Medicues

The Sleeping Pill Nation

Americans are using sleeping pills at an alarming rate.  Doctors gave out more than 56 million prescription for sleeping pills in 2008.
Why are Americans increasingly using medications to induce sleep?  There are many answers to this question.  First, insomnia is very common, it affects up to 40% of the population.  Chronic insomnia affects about 15% of adults.
Then add the fast pace and high stress pressures of society and you have people who just do not have time to relax and fall asleep.

Insomnia is really defined by a complaint of the quality or amount of sleep for at least three times per week for at least one whole month.  A significant number of people believe they have the diagnosis of insomnia if they do not fall asleep upon going to bed.  These people may attempt to take a sleeping pill as a form of control of sleep and not really to treat a disease.

Over the past 5 years, new sleeping medications have been developed which have influenced the ways we treat insomnia or the complaint of insomnia.  Many of the older sleeping pills interfere with certain stages of sleep.  These medications suppress the REM sleep stage(dreaming sleep) and the slow-wave deep non-dreaming sleep stage.  Suppressing these stages of sleep interferes with normal brain function and the FDA had previously restricted physicians from prescribing sleeping medications for more than a 2 month period.  The newer sleep medications including Ambien and Lunesta do not appear to interfere with these sleep stages and therefore should not interfere with normal brain function.  The FDA has subsequently changed the prescribing restrictions for these medications.

There are other concerns with taking sleeping pills including dependence.  Patients should be aware of this and should be cautioned against using these medications routinely.  Patients with a diagnosis of insomnia should always attempt to fall asleep before taking the sleeping pill.  Patients should be cautious not to mix sleeping pills with alcohol or other depressants.  Patients should take attempt to take the lowest dose for the shortest possible period of time.

Over the counter sleeping pills use antihistamine types medications that cross the blood-brain barrier and induce sleep by inhibiting the histamine neurotransmitter.  This slows brain functions and causes sleepiness.  Although these medications can be taken without a prescription, they interfere with memory and can cause forgetfulness.

So what is the answer?  Practice good sleep hygiene.  This includes avoiding all napping in order to concentrate sleep at night.  Get regular exercise and eat dinner at a reasonable time.  You should reduce noise in the room while sleeping and avoid caffeine, alcohol, and cold medications.  Avoid clock watching while trying to sleep (take the clock out of the bedroom).  If not asleep within 15 minutes after going to bed, get up and return to bed when you feel sleepy
If you still want to lie down, do so in another room.  These easy techniques cure 80% of all cases of insomnia.

Cristopher Geiler, MD

Nature Medicine 15, 481 (2009)

Read more – August 16, 2010

Lifting Weights Strengthens The Mind

Resistance exercising including weight lifting can strengthen the brain.  Apparently weight training exercises produce a release of a special neuro-protective protein called Brain-Derived Neurotrophic Factor (BDNF).  This is according to new study presented at annual meeting of the American College of Sports Medicine.  Weight lifting exercise caused the release of this nerve protecting protein that helps to support the survival of existing neurons in the brain, and encourage the growth and differentiation of new neurons and synapses.

Researchers reported on a study of 20 college-aged men who were enrolled in a trial to determine whether repeated resistance exercise resulted in increased circulating BDNF after exercise.  The study authors report that blood levels of the BDNF protein increased 32% from resting levels at 1 minute after exercise compared to the baseline levels.  This study showed a robust and transient increase in circulating BDNF concentrations with weight lifting exercises.

The incidence of neurodegenerative diseases such as Alzheimer’s disease is lower in people who participate in regular exercise programs.  This may be in part due to the beneficial affects of this neuro-protecting protein (neurotrophins).

Increasing the amount of these near protective (neurotrophins) proteins can have a positive effect on cognition, mood, emotions, and several other domains of brain function. Additional studies may focus on ways to maximize the release of these beneficial proteins.

Cristopher Geiler, M.D.

Read more – June 18, 2010

Fight Heart Disease with a Toothbrush

Neglecting your teeth may lead to heart disease.  This is according to a study published the latest issue of the British Medical Journal.
Researchers report that brushing your teeth less than twice a day can increase your risk of heart disease.

Researchers analyzed data from more than 11,000 people who participated in the Scottish Health Survey, in which individuals were asked about lifestyle behaviors such as smoking, physical activity, and oral health routines. Questions asked include how often they visited the dentist and how often they brushed their teeth.  This information was analyzed and compared with the participant’s medical history and family history of heart disease and blood pressure. Additionally, blood samples were taken from a subgroup of participants and tested for the inflammatory protein CRP and fibrinogen levels. The data gathered from the interviews were linked to hospital admissions and deaths.

The results showed that generally good oral hygiene practices, with 62% of participants saying they visited the dentist every six months and 71% reporting that they brushed their teeth twice a day.

Researchers analyzed the data and adjustment for established risk factors for heart disease which include age, sex, diabetes, smoking, physical activity, visits to dentist, body-mass index, family history of cardiovascular disease, hypertension, and socioeconomic group.

Researchers found that participants who reported less frequent toothbrushing had an increased risk of heart disease compared with people who brushed their teeth twice a day.  Researchers also found that participants who had poor oral hygiene also had increased levels of the CRP and fibrinogen blood tests.

The study authors comment that while it has been established that inflammation in the body (including mouth and gums) plays an important role in the buildup of atherosclerosis, this is the first study to investigate whether the number of times individuals brush their teeth has any bearing on the risk of developing heart disease.

The study authors also comment that “to the best of our knowledge, this is the first study to show an association between a single-item self-reported measure of toothbrushing and incident cardiovascular disease in a large representative sample of adults without overt cardiovascular disease.”   Additionally they add, “Our study suggests a possible role of poor oral hygiene in the risk of cardiovascular disease via systemic inflammation. Raised inflammatory responses as well as lipid metabolism disturbance caused by periodontal infection might be possible pathways underlying the observed association between periodontal disease and the increased risk for cardiovascular disease.”

The results of this study need to be further evaluated with additional studies to confirm whether the observed association between dental hygiene and cardiovascular disease is in fact causal or merely a risk marker.
Cristopher Geiler, MD
BMJ 2010; DOI:10.1136/bmj.c2451. Available at: http://www.bmj.com.

Read more – May 28, 2010

Bananas Could Help Prevent HIV

A protein that is found in bananas know as banana lectin was found to be a powerful inhibitor of the HIV virus.  This is according to an article published in the January issue of the Journal of Biological Chemistry.

The protein Banana lectin, also called BanLec, can bind to certain molecules on the surface of the HIV virus inhibiting infection.

Researchers from the University of Michigan studied the function of BanLec and determined that it binds to a specific surface protein called gp120.  BanLec inhibited the ability of the HIV virus to enter cells.  A virus must be able to enter a cell in order to cause an infection.  BanLec appears to inhibit this process and therefore may inhibit an infection of HIV.

BanLec appears to be a promising potential future treatment to prevent HIV infection.

Cristopher Geiler, MD

Reference

J. Biol. Chem. 2010 285: 8646-8655

Read more – May 5, 2010

Common Obesity Gene Also Causes Brain Atrophy

-The recently identified variant of the FTO gene (fat mass and obesity-associated gene) which is carried by greater than 30% of the U.S. population is also associated with brain atrophy.  This is according to a recent study published in the journal Proceedings of the National Academy of Sciences.

Researchers report that this gene not only predisposes people to weight gain, it also causes premature aging of the brain.
In order to learn more about the implications of this very common gene,  study authors analyzed brain imaging scans of more than 200, otherwise healthy individuals, age 55 to 90 years.  Researchers found that there was consistently less tissue in the brains of people who carry the variant of the FTO gene compared to non-carriers of the gene.

Researchers commented that reduced brain volume (atrophy) is associated with the development of Alzheimer’s disease.  This happens because the brain atrophy leads to a reduced amount of brain reserve a person has to compensate for cerebral damage from vascular disease (strokes) and from the deposition of the specific proteins in the brain that cause Alzheimer’s disease.

The study authors noted that the atrophy of the brain tissue in the affected people was not attributed to differences in cholesterol levels, nor from hypertension.

This is a very common gene variant and it is affecting a large portion of our population.  This is an observational study and it does not offer answers.  Hopefully future researchers will find ways to silence the the effects of this gene.

Cristopher Geiler, MD
Proc Natl Acad Scie USA 2010

Read more – April 26, 2010

Blood Test Can Indicate Risk of Dementia

A blood test called the C-reactive protein is linked to the loss of higher level brain function.  This is according to a study published in the journal Neurology.

Elevated levels of the C-reactive protein have been associated with the development of dementia.  The current study was designed to assess the underlying mechanism of how this happens.  The C-reactive protein is known to be a marker of inflammation and has been associated with risk of heart disease and stroke.

The authors of this study examined 447 patients with the average age of 63 years.  They analyzed the test subjects with special brain MRI scans and a battery of test for higher level brain functions.

The results of this study showed that low-grade inflammation which was noted by an elevated (high-sensitivity) C-reactive protein and was associated with degenerative changes in certain areas of the brain and also with impairment of certain higher level brain functions.

Dementia and the risk of developing dementia is becoming increasingly important in our society as the baby boomers age.  In an attempt to learn more about how dementia develops, this study examined the role of inflammation, measured with the C-reactive protein blood test.

A very important question that was not addressed in this study is how do we treat patients who have elevated C-reactive proteins and does treatment stop the development of dementia and or degenerative processes?  Definitely more research is needed to answer these questions.

Cristopher Geiler, MD

Reference
Neurology.2010; 74: 1014-1015

Read more – April 19, 2010

Relaxed Minds Make Better Memories

In a recent study published in the journal Nature, stronger and longer lasting memories are more likely to be formed when a person is relaxed and the memory-related neurons in the brain fire in sync with certain brain waves.

Scientist report that synchronization in the brain is influenced by certain brain waves called “theta waves” which are associated with relaxation as well as influencing learning and memory formation.

Researchers studied eight volunteers who were shown 100 photos of a range of objects and allowed to view each for one second. Fifteen to 30 minutes later they were shown another 100 photos; 50 new ones and 50 from the first set. They were then asked to recall which ones they had seen before and say how confident they were in their answers. Researchers used electroencephalography (EEG) to record brain activity when memories are formed. Researchers found that recognition was stronger when the learning took place while neurons were firing in sync with theta waves, indicating that the brain was relaxed.

Researchers said their findings could help develop new therapies for people with learning disabilities and some types of dementia.

Although this was a relatively small study, only eight people participating, the conclusions are intriguing. The EEG is a sensitive machine for detecting brain waves, and the study subjects reproducibly had better memory during relaxation periods when “delta waves” were present.

The implications from this study are far-reaching. Based on this research, we should study and prepare for tests while we are relaxing. Education, schools and teachers should consider the comfort of their students. Also, as noted by researchers, alzheimer’s patients would likely preform better if relaxed and not in a threatening environment.

Cristopher Geiler, MD

Reference
Nature 2010.

Read more – March 29, 2010

One Hour of Daily Exercise Needed to Prevent Weight gain!

Women need one hour of moderate intensity physical activity every day in order to prevent weight gain. This is according to a recent study published in the Journal of the American Medical Association.

Study authors set out to clarify the amount of physical activity that is required to prevent long-term weight gain among women following a usual diet.
The study included 34,079 healthy US women, with an average age of 54.2 years. The study subjects were followed from 1992 to 2007.

The average weight gain during this study was 5.7 lbs over five years.

There was a significant relationship between the effect of physical activity and the the Body Mass Index (BMI) readings.

Among women with a BMI of less than 25, there was an inverse dose-response relationship between activity levels and weight gain. However, no such relationship occurred among women with a BMI from 25 to 29.9 or in those with a BMI of 30.0 or more.

In 4,500 women whose BMI was less than 25 at the beginning of the study  and who successfully maintained their weight by gaining less than 5.7 lbs during the study, the average activity level over the five years was approximately 60 minutes per day of moderate-intensity exercise.

This study shows that women need to exercise at least one hour per day in order to prevent weight gain over their lifetime.  These conclusions may not be completely accurate given the study was limited by the fact that the women self-reported their activity levels and weight measurements. In addition, the women in the study did not report on dietary habits. The study did not address activity levels needed for weight management among women who were restricting caloric intake.

Cristopher Geiler, MD
Reference
JAMA. 2010;303:1173-1179

Read more – March 26, 2010

Running marathons may lead to heart disease

Running marathons may lead to heart disease

Running marathons may be associated with the development of heart disease. This is according to a study presented at the American College of Cardiology 2010 Scientific Sessions. Investigators reported that long term marathon runners had more calcified plaque within coronary arteries compared to non-marathon runners.
Study authors report that they were concerned over the frequency in which marathon runners are dying of heart attacks and sudden death. They stated that at least three runners have died this year during marathons, three of which died during the 2009 Detroit Marathon, a race that included almost 4,000 participants. They commented that marathon runners are usually considered to be a healthier group of people within our society. However, one recent estimate suggests that the rate of sudden cardiac death among marathon runners is rare, roughly 0.8 per 100,000 runners.

Study authors analyzed 25 runners who completed the Minneapolis-St Paul Twin Cities Marathon every year for 25 consecutive years, thus completing a minimum of 25 marathons. The study subjects and 25 controlled matched people who were not marathon runners were analyzed with a heart scan that was able to measure calcified plaque within the arteries around the heart. Calcified plaque is associated with a higher risk of heart attack. The results of the heart scans for the marathon runners showed 62% more calcified plaque than the non-marathon runners.

The reason why marathon runners would have more coronary artery plaque is not obvious. As stated above, marathon runners tend to be healthier than the average person. The typical risk factors for heart disease such as cholesterol, blood pressure and diabetes were controlled for in the study.

It is possible that the excessive physical stress of running long distances may some how impact the coronary arteries, causing local inflammation and plaque deposition.

It is difficult to make a conclusion based on this one study and we should wait and see if more research will clarify this perplexing question.

Cristopher Geiler, MD

Read more – March 24, 2010

Vitamin E May Help Fatty Liver Disease

People with the common obesity-related liver disease known as NASH (non-alcoholic steatohepatitis) may benefit from supplemental vitamin E pills.  This is according to a study published in the most recent issue of The New England Journal of Medicine.

Researchers comment that it appears to be the first time that a vitamin supplement has been shown to help treat a major disease that is not caused by the vitamin deficiency.  However, doctors warned that this does not mean people should automatically take vitamin E since some research suggests it might raise the risk of other problems.

The latest study tested vitamin E supplementation for nonalcoholic fatty liver disease.   This is a fat buildup that can cause the liver to become inflamed and scarred over time and in severe cases, to fail.

The disease usually develops in people who are middle-aged and overweight or obese. Up to 5 percent of Americans have the most serious form of it, and as many as 20 percent have fat in their livers but no organ damage.

Researchers studied 247 adults with advanced fatty liver disease who were randomly assigned to take a high dose of vitamin E (800 international units), the diabetes drug Actos or placebo for nearly two years.

The vitamin E and drug were tested because earlier research suggested liver cell deterioration and insulin resistance might be involved in the development of the disease.

Biopsies before and after treatment showed that liver function improved in 43 percent of those in the vitamin E group compared with 19 percent in the placebo group.

Study participants on the diabetes drug Actos also improved, but to a lesser degree and with a drawback: gaining 10 pounds on average, which remained even after they stopped taking the drug. Four people who took vitamin E developed diabetes, but the study was too small to determine if the vitamin played any role.

Researchers commented that vitamin E could potentially become the initial treatment for advanced cases of the this liver problem.

Reference:
N Engl J Med

Read more – March 23, 2010