The old story about drinking eight glasses of water a day for overall health has been a topic for debate.

But research over the years has suggested that drinking extra water helps the kidneys clear sodium, urea and toxins from the body. And in the past year, two large studies found a lower risk of long-term kidney problems among people who drink more water and other fluids daily.

In a report published in the journal Nephrology in March, researchers at the University of Sydney in Australia and elsewhere followed more than 2,400 people older than 50. Those who drank the most fluids, about three liters daily, had a "significantly lower risk" of chronic kidney disease than those who drank the least.

And in a study published last month in The Clinical Journal of the American Society of Nephrology, Canadian scientists followed 2,148 healthy men and women, average age 46, for seven years. They looked at markers of kidney function and health and used urine volume to determine how much fluid the subjects drank daily. After controlling for diabetes, smoking, medication and other factors, they found that those who had the highest urine volume — in other words, those who drank the most fluids were least susceptible to declines in kidney function.

The findings, the authors said, do not support “aggressive fluid loading,” which can cause side effects. But they do provide evidence that moderately increased fluid intake, above two liters daily, “may in fact benefit the kidney.”

“Believe it or not, there now does seem to be some merit and evidence to support the ‘myth’ that eight large glasses of fluid a day is good for your kidneys,” said Dr. William Clark, an author of the study and a nephrologist at the London Health Sciences Center in Ontario.

THE BOTTOM LINE
A moderately increased intake of fluids may protect the kidneys.

If you would like more information, please call the office of Dr. Gregory Cohen at Westside Preventive Medicine at 310-231-9500 for an appointment.

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Sugary Drinks May Increase Heart, Diabetes Risk In Women, Even Of Normal Weight

Women who drink two or more sugary drinks a day, even if they are of normal weight, appear to be at higher risk of heart disease and diabetes, according to a new study presented to the American Heart Association's (AHA's) Scientific Sessions 2011.

Sugar-sweetened drinks includes beverages such as carbonated sodas or flavored waters with added sugar.

Previous studies have examined and found links between drinking sugar-sweetened beverages and obesity, high blood fats, high blood pressure, and type 2 diabetes. But studies following large, ethnically diverse populations looking at links with cardiovascular risk factors are sparse, said the researchers.

Lead author Dr. Christina Shay, an assistant professor at the University of Oklahoma Health Sciences Center in Oklahoma City and colleagues, compared middle-aged and older women who consumed two or more sugar-sweetened drinks to women who drank one or less a day.

They found that women who drank two or more such drinks a day were significantly more likely to develop larger waists and have impaired fasting levels of glucose. They were also nearly four times as likely to develop high triglycerides, a type of blood fat linked to increased risk of heart disease.

Dr. Shay said: "Women who drank more than two sugar-sweetened drinks a day had increasing waist sizes, but weren't necessarily gaining weight. These women also developed high triglycerides, and women with normal blood glucose levels more frequently went from having a low risk to a high risk of developing diabetes over time."

"Most people assume that individuals who consume a lot of sugar-sweetened drinks have an increase in obesity, which in turn, increases their risk for heart disease and diabetes. Although this does occur, this study showed that risk factors for heart disease and stroke developed even when the women didn't gain weight," she added.

For the study, Shay and colleagues examined data from 4,166 African-American, Caucasian, Chinese-Americans and Hispanic adults who took part in the the Multi-Ethnic Study of Atherosclerosis (MESA). The participants, aged from 45 to 84 years, had completed food-frequency questionnaires when the study started in 2000-2002.

During five years of follow-up, the participants underwent three exams from which the researchers were able to assess changes in body weight, waist size, levels of high density lipoproteins (HDL "good" cholesterol), levels of low density lipoproteins (LDL "bad" cholesterol), triglycerides, levels of fasting glucose, and presence of type 2 diabetes.

The study was conducted at Northwestern University's Department of Preventive Medicine in Chicago.

But exactly how such drinks influence cardiovascular risk, what biological mechanisms might be involved, is still somewhat unclear and warrants further investigation, said the researchers, who are planning to do just that.

Funds from the National Heart, Lung, and Blood Institute helped pay for the study.

If you would like more information, please call the office of Dr. Gregory Cohen at Westside Preventive Medicine at 310-231-9500 for an appointment.

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Eating Fish Can Reduce Risk of Diabetes

A recent study analysis of the dietary patterns of the adult Spanish population with high cardiovascular risk, revealed a high consumption of both red meat and fish. However, while eating lots of cured meats is associated with greater weight gain and a higher obesity rate, the consumption of fish is linked to lower glucose concentrations and a smaller risk of developing diabetes.

Mercedes Sotos Prieto, lead author of the study which forms part of the Predimed study (Prevention with a Mediterranean Diet) and researcher at the University of Valencia explains how in Mediterranean countries, consumption of foods that typically form part of the diet has decreased in recent decades. The consumption of saturated fats mainly from red meats and industrial baking has increased and this is really worrying.

Conducted in the Valencian Community on 945 people (340 men and 605 women) between 55 and 80 years of age and with a high cardiovascular risk, the aim of the study was to understand dietary patterns in terms of meat and fish consumption. It also sought to understand the correlation between the Mediterranean diet and its association with cardiovascular risk factors. The results were published in the Nutrición Hospitalaria journal and show that the studied Mediterranean population eat a large amount of red meat and fish. However, the consumption of fish is associated with a decreased prevalence of diabetes and lower glucose concentrations whereas the consumption of red meat, especially cured meats is related to increased weight gain and obesity.

The researcher points out that "the red meat consumption of the sample population reaches an average of once a day, which is high in comparison to dietary recommendations. This could be influenced by many weight-loss diets which recommend eating grilled veal."

Eating red meat in excess is linked to higher cardiovascular risk, higher blood pressure, diabetes and a moderate decrease in life expectancy mainly due to cancer and heart disease. In contrast, fish appears in the Mediterranean diet and has health benefits for the heart.

Despite being a cross-sectional study that does not determine a causal effect, its authors confirm that there are many similar studies where the consumption of fish, both white and, even more so oily fish, is associated with a lower risk of developing diabetes type 2. "Various hypotheses have been put forward that attempt to explain why the consumption of fish can be related to diabetes," they explain. "The increase of omega-3 in the cells of the skeletal muscles improves insulin sensitivity."

"It is important to understand the dietary patterns of the Spanish population in order to learn whether dietary habits are changing. We should therefore strengthen dietary education," outlines Mercedes Sotos Prieto, who goes on to say that "we ought to establish dietary intervention programmes so that we do not stray from the Mediterranean diet. In other words, such a diet involves decreasing the amount of red meat that we eat and maintaining equal levels of fish consumption."

The bottom line: Eat fish... it's good for you!

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Afternoon Sleepiness? Protein, Not Sugar, Keeps Us Awake

A new study finds that protein, not sugar, stimulates certain brain cells into keeping us awake, and also, by telling the body to burn calories, keeping us thin. Study leader Dr Denis Burdakov, from the University of Cambridge in the UK, and colleagues, write about their findings in the 17 November issue of Neuron. They suggest their discovery will increase understanding of obesity and sleep disorders.

Burdakov, from the Department of Pharmacology and Institute of Metabolic Science at Cambridge, told the media scientists had already established orexin cells in the brain send electrical signals that stimulate wakefulness and tell the body to use up energy. He and his co-authors wanted to take this further and find out if particular dietary nutrients influenced those signals:

"Sleep patterns, health, and body weight are intertwined. Shift work, as well as poor diet, can lead to obesity," he explained. "Electrical impulses emitted by orexin cells stimulate wakefulness and tell the body to burn calories. We wondered whether dietary nutrients alter those impulses."

Orexin cells in the brain's hypothalamus release a stimulant called orexin/hypocretin, which regulates energy balance, wakefulness and reward. We already know that loss of these unique cells results in narcolepsy and weight gain.

For their study, Burdakov and colleagues compared the effect of different nutrients on orexin cells. They discovered that amino acids, the building blocks of proteins, stimulated them much more than any other nutrients.

"We show that orx/hcrt cells are stimulated by nutritionally relevant mixtures of amino acids (AAs), both in brain slice patch-clamp experiments, and in c-Fos expression assays following central or peripheral administration of AAs to mice in vivo," they write.

To do this, they highlighted the rather elusive orexin cells by breeding mice genetically engineered to have orexin cells capable of fluorescing. They then introduced different nutrients, including amino acid mixtures similar to egg white, and tracked the orexin cell impulses by observing the fluorescence.

Work they had done before this study had already established that glucose blocked the activity of orexin cells, which had led to the idea that this was the cause of sleepiness after meals. So in this study they also looked at interactions between sugar and protein.

They found that amino acids prevented glucose from blocking the orexin cell activity:

"... the presence of physiological concentrations of AAs suppressed the glucose responses of orx/hcrt cells," they write.

In other words, it appears that protein counteracts the after-meal sleepiness induced by sugar or carbohydrate.

The researchers concluded that the orexin cells are sensitive to nutrient balance, rather than just the net calorie content of the fluid that surrounds them.

They suggest the findings help to explain why people seem to feel less calm and more alert after meals high in protein than after meals high in carbohydrates.

Burdakov said the results are exciting because it gives us a "rational" way to "tune" particular brain cells to be more or less active, just by changing the food we eat. It seems that some brain cells at least, respond to dietary composition, and not just to whether nutrients are present or not.

He said we need better information on how diet affects sleep and appetitle if we are to improve our ways of fighting obesity and insomnia in today's society:

"For now, research suggests that if you have a choice between jam on toast, or egg whites on toast, go for the latter!"

"Even though the two may contain the same number of calories, having a bit of protein will tell the body to burn more calories out of those consumed," he added.

Written by Catharine Paddock PhD

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Acne - Oral Antibiotics Raise Sore Throat Risk

Patients with acne who are prescribed oral antibiotics have a higher chance of developing pharyngitis (sore throat) symptoms than those who are not, researchers from the Perelman School of Medicine, University of Pennsylvania, Philadelphia, reported in Archives of Dermatology today. Pharyngitis means inflammation of the pharynx, causing sore throat.

The researchers explained as background information to the article:

"Many inconsistent concerns have been voiced about the safety of long-term use of antibiotics. Because of the high prevalence of acne and the frequent use of antibiotics to control acne, individuals undergoing therapy to treat their acne are an ideal group in which to study the effects of long-term antibiotic use."

David J. Margolis, M.D., Ph.D., and team carried out two studies - a longitudinal and a cross-sectional study - to determine whether antibiotic usage, specifically oral antibiotics, for acne treatment might be linked to pharyngitis. They also sought to find out whether oral antibiotics might be associated with group A streptococcus, a type of bacterium that causes most streptococcal illnesses. (GAS = Group A Streptococcus). Prior studies had demonstrated an association between oral antibiotic usage and higher GAS rates.

Both of the studies they assessed included college students. The participants had to complete a questionnaire, they were visually examined for signs of acne, and were swabbed for culture.

The Cross-Sectional Study

The researchers found:

15 students were receiving oral antibiotics for acne. 10 (66.6%) of them said they had an episode of pharyngitis during the previous 30 days.
130 students had acne but were not taking oral antibiotics. 47 of them said they had had an episode of pharyngitis during the previous 30 days.
When they combined all the 251 participants not taking oral antibiotics, 32.7% (82) said they had had an episode of pharyngitis during the previous 30 days. 2.1% (3) of the 145 with acne were colonized with GAS, but none of them had been taking antibiotics.

The Longitudinal Study

This study involved 358 female and 218 male students. Below are some data from the study:

36 (6.2%) of them took oral antibiotics for acne while the study was underway.
11.3% of them reported symptoms of pharyngitis.
96 (16.6%) of them took topical (medication you apply to skin) antibiotics for acne while the study was underway.
3.3% of them reported symptoms of pharyngitis. None of these participants were colonized by GAS.

In the journal the authors concluded in an Abstract:

"Our studies show that the odds of developing self-reported pharyngitis is more than three times baseline in patients receiving oral antibiotics for acne vs. the odds for those who are not receiving oral antibiotics. The true clinical importance of these findings needs to be evaluated further by prospective studies."

New Stent Type Has Rare But Potentially Serious Problem, FDA Investigates

The FDA says it is working with drug-eluting stent makers to better understand what makes the devices shrink or become deformed on rare occasions. A drug-eluting stent is a scaffold placed into narrowed, diseased peripheral or coronary arteries; it releases a medication to block cell proliferation, which helps prevent eventual reclogging of the blood vessel. The DES (drug-eluting stent) is placed during an angioplasty procedure.

The FDA (Food and Drug Administration) says it is working closely with Boston Scientific Corp. the makers of several devices, including the Ion and Promus. The Ion stent was approved by the FDA this year, while earlier in 2011 Boston submitted the Promus Element for approval.

The FDA said to Reuters news agency:

"FDA is actively working with (drug-eluting stent) manufacturers, including Boston Scientific, to better understand longitudinal stent deformation with respect to its causes, predisposing underlying anatomic conditions, operator techniques that can reduce the likelihood of its occurrence, and treatment strategies should it occur."

Boston Scientific is said to have over one third of the global market for DES; a market worth over $4 billion annually. It has nearly one half of the US market.

Earlier this month, stent deformation was discussed at the Transcatheter Cardiovascular Therapeutics meeting, San Francisco. There are some factors in patients which increase the risk of problems when receiving a stent, including improper positioning of the device, implanting it in a twisted blood vessel, and calcification of coronary arteries.

Human trials involving 4,600 participants who received a Promus stent reported only one case of longitudinal stent deformation, according to the FDA. However, the Agency added that a number of adverse events had been reported to it - the FDA did not specify how many.

The FDA wrote:

"At this time, additional data collection and analyses are ongoing, but the information available to date indicates that the Ion Paclitaxel-Eluting Platinum Chromium Stent remains safe and effective when used for its approved indications."

Some studies have indicated that some patients might be better off if they do exercise and take medications than have a DES implanted.

Heart stents are fragile devices. They are made of extremely thin metal, about 3/1000 of an inch thick and cannot withstand more than a certain amount of pressure. Even during implantation, the balloon that is used during an angioplasty procedure can catch on the device and deform it. Pushing on the stent can also make it lose its proper form.

Because so many thousands of people receive these types of stents in the USA each year, even a small risk of stent deformation can mean a sizeable number of people.

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Colchicine May Help Prevent Afib After Heart Surgery.

MedPage Today reported, "The oral agent colchicine -- a drug almost as old as the hills-- appears to offer a new way to prevent atrial fibrillation (Afib) after heart surgery," according to a study presented at the American Heart Association meeting and published in Circulation. Investigators found that "the relative risk of developing postop Afib was reduced 42.1% if patients were treated with colchicine rather than placebo (P=0.002)." The researchers found that "the incidence of atrial fibrillation at 12 months was 8.9% in patients given colchicine compared with 21.1% among patients randomized to placebo.

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Exercise, Stents May Be Better Than Usual Care For Claudication.

MedPage Today reported, "Compared with usual care for moderate to severe claudication, walking improved most with supervised exercise, but stenting won more quality-of-life points, researchers from the CLEVER trial found." Investigators reported that "the change from baseline in the peak walking time (the primary endpoint) at six months in the supervised exercise group was 4.6 minutes (P<0.001) and 2.5 minutes for those in the stenting group (P=0.02), compared with medical therapy alone." The research, published online in Circulation and presented at the American Heart Association meeting, indicated that "the difference in claudication onset time (a secondary endpoint) compared with usual care was 2.2 minutes for supervised exercise (P<0.003) and 2.9 minutes for stenting (P=0.006)."

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Soccer Teams Use Heart Rate Monitors To Modify Players' Fitness.

The New York Times (11/18, D6, Longman) reports, "Coaches estimate that 10 percent to 30 percent of college soccer teams use similar technology to customize workouts, help plan their lineups and substitution patterns, and rethink the hoary tenet that harder training is always the best training." The goal "is to calculate precisely that players are giving the desired effort during workouts and, just as important, to prevent them from overtraining and to limit their susceptibility to soft-tissue injuries that can arise from fatigue."

Article Examines Pros, Cons Of Moderate Alcohol Consumption.

The Los Angeles Times (11/21, Adams) discusses the pros and cons of alcohol consumption, noting that evidence suggests that having heavy drinking "had long been known to raise the risk of breast cancer" by "increasing the amount of estrogen and related hormones." However, moderate alcohol intake is linked to a larger "drop in risk for heart disease" than the accompanying rise "in risk for breast cancer." Since women have "a higher lifetime risk of developing cardiovascular disease than breast cancer," it is difficult to make a "blanket recommendation for women who are trying to balance a breast cancer risk against cardiovascular benefits." Other benefits to moderate drinking may be "lower rates of diabetes, dementia, arthritis, enlarged prostate, osteoporosis, gall bladder disease, and even some cancers, such as those of the kidney and thyroid."

Some Experts Say Limiting Treatment Choices Necessary For Controlling Health Costs.

In an opinion piece in USA Today (11/21), Emily Bazar, of the California HealthCare Foundation Center for Health Reporting, writes, "Health care systems, insurers and government agencies are using sophisticated data to identify doctors and hospitals operating outside medical norms," with the purpose of weaning physicians "off procedures that don't necessarily benefit patients. The result is a narrowing of doctors' treatment choices, but advocates say that's a necessary step" in controlling the cost of healthcare in the US. However, "many physicians adamantly oppose the idea of having their decision-making curtailed." According to Peter Carmel, MD, president of the American Medical Association, "treatment guidelines should come from doctors who have studied the evidence...not insurers, suppliers or others with a financial interest."

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More Than 20% Of Individuals With Heart Problems Are Not Receiving Statins.

Reuters (11/18, Thrasybule) reports that, according to a study published in Circulation, more than 20% of individuals with heart problems are not receiving statins, even though guidelines indicate that they should. Investigators looked at data on approximately 39,000 individuals who either had had a heart attack or had undergone heart surgery. The researchers found that roughly 8,600 of these people were not given a prescription for statins.

Children With Sunken Chest May Require Prompt Evaluation, Experts Say.

HealthDay(11/18, Preidt) reports, "Children with sunken chest require prompt evaluation to rule out more serious underlying conditions and to plan corrective surgery if necessary, according to experts." The condition "affects one in 300 to 400 children and is rarely life-threatening." HealthDay adds, "The main reason to perform surgery is to improve heart and lung function, not to improve appearance, Dr. Fizan Abdullah, a pediatric surgeon at Johns Hopkins Children's Center in Baltimore, explained in a Hopkins news release."

Psoriasis Associated With Changes In HDL Cholesterol.

HealthDay reports, "Inflammation caused by psoriasis may trigger changes in a person's cholesterol, including weakening the function of high-density lipoprotein (HDL), the 'good' cholesterol," according to two studies presented at the American Heart Association annual meeting. In the first study, "researchers measured cholesterol levels in 78 people with psoriasis and examined the number and size of the cholesterol particles," then compared those results to those of 84 people without psoriasis. "The investigators found that patients with psoriasis had a greater number of low-density lipoprotein (LDL), or 'bad' cholesterol particles unrelated to other risk factors or obesity." The second study found that "having psoriasis was associated with a reduction in the protective benefit of good cholesterol by about 25 percent."

Vitamin D Deficiency May Be Linked To Damaging Vascular Effects In Children.

MedPage Today reports, "Vitamin D deficiency may have damaging vascular effects in children with a high cardiovascular risk," according to a study presented at the American Heart Association meeting. Researchers found, "at a clinic for high-risk children and teens," that "those who had a serum 25-hydroxyvitamin D3 (25(OH)D) level less than 20 ng/mL had a significant reduction in carotid artery distensibility," although "the deficient children did not...have a higher average carotid artery intima-media thickness."

Long-Term Treatment With Epilepsy Medications May Accelerate Atherosclerosis.

MedPage Today (11/18, Pal) reports, "The duration of anti-epileptic monotherapy was associated with accelerated atherosclerosis, although individual drugs had different underlying mechanisms in epilepsy patients, according to a single-center study" published online Nov. 15 in Epilepsia. The researchers looked at epileptic patients taking four different older generation anti-epileptic drugs (AEDs). They were carbamazepine (CBZ) and phenytoin (PHT), valproic acid (VPA), and lamotrigine (LTG, Lamictal). The researchers found that "common carotid artery intima media thickness (IMT) in patients with epilepsy seemed to be positively correlated with the duration of AED therapy." However, no significant correlation was found with common carotid IMT and anti-epileptic treatment with LTG. The investigators said, "The results offer some guidelines to clinicians on choosing the best AED drug for a patient based on their vascular risk factors and age."

The American Heart Association recently announced the biggest threat to heart patients—and it's not cheese fries or stress. It is "patients' failure to take prescription medicines correctly."

Statistics suggest that if a doctor prescribes a drug to 100 patients, 12% of them won't fill the prescription, another 12% will fill it but not take a single pill, and 22% will stop taking the drug before the prescription runs out.

Skipped meds, needless heart attacks
When it comes to medications for the heart, skipping doses can be costly. It's estimated that thousands of Americans have avoidable heart attacks each year because they neglect to consistently take the cholesterol-lowering statins prescribed by their doctors. A 2007 study of heart patients suggested that skimping on prescribed medications can double the risk of heart attack, stroke, or other cardiovascular events.

Why heart patients skip doses
People have many reasons for skipping doses: forgetfulness, wariness of side effects, and the high cost of some medications, to name a few.

People who are depressed - and that includes up to 20% of heart disease patients—may take a "so what" attitude that makes it hard to stick to a treatment plan.

Heart medications can be especially easy to ignore or forget because most do their work silently. Since you can't feel your cholesterol dropping, you may not notice any obvious benefits of your medication.

Here are some strategies for remembering to take your drugs.

Make your medicine schedule as simple as possible. Plan times to take your medicines when you are doing other things, like eating or getting ready for bed.
Talk with your doctor if you are having problems with your medicine schedule. Your doctor may be able to change your medicines or the times you are taking them.
Talk with your doctor if you have any changes in your health that might affect your heart condition, such as side effects of medicines or a medical condition.
Use any tools, like daily or weekly pill containers, that make taking your medicines simpler.

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If you would like more information, please call the office of Dr. Gregory Cohen at Westside Preventive Medicine at 310-231-9500 for an appointment or use our Contact Page to send us an email.