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Content 7


The Doctor and the Pharmacist

Radio Show Articles:
June 29, 2013

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Probiotics May Alter Brain Activity Involving Emotional Regulation
Iodine Deficiency During Pregnancy and Adverse Cognitive Effects in Offspring
Lithium Reduces Suicide Risk in Mood Disorders
Higher Intake of Marine Omega-3 Fatty Acids Linked to Lower Breast Cancer Risk
New Silicone Breast Implant Approved
Use of Advanced Technologies in Low Risk Prostate Cancer on the Rise
Growing to Adulthood While Becoming Obese Increases Depression
Refining Estimates of Risk for Breast and Ovarian Cancer in BRCA1 and BRCA2

MM: We have discovered that probiotics have far-ranging beneficial properties from anti-inflammatory to enhancement of nutritional product absorption. Should it be a surprise that they would be mood enhancers too? I think not. Probiotics are an elemental life form that have been placed on this earth to allow organisms to thrive and adapt to their environments. Probiotics stabilize living organism systems and their environments. they need to be respected and they will work on our behalf to improve our quality of life. If they are abused or mismanaged we run the risk of creating problems similar to those that we created with the cavalier use of antibiotics. I believe that it is inappropriate to create artificial probiotics in the laboratory so that they may be patented. These artificial probiotics provide a possible competitive danger to those natural commensal microorganisms that are supposed to reside in our bodies.
Gastroenterology 2013 Jun; 144:1394
Probiotics May Alter Brain Activity Involving Emotional Regulation
Women who took probiotics for 4 weeks had altered activity in widespread parts of the brain, including those that regulate emotional and sensory responses.
Several recent studies suggest that gut microbiota may influence brain and emotional function. Now, researchers have conducted the first intervention trial in humans to test this hypothesis. Participants were 36 healthy women (mean age, 30) randomized to 4-week consumption of a fermented milk product containing four different probiotic bacteria species, 4-week consumption of a nonfermented milk product, or no intervention. To assess compliance, researchers analyzed stool samples to confirm the presence or absence of probiotic species in the intervention and control groups, respectively. Before and after the intervention, participants performed a validated emotional faces attention task in which they were shown faces depicting fear and anger, or control geometric forms, and asked to match them with one of two other faces (or forms). Their responses were assessed using functional magnetic resonance imaging. In response to the emotional faces, brain activity showed widespread decrease in the probiotic group, did not change in the nonfermented milk group, and showed widespread increase in the no-intervention group. Further analysis revealed that the probiotic concoction induced alteration in the resting state activity in the periaqueductal gray matter that was correlated with the response to the emotional faces task.
Comment:  Although the mechanisms of the effect are unclear, these findings indicate that ingestion of a fermented milk product containing probiotic bacteria can modulate brain activity. We will likely see an increasing number of trials testing whether probiotic administration can affect pain and emotional responses in both healthy individuals and patients with gut symptoms.
Citation(s): Tillisch K et al. Consumption of fermented milk production with probiotic modulates brain activity. Gastroenterology 2013 Jun; 144:1394.
Douglas K. Rex, MD reviewing Tillisch K et al. Gastroenterology 2013 Jun. Douglas K. Rex, MD
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MM: Iodine is a grossly misunderstood element and nutrient. Our bodies are very efficient at its removal and various environmental factors and nutritional mis-information may contribute to general public Iodine deficiency. Many people are under the misunderstanding that they can get an adequate Iodine supplementation from simple table salt. This is simply not true. A person must eat several teaspoonfuls of iodized salt to achieve a simple RDA of iodine. dd the stigma of eating "too much salt" to the mix and it's a wonder that a larger portion of the population is not iodine deficient. Supplements such as Iodoral are excellent for restoring iodine levels to appropriate points. Half a tablet daily is enough for most people to restore appropriate iodine levels in 3-6 months.
Lancet 2013 May 22
Iodine Deficiency During Pregnancy and Adverse Cognitive Effects in Offspring
Even mild deficiency in developed countries poses elevated risk
Iodine is an important component of thyroid hormone and essential for fetal brain development. Maternal iodine intake during pregnancy must be increased by 50% because of elevated maternal and fetal thyroid production. In developing countries, gestational iodine deficiency is the leading cause of preventable mental impairment. Recent changes in iodine content in dairy products and bread in the U.K. have led to moderate iodine deficiency in adolescent girls.
Researchers examined the association between mild iodine deficiency during pregnancy and cognitive development in children among 1040 mother–child pairs enrolled in a U.K. longitudinal observational study (56% of children in the original cohort). They analyzed maternal iodine concentrations from random urine samples collected during the first trimester and standardized measures of intelligence as well as reading ability in children at ages 8 to 9 years. The median urinary iodine concentration (91 µg/L) reflected mild-to-moderate iodine deficiency based on WHO criteria (<150 µg/L). After adjusting for social, economic, parental, and child confounders, children of women with iodine-to-creatinine ratios <150 µg/g were more likely to have scores in the lowest quartile for verbal IQ (odds ratio, 1.58), reading accuracy (OR, 1.69), and reading comprehension (OR, 1.54) than children of mothers with ratios >150 µg/g
Comment:  The observation that iodine insufficiency during pregnancy in a developed country is associated with adverse childhood cognitive outcomes is important. However, selection bias may have influenced the results. Editorialists note that iodine insufficiency in pregnant women in the U.K. probably results from limited availability of iodized salt and use of prenatal vitamins with iodine and insufficient recommendations for increasing iodine intake during pregnancy. Although consumption of iodized salt is more common in the U.S. and iodine is available in prenatal vitamins, the most recent National Health and Nutrition Examination Survey indicates that 37% of reproductive-aged women had urinary iodine values <100 μg/L (N Engl J Med 2009; 360:939). We need to pay more attention to this micronutrient in women of childbearing age to prevent low levels during pregnancy and the effect on fetal brain development
Citation(s): Bath SC et al. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: Results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet 2013 May 22; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S0140-6736(13)60436-5)
Stagnaro-Green A and Pearce EN. Iodine and pregnancy: A call to action. Lancet 2013 May 22; [e-pub ahead of print].
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Lithium Reduces Suicide Risk in Mood Disorders
By Joe Elia
Lithium is associated with significantly lower risk for suicide and all-cause mortality among both patients with unipolar depression and those with bipolar disorder, according to an updated meta-analysis in BMJ.The original analysis was published in 2005, and the update incorporates a total of some 50 trials including 6700 patients. The principal findings were that lithium was significantly more effective than placebo at reducing the odds of suicide (odds ratio, 0.13) and death from any cause (OR, 0.38) but not nonfatal self-harm (OR, 0.60; 95% CI, 0.27 to 1.32). A sensitivity analysis found the same results both in unipolar depression and bipolar disorder.The authors write that, given the 30-fold increased risk for suicide in these patients, "lithium should continue to have an important clinical role."
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MM: Once again we see the benefits of using omega 3 fish oil. I realize that many people are vegetarians for ethical reasons but fish oil should be one of the exceptions that are made. We all compromise with various aspects of our lives. vegetarian consumption of omega 3 rich fish oil should be one of those compromises.
Higher Intake of Marine Omega-3 Fatty Acids Linked to Lower Breast Cancer Risk
By Amy Orciari Herman
High intake of marine omega-3 polyunsaturated fatty acids, but not other types of omega-3s, is associated with reduced risk for breast cancer, according to a BMJ meta-analysis. Researchers examined data from 21 prospective studies comprising nearly 900,000 participants and 2100 cases of breast cancer. They found that the highest level of intake of marine omega-3s was associated with a significant 14% reduction in breast cancer risk, relative to the lowest intake. In addition, risk dropped by 5% with each 1 g/day increase in consumption. There was no association between breast cancer risk and intake of fish, alpha linoleic acid (a plant-based omega-3), or overall omega-3s.The researchers note that adjustment for body-mass index "greatly attenuated" the protective effect of marine omega-3s. Nonetheless, they call the risk reduction "biologically plausible," perhaps through an effect on molecules involved in cell growth and differentiation.
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MM: The FDA may state that breast implants are "not lifetime devices" but I can't ever remember knowing a patient who had either breast augmentation or post-surgical reconstruction that planned on having the product implanted so that she could have them removed in 10-20 years. This statement is blind stupidity.
New Silicone Breast Implant Approved
By Kristin J. Kelley
The FDA has approved a new silicone gel-filled breast implant — the agency's fifth such approval — for reconstruction in women of any age and for augmentation in women aged 22 and older.
The most frequently observed adverse outcomes for the new implant, marketed as MemoryShape, included asymmetry, capsular contracture, implant removal, and wrinkling. Fissures in the gel were also seen in some of the implants. Approval was based on 6 years' worth of data from nearly 1000 women.
The manufacturer will be required to conduct postapproval studies to assess long-term safety and efficacy and a 10-year follow-up on the women in the core study. The agency stressed that breast implants "are not lifetime devices" and require long-term monitoring.
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Use of Advanced Technologies in Low Risk Prostate Cancer on the Rise
By Amy Orciari Herman
The use of advanced treatment technologies for prostate cancer has nearly doubled among men who are least likely to benefit, a JAMA study finds.
Researchers examined Medicare data to compare the use of different prostate cancer treatments between 2004 and 2009. Some 56,000 men with new prostate cancer diagnoses were included; advanced treatment technologies were defined as intensity-modulated radiotherapy and robotic prostatectomy.
The use of advanced technologies for men with low-risk disease rose from 32% in 2004 to 44% in 2009; among men at high risk for death from other causes within 10 years, the use of these treatments increased from 36% to 57%. Overall, advanced technologies among men unlikely to die from prostate cancer rose from 13% to 24%.
The researchers conclude: "Continued efforts to differentiate indolent from aggressive disease and to improve the prediction of patient life expectancy may help reduce the use of advanced treatment technologies in this patient population."
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Am J Epidemiol 2013 Jun 9
Growing to Adulthood While Becoming Obese Increases Depression
Consistently obese young women and those who become obese have elevated risks for new-onset depression as they enter adulthood.
 Studies examining obesity as a potential risk factor for depression among adolescent girls have been inconclusive. To explore this possible association in slightly older women, investigators analyzed national study data collected from 5243 young women at two points (at ages 13–18 and 19–25).
Overall, 78% were not depressed at either point, 4% were depressed at both time points, 7% developed new-onset depression between the two points, and 11% recovered from depression after the first time point. In analyses adjusting for race/ethnicity, family income, family education, self-reported health, and pregnancy histories, risk for new-onset depression was elevated in consistently obese young women (odds ratio, 1.97) and in those who became obese (normal weight at first time point: OR, 2.10; overweight at first point: OR, 1.86), compared with never-overweight young women. Stressful life events did not alter these risks. Consistently obese young women had elevated risks for consistent depression (i.e., at both points), but poor self-reported physical health accounted for this finding. Initial depression was not associated with subsequent obesity. No links between obesity and depression were found in young men or older women.
Comment:  Although these data cannot reveal other factors mediating the relationships between developing obesity and new-onset depression, the data suggest sex-linked vulnerabilities. Determining whether these findings are “culture-bound” requires studies in other cultures where female obesity is less stigmatized than in ours. Clinicians treating obese young women or those developing obesity should foster lifestyle changes and psychosocial interventions that might reduce depression risk
Citation(s): Frisco ML et al. Weight change and depression among US young women during the transition to adulthood. Am J Epidemiol 2013 Jun 9; [e-pub ahead of print].
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Natl Cancer Inst 2013 Jun 5; 105:812
Refining Estimates of Risk for Breast and Ovarian Cancer in BRCA1 and BRCA2
The largest-ever prospective study sheds light on the magnitude of risk and predictive influence of breast cancer susceptibility alleles
Several studies have addressed risk for breast cancer (BC) and ovarian cancer (OC) in BRCA1 and BRCA2 carriers, but most have been retrospective, yielding large variations in estimated risks. Now, U.K. investigators have conducted a large, prospective study of risk for BC and OC in a cohort of 978 BRCA1 carriers and 909 BRCA2 carriers.
Several single nucleotide polymorphisms (SNPs) affect breast cancer risk. Eleven of these were selected and risk scores were calculated for BRCA1 and BRCA2 carriers. Among BRCA1 carriers, average cumulative risk by age 70 was 60% for BC, 83% for contralateral BC, and 59% for OC. In BRCA2 carriers, cumulative risks were 55% for BC, 62% for contralateral BC, and 16% for OC. BC incidence peaked at age 50 to 59 in BRCA1 carriers and at age 40 to 49 in BRCA2 carriers. BC risk estimates were higher when follow-up stopped at oophorectomy. OC incidence peaked at age 60 to 69 in both BRCA1 and BRCA2 carriers. Among BRCA2 carriers, cumulative risk for BC by age 70 was 72% for those in the highest SNP-based risk tertile versus 20% for those in the lowest tertile
Comment:  This study is the largest of its kind, and may help clinicians assess risk for breast cancer and ovarian cancer in BRCA1/2 carriers. However, because factors such as oophorectomy, family history, and age can alter these risks, clinicians should take all of these factors into account when counseling their patients. Lastly, recent work has shown that other single nucleotide polymorphisms can also substantially alter risk estimates for BC in women with BRCA1/2 mutations (PLoS Genet 2013; e1003212). More studies are needed to incorporate these SNPs into clinical practice.
Citation(s): Mavaddat N et al. Cancer risks for BRCA1 and BRCA2 mutation carriers: Results from prospective analysis of EMBRACE. J Natl Cancer Inst 2013 Jun 5; 105:812.

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