer diagnosed in men are prostate cancers.
• In 2005, more than 34,000 men in the UK were diagnosed with prostate cancer.
• Over the last 30 years prostate cancer rates in Great Britain have almost tripled, although much of the increase is due to increased detection through widespread use of the PSA test.
• Almost 60% of prostate cancer cases are diagnosed in men aged over 70 years.
• Around 7 in 10 newly diagnosed prostate cancer patients now survive beyond five years. In the 1970s it was only 3 in 10.
• Prostate cancer is the second most common cause of cancer death in UK men, after lung cancer.
• Each year around 10,000 men in the UK die from prostate cancer
• The majority of prostate cancer deaths (93%) occur in men aged 65 and over as Figure 2.1 shows (source)
  

PSA is, like Trypsin, a serine protease.

The U.S. Food and Drug Administration (FDA) (wikipedia) has approved the PSA test for annual screening of prostate cancer in men of age 50 and older. PSA levels between 4 and 10 ng/mL (nanograms per milliliter) are considered to be suspicious and should be followed by rectal ultrasound imaging and, if indicated, prostate biopsy. PSA is false positive-prone (7 out of 10 men in this category will still not have prostate cancer) and false negative-prone (2.5 out of 10 men with prostate cancer have no elevation in PSA).^[19]

Diet has been extensively researched because of the large variation in prostate cancer incidence between different cultures and their traditional diets around the world, particularly the Asian versus ‘western’ diet. A variety of factors have been looked at but much of the research is at present inconclusive. A recent review of the evidence concluded that foods containing lycopenes and selenium probably have a protective effect while diets high in calcium may increase risk.16 (source: CancerStats)
Lycopene, found principally in tomatoes and tomato-based products, may reduce the risk of prostate cancer. Cooked and processed tomatoes, such as tomato sauce, are a better source of lycopene than fresh tomatoes. A meta-analysis of 21 studies published from 1966–2003, showed that men with the highest intake of cooked tomato products had a 20% reduced risk of prostate cancer compared to men with the lowest intake.17 (source: CancerStats)
Since then, three studies including the European Investigation into Cancer and Nutrition (EPIC) study18-20 have shown a significant protective effect with higher intake of lycopene, although three other studies showed no association.21-23 (source: CancerStats)
Several studies have shown a protective association for selenium, reporting a 30–80% risk reduction for prostate cancer.24-26 However, at least three studies showed no association.27-29 Further research is needed and the Selenium and Vitamin E Cancer Prevention Trial (SELECT) may provide much needed answers.30 (source: CancerStats)

Calcium and dairy products

Some cohort studies have shown a raised risk of prostate cancer for men with high intakes of calcium from diet and/or supplementation31-34 but others have not.35-37
Dairy products, as a source of calcium, have been extensively studied in relation to prostate cancer. Several cohort studies show a small significant increase in risk but findings differ by whether it affects advanced or localised tumours.34-39
The EPIC study showed overall a 32% increased risk for 35g/day higher intake of dairy protein and a 7% risk increase for an 0.3g/day intake of dairy calcium. Protein and calcium from non-dairy sources were not associated with risk.40
An easy guide to cancer statistics is here and here.

Evidence suggests that around half of all cases of cancer diagnosed in the UK could be avoided if people made changes to their lifestyle. (source)

Bodyweight and risk of cancer in the UK

There is convincing evidence that being overweight or obese increases cancer risk1. Estimates suggest that, in the UK, more than 13,000 cases of cancer (about 4% of all cases) could be avoided if no-one exceeded a body mass index (BMI) of 252. Table 2.1 summarises what we currently know about overweight, obesity and risk of cancer.

Physical activity and risk of cancer

More than 60 studies have looked at the association between physical activity and colon cancer, the overwhelming majority showing a reduced risk with higher levels of exercise. The largest cohort studies suggest that the risk reduction for the most active people is between 20% and 25%.1,2
Physical activity may affect colon cancer risk in various ways, including by reducing faecal transit time, inflammation and insulin resistance

and modifying hormone metabolism.3,4

Diet, alcohol and cancer in the UK

Alcohol and cancer risk

Alcohol is well established as a cause of cancer: Around 6% of UK cancer deaths could be avoided if people did not drink.1
Alcohol consumption increases the risk of oral (oral cancer includes cancers of the oral cavity, pharynx excluding nasopharynx and lip), laryngeal, oesophageal, breast, bowel and liver cancer. Risk of cancers of the upper aerodigestive tract (oesophagus, oral cavity, pharynx and larynx) increases linearly with quantity of alcohol consumed above 25g/day . Someone drinking 100 g/day has a 4–6-fold increased risk of these cancers compared to light or non-drinkers.2

Tesofensine Diet Drug - average 2 stone or 13kg loss in 6 months

New Scientist 1st November 2008: People weighing more than 100 kilograms who took the drug tesofensine (wikipedia | Daily Mail - A diet pill that makes you feel full as soon as you start eating), made by NeuroSearch of Copenhagen, Denmark, lost almost 13 kilograms (2 stone) in 6 months, on average - twice as much as with any previous diet drug (The Lancet, DOI: 10.1016/S0140-6736(08)61525-1). The drug makes people feel full early in a meal by increasing the pleasurable effects of three neurotransmitters. Tesofensine—an inhibitor of the presynaptic uptake of noradrenaline, dopamine, and serotonin. Larger trials to come will delay its approval, however.

Source: The Lancet

Effect of tesofensine on bodyweight loss, body composition, and quality of life in obese patients: a randomised, double-blind, placebo-controlled trial

Prof Arne Astrup et al

Available online 22 October 2008.

Background

Weight-loss drugs produce an additional mean weight loss of only 3–5 kg above that of diet and placebo over 6 months, and more effective pharmacotherapy of obesity is needed. We assessed the efficacy and safety of tesofensine—an inhibitor of the presynaptic uptake of noradrenaline, dopamine, and serotonin—in patients with obesity.

Methods

We undertook a phase II, randomised, double-blind, placebo-controlled trial in five Danish obesity management centres. After a 2 week run-in phase, 203 obese patients (body-mass index 30−≤40 kg/m²) were prescribed an energy restricted diet and randomly assigned with a list of randomisation numbers to treatment with tesofensine 0·25 mg (n=52), 0·5 mg (n=50), or 1·0 mg (n=49), or placebo (n=52) once daily for 24 weeks. The primary outcome was percentage change in bodyweight.

Findings

161 (79%) participants completed the study. After 24 weeks, the mean weight loss produced by diet and placebo was 2·0% (SE 0·60). Tesofensine 0·25 mg, 0·5 mg, and 1·0 mg and diet induced a mean weight loss of 4·5% (0·87), 9·2% (0·91), and 10·6% (0·84), respectively, greater than diet and placebo (p<0·0001). p="">

Interpretation

Our results suggest that tesofensine 0·5 mg might have the potential to produce a weight loss twice that of currently approved drugs. However, these findings of efficacy and safety need confirmation in phase III trials.

The yo-yo world of diet drugs

Would you take a diet drug? See our poll right.

• 01 November 2008

IN THE world of diet pills, last week was a roller coaster.
On 23 October, Sanofi-Aventis suspended European sales of its anti-obesity drug rimonabant (Acomplia), following a recommendation from the European Medicines Agency. The EMA pointed to evidence that the drug doubles the risk of psychiatric disorders and that five people in a large study committed suicide after taking it, compared to just one in a group taking a dummy drug. Concerns over side effects led the US Food and Drug Administration to refuse approval for rimonabant last year.

But it's not all bad news for dieters. People weighing more than 100 kilograms who took the drug tesofensine, made by NeuroSearch of Copenhagen, Denmark, lost almost 13 kilograms in 6 months, on average - twice as much as with any previous diet drug (The Lancet, DOI: 10.1016/S0140-6736(08)61525-1). The drug makes people feel full early in a meal by increasing the pleasurable effects of three neurotransmitters. Larger trials to come will delay its approval, however.

Meanwhile, orlistat, sold over the counter as Alli in the US since February 2007, should soon be approved for pharmacy-counter sales in Europe, too.