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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Ease of access improves fruit and vegetable consumption

Sep. 3, 2013 — Low-income communities have particular problems getting adequate fruits and vegetables because of limited access to supermarkets and farmers markets. A new study from Wake Forest Baptist Medical Center shows that community-supported agriculture (CSA) programs may be a feasible approach for providing fresh fruits and vegetables to under-resourced communities.Lead author Sara A. Quandt, Ph.D., a professor of epidemiology and prevention at Wake Forest Baptist, said that CSAs, which link consumers to a local farm’s produce over a growing season, have been proposed as a solution for disparities in fruit and vegetable consumption, though evaluation of such efforts has been limited. The typical U.S. diet fails to meet daily recommendations for fruit and vegetable consumption.This CSA program, Farm Fresh Healthy Living of Forsyth County, N.C., was developed, administered, and evaluated by a partnership of university researchers, Experiment in Self Reliance Inc., a community nonprofit agency, and Harmony Ridge Farms, a Forsyth County, N.C., farm using organic practices.”Expanding access to healthful foods is an important step in reducing health disparities,” said Quandt. “The objective of this study was to test the feasibility of a CSA program for low-income families in Forsyth County.”The study appears last month in the Centers for Disease Control and Prevention’s journal Preventing Chronic Disease.For a small randomized, controlled feasibility study, Quandt and fellow researchers recruited 50 low income women with children, then divided them into an intervention group and a control group of 25 each. The participants ranged in age from 24 to 60; most were African-American and unmarried.Intervention participants received a free box of fresh produce for 16 weeks from May through August 2012. They were also offered five educational sessions, including cooking classes, a farm tour and a grocery store tour with a dietitian that focused on healthful eating on a budget. The control participants did not receive education or the produce boxes.The researchers observed a significant increase over the summer in the number of different fruits and vegetables in the households of the intervention group compared with the control group. …

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New way to measure cumulative effect of head hits in football

July 18, 2013 — Scientists at Wake Forest Baptist Medical Center have developed a new way to measure the cumulative effect of impacts to the head incurred by football players.The metric, called Risk Weighted Cumulative Exposure (RWE), can capture players’ exposure to the risk of concussion over the course of a football season by measuring the frequency and magnitude of all impacts, said senior author of the study Joel Stitzel, Ph.D., chair of biomedical engineering at Wake Forest Baptist and associate head of the Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences.The study is published in the current online edition of the Annals of Biomedical Engineering.Based on data gathered throughout a season of high school football games and practices, the researchers used RWE to measure the cumulative risk of injury due to linear and rotational acceleration separately, as well as the combined probability of injury associated with both.”This metric gives us a way to look at a large number of players and the hits they’ve incurred while playing football,” Stitzel said. “We know that young players are constantly experiencing low-level hits that don’t cause visible injury, but there hasn’t been a good way to measure the associated risk of concussion.”Concussion is the most common sports-related head injury, with football players having the highest rate among high school athletes, according to the study. It is estimated that nearly 1.1 million students play high school football in the United States. However, research on the biomechanics of football-related head impacts traditionally has concentrated on the collegiate level rather than on the high school level.With such a large number of players in the sport, it is critical to understand the risk associated with different levels of impact and accurately estimate cumulative concussion risk over the course of a practice, game, season or lifetime, Stitzel said.In the Wake Forest Baptist study, the researchers measured the head impact exposure in 40 high school football players by using sensors placed in their helmets to record linear and rotational acceleration. A total of 16,502 impacts were collected over the course of one football season and the data were analyzed as a group and as individual players.Impacts were weighted according to the associated risk from linear acceleration and rotational acceleration alone, as well as to the combined probability of injury associated with both. This is an improved method of capturing the cumulative effects from each impact because it accounts for nonlinear relationships between impact magnitude and the associated risk of injury, Stitzel said.”All hits involve both linear and rotational acceleration, but rotation coveys the idea that your head is pivoting about the neck whereas linear acceleration is experienced from a direct blow in more of a straight line through the center of mass of the head,” Stitzel said.The median impact for each player ranged from 15.2 to 27.0 g, with an average value of 21.7 g, which shows the wide variability in the force of impacts.The study found that impact frequency was greater during games (15.5) than during practices (9.4). However, overall exposure over the course of the season was greater during practices.This information may help teams reduce exposure to head impacts during practices by teaching proper tackling techniques that could reduce exposure to impacts that may result in a higher concussion rate, the researchers reported.Additionally, the study found a wide variation in player exposure within the team, with a 22-fold variation in the exposure per impact for practices and a 47-fold variation in the exposure for impact for games.Studies like this are vital to understanding the biomechanical basis of head injuries related to football, Stitzel said. The metric fully captures a player’s exposure over the course of the season and will be used in conjunction with other pre- and post-season evaluations, including MRI and neurological tests conducted as part of this study. The research team hopes that this work may ultimately improve helmet safety and design to make football a safer sport.The study was funded by the Childress Institute for Pediatric Trauma.Co-authors are Jillian Urban, M.S., Elizabeth Davenport, B.S., Adam Golman, M.S., Joseph Maldjian, M.D., Christopher Whitlow, M.D., and Alexander Powers, M.D., of Wake Forest Baptist.

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Neuroscientists explain how the sensation of brain freeze works

May 22, 2013 — Brain freeze is practically a rite of summer. It happens when you eat ice cream or gulp something ice cold too quickly. The scientific term is sphenopalatine ganglioneuralgia, but that’s a mouthful. Brain freeze is your body’s way of putting on the brakes, telling you to slow down and take it easy. Wake Forest Baptist Medical Center neuroscientist Dwayne Godwin, Ph.D., explains how it works.

“Brain freeze is really a type of headache that is rapid in onset, but rapidly resolved as well,” he said. “Our mouths are highly vascularized, including the tongue — that’s why we take our temperatures there. But drinking a cold beverage fast doesn’t give the mouth time to absorb the cold very well.”

Here’s how it happens: When you slurp a really cold drink or eat ice cream too fast you are rapidly changing the temperature in the back of the throat at the juncture of the internal carotoid artery, which feeds blood to the brain, and the anterior cerebral artery, which is where brain tissue starts.

“One thing the brain doesn’t like is for things to change, and brain freeze is a mechanism to prevent you from doing that,” Godwin said.

The brain can’t actually feel pain despite its billions of neurons, Godwin said, but the pain associated with brain freeze is sensed by receptors in the outer covering of the brain called the meninges, where the two arteries meet. When the cold hits, it causes a dilation and contraction of these arteries and that’s the sensation that the brain is interpreting as pain.

Analyzing brain freeze may seem like silly science to some, but “it’s helpful in understanding other types of headaches,” Godwin said.

“We can’t easily give people migraines or a cluster headache, but we can easily induce brain freeze without any long-term problems,” he said. “We can learn something about headache mechanisms and extend that to our understanding to develop better treatments for patients.”

Is there a cure for brain freeze? Yes — stop drinking the icy cold beverage. You can also jam your tongue up to the roof of your mouth because it’s warm or drink something tepid to normalize the temperature in your mouth.

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