A long-running study questions the conventional wisdom that a healthy diet may help ward off dementia.
European researchers followed more than 8,200 middle-aged adults for 25 years -- looking at whether diet habits swayed the odds of being diagnosed with dementia. In the end, people who ate their fruits and vegetables were at no lower risk than those who favored sweets and steaks.
The findings, published March 12 in the Journal of the American Medical Association, stand in stark contrast to many past studies.
Those studies have linked heart-healthy diets to lower odds of mental decline and abnormalities in the brain that can foretell dementia. Currently, groups like the Alzheimer's Association suggest that people adopt those diets as one potential way to stave off dementia.
Most studies, though, have followed people for only a fairly short time -- less than 10 years, said lead researcher Tasnime Akbaraly, from the French national research institute INSERM.
This study is the first to look at diet quality starting in middle age and the long-term risk of dementia, explained Akbaraly.
Her team found that 344 people were diagnosed with Alzheimer's over the quarter-century they were followed. And the rates were similar among the one-third of study participants with the "best" diet quality and the one-third with the "worst."
People in that first group typically had several servings of fruits, vegetables and whole grains every day; at least a couple servings of nuts and legumes each week; regularly had unsaturated fats, like olive oil; and put limits on red meat, sodium and sugary drinks.
No one is advising people to give up on that type of eating, however.
"I would certainly not want anyone to come away from this thinking a healthy diet is futile," said Keith Fargo, director of scientific programs and outreach for the Alzheimer's Association.
"This study has to be viewed within the context of the larger scientific literature on diet and cognition -- which does suggest there's a benefit [from healthy eating]," said Fargo, who was not involved in the study.
According to the Alzheimer's Association, the best evidence is for two heart-healthy diets: the traditional Mediterranean diet and the DASH diet -- which is a standard recommendation for lowering high blood pressure.
The diets differ, but both emphasize a familiar refrain: Get plenty of fruits, vegetables, legumes, fiber-rich grains, "good" fats, and fish and poultry -- and limit red meat, sweets and added salt.
Akbaraly also stressed that her findings do not imply "diet doesn't matter."
For one, diet clearly is vital to overall health -- physical and mental. Akbaraly noted that in an earlier study of this same group, middle-aged adults with the healthiest diets had a lower risk of depression over the next two-plus decades.
And, she said, these findings still leave many questions unanswered -- such as whether diet is more powerful when combined with other lifestyle measures, like regular exercise.
In reality, Fargo said, studies like this one -- which ask people about their usual lifestyle habits -- cannot answer the major question: Will changing my diet -- or any other habit -- lower my risk of dementia?
"You can't rely on observational studies like this to tell you what to do," Fargo said, because they do not prove cause and effect.
More definitive answers, he said, come from clinical trials -- which randomly assign people to adopt a lifestyle change or not.
The Alzheimer's Association is sponsoring an ongoing trial that is testing the effects of diet changes along with other measures -- including exercise and mental-stimulating activities. It is focusing on older adults at increased risk of mental decline.
Saturday, 15 June 2019
ADHD Meds Safe With Epilepsy, Study Finds
Attention-deficit/hyperactivity disorder (ADHD) often occurs in people with epilepsy. Now, new research provides reassurance that taking ADHD medications won't raise their risk of seizures.
For the study, researchers analyzed data from thousands of epilepsy patients in Sweden. Taking ADHD medications such as Ritalin (methylphenidate), was associated with a 27 percent reduction in seizures, compared with not taking the medications, the investigators found.
"When you compare risk between individuals, there's a lot of factors that might explain associations that have nothing to do with the medication itself," said study author Kelsey Wiggs, a Ph.D. candidate at Indiana University, in Bloomington.
The study was published online recently in the journal Epilepsia.
"It's a good feature of this study that we were able to compare the same individual on and off the medication -- we could rule out a lot of other confounders," Wiggs said in a journal news release.
Another expert said the results are reassuring.
"This study provides another piece of evidence that medications for kids with ADHD do not increase the risk for seizures," said Kimford Meador, a professor of neurology and neurosciences at Stanford University.
"I think that physicians should feel safe prescribing these medications within standard doses," said Meador, who was not involved in the study.
Another expert, Torbjorn Tomson, a professor of neurology and epileptology at the Karolinska Institute in Stockholm, pointed out in the news release that people with epilepsy are often denied effective treatment for their psychiatric conditions out of fear the medications might negatively affect seizure control.
A study published last year in the journal Neurology found no evidence that taking ADHD medication increased seizure risk in people with and without epilepsy. The findings were based on data from more than 800,000 people in the United States.
Approximately 9 percent of children aged 2 to 17 have had an ADHD diagnosis, according to the U.S. Centers for Disease Control and Prevention. And ADHD is more common in people with epilepsy than in the general population. Among epilepsy patients, as many as half of children and 20 percent of adults have been diagnosed with ADHD, the researchers noted.
For the study, researchers analyzed data from thousands of epilepsy patients in Sweden. Taking ADHD medications such as Ritalin (methylphenidate), was associated with a 27 percent reduction in seizures, compared with not taking the medications, the investigators found.
"When you compare risk between individuals, there's a lot of factors that might explain associations that have nothing to do with the medication itself," said study author Kelsey Wiggs, a Ph.D. candidate at Indiana University, in Bloomington.
The study was published online recently in the journal Epilepsia.
"It's a good feature of this study that we were able to compare the same individual on and off the medication -- we could rule out a lot of other confounders," Wiggs said in a journal news release.
Another expert said the results are reassuring.
"This study provides another piece of evidence that medications for kids with ADHD do not increase the risk for seizures," said Kimford Meador, a professor of neurology and neurosciences at Stanford University.
"I think that physicians should feel safe prescribing these medications within standard doses," said Meador, who was not involved in the study.
Another expert, Torbjorn Tomson, a professor of neurology and epileptology at the Karolinska Institute in Stockholm, pointed out in the news release that people with epilepsy are often denied effective treatment for their psychiatric conditions out of fear the medications might negatively affect seizure control.
A study published last year in the journal Neurology found no evidence that taking ADHD medication increased seizure risk in people with and without epilepsy. The findings were based on data from more than 800,000 people in the United States.
Approximately 9 percent of children aged 2 to 17 have had an ADHD diagnosis, according to the U.S. Centers for Disease Control and Prevention. And ADHD is more common in people with epilepsy than in the general population. Among epilepsy patients, as many as half of children and 20 percent of adults have been diagnosed with ADHD, the researchers noted.
Bipolar Disorder a Risk Factor for Parkinson's?
Struggling with bipolar disorder is hard enough, but now a new study from Taiwan suggests these patients are seven times more likely to develop Parkinson's disease.
But U.S. experts cautioned that the absolute risk of developing Parkinson's -- an incurable movement disease -- is still very low for those with the mood disorder.
"I wasn't surprised [by the study's findings], because similar disorders like major depression and anxiety disorder convey a similar increased risk of Parkinson's later in life," said Dr. Gregory Pontone, director of the Parkinson's disease research center at Johns Hopkins Medicine in Baltimore.
"This gives you two reasons to treat bipolar disorder aggressively," he added.
Also known as manic-depressive illness, bipolar disorder is a mood disorder marked by swings from elated, energized behavior to feelings of sadness and hopelessness. It affects about 2.6% of American adults, according to the U.S. National Institute of Mental Health.
Parkinson's is a progressive condition causing tremors, rigid muscles and slowed movement, among other symptoms. By 2030, the Parkinson's Foundation projects 1.2 million Americans will be living with the disease.
For the study, researchers led by Dr. Mu-Hong Chen of Taipei Veterans General Hospital, reviewed health records for 56,000 people in Taiwan who were diagnosed with bipolar disorder between 2001 and 2009. They were compared to 225,000 people with no history of bipolar or Parkinson's. Both groups were tracked until late 2011.
During the study period, 372 people with bipolar disorder -- or 0.7% -- developed Parkinson's. This compared to 222 -- or 0.1% -- of those who didn't have bipolar disorder.
Those with bipolar who developed Parkinson's were nine years younger -- average age 64 -- than others who also developed Parkinson's, the study found.
"When you say there's seven times the risk, it gets scary. But it's still very few [bipolar] patients who get Parkinson's," said Dr. Justin Martello, who reviewed the findings. He's a neurologist specializing in movement disorders and Parkinson's disease at Christiana Care Health System in Wilmington, Del.
Martello pointed out that while the study was large, it was limited by including only people in Taiwan.
"We don't know how this would apply more globally or broadly," Martello said. "I think it's more interesting for physicians to know this and be more aware of the association."
The study was published online May 22 in the journal Neurology.
Pontone, who cowrote an accompanying editorial, and Martello said scientists have many theories -- still unproven -- about how bipolar disorder might be connected to the development of Parkinson's.
"A depressive or manic episode may do something to the brain that renders it more vulnerable" to Parkinson's over time, Pontone said.
And Martello noted that many medications used to treat bipolar disorder can trigger Parkinson's-like symptoms.
Many experts think Parkinson's is active years or decades before movement problems show up, and mood disorders such as bipolar may actually be an early symptom of Parkinson's, Pontone and Martello said.
Much more research is still needed, they agreed.
"We definitely need to look more at a global population," Martello said. "The researchers here did follow patients for 10 years, but it needs to be extended longer to see how many of these patients convert to Parkinson's down the road."
But U.S. experts cautioned that the absolute risk of developing Parkinson's -- an incurable movement disease -- is still very low for those with the mood disorder.
"I wasn't surprised [by the study's findings], because similar disorders like major depression and anxiety disorder convey a similar increased risk of Parkinson's later in life," said Dr. Gregory Pontone, director of the Parkinson's disease research center at Johns Hopkins Medicine in Baltimore.
"This gives you two reasons to treat bipolar disorder aggressively," he added.
Also known as manic-depressive illness, bipolar disorder is a mood disorder marked by swings from elated, energized behavior to feelings of sadness and hopelessness. It affects about 2.6% of American adults, according to the U.S. National Institute of Mental Health.
Parkinson's is a progressive condition causing tremors, rigid muscles and slowed movement, among other symptoms. By 2030, the Parkinson's Foundation projects 1.2 million Americans will be living with the disease.
For the study, researchers led by Dr. Mu-Hong Chen of Taipei Veterans General Hospital, reviewed health records for 56,000 people in Taiwan who were diagnosed with bipolar disorder between 2001 and 2009. They were compared to 225,000 people with no history of bipolar or Parkinson's. Both groups were tracked until late 2011.
During the study period, 372 people with bipolar disorder -- or 0.7% -- developed Parkinson's. This compared to 222 -- or 0.1% -- of those who didn't have bipolar disorder.
Those with bipolar who developed Parkinson's were nine years younger -- average age 64 -- than others who also developed Parkinson's, the study found.
"When you say there's seven times the risk, it gets scary. But it's still very few [bipolar] patients who get Parkinson's," said Dr. Justin Martello, who reviewed the findings. He's a neurologist specializing in movement disorders and Parkinson's disease at Christiana Care Health System in Wilmington, Del.
Martello pointed out that while the study was large, it was limited by including only people in Taiwan.
"We don't know how this would apply more globally or broadly," Martello said. "I think it's more interesting for physicians to know this and be more aware of the association."
The study was published online May 22 in the journal Neurology.
Pontone, who cowrote an accompanying editorial, and Martello said scientists have many theories -- still unproven -- about how bipolar disorder might be connected to the development of Parkinson's.
"A depressive or manic episode may do something to the brain that renders it more vulnerable" to Parkinson's over time, Pontone said.
And Martello noted that many medications used to treat bipolar disorder can trigger Parkinson's-like symptoms.
Many experts think Parkinson's is active years or decades before movement problems show up, and mood disorders such as bipolar may actually be an early symptom of Parkinson's, Pontone and Martello said.
Much more research is still needed, they agreed.
"We definitely need to look more at a global population," Martello said. "The researchers here did follow patients for 10 years, but it needs to be extended longer to see how many of these patients convert to Parkinson's down the road."
Health Tip: Causes of Swollen Lymph Nodes
-- Swollen lymph nodes often occur after exposure to bacteria or viruses, says Mayo Clinic.
Common triggers include:
Strep throat.
Measles.
Ear infection.
An abscessed tooth.
Mononucleosis.
Skin infection.
To diagnose what might be causing your swollen lymph nodes, visit your doctor.
Friday, 14 June 2019
Colon Cancer Screenings Increase When Medicaid Arrives
There were greater increases in colon cancer screening rates in states that expanded Medicaid than in those that did not, a new study finds.
It also found that expansion resulted in hundreds of thousands more people getting screened for colon cancer through colonoscopy, stool testing or sigmoidoscopy.
"Health insurance is a strong predictor of cancer screening, and the uninsured and those with lower socioeconomic status are more likely to be diagnosed at late stage and die from screen-detectable cancers, including colorectal cancer," study leader Stacey Fedewa said in an American Cancer Society news release. Fedewa is senior principal scientist for the society's Surveillance and Health Services Research.
The Affordable Care Act let states expand Medicaid insurance coverage to low-income adults, who tend to have poor access to preventive health services.
Five states and the District of Columbia were very early adopters and expanded Medicaid eligibility in 2010-2011. Another 21 states expanded Medicaid in 2014, five states expanded in 2015-2016, and 19 states did not expand.
American Cancer Society researchers analyzed data from the U.S. Centers for Disease Control and Prevention and found that in states that were very early adopters of the expansion, the rate of low-income adults ages 50-64 who were up to date with colon cancer screening rose from 42.3% in 2012 to 51.1% in 2016.
Rates increased from 49.6% to 52.5% in states that expanded Medicaid between 2014 and 2016, and from 44.2% to 48% in non-expansion states.
Rates of recent colon cancer screening (in the past two years) increased from 30.1% to 38.1% in very early adopters and from 29.1% to 31.8% in non-expansion states.
The increase in screening rates in very early adopters led to nearly 236,600 additional low-income adults with recent colon cancer screening in 2016.
If the same increase had occurred in non-expansion states, more than 355,000 more low-income adults would have had recent colon cancer screening, according to Fedewa and her colleagues.
The report also found that breast cancer screening increased only modestly among low-income women in the states that expanded Medicaid coverage.
But the authors say that there is more widespread support for mammography in low-income populations through programs like the CDC's National Breast and Cervical Cancer Early Detection Program, as well as programs offered by nonprofits and mobile mammography clinics.
Also, they added, mammography is cheaper and requires less preparation than colon cancer tests.
The study was published online May 22 in the American Journal of Preventive Medicine.
It also found that expansion resulted in hundreds of thousands more people getting screened for colon cancer through colonoscopy, stool testing or sigmoidoscopy.
"Health insurance is a strong predictor of cancer screening, and the uninsured and those with lower socioeconomic status are more likely to be diagnosed at late stage and die from screen-detectable cancers, including colorectal cancer," study leader Stacey Fedewa said in an American Cancer Society news release. Fedewa is senior principal scientist for the society's Surveillance and Health Services Research.
The Affordable Care Act let states expand Medicaid insurance coverage to low-income adults, who tend to have poor access to preventive health services.
Five states and the District of Columbia were very early adopters and expanded Medicaid eligibility in 2010-2011. Another 21 states expanded Medicaid in 2014, five states expanded in 2015-2016, and 19 states did not expand.
American Cancer Society researchers analyzed data from the U.S. Centers for Disease Control and Prevention and found that in states that were very early adopters of the expansion, the rate of low-income adults ages 50-64 who were up to date with colon cancer screening rose from 42.3% in 2012 to 51.1% in 2016.
Rates increased from 49.6% to 52.5% in states that expanded Medicaid between 2014 and 2016, and from 44.2% to 48% in non-expansion states.
Rates of recent colon cancer screening (in the past two years) increased from 30.1% to 38.1% in very early adopters and from 29.1% to 31.8% in non-expansion states.
The increase in screening rates in very early adopters led to nearly 236,600 additional low-income adults with recent colon cancer screening in 2016.
If the same increase had occurred in non-expansion states, more than 355,000 more low-income adults would have had recent colon cancer screening, according to Fedewa and her colleagues.
The report also found that breast cancer screening increased only modestly among low-income women in the states that expanded Medicaid coverage.
But the authors say that there is more widespread support for mammography in low-income populations through programs like the CDC's National Breast and Cervical Cancer Early Detection Program, as well as programs offered by nonprofits and mobile mammography clinics.
Also, they added, mammography is cheaper and requires less preparation than colon cancer tests.
The study was published online May 22 in the American Journal of Preventive Medicine.
FDA Warns of Infections From Fecal Transplants After 1 Death
Fecal transplants -- transferring fecal matter from a healthy person into an ill person with a compromised "microbiome" -- is an increasingly used new treatment for a variety of ills.
But on Thursday federal health officials announced that a patient died after such a procedure, highlighting the potential for severe infections linked to fecal transplants.
"While we support this area of scientific discovery, it's important to note that fecal microbiota for transplantation does not come without risk," said Dr. Peter Marks, director the Center for Biologics Evaluation and Research at the U.S. Food and Drug Administration.
After reports of serious, antibiotic-resistant infections linked to the procedures, the FDA wants "to alert all health care professionals who administer FMT [fecal microbiota transplant] about this potential serious risk so they can inform their patients," Marks said in an agency news release.
Fecal microbiota transplant is a still-experimental procedure, as yet unapproved by the FDA. It's been primarily used to treat serious infections of antibiotic-resistant forms of the Clostridium difficile (C. difficile) bacterium.
The transplant involves taking stool from a healthy donor and placing it in the ill patient's colon. The aim is to help replace an unhealthy "microbiome" -- the trillions of bacteria that reside in the human gut -- with a more robust, disease-fighting microbiome from the donor.
Once delivered via the fecal transplant, this new microbiome repopulates the patient's microbiome with healthier microorganisms, which effectively crowd out dangerous C. difficile.
Researchers are also looking into the use of fecal transplants to treat chronic gastrointestinal illnesses such as ulcerative colitis or irritable bowel syndrome.
But every therapy comes with risks, and the FDA said that two patients who received fecal microbiota transplants as part of a clinical trial developed life-threatening infections from multidrug-resistant bacteria delivered in the transplants. One of the patients has died.
Both patients had weakened immune systems, making them more vulnerable to germs that are resistant to multiple antibiotics. So, the FDA is now mandating that special screening and testing of the stool used in these procedures be done, to ensure that no drug-resistant bacteria are in the donated material.
Also, when fecal microbiota transplants are used, doctors need to have adequate informed consent from the patient, the FDA said. Patients need to be warned of any potential risks associated with the treatment and be told that the treatment is still considered experimental.
Marks stressed that the FDA still supports research into fecal transplant therapy.
"The medical community is actively engaged in exploring the potential uses of fecal microbiota for transplantation," he said. Although the therapy isn't approved by the FDA, the agency supports the use of this treatment and is looking to "strike a balance between assuring patient safety and facilitating access to unapproved treatments for unmet medical needs," Marks said.
To that end, "we will continue to aggressively monitor clinical trials to ensure patients are protected when safety concerns arise," Marks said.
But on Thursday federal health officials announced that a patient died after such a procedure, highlighting the potential for severe infections linked to fecal transplants.
"While we support this area of scientific discovery, it's important to note that fecal microbiota for transplantation does not come without risk," said Dr. Peter Marks, director the Center for Biologics Evaluation and Research at the U.S. Food and Drug Administration.
After reports of serious, antibiotic-resistant infections linked to the procedures, the FDA wants "to alert all health care professionals who administer FMT [fecal microbiota transplant] about this potential serious risk so they can inform their patients," Marks said in an agency news release.
Fecal microbiota transplant is a still-experimental procedure, as yet unapproved by the FDA. It's been primarily used to treat serious infections of antibiotic-resistant forms of the Clostridium difficile (C. difficile) bacterium.
The transplant involves taking stool from a healthy donor and placing it in the ill patient's colon. The aim is to help replace an unhealthy "microbiome" -- the trillions of bacteria that reside in the human gut -- with a more robust, disease-fighting microbiome from the donor.
Once delivered via the fecal transplant, this new microbiome repopulates the patient's microbiome with healthier microorganisms, which effectively crowd out dangerous C. difficile.
Researchers are also looking into the use of fecal transplants to treat chronic gastrointestinal illnesses such as ulcerative colitis or irritable bowel syndrome.
But every therapy comes with risks, and the FDA said that two patients who received fecal microbiota transplants as part of a clinical trial developed life-threatening infections from multidrug-resistant bacteria delivered in the transplants. One of the patients has died.
Both patients had weakened immune systems, making them more vulnerable to germs that are resistant to multiple antibiotics. So, the FDA is now mandating that special screening and testing of the stool used in these procedures be done, to ensure that no drug-resistant bacteria are in the donated material.
Also, when fecal microbiota transplants are used, doctors need to have adequate informed consent from the patient, the FDA said. Patients need to be warned of any potential risks associated with the treatment and be told that the treatment is still considered experimental.
Marks stressed that the FDA still supports research into fecal transplant therapy.
"The medical community is actively engaged in exploring the potential uses of fecal microbiota for transplantation," he said. Although the therapy isn't approved by the FDA, the agency supports the use of this treatment and is looking to "strike a balance between assuring patient safety and facilitating access to unapproved treatments for unmet medical needs," Marks said.
To that end, "we will continue to aggressively monitor clinical trials to ensure patients are protected when safety concerns arise," Marks said.
Turn Up the Heat With Healthy Hot Chili Peppers
Red or green, sweet or hot, peppers are a great source of vitamins A, C, E and many of the B vitamins, plus minerals like calcium, iron and potassium.
These and other nutrients are jammed into a low-calorie "package" that's perfect for stuffing with other healthful foods. Chili peppers, such as jalapenos and serranos, also add zesty spice to dishes. They get their heat from a special compound called capsaicin that may also have health properties, including pain relief. (All peppers except bell peppers contain some capsaicin.)
When shopping for peppers, look for firm, unblemished skins with no soft spots. Store them in produce bags in the fridge for up to three days.
One of the tastiest Mexican chili peppers is the poblano. It looks similar to a green bell pepper, but has a slightly darker skin, longer shape and spicier, deeper flavor. Like bell peppers, poblanos can be heartily stuffed to make a complete meal. Here's a meatless recipe that delivers on flavor as well as satisfaction.
Stuffed Poblanos
4 poblano chili peppers
4 cups baby spinach or 10-ounce package of frozen spinach, thawed
1/4 cup raisins, red or golden
2 tablespoons pine nuts or chopped walnuts
4 tablespoons mild or medium salsa
1 cup grated Colby or Jack cheese
Roast poblanos under the broiler on an ungreased baking tray for three to four minutes, turning often until their skins start to blacken and blister. Transfer the peppers to a glass bowl and cover with plastic wrap to loosen the skins. When cool, remove skins and place chili peppers in a baking dish.
Steam spinach if using fresh and chop coarsely. Combine with raisins and nuts, and use mixture to stuff chili peppers. Top with salsa and grated cheese.
Place under the broiler for one minute to melt the cheese. Serve immediately.
Yield: 4 servings
These and other nutrients are jammed into a low-calorie "package" that's perfect for stuffing with other healthful foods. Chili peppers, such as jalapenos and serranos, also add zesty spice to dishes. They get their heat from a special compound called capsaicin that may also have health properties, including pain relief. (All peppers except bell peppers contain some capsaicin.)
When shopping for peppers, look for firm, unblemished skins with no soft spots. Store them in produce bags in the fridge for up to three days.
One of the tastiest Mexican chili peppers is the poblano. It looks similar to a green bell pepper, but has a slightly darker skin, longer shape and spicier, deeper flavor. Like bell peppers, poblanos can be heartily stuffed to make a complete meal. Here's a meatless recipe that delivers on flavor as well as satisfaction.
Stuffed Poblanos
4 poblano chili peppers
4 cups baby spinach or 10-ounce package of frozen spinach, thawed
1/4 cup raisins, red or golden
2 tablespoons pine nuts or chopped walnuts
4 tablespoons mild or medium salsa
1 cup grated Colby or Jack cheese
Roast poblanos under the broiler on an ungreased baking tray for three to four minutes, turning often until their skins start to blacken and blister. Transfer the peppers to a glass bowl and cover with plastic wrap to loosen the skins. When cool, remove skins and place chili peppers in a baking dish.
Steam spinach if using fresh and chop coarsely. Combine with raisins and nuts, and use mixture to stuff chili peppers. Top with salsa and grated cheese.
Place under the broiler for one minute to melt the cheese. Serve immediately.
Yield: 4 servings
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