Wednesday, June 27, 2007

Fat Diabetics get less heart disease

Researchers at the University of Pittsburgh Schools of the Health Sciences studying links between an early sign of heart disease called coronary artery calcification and body fat have found that, paradoxically, more fat may have some advantages, at least for people -- particularly women -- who have type 1 diabetes. Cardiovascular complications, including heart disease, are a leading cause of death for people with diabetes, who tend to suffer cardiovascular disease decades earlier than non-diabetics.

"Gaining weight may reflect good or better treatment with insulin therapy, which may partly explain why participants who gained weight over time had lower mortality rates," said Trevor Orchard, M.D., professor of epidemiology at the University of Pittsburgh Graduate School of Public Health (GSPH), who is presenting the findings during the 67th annual meeting of the American Diabetes Association.

For this particular report, Dr. Orchard and his colleagues focused on 315 patients with type 1 diabetes participating in the Pittsburgh Epidemiology of Diabetes Complications Study, an 18-year prospective study of childhood onset type 1 diabetes, which began in 1986. As part of the study, the patients recently received a special computed tomography scan (CT) to assess coronary artery calcification.

The participants' mean age was 42, and mean duration of diabetes was 34 years. In addition to the CT scan, patients were evaluated for fat underneath the skin and in the abdominal region, body mass index (BMI) and waist circumference. Although investigators noted a positive association for all measures of fatness and having any coronary artery calcification, in the two-thirds of patients who had calcification, the relationship reversed so that people with more fat had less severe calcification.

This association also varied by gender. Women with less fat under the skin had more evidence of coronary artery calcification than those with more fat. Thinner men also had more evidence of coronary artery calcification than men with a higher BMI.

"What it comes down to is a kind of double-edged relationship," said Baqiyyah Conway, M.P.H., lead author of the abstract, adding that these associations of less severe artery calcification with greater fat persisted even when controlling for standard cardiovascular disease risk factors such as increased levels of LDL, or bad cholesterol, triglycerides, high blood pressure and lower levels of HDL, or good cholesterol. Controlling for kidney disease, another common complication of diabetes, weakened the association in men but not in women.

"This is not a firm recommendation to people with type 1 diabetes to put on weight, but it does raise the possibility that weight recommendations in type 1 diabetes may be somewhat different than those for the general population, and emphasizes the complex relationship between body fat and cardiovascular risk in diabetes," said Dr. Orchard, who also is professor of medicine and pediatrics at the University of Pittsburgh School of Medicine.


ADHD: Amazing government decision in Australia

The drug may harm more than help. And there is a growing consensus that drug solutions for ADHD are much overdone anyway. Such drugs are very often just a substitute for school discipline

A CONTROVERSIAL treatment for attention deficit hyperactivity disorder will be added to the Pharmaceutical Benefits Scheme, despite its potential to cause suicidal thoughts and stunt growth. Health Minister Tony Abbott announced in April that Strattera would be added to the scheme from July 1 for the treatment of ADHD in children aged six to 18 who could not take stimulant treatments such as methylphenidate, known as Ritalin, or dexamphetamine.

Under the PBS, the drug's price will drop from more than $100 for a month's supply to just $30.70, or $4.90 for concession-card holders. Mr Abbott said about 18,000 people would take Strattera during its first full financial year of listing, adding about $101.2million to PBS expenditure between 2007-08 and 2010-11.

The move comes after a Therapeutic Goods Administration assessment of Strattera last year, which identified suicidal thoughts, agitation, weight loss, chest pain and swollen testicles as potential side effects of the drug.

A spokeswoman for Strattera manufacturer Eli Lilly said drug regulation agencies in the US, Europe, Britain and Australia had all recently reviewed the safety of the drug and had reaffirmed the drug's benefits justified the risks. "There are benefits and risks associated with every medication," she said. "Strattera is the most extensively studied psychiatric drug in children with the most comprehensive clinical-trials database compared to any other ADHD medication."

The head of psychological medicine at Adelaide's Women's and Children's Hospital, Jon Jureidini, said he was concerned that doctors would not exhaust other treatment options before using Strattera. "Although it's not supported to be a first-line drug, I think we'll find that it will be used as a first-line drug, which is not what the PBAC (Pharmaceutical Benefits Advisory Committee) intended," Dr Jureidini said. "The concerns about this drug are that it's very expensive and it's not proven to be any better than the cheaper drugs that are around and that's reflected in the determination by the PBAC, who will only financially support its use if other stimulant drugs have been tried."

University of NSW ADHD specialist Florence Levy said stimulant drugs such as Ritalin were not suitable for about 10 to 20 per cent of children with the disorder because of side effects. Professor Levy said she had not seen any of the serious psychiatric side effects reported in the US. "They apply more to adolescents and at higher dosage levels. The children I see are younger children and I haven't experienced those sorts of problems," she said. Australian Medical Association vice-president Choong-Siew Yong, who specialises in child and adolescent mental health issues, said Strattera's side effects were "fairly rare" but recommended doctors and families discuss ways to monitor potential reactions in children taking the drug.



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

Trans fats:

For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.


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