Probiotics Alone or Combined with Prebiotics May Help Ease Depression

Probiotics either taken by themselves or when combined with prebiotics, may help to ease depression, suggests a review of the available evidence, published in BMJ Nutrition Prevention & Health.

But as to whether they might help to lessen anxiety isn’t yet clear, say the researchers.

Foods that broaden the profile of helpful bacteria in the gut are collectively known as probiotics, while prebiotics are compounds that help these bacteria to flourish.

In the UK in 2016-17, 1.4 million people were referred with mental health issues, over half of them (53%) had anxiety or stress related disorders, while a third (33%) had depression.

A two-way relationship exists between the brain and digestive tract, known as the gut-brain axis. And the possibility that the microbiome–the range and number of bacteria resident in the gut–might help treat mental ill health has become a focus of interest in recent years.

To explore this further, the researchers searched for relevant studies published in English between 2003 and 2019, which looked at the potential therapeutic contribution of pre-and probiotics in adults with depression and/or anxiety disorders.

Out of an initial haul of 71 studies, just 7 met all the criteria for inclusion. All 7 investigated at least 1 probiotic strain; 4 looked at the effect of combinations of multiple strains.

In all, 12 probiotic strains featured in the selected studies, primarily Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidium. One study looked at combined pre-probiotic treatment, while one looked at prebiotic therapy by itself.

The studies varied considerably in their design, methods used, and clinical considerations, but all of them concluded that probiotic supplements either alone or in combination with prebiotics may be linked to measurable reductions in depression.

And every study showed a significant fall or improvement in anxiety symptoms and/or clinically relevant changes in biochemical measures of anxiety and/or depression with probiotic or combined pre-probiotic use.

Of the 12 different probiotics investigated, 11 were potentially useful, the findings showed.

The researchers highlight several caveats to their review: none of the included studies lasted very long; and the number of participants in each was small.

This makes it difficult to draw any firm conclusions about the overall effects, whether they are long lasting, and whether there might be any unwanted side effects associated with prolonged use, they say.

Nevertheless on the basis of the preliminary evidence to date, pre- and probiotic therapy warrant further investigation, they suggest.

Probiotics may help reduce the production of inflammatory chemicals, such as cytokines, as is the case in inflammatory bowel disease, suggest the researchers. Or they may help direct the action of tryptophan, a chemical thought to be important in the gut-brain axis in psychiatric disorders.

As anxiety disorders and depression affect people very differently, they require treatment approaches that take account of these complexities, they say. “In this way, with a better understanding of the mechanisms, probiotics may prove to be a useful tool across a wide range of conditions,” they write.

People with depression and/or anxiety disorders also often have other underlying conditions, such as impaired insulin production and irritable bowel syndrome, they point out.

“As such, the effect that probiotics have on patients with [common mental disorders] may be twofold: they may directly improve depression in line with the observed findings of this review, and/or they might beneficially impact a patient’s experience of their [common mental disorder] by alleviating additional comorbidities,” they write.

“Purely from the information gathered for this review, it is valid to suggest that, for patients with clinically recognised depression: isolate, or adjuvant prebiotic therapy is unlikely to affect an individual’s experience of their condition in a quantitatively evident way; and that isolate or adjuvant, probiotic/combined prebiotic-probiotic therapy may offer a quantitatively measurable improvement in parameters relating to depression,” they conclude.

“However, there are inadequate data to suggest anything meaningful to support or refute the use of either pre/probiotic agents (or a combination of both) in patients with clinically recognised anxiety disorders; this would be a useful area to investigate further.”

Source: BMJ

75 or Older? Statins Can Still Benefit Your Heart

Dennis Thompson wrote . . . . . . . . .

Older adults with healthy hearts probably would benefit from taking a cholesterol-lowering statin, a new study contends.

People 75 and older who were free of heart disease and prescribed a statin wound up with a 25% lower risk of death from any cause and a 20% lower risk of heart-related death, researchers reported July 7 in the Journal of the American Medical Association.

“Based on these data, age is not a reason to not prescribe statins,” said lead researcher Dr. Ariela Orkaby, a physician-scientist at the VA Boston Healthcare System and associate epidemiologist with Brigham and Women’s Hospital in Boston.

Statins are drugs used to prevent buildup of plaques that can narrow or block arteries, leading to heart attack and stroke.

Until recently, guidelines recommended halting statin therapy at age 75, said Dr. Mary Ann McLaughlin, medical director of the Cardiac Health Program at Mount Sinai Hospital in New York City.

“In 2018, the guidelines changed to say statins are a reasonable choice for those older than 75 without a life-limiting disease” like cancer or organ failure, she said.

This new study provides evidence that changing the guidelines to allow statin therapy to continue was the right move, said McLaughlin, who wasn’t part of the research.

“This age group is one of the fastest-growing groups,” she said. “The over-75 cohort is living even longer, and the first evidence of atherosclerotic disease or cardiovascular disease can be sudden death. There are many patients who are living very active and full lives into their late 80s and 90s these days.”

For this study, Orkaby’s team analyzed data from more than 300,000 veterans 75 or older who used VA health care services between 2002 and 2012. None had experienced a heart attack, stroke or other heart problem.

Of those vets, more than 57,000 started taking statins during that period. Researchers compared those who used statins against those who did not, and found that their risk of heart-related death was significantly lower.

The benefits remained for veterans at advanced ages, including those 90 or older, and also were strong among vets with dementia, results showed.

Patients on statins also had a lower risk of heart attacks and strokes, researchers said.

Because the study relied on VA data, the patients involved were overwhelmingly male (97%) and white (91%), McLaughlin noted.

But randomized clinical trials now underway will provide additional evidence about statin use in a broader mix of older people, Orkaby and McLaughlin said.

There’s been an age bias in statin clinical trials, because older folks tend to have more medical problems and including them can confuse the results, Orkaby said.

“Older adults usually have more than one thing going on,” she said. “It’s much easier to study people in their 50s who may just have high blood pressure or just have diabetes. When you’re running a big trial, you may not want to include people who are going to get hospitalized for some other issue — for example, because they fell.”

As a result, “almost all the data that exists right now for statins is in younger people, even though it’s really older adults who have the highest risk of having a heart attack or a stroke,” Orkaby said.

These new results indicate it’s time to stop discriminating based on age alone and saying there is no data to support statin use in older folks, she said.

“We have some reasonably good data to suggest that statins could save lives,” Orkaby said. “If you got to 75 and you weren’t yet put on a statin, you may actually be a healthier older adult who’s likely to live another 10 or 15 years. Those people may be the ones who would benefit the most from that, long-term.”

Source: HealthDay


Today’s Comic

Study: Started Early, Drug Combo Eases Fatigue of Rheumatoid Arthritis

Early and intensive treatment with methotrexate and prednisone can ease fatigue in people with rheumatoid arthritis (RA), according to a new study.

RA causes chronically inflamed joints and that inflammation can lead to severe fatigue that isn’t relieved by resting, according to the European League Against Rheumatism (EULAR).

“In addition to pain, profound fatigue reduces the quality of life for many people, even more than the swelling of the joints,” EULAR’s president, Iain McInnes, said in a league news release. He’s a professor of rheumatology at the University of Glasgow in Scotland.

But doctors often don’t pay enough attention to patients’ fatigue, he added.

“Up to 90% of patients with rheumatoid arthritis report profound fatigue,” said study author Diederik De Cock, a researcher at KU Leuven in Belgium.

His two-year study included 80 RA patients who began a drug regimen immediately after their diagnosis. They received either 15 mg of methotrexate a week (control group) or a combination therapy. The combo included 15 mg of methotrexate and 30 mg of cortisone (prednisone) weekly, which was eventually reduced to 5 mg a week.

Methotrexate suppresses RA-related inflammation, while prednisone eases joint pain and inflammation.

Patients who had intensive treatment with the drug combo for two years were less tired than those in the control group, even though both groups had similar disease activity over time, the study found.

Differences in fatigue levels between the two groups appeared to increase over time, according to the study.

“The early course of the disease could provide an opportunity to manage fatigue,” De Cock said in the release.

The study was presented as an abstract online for EULAR’s E-Congress 2020, which began earlier this month. Findings presented at meetings are typically viewed as preliminary until they’ve been published in a peer-reviewed journal.

Based on the findings, EULAR recommends early consideration of intensive treatment even in low-risk patients with RA.

RA affects about 1% people worldwide, according to EULAR.

Source: HealthDay

Breakthrough Discovery to Transform Prostate Cancer Treatment

Zytiga, the drug to treat prostate cancerA novel formulation of the prostate cancer drug abiraterone acetate – currently marketed as Zytiga – will dramatically improve the quality of life for people suffering from prostate cancer, as pre-clinical trials by the University of South Australia show the new formulation improves the drug’s effectiveness by 40 per cent.

Developed by Professor Clive Prestidge’s Nanostructure and Drug Delivery research group at UniSA’s Cancer Research Institute, the breakthrough discovery uses an oil-based oral formulation that not only enables a smaller dose of the drug to be effective, but also has the potential to dramatically reduce possible side effects, such as joint swelling and diarrhoea.

Despite Zytiga being the leading formulation to treat prostate cancer, lead researcher, Dr Hayley Schultz says the new formulation will ultimately provide a better treatment for patients with prostate cancer.

Prostate cancer is the most commonly diagnosed cancer in men, with one in six at risk of diagnosis before the age of 85.

In 2019, more than 19,500 cases of prostate cancer were diagnosed in Australia. Globally, prostate cancer cases reached 1.28 million in 2018.

“Many drugs are poorly water soluble, so when they’re ingested, they enter the gut but don’t dissolve, which means that their therapeutic effect is limited,” Dr Schultz says.

“This is the case for Zytiga. Here, only 10 per cent of the dose is absorbed, leaving the other 90 per cent undissolved, where it simply passes through the body as waste.

“On top of this, patients taking Zytiga must fast for two hours prior to taking the drug, and another hour after taking the drug to achieve predictable absorption. And as you can imagine, this can be painstakingly inconvenient.

“Our new formulation changes this. By using oils to mimic pharmaceutical food effects, we’re able to significantly increase the drug’s solubilisation and absorption, making it more effective and a far less invasive treatment for patients.”

The new formulation uses very high levels of abiraterone acetate dissolved within a specific oil and encapsulated within porous silica microparticles to form a powder that can be made into tablets or filled into capsules. Applied to human treatment, it could reduce the dose from 1000mg to 700mg per day, without the need for fasting.

Prof Prestidge says if the team can secure funding, clinical trials in humans could be just two years away.

“Based on our knowledge of this drug’s pharmaceutical food effect, we hypothesise its absorption in humans will be extensively improved using this technology”, Prof Prestidge says.

“Anything we can do to contribute to the development of a commercialised product to improve the lives of patients, is invaluable.

“This novel formulation is flexible enough to be adopted by thousands of different medicines; its potential to help patients of all kinds is exponential.”

Source: University of South Australia

Drug Might Relieve Low Back Pain in Whole New Way

Steven Reinberg wrote . . . . . . . . .

A new nonopioid pain reliever could be welcome news for people who have difficult-to-treat back pain.

Tanezumab is what’s called a monoclonal antibody. And it might offer extended relief from chronic lower back pain, a large, new study finds. However, a serious side effect remains a concern.

Tanezumab works differently from other treatments, as it blocks nerve growth factor, a protein that causes pain, researchers say.

“It appears that we are on the cusp of developing new drugs, which treat chronic pain by turning down the sensitivity of the nervous system, which is a whole new way of approaching the problem of chronic pain,” said lead researcher Dr. John Markman. He’s a professor of neurosurgery and neurology at the University of Rochester School of Medicine in New York.

“This is very important because we haven’t really had drugs with a new way of affecting chronic pain developed in maybe 100 years,” Markman said.

This phase 3 trial was funded by drugmakers Pfizer and Eli Lilly and Co. Twelve-hundred patients were randomly assigned to one of two doses of tanezumab or placebo. Another 600 patients received the opioid tramadol.

The higher dose of tanezumab reduced pain and also improved function, the researchers said.

Currently, opioid painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are the only medications for chronic lower back pain. But opioids can be addictive, and NSAIDs can cause serious gastrointestinal bleeding.

If these drugs don’t work, the alternative is spinal fusion surgery, and that’s not always effective, Markman said.

Tanezumab is given by injection about every two months. It has none of the side effects of opioids or NSAIDs.

It does, however, have one very serious side effect that affects up to more than 2% of patients. The drug has been linked to joint deterioration that may require joint replacement.

This concern is the major focus of the U.S. Food and Drug Administration’s current review of the drug as a treatment for chronic pain from severe osteoarthritis, Markman said.

The current study was done in 191 sites in eight countries in North America, Europe and Asia. It involved patients who did not get pain relief after trying at least three different pain drugs, including opioids.

Patients underwent treatment for a little over a year. At four months, patients taking 10 milligrams of tanezumab reported significantly more pain relief than those using the placebo.

Also, after four months, more patients taking the experimental drug reported pain relief than those taking tramadol.

Markman said the drug “is very promising and really represents a step forward.”

Lower back pain affects 80% of Americans, and in as many as 20% of cases can become chronic and debilitating and disruptive, said Dr. Yili Huang, director of pain management at Northwell Health Phelps Hospital in Sleepy Hollow, N.Y.

“Any potentially effective new treatment is truly exciting,” said Huang, who was not involved in the study.

Many of the currently available treatments for chronic lower back pain act on the same anti-inflammatory or opioid receptors, he said. “Treating a new target along the pain pathway can open the door to potentially safer and more effective treatments,” Huang noted.

Medical treatment of lower back pain is becoming increasingly challenging as many medications may have dangerous long-term side effects that can lead to cardiovascular disease, addiction, and kidney and liver disease, Huang said.

“The efficacy of tanezumab in treating pain in patients who have already failed treatment with these medications, including opioids, is very encouraging, but we must not discount the very small chance of it causing potentially devastating serious joint problems,” he said.

“Like all treatments, we must weigh the risks and benefits before proceeding, but it is a welcome addition to the treatment toolbox,” Huang added.

Because the drug doesn’t yet have FDA approval, Markman said it’s too early to estimate the cost. But like most new drugs, he said it will likely be expensive.

The report was published online in the journal Pain.

Source: HealthDay


Today’s Comic