Common herbal supplement can cause dangerous interactions with prescription drugs

St. John’s wort, the leading complementary and alternative treatment for depression in the United States, can be dangerous when taken with many commonly prescribed drugs, according to a study by researchers at Wake Forest Baptist Medical Center.The researchers reported that the herbal supplement can reduce the concentration of numerous drugs in the body, including oral contraceptive, blood thinners, cancer chemotherapy and blood pressure medications, resulting in impaired effectiveness and treatment failure.”Patients may have a false sense of safety with so-called ‘natural’ treatments like St. John’s wort,” said Sarah Taylor, M.D., assistant professor of dermatology at Wake Forest Baptist and lead author of the study. “And it is crucial for physicians to know the dangers of ‘natural’ treatments and to communicate the risks to patients effectively.” The study is published in the current online issue of The Journal of Alternative and Complementary Medicine.To determine how often S. John’s wort (SJW) was being prescribed or taken with other medications, the team conducted a retrospective analysis of nationally representative data collected by the National Ambulatory Medical Care Survey from 1993 to 2010. The research team found the use of SJW in potentially harmful combinations in 28 percent of the cases reviewed.Possible drug interactions can include serotonin syndrome, a potentially fatal condition that causes high levels of the chemical serotonin to accumulate in your body, heart disease due to impaired efficacy of blood pressure medications or unplanned pregnancy due to contraceptive failure, Taylor said.Limitations of the study are that only medications recorded by the physician were analyzed. However, she said the rate of SJW interactions may actually be underestimated because the database did not include patients who were using SJW but did not tell their doctor.”Labeling requirements for helpful supplements such as St. John’s wort need to provide appropriate cautions and risk information,” Taylor said, adding that France has banned the use of St. John’s wort products and several other countries, including Japan, the United Kingdom, and Canada, are in the process of including drug-herb interaction warnings on St. John’s wort products.”Doctors also need to be trained to always ask if the patient is taking any supplements, vitamins, minerals or herbs, especially before prescribing any of the common drugs that might interact with St. …

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Shifting evolution into reverse promises cheaper, greener way to make new drugs

This alternative approach to creating artificial organic molecules, called bioretrosynthesis, was first proposed four years ago by Brian Bachmann, associate professor of chemistry at Vanderbilt University. Now Bachmann and a team of collaborators report that they have succeeded in using the method to produce the HIV drug didanosine. The proof of concept experiment is described in a paper published online March 23 by the journal Nature Chemical Biology.”These days synthetic chemists can make almost any molecule imaginable in an academic laboratory setting,” said Bachmann. “But they can’t always make them cheaply or in large quantities. Using bioretrosynthesis, it is theoretically possible to make almost any organic molecule out of simple sugars.”Putting natural selection to use in this novel fashion has another potential advantage. “We really need a green alternative to the traditional approach to making chemicals. Bioretrosynthesis offers a method to develop environmentally friendly manufacturing processes because it relies on enzymes — the biological catalysts that make life possible — instead of the high temperatures and pressures, toxic metals, strong acids and bases frequently required by synthetic chemistry,” he said.Normally, both evolution and synthetic chemistry proceed from the simple to the complex. Small molecules are combined and modified to make larger and more complex molecules that perform specific functions. Bioretrosynthesis works in the opposite direction. It starts with the final, desired product and then uses natural selection to produce a series of specialized enzymes that can make the final product out of a chain of chemical reactions that begin with simple, commonly available compounds.Bachmann got the idea of applying natural selection in reverse from the retro-evolution hypothesis proposed in 1945 by the late Caltech geneticist Norman Horowitz. …

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Mesothelioma Alternative Therapy – What Are Your Options?

Quite a number of patients afflicted with asbestos related diseases such as asbestosis and mesothelioma now-a days use different types of complimentary and alternative therapies in addition to conventional therapies like surgery and drugs.These alternative therapies are used by patients coping with asbestos related disease as a form of pain management, to improve general health, and also to provide symptomatic relief.Although these treatments do not offer a cure, they certainly help you to live more comfortable lives by providing relief from pain and stress.The most commonly used alternative therapies include the following:1} AcupunctureThis is one of the commonest forms of available alternative therapies today, and there are a lot of insurance companies offering coverage for this type of treatment. Acupuncture involves the …

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Modified law of gravity predicts dwarf galaxy feature prior to observations

Aug. 28, 2013 — A modified law of gravity correctly predicted, in advance of the observations, the velocity dispersion — the average speed of stars within a galaxy relative to each other — in 10 dwarf satellite galaxies of the Milky Way’s giant neighbor Andromeda.The relatively large velocity dispersions observed in these types of dwarf galaxies is usually attributed to dark matter. Yet predictions made using the alternative hypothesis Modified Newtonian Dynamics (MOND) succeeded in anticipating the observations.Stacy McGaugh, professor of astronomy at Case Western Reserve, and Mordehai Milgrom, the father of MOND and professor of physics at Weizmann Institute in Israel, report their findings, which have been accepted for publication by the Astrophysical Journal.The researchers tested MOND on quasi-spherical, very low-surface brightness galaxies that are satellites of Andromeda. In the cosmic scale, they are among the smallest galaxies, containing only a few hundred thousand stars. But with conventional gravity, they are inferred to contain huge amounts of dark matter.”Most scientists are more comfortable with the dark matter interpretation,” McGaugh said. “But we need to understand why MOND succeeds with these predictions. We don’t even know how to make this prediction with dark matter.”While this study is very specific, it’s part of a broader effort to understand how the universe, the Milky Way and Earth formed and what it’s all made of. This informs human understanding of our place in the universe, McGaugh said. Such issues have been of such importance that they’ve changed religion and philosophy over the centuries, sometimes sending people to be burnt at the stake.”At stake now is whether the universe is predominantly made of an invisible substance that persistently eludes detection in the laboratory, or whether we are obliged to modify one of our most fundamental theories, the law of gravity,” McGaugh continued.The MOND hypothesis says that Newton’s force law must be tweaked at low acceleration — 11 orders of magnitude lower than what we feel on the surface of Earth. Acceleration above that threshold is linearly proportional to the force of gravity — as Newton’s law says — but below the threshold, no. …

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Aberrant splicing saps the strength of ‘slow’ muscle fibers

July 29, 2013 — When you sprint, the “fast” muscle fibers give you that winning kick. In a marathon or just day-to-day activity, however, the “slow,” or type 1 fibers, keep you going for hours.In people with myotonic dystrophy, the second most common form of muscular dystrophy and the one most likely to occur in adults, these slow or type 1 fibers do not work well, wasting away as the genetic disorder takes its grim toll. In a report that appears online in the Proceedings of the National Academy of Sciences, Dr. Thomas A. Cooper, professor of pathology & immunology at Baylor College of Medicine, and Dr. Zhihua Gao, a postdoctoral associate at BCM, showed how an aberrant alternative splicing program changes the form of an enzyme (pyruvate kinase of PKM) involved in the fundamental metabolism of these muscle cells, leaving them unable to sustain exercise. The enzyme reverts to the embryonic form (PKM2), which changes its activity in the cell.Slow fibers most affected in MDAlternative splicing is one of the secrets as to how the estimated 25,000 human genes code for the 100,000 or more proteins important to the functioning of the human body. For one gene to make different proteins, it has to alter the genetic message, choosing which coding parts of the gene called exons are included in the protein “recipe” used by the cell’s protein-making machinery.”In the case of PKM2, this enzyme represents a shift back to the fetal splicing pattern,” said Cooper. “What was striking was that if you look at the histology (the tissues seen at a microscopic level) of the skeletal muscle, only the slow fiber types — the ones affected in myotonic dystrophy — have this splicing event switch.” The slow fibers are those most affected in myotonic dystrophy.”We don’t know what it is doing to the metabolism, but it seems to be pushing it in the opposite direction from what slow fibers do,” said Cooper. “This is related to the loss of slow fibers in myotonic dystrophy.”Abnormal GTG repeatTo figure out how this happens, Cooper and his colleagues used antisense oligonucleotides (snippets of genetic material designed to target specific areas of a gene) to bind to the precursor RNA (genetic material that carries the code for a protein) for PKM, and thus force it in the other direction — to the embryonic form.”Doing this, we showed there could be a change in metabolism in myotonic dystrophy and we showed it in the whole animal,” said Cooper.Myotonic dystrophy occurs when the nucleotides CTG (cytosine, thymine, guanine) repeat an abnormal number of times. …

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Volunteering reduces risk of hypertension in older adults

June 13, 2013 — It turns out that helping others can also help you protect yourself from high blood pressure.New research from Carnegie Mellon University shows that older adults who volunteer for at least 200 hours per year decrease their risk of hypertension, or high blood pressure, by 40 percent. The study, published by the American Psychological Association’s Psychology and Aging journal, suggests that volunteer work may be an effective non-pharmaceutical option to help prevent the condition. Hypertension affects an estimated 65 million Americans and is a major contributor to cardiovascular disease, the leading cause of death in the U.S.”Everyday, we are learning more about how negative lifestyle factors like poor diet and lack of exercise increase hypertension risk,” said Rodlescia S. Sneed, a Ph.D. candidate in psychology in CMU’s Dietrich College of Humanities and Social Sciences and lead author of the study. “Here, we wanted to determine if a positive lifestyle factor like volunteer work could actually reduce disease risk. And, the results give older adults an example of something that they can actively do to remain healthy and age successfully.”For the study, Sneed and Carnegie Mellon’s Sheldon Cohen studied 1,164 adults between the ages of 51 and 91 from across the U.S. The participants were interviewed twice, in 2006 and 2010, and all had normal blood pressure levels at the first interview. Volunteerism, various social and psychological factors, and blood pressure were measured each time.The results showed that those who reported at least 200 hours of volunteer work during the initial interview were 40 percent less likely to develop hypertension than those who did not volunteer when evaluated four years later. The specific type of volunteer activity was not a factor — only the amount of time spent volunteering led to increased protection from hypertension.”As people get older, social transitions like retirement, bereavement and the departure of children from the home often leave older adults with fewer natural opportunities for social interaction,” Sneed said. …

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Anatomy determines how lizards attract partners and repel rivals

June 4, 2013 — Catching the attention of female lizards in a darkened rainforest amid a blur of windblown vegetation is no easy task.But male Anolis lizards on the island of Jamaica have evolved an ideal visual technique — very rapid extension and retraction of a large, coloured pouch under their throats, combined with quick bobbing of their heads to warn off any other rival suitors.Now the mystery of why their close relatives on the neighbouring island of Puerto Rico do not adopt the same strategy to advertise their ownership of a territory has been solved.The study, led by UNSW’s Dr Terry Ord, is published in the journal Functional Ecology.The research shows the Puerto Rican lizards lack the right physiology to be able to perform the rapid movement of the conspicuous pouch, or dewlap. They can still compete successfully, however, in the same way that being either a sprinter, or a long-distance runner, can have different advantages.”Puerto Rican Anolis have evolved a range of alternative strategies for enhancing detection of their displays, such as tailoring the speed and duration of their displays to match conditions in the forest, and timing their display to avoid periods of high visual noise,” said Dr Terry Ord, of the UNSW School of Biological, Earth and Environmental Sciences.Dr Ord said his team was very surprised when they first discovered the Anolis lizards on Puerto Rica did not rapidly extend their dewlap, like their Jamaican cousins.”We had previously used realistic-looking robot lizards in the forest to show that rapidly extending the dewlap, like a colourful flag, is a very effective territorial display amidst all the distractions of the rainforest.”For the latest study the researchers developed a mathematical model of the biomechanical properties of the lever mechanism that controls dewlap extension. They then dissected museum specimens of lizards to study their anatomy and compare this with their behaviour in the forest, as recorded on video.”Lizards on Puerto Rica that do not rapidly extend their dewlaps have biomechanical constraints that restrict them from doing this at the right speed. Because of this, they extend the dewlap at considerably slower speeds and instead rely on other strategies to maintain an effective display,” Dr Ord said.”Research on the evolution of communication and sexual ornaments has rarely been carried out in this “bottom-up” way of seeing how the anatomy of a signal shapes the way that the signal is used in communication. But our study shows it has the potential to be critically important in truly understanding why animals behave — and evolve — the way they do.”There are more than 400 species of Anolis in the Caribbean and Americas, making them of particular interest to scientists studying how species evolve.

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Precision-guided needle used to glue shut dangerous and disfiguring blood vessel growth

Nov. 9, 2012 — Using a technique performed at Johns Hopkins but rarely elsewhere, imaging specialists and surgeons have successfully used precision, image-guided technology to glue shut a tangle of abnormal blood vessel growths in a 43-year-old woman’s upper lip, face and nose. Surgery had earlier been ruled out because traditional approaches were considered too risky.

Susan Adams, an accountant from Owings, Md., says her arteriovenous malformation (AVM) had caused a decade of spontaneous nose and lip bleeds that were difficult to control, and that more than a half dozen previous operations had failed to stop the bleeding or facial disfigurement.

Adams’ condition is rare and notoriously difficult to treat. Her AVM had grown -for no known reason — between her upper lip and base of her nose. As it grew, her upper lip and skin above it had bulged out, causing the lower-left side of her face to droop. If left untreated, the condition can lead to life-threatening blood loss from a burst vessel.

For her May 14 procedure, which took about two hours at The Johns Hopkins Hospital, interventional neuroradiologist Monica Pearl, M.D., used an ultrathin needle, precisely guided from the outside in by real-time ultrasound scanning and angiography, to puncture Adams’ facial skin and several of the outermost and largest tangled blood vessels. Once the needle was inside the abnormal blood vessels, which are no more than 1 to 2 millimeters wide, Pearl injected a glue-like substance to block each vessel and cut off the blood supply to any smaller, abnormal branching blood vessels. Pearl says this effectively destroyed the blood vessels making up the AVM.

Pearl was able to select which blood vessels to block using a contrasting dye injected into the tangle immediately prior to the glue-sealing embolization treatment. Using digital subtraction angiography (DSA) — in which computer software removes the images of bones and other organs, showing only the blood vessels — Pearl was able to track reduced blood flow through the AVM after every individual embolization. After three major blood vessels were sealed, blood flow through the tangle became nearly invisible on the DSA images.

Pearl cautioned that the procedure she and her team used is riskier than traditional AVM therapies. Typically, says Pearl, an assistant professor at the Johns Hopkins University School of Medicine who sees an AVM patient about once a week, interventional neuroradiologists and surgeons use the glue sealant to destroy — from the inside — the larger, misshapen arteries, using catheters through major blood vessels elsewhere in the body.

This “inside-in” approach usually lowers the risk of any life-threatening bleeding from burst arteries. However, scarring and postsurgical infections from Adams’ earlier procedures led Pearl and plastic and reconstructive surgeon Amir Dorafshar, M.D., to decide in favor of an “outside-in” approach. Although, other surgeons had ruled Adams situation too risky for further surgery, Pearl and Dorafshar thought success was still possible if Adams AVM could be sealed.

Once the tangle was glued shut, Dorafshar threaded a protective line of sutures around Adam’s facial outgrowth, as protection against any sudden blood loss during Adams’ reconstructive surgery, performed immediately after embolization. In that operation, lasting almost four hours, he cut out the destroyed AVM tangle and put Adams’ upper lip back together, repairing the mucosa, muscle and skin, and re-aligning her nose.

“Our success with this alternative outside-in approach shows our ability to look at medical problems from a different perspective and the potential capabilities for treating what was once considered untreatable,” says Pearl. “People with complex vascular malformations require individualized treatment plans that rely on close collaborations across physician specialties and disciplines.”

According to Pearl and Dorafshar, Adams will need three months to fully recover and will require at least one more operation to repair facial scarring.

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Alternative medicine use by MS patients now mapped

Apr. 19, 2013 — A major Nordic research project involving researchers from the University of Copenhagen has, for the first time ever, mapped the use of alternative treatment among multiple sclerosis patients — knowledge which is important for patients with chronic disease and the way in which society meets them.

People with multiple sclerosis (MS) often use alternative treatments such as dietary supplements, acupuncture and herbal medicine to facilitate their lives with this chronic disease. This is the result of a new study of how MS patients use both conventional and alternative treatments which has been carried out by researchers from five Nordic countries. The results have been published in two scientific journals, the Scandinavian Journal of Public Health and Autoimmune Diseases.

“What we see is that patients do not usually use alternative treatments for treating symptoms, but as a preventative and strengthening element,” says Lasse Skovgaard, industrial PhD candidate from the Faculty of Health and Medical Sciences and the Danish Multiple Sclerosis Society, who has been involved in conducting the questionnaire-based study among 3,800 people with MS in Denmark, Sweden, Norway, Finland and Iceland.

Multiple sclerosis is a chronic disease which attacks the central nervous system, and which can lead to a loss of mobility and sight. Denmark is one of the countries with the highest incidence of the disease worldwide, with approx. 12,500 MS patients. At the same time, the number of MS patients in the West is increasing, posing considerable challenges in respect of treatment, prevention and rehabilitation.

Access to knowledge bank

Together with researchers from the five other Nordic countries, Lasse Skovgaard has spent three years gathering the new data, and he is delighted at what it offers: “Within the field of health research, it is often a question of studying the extent to which a particular type of drug affects a particular symptom. However, it is equally as important to look at how people with a chronic disease, for example, use different treatments to cope with their situation. Here, MS patients offer valuable experience. Their experiences constitute a knowledge bank which we must access and learn from,” he says.

Lasse Skovgaard draws attention to the significance of this new knowledge because, if people with chronic disease are better able to manage their lives, it can potentially save society large sums of money.

“There is a lot of talk about ‘self-care competence’, in other words patients helping themselves to get their lives to function. Here, many people with a chronic disease find they benefit from using alternative treatments, so we should not ignore this possibility,” says Lasse Skovgaard.

At the same time, he emphasises that knowing more about why patients choose particular treatments is important in relation to improving patient safety because of the possible risks involved in combining conventional and alternative medicine.

Growing use of alternative treatments

According to the latest Health and Sickness Study from the Danish National Institute of Public Health (NIPH) in 2010, one in four Danes say that they have tried one or more types of alternative treatments within the past twelve months. Among MS patients, the use of alternative medicine has been growing steadily over the past fifteen years. In the researchers’ latest study, more than half of the respondents say that they either combine conventional and alternative medicine or only use alternative medicine.

“We cannot ignore the fact that people with chronic disease use alternative treatments to a considerable extent, and that many of them seem to benefit from doing so. It doesn’t help to only judge this from a medical point of view or say that alternative treatments are nonsense — rather, we must try to understand it,” says Lasse Skovgaard.

Highly qualified women top the list

The study shows that, among MS patients using alternative treatments, there is a significantly bigger proportion of people with a high level of education compared to those who do not use alternative treatments. There is also a larger proportion of highly paid people and of younger women.

“Some critics are of the opinion that when alternative treatments are so popular, it is because they appeal to naïve people looking for a miraculous cure. But our results indicate that it is primarily the well-educated segment that is subscribing to alternative treatments. And that using alternative treatments is part of a lifestyle choice,” says Lasse Skovgaard.

He hopes that the new knowledge will improve communication regarding how the chronically ill use alternative treatments in combination with conventional medicine:

“We see that so many people are combining conventional medicine with alternative treatment that it should be taken seriously by the health service. Until now, there hasn’t been much focus on the doctor-patient dialogue in relation to the alternative methods used by the chronically ill to manage their lives,” says Lasse Skovgaard. He says that the research group is continuing to analyse the results and, among other things, is conducting several interview studies based on the results of the questionnaires. The interview studies will, for example, provide additional knowledge on how patients perceive the risks associated with using alternative medicine and explore why some patients turn their backs completely on conventional medicine.

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Alternative therapies may help lower blood pressure

Apr. 22, 2013 — Alternative therapies such as aerobic exercise, resistance or strength training, and isometric hand grip exercises may help reduce your blood pressure, according to the American Heart Association.

In a new scientific statement published in its journal Hypertension, the association said alternative approaches could help people with blood pressure levels higher than 120/80 mm Hg and those who can’t tolerate or don’t respond well to standard medications.

However, alternative therapies shouldn’t replace proven methods to lower blood pressure — including physical activity, managing weight, not smoking or drinking excess alcohol, eating a low sodium balanced diet and taking medications when prescribed, the association said.

High blood pressure — a major risk factor for heart attack and stroke — affects more than 26 percent of the population worldwide and contributes to more than 13 percent of premature deaths.

An expert panel assessed three alternative remedy categories: exercise regimens; behavioral therapies such as meditation; and non-invasive procedures or devices including acupuncture and device-guided slow breathing. The panel did not review dietary and herbal treatments.

“There aren’t many large well-designed studies lasting longer than a few weeks looking at alternative therapies, yet patients have a lot of questions about their value,” said Robert D. Brook, M.D., Chair of the panel and an associate professor of medicine at the University of Michigan in Ann Arbor. “A common request from patients is, ‘I don’t like to take medications, what can I do to lower my blood pressure?’ We wanted to provide some direction.”

The alternative therapies rarely caused serious side effects and posed few health risks, but the analysis revealed some approaches were more beneficial than others and could be part of a comprehensive blood pressure-lowering treatment plan.

Brook and colleagues reviewed data published in 2006-11, including 1,000 studies on behavioral therapies, non-invasive procedures and devices, and three types of exercise (aerobic, resistance or weight training and isometric exercises, most commonly handgrip devices).

The studies also examined the effects of yoga, different styles of meditation, biofeedback methods, acupuncture, device-guided breathing, relaxation and stress reduction techniques.

The panel found:

All three types of exercise reduced blood pressure. Walking programs provided modest benefit while, somewhat surprisingly, four weeks of isometric hand grip exercises resulted in some of the most impressive improvements — a 10 percent drop in systolic and diastolic blood pressure. However, isometric exercise should be avoided among people with severely-uncontrolled high blood pressure (180/110 mm Hg or higher).
Behavioral therapies such as biofeedback and transcendental meditation may help lower blood pressure by a small amount. However, there’s not sufficient data to support using other types of meditation.
Strong clinical evidence is also lacking to recommend yoga and other relaxation techniques for reducing blood pressure.
There isn’t enough evidence to recommend acupuncture for lowering blood pressure, particularly given the complexities involved in employing this treatment. However, device-guided slow breathing did prove effective in lowering blood pressure when performed for 15-minute sessions three to four times a week.

“Most alternative approaches reduce systolic blood pressure by only 2-10 mm Hg; whereas standard doses of a blood pressure-lowering drug reduce systolic blood pressure by about 10-15 mm Hg,” Brook said. “So, alternative approaches can be added to a treatment regimen after patients discuss their goals with their doctors.”

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