Wednesday, November 13, 2013

A daily bowl of wild blueberries could protect against obesity, heart disease and diabetes

If you are a specially bred obese lab rat

A bowl of wild blueberries a day could protect against a range of health problems including obesity, heart disease and diabetes.  Regular consumption of the berries over an eight-week period can improve or prevent metabolic syndrome, researchers say.

Metabolic syndrome is the medical term for a combination of diabetes, high blood pressure and obesity.

It increases the risk of heart disease, stroke and other conditions affecting blood vessels.

On their own, diabetes, high blood pressure, and obesity can potentially damage the blood vessels, but having all three together is particularly dangerous.

Berries are rich in polyphenols - antioxidants that protect cells in the heart and help lower blood pressure.

This means they may help reduce damage to the lining of blood vessels and tackle glucose intolerance - excess sugar in the blood that can lead to diabetes.

In the study, published in the journal the Applied Physiology, Nutrition, and Metabolism, specially bred obese lab rats were fed a diet of blueberries - the equivalent of two cups a day for a human.

The researchers found this improved the relaxing and constricting in the blood vessels (endothelial function), which had a significant impact on blood flow and blood pressure.

Dorothy Klimis-Zacas, professor of clinical nutrition at the University of Maine and a co-author of the study, said: 'Metabolic syndrome is a group of risk factors characterised by obesity, hypertension [high blood pressure], inflammation, high cholesterol, glucose intolerance and insulin resistance, and endothelial dysfunction.

'Many substances found in food have the potential to prevent metabolic syndrome, thus reducing the need for medication and medical intervention.'

She added that previous research had shown the heart benefits of the 'polyphenol-rich' wild blueberry, using rats who had high blood pressure.

This study used rats whose bodies act in a similar way to humans.

Professor Klimis-Zacas added this study showed that eating wild blueberries long-term could normalise inflammation and improve endothelial function.

But it's best to eat the berries raw. Previous research has found that cooking in pies or muffins could reduces their disease fighting nutrients.

Heating the fruit affects the levels of some polyphenols - which give them their 'superfood' credentials - potentially reducing their ability to cut the risk of heart attack, sooth inflammation and sharpen thinking.

Experts say eating blueberries raw is the best way to get as much nutritional benefit from them, whereas baking them into breads, muffins or pies can cut their polyphenol levels by up to a fifth.


Should the drug that transformed Megan's skin be banned? Experts think it's a wonder cure but it's been linked to depression and suicidal thoughts

A generally balanced discussion below but it is a pity that the teratogenic effects are not mentioned.  Women taking it should exercise rigorous birth control

Megan Taylor began to fear her modelling and acting career was over last year when, at the age of 27, she suddenly developed spots on her face.

Her GP diagnosed cystic acne, a severe form of the condition that extends deep into the skin, and prescribed antibiotics - the standard treatment - for six weeks. When this didn't help, Megan was given a different antibiotic, then another and another - but none made a difference.

She had sailed through her teens without any spots, and developing acne in her 20s was not only distressing but threatened her livelihood. 'Obviously your skin is scrutinised at castings and I became really self-conscious,' says Megan, 28, who lives with her fiancé Liam, 31, a sports physiotherapist, in Thames Ditton, Surrey.

'I tried everything to improve my skin. I gave up chocolate and alcohol, and tried dozens of over-the-counter skin lotions and creams - some were very expensive.'  Then an actress friend mentioned that she'd had a similar skin problem and recommended the acne drug Roaccutane.

Roaccutane is a brand name for isotretinoin, a compound derived from vitamin A. Dermatologists regard it as something of a 'wonder drug'. But recently it has made headlines for the wrong reasons, with suggestions that it is linked to suicidal feelings. As a result, people who might benefit from the drug - and their doctors - are reluctant to use it.

When Megan asked her GP to prescribe the drug, he said that only a dermatologist could do this, and her condition wasn't severe enough to refer her. Desperate for an improvement to her skin, Megan paid £300 to see a private dermatologist and was put on Roaccutane straight away.

After five months her skin had cleared completely. Now, six months after finishing the treatment, Megan remains acne-free and is back modelling. 'It gave me my life back and my career,' she says.

So have safety fears over Roaccutane been exaggerated, denying patients a potentially life-changing treatment? Or was Megan merely the positive side of a story that remains more troubling?

Acne is triggered by an oversensitivity to hormones, such as testosterone. This causes the sebaceous glands - the oil-producing glands in the skin - to go into overdrive.

At the same time, the dead skin cells lining the pores are not shed properly. The two factors result in a build-up of oil (sebum), which leads to blackheads (a darkened plug of oil and dead skin)  and whiteheads.

This is the ideal environment for the acne bacterium, Propionibacterium acnes, to flourish. We all have this on our skin and usually it causes no problems, but in those prone to acne it triggers inflammation and the formation of red or pus-filled spots.

Roaccutane works by reducing the size and activity of the sebaceous glands, so reducing the amount of oil; it also eases inflammation. It is more effective than antibiotics for severe acne because it tackles the main cause - the oil - while antibiotics only kill pore-blocking bacteria. It is usually prescribed for 16 to 24 weeks.

For dermatologists the drug represents a real breakthrough. 'Isotretinoin came along 30 years ago and revolutionised the treatment of severe acne - from a dermatologist's point of view, it is an extraordinarily useful drug,' says Dr Neil Walker, honorary consultant dermatologist at the Churchill Hospital and the Stratum Clinic, both of which are in Oxford.

And its use is soaring - prescriptions for acne products containing isotretinoin rose from 1,697 in 2008 to 48,797 in 2012.

Around 80 per cent of teenagers will have acne at some point, and for 10 to 15 per cent (an estimated 250,000) it is bad enough to warrant treatment with an isotretinoin product.

However, as well as side-effects such as dry skin (linked to reduced sebum) and a risk to unborn babies (women, while taking it, must use contraception during treatment and for a month after stopping), it has been associated with depression and suicidal thoughts. Although this is rare - the manufacturer, Roche, says depression affects one in 1,000 patients and suicide/suicidal thoughts affect one in 10,000 - several recent high-profile cases have highlighted the terrible cost for those involved.

Last year, 16-year-old Jack Bowlby, the nephew of racehorse trainer Jenny Pitman, was found dead at his boarding school. The cause of death was neck compression due to a ligature.

He had been taking Roaccutane for four months, stopped it, then started back on it. His family said they felt Roaccutane 'may have played a part' in his death, and that patients and their parents should be 'very aware of the possible risks'. The coroner recorded an open verdict.

James Sillcock, 26, from Kent, also killed himself, after years of mental health problems that he blamed on Roaccutane, which he took at 16. In a suicide note he said the drug had left his world 'in tatters'.

Perhaps not surprisingly there have been calls for Roaccutane to be banned.

So how might the drug have this effect?  A study of rats by Dr Sarah Bailey, a pharmacologist from the University of Bath, suggests that isotretinoin may trigger depressive behaviour.

'Our theory is that it may turn on genes responsible for metabolising serotonin - a feel-good chemical made in the brain,' explains Dr Bailey. 'This means less serotonin, which may then precipitate depression.'

What is not clear is if this is a temporary or permanent effect. For although the drug clears from the body a month after the last pill is taken, some families of those who committed suicide after taking it maintain its psychological side-effects persist for much longer - months, even years.

However, evidence cited by Roche and leading dermatologists suggests that those who suffer from acne are at an increased risk of suicide because of the acne itself, not the treatment. Dr Anthony Bewley, consultant dermatologist at Barts Health NHS Trust, says: 'I see a lot of patients with acne who are very depressed - it can be absolutely devastating for confidence and self-esteem.

'Young teenagers are vulnerable to depression and having acne can increase the suicide rate in this group by up to five times.'

Dr Bewley, who runs specialist psycho-dermatology clinics in partnership with consultant psychiatrists, says that Roaccutane has been used for decades and is largely safe. 'The evidence suggests that if it is an effect, it's a small one, and it may just be that it exacerbates existing low mood.

'Even so, it's a drug that should be treated with the greatest respect and prescribed carefully by dermatology specialists only.

'They should always ask questions about mood and how the patient is feeling beforehand and during treatment.'

Unfortunately, in some cases the drug may be being prescribed inappropriately to those with moderate to mild acne, says Tony Chu, professor of dermatology at Hammersmith Hospital.

'There is a lot of pressure in the NHS for dermatologists to clear patients from their books quickly - we're told we should have a maximum of two follow-up appointments because of financial pressures, so I think Roaccutane is sometimes prescribed to speed things up when it's not always the most appropriate drug.

'A combination of antibiotics and retinoid cream might work,  or a laser treatment, as they  can be effective and have  fewer side-effects.'

Professor Chu also warns that, while isotretinoin treatment can be a cure in some cases, 'in my experience, 50 per cent of patients will relapse after a course of treatment. This can be very fast, within two weeks of stopping the drug, or it may be several years later'.

He adds that the drug can, in his view, also affect concentration. 'Another rare side-effect I've seen is chronic fatigue. I once had a bright, straight-A-star patient referred to me who had developed this after taking Roaccutane for four months. It had persisted for years after stopping the drug.

'He subsequently dropped out of Oxford University. Although his acne cleared, he never recovered from the chronic fatigue and, sadly, two years later I learnt that he'd taken his own life. I think his suicide mey well have been related to Roaccutane.

'Although the drug only stays in the system for about a month, the effects on the brain can in some cases be permanent. A biological switch is flicked by Roaccutane and sometimes it doesn't turn on or off again.

'All these side-effects are rare but there is no way of predicting beforehand whether a patient may be affected. My experience has  made me very cautious about prescribing it. You have to weigh up the benefits against the potential side-effects - in severe cases of acne that hasn't responded to treatment, it is worth it, but in milder cases it probably isn't.'

Lisa Tester strongly agrees. When she first took Roaccutane, she was delighted. The 44-year-old translator had suffered years of misery because of acne.

'I'd been bullied at school. I even decided against university because it affected my confidence so much. My face, neck, back and chest were all covered in ugly red pustules, which left scars.'

After she was prescribed Roaccutane at 26, Lisa's spots cleared up within weeks.

'I'd never felt so good,' says Lisa, who is divorced and lives in Brighton with her son Andrew, 16.

'Back then I was given no warnings about the drug affecting mood or causing depression, but I didn't notice anything like that anyway - I'd never felt happier.'

Lisa was given repeated courses over the next few years and her skin stayed clear. Then last year she saw a different dermatologist. 'He said the latest thinking was that a higher dose of Roaccutane would prevent the acne coming back for longer. He more than doubled my dose to 60mg a day.'

This is a standard dose, and teenagers are often put on it. But while her skin cleared, Lisa's mood was affected and two weeks later she woke up and - with no previous history of depression - decided to kill herself.

'Suddenly I had very dark thoughts. Over the next four weeks I felt worse and worse and could not see a way forward.'

When her boyfriend, Jeremy, and her son were both away one weekend - six weeks after her dose was raised - Lisa took an overdose of alcohol and painkillers. Fortunately this failed and the next day she went to her GP.

'Even at that stage I didn't connect my feelings to Roaccutane - it was only when I was discussing possible triggers with the community psychiatric nurse that I realised it had started after my dose had been doubled.

'I will never take Roaccutane again. My son has severe acne, but he doesn't want to take the risk either.'

Dermatologists are concerned that such rare experiences will put patients and doctors off the drug. 'I'm fearful that a good drug may start to be withheld because of the publicity about suicides,' says Dr Bewley.

Dr Neil Walker says Roaccutane must be handled carefully. 'Dermatologists should counsel patients and their families about the risks and tell them to report any changes in behaviour, and it should not be prescribed to anyone with a history of depression.'

Megan Taylor is in no doubt about the drug's benefits. 'I've got the greatest sympathy for the families of teenagers who have taken their own lives after taking Roaccutane, but those side-effects are extremely rare.

'I think if your acne is severe and persistent, and you inform your family of the risks, and the dermatologist monitors you carefully, the benefits may outweigh the risks.'


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