Video: Should You Eat a Low-gluten Diet?

When healthy people eat a low-gluten and fibre-rich diet compared with a high-gluten diet they experience less intestinal discomfort including less bloating, a new study shows. The researchers attribute the impact of diet on healthy adults more to change in composition of dietary fibres than gluten itself.

Watch video at vimeo (1:37 minutes) . . . . .


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Purdue’s Giant Leap toward Personalized Medicine Helps Eyes Drain Themselves for Glaucoma Patients

Purdue University researchers have invented a new smart drainage device to help patients with glaucoma, a leading cause of blindness in the world, as they try to save their eyesight.

Glaucoma can be treated only with medications or surgical implants, both of which offer varying degrees of success in helping to improve sight and to relieve pressure buildup inside the eye. The U.S. Centers for Disease Control and Prevention says about 3 million Americans have glaucoma.

Implantable glaucoma drainage devices have grown in popularity over the past years, but only half of the devices are still operational after five years because microorganisms accumulate on the device during and after implantation. This problem is known as biofouling.

“We created a new drainage device that combats this problem of buildup by using advances in microtechnology,” said Hyowon “Hugh” Lee, an assistant professor in Purdue’s Weldon School of Biomedical Engineering and a researcher at the Birck Nanotechnology Center, who led the research team. “It is able to clear itself of harmful bio-buildup. This is a giant leap toward personalized medicine.”

The Purdue glaucoma drainage device is built with microactuators that vibrate when a magnetic field is introduced. The vibrations shake loose the biomaterials that have built up in the tube.

“We can introduce the magnetic field from outside the body at any time to essentially give the device a refresh,” Lee said. “Our on-demand technology allows for a more reliable, safe and effective implant for treating glaucoma.”

The Purdue technology is published in the latest issue of Microsystems and Nanoengineering. Another unique aspect of the Purdue device is its ability to vary flow resistance, which allows the drainage technology to customize treatment for each patient at different stages of glaucoma with varying degrees of pressure buildup inside the eye.

Other members of the Purdue research team include Arezoo Ardekani, an associate professor of mechanical engineering, and Simon John from the Jackson Laboratory.

The work aligns with Purdue’s Giant Leaps celebration, acknowledging the university’s global advancements in health as part of Purdue’s 150th anniversary. This is one of the four themes of the yearlong celebration’s Ideas Festival, designed to showcase Purdue as an intellectual center solving real-world issues.

Researchers are working with the Purdue Office of Technology Commercialization to patent the technology. They are looking for partners to license it.

Source : Purdue University

Updated Cholesterol Guidelines – A Lifetime Approach to Lowering Cholesterol is Still Key to Reducing Cardiovascular Risk

More personalized risk assessments and new cholesterol-lowering drug options for people at the highest risk for cardiovascular disease (CVD) are among the key recommendations in the 2018 cholesterol guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC).

The guidelines were presented today at the Association’s 2018 Scientific Sessions conference in Chicago, the premier annual global forum for the exchange of the latest advances in cardiovascular science for researchers and clinicians. The guidelines were simultaneously published in the American Heart Association journal, Circulation and the Journal of the American College of Cardiology.

“The updated guidelines reinforce the importance of healthy living, lifestyle modification and prevention. They build on the major shift we made in our 2013 cholesterol recommendations to focus on identifying and addressing lifetime risks for cardiovascular disease,” said Ivor Benjamin, M.D., FAHA, president of the American Heart Association. “Having high cholesterol at any age increases that risk significantly. That’s why it’s so important that even at a young age, people follow a heart-heathy lifestyle and understand and maintain healthy cholesterol levels.”

Nearly one of every three American adults have high levels of low-density lipoprotein cholesterol (LDL-C), considered the “bad” cholesterol because it contributes to fatty plaque buildups and narrowing of the arteries. About 94.6 million, or 39.7 percent, of American adults have total cholesterol of 200 mg/dL or higher, while research shows that people with LDL-C levels of 100 mg/dL or lower tend to have lower rates of heart disease and stroke, supporting a “lower is better” philosophy.

“High cholesterol treatment is not one size fits all, and this guideline strongly establishes the importance of personalized care,” said Michael Valentine, M.D., FACC, president of the American College of Cardiology. “Over the past five years, we’ve learned even more about new treatment options and which patients may benefit from them. By providing a treatment roadmap for clinicians, we are giving them the tools to help their patients understand and manage their risk and live longer, healthier lives.

A special report simultaneously published as a companion to the cholesterol guidelines provides a more detailed perspective about the use of quantitative risk assessment in primary prevention for cardiovascular disease. The risk calculator introduced in the 2013 guidelines remains an essential tool to help health care providers identify a patient’s 10-year risk for CVD.

Because the calculator uses population-based formulas, the guidelines now urge doctors to talk with patients about “risk-enhancing factors” that can provide a more personalized perspective of a person’s risk, in addition to traditional risk factors such as smoking, high blood pressure and high blood sugar to address under or over-estimated risk in some individuals. Risk-enhancing factors include family history and ethnicity, as well as certain health conditions such as metabolic syndrome, chronic kidney disease, chronic inflammatory conditions, premature menopause or pre-eclampsia and high lipid biomarkers. This additional information can make a difference in what kind of treatment plan a person needs.

In primary and secondary prevention, when high cholesterol can’t be controlled by diet or exercise, the first line of treatment is typically statins, mostly available in generic forms and long-proven to safely and effectively lower LDL-C levels and CVD risk.

For people who have already had a heart attack or stroke and are at highest risk for another and whose LDL-C levels are not adequately lowered by statin therapy, the guidelines now recommend the select use of other cholesterol-lowing drugs that can be added to a statin regimen. The guidelines recommend a stepped-approach of ezetimibe, available as a generic, in addition to the statin for these patients. If that combination doesn’t work well enough, a PCSK9 inhibitor could be added, specifically for people who are at very high risk. This approach may also be considered in primary prevention for people who have a genetic condition that causes their very high LDL-C.

“There have been concerns over the cost of PCSK9 inhibitors and some insurance companies have been slow to cover them, so it’s important to note that the economic value of these new medications may be substantial only for a very specific group of people for whom other treatments haven’t worked,” Benjamin said. “The Association is bringing together stakeholders to discuss financial barriers to the care of heart disease and stroke. We have been heartened that drug makers have recently agreed to reduce the prices of PSCK9 inhibitors and are making arrangements with payors to ease the financial burden for patients who could benefit from the additional medication options.”

“The College has long recognized that the cost of PCSK9s have made patient access an issue. We are committed to helping physicians with access to care issues, while also bringing together stakeholders, including payer, industry and clinician representatives, to talk about opportunities to move forward together,” Valentine said. “Our goal is to make sure the highest risk patients have access to the care they need.”

Once treatment is started, whether only lifestyle modifications are prescribed or if medication therapy is added, adherence and effectiveness should be assessed at 4 to 12 weeks with a fasting lipid test, then retested every 3-12 months based on determined needs.

Another new aspect of the guidelines is the recommendation of coronary artery calcium (CAC) measurements for people in some risk categories, when their risk level isn’t clear and treatment decisions are less certain. A CAC score of zero typically indicates a low risk for CVD and could mean those people can forego or at least delay cholesterol-lowering therapy as long as they are non-smokers or don’t have other high-risk behaviors or characteristics. This measurement of calcified plaque is a non-invasive heart scan that should be done by a qualified provider in a facility offering the most current technology.

Recognizing the cumulative effect of high cholesterol over the full lifespan, identifying and treating it early can help reduce the lifetime risk for CVD. Selective cholesterol testing is appropriate for children as young as two who have a family history of heart disease or high cholesterol. In most children, an initial test can be considered between the ages of nine and 11 and then again between 17 and 21. Because of a lack of sufficient evidence in young adults, there are no specific recommendations for that age group. However, it is essential that they adhere to a healthy lifestyle, be aware of the risk of high cholesterol levels and get treatment as appropriate at all ages to reduce the lifetime risk of heart disease and stroke.

This lifespan approach to reducing CVD risk should start at an early age. Kids may not need medication but getting them started on healthy behaviors when they’re young can make a difference in their lifetime risk. When high cholesterol is identified in children, that could also alert a doctor to test other family members who may not realize they have high cholesterol, because awareness and treatment can save lives.

The guidelines offer more specific recommendations for certain age and ethnic groups, as well as for people with diabetes, all important for the comprehensive and individualized provider-patient discussion.

Source : American Heart Association


Today’s Comic

Traditional Glaucoma Test Can Miss Severity of the Disease

Carla Cantor wrote . . . . . . . . .

The most common tests for glaucoma can underestimate the severity of the condition by not detecting the presence of central vision loss, according to a new Columbia University study.

The study, published Nov. 8 in JAMA Ophthalmology, found that administering a variation of the visual field test that better assesses macular damage can improve diagnosis of glaucoma at no extra cost and an additional 10 minutes of examination time.

“When looking for signs of early glaucoma, clinicians tend to focus on loss of peripheral (side) vision and seldom on the macula, the central area of the retina—which determines our ability to read, drive and to see our children’s faces,” said Donald C. Hood, the James F. Bender Professor of Psychology and a Professor of Ophthalmic Science at Columbia University, who co-authored the study with C. Gustave De Moraes, an associate professor and the Medical Director of Clinical Trials in the Department of Ophthalmology at Columbia University Irving Medical Center.

“Our work has shown that damage can and does occur in this area, and the most commonly used field test can fail to detect most of the damage,” Hood said. “It is important to detect this damage, because early diagnosis and treatment can prevent further vision loss.”

Glaucoma, which affects an estimated three million people in the United States alone, is the second leading cause of irreversible blindness in the world, according to the National Eye Institute. In its early stages, the disease has no symptoms, pain or perceived vision loss. If left untreated, however, glaucoma results in decreasing vision, and eventually tunnel vision and blindness.

The most common exam for glaucoma is the visual field test, which uses an instrument to assess how each eye can see, looking at one eye at a time. The patient looks into a dimly lit bowl-shaped area and small blinking lights appear briefly in different places in the field of view. The patient presses a button to indicate when lights are seen and the instrument records which were not seen.

For the study, the researchers examined 57 eyes from 33 patients diagnosed with early-stage of glaucoma using two different visual field measures. All participants were tested with the 24-2 visual test, which uses a grid of 54 test points (projected lights). They then conducted an additional assessment using a 10-2 visual field test, which uses a grid of 68 test points. In addition, optical coherence tomography (OCT)—a high-resolution imaging device analogous to an MRI—was used to confirm the presence of damage.

“In an early study, we found that in using the 10-2 visual field more than 75 percent of patients diagnosed with early glaucoma had central vision loss,” Hood said. “Because the conventional 24-2 test often misses or underestimates damage in the central vision, it therefore underestimates disease severity. Patients in a later stage of the disease require closer monitoring and often require more aggressive treatment, which is unlikely to happen if 10-2 tests and OCT are not performed at some point during follow-up.”

The researchers recommend that clinicians test all patients with or suspected to have glaucoma with the finer test grid in the macular area within the first two visits.

“By having a better assessment of the true severity of glaucomatous damage to the eye, doctors can tailor the most appropriate treatment to help prevent future vision loss,” De Moraes said

Source: Columbia University


Today’s Comic

How Many Calories Burnt Depends on Time of the Day

Researchers reporting in Current Biology on November 8 have made the surprising discovery that the number of calories people burn while at rest changes with the time of day. When at rest, people burn 10 percent more calories in the late afternoon and early evening than in the early morning hours.

The findings reinforce the important role of the circadian clock in governing metabolism. They also help to explain why irregularities in eating and sleeping schedules due to shift work or other factors may make people more likely to gain weight.

“The fact that doing the same thing at one time of day burned so many more calories than doing the same thing at a different time of day surprised us,” says Kirsi-Marja Zitting of the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital and Harvard Medical School, lead author of the paper.

To determine changes over the course of the day in metabolism apart from the effects of activity, sleep-wake cycle, and diet, the researchers studied seven people in a special laboratory without any clues about what time it was outside. There were no clocks, windows, phones, or Internet. Study participants had assigned times to go to bed and wake up. Each night, those times were adjusted four hours later, the equivalent of traveling westward across four time zones each day for three weeks.

“Because they were doing the equivalent of circling the globe every week, their body’s internal clock could not keep up, and so it oscillated at its own pace,” co-author Jeanne Duffy, also in the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital, explains. “This allowed us to measure metabolic rate at all different biological times of day.”

The data showed that resting energy expenditure is lowest at the circadian phase the researchers designated as ~0°, corresponding to the dip in core body temperature in the late biological night. Energy expenditure was highest at circadian phase ~180°, about 12 hours later, in the biological afternoon into evening.

The researchers found that participants’ respiratory quotient, which reflects macronutrient utilization, varies by circadian phase, too. This measure was lowest in the evening and highest in the biological morning.

The findings offer the first characterization of a circadian profile in fasted resting energy expenditure and fasted respiratory quotient, decoupled from effects of activity, sleep-wake cycle, and diet in humans, the researchers say.

“It is not only what we eat, but when we eat — and rest — that impacts how much energy we burn or store as fat,” Duffy says. “Regularity of habits such as eating and sleeping is very important to overall health.”

Duffy, Zitting, and their colleagues next will look at how appetite and the body’s response to food varies with the time of day. They are also exploring how the timing, duration, and regularity of sleep influences those responses.

Source: Daily Science