Wednesday, April 20, 2011

Hep C In The News;Menopause,Oysters,Antidepressants,Acai Berry and More

Hi Folks,
Its the middle of the week yet again, with rain, wind and only a few days until Easter. In Michigan we're waiting for spring to stick around, but it seems that isn't happening anytime soon. In today's Detroit News we had a little write up about hepatitis C from Dr. Donohue. A reader wrote in asking him the differences among hepatitis A, B and C. In response Dr. Donohue wrote; 
"Hepatitis" means "liver inflammation with death of liver cells." Viruses are not the sole cause. Our immune systems can turn on the liver to produce autoimmune hepatitis. Chemicals and drugs can be responsible for it. Too much alcohol leads to alcoholic hepatitis.  
The five hepatitis viruses — A, B, C, D and E — are responsible for many hepatitis cases. All of these viruses produce a similar picture in the acute phase of illness: nausea, vomiting, loss of appetite, loss of energy, fever and yellowing of the skin and whites of the eyes. A few people succumb to acute hepatitis, but most recover
Hepatitis A usually is transmitted from food or drink contaminated with the hepatitis A virus. The acute illness can be quite serious, but most pull through it. This virus doesn't cause chronic infection. Once the acute illness is over, the future is free of any permanent liver damage. I believe your daughter might have had this type.
One-third of the earth's population is infected with the hepatitis B virus. After the acute illness, hepatitis B virus remains in the livers of 5 percent to 10 percent of patients. It can progress to liver cirrhosis or liver cancer. It's acquired through dirty needles used in illicit drug injections, through intercourse, passed from infected mother to her fetus and, formerly, through infected blood transfusions.
Hepatitis C also comes from injection of illegal drugs. It used to be transmitted by blood transfusions. Rarely is it transmitted by sexual relations. About 80 percent of infected people carry the virus for life. Progression to liver cirrhosis and liver cancer is possible, but it takes 20 to 30 years to occur.
Hepatitis D and E are seen less frequently in North America.

An announcement from the UK at the University of Glasgow Centre for Virus Research, brought good news with the centre receiving almost £2 million from the Medical Research Foundation. They will use the money to set up a database of 10,000 patients who are infected with HCV. The centre said it will help enable a UK-wide network of researchers to find new ways to fight the virus.

While there has been considerable progress in the scientific understanding of the disease in recent years, it is currently extremely difficult to effectively track the spread of HCV and to understand the biological roots of the illness. Dr John McLauchlan will lead the project at the MRC - University of Glasgow Centre for Virus Research in partnership with Professor Will Irving at Nottingham University.

At least 250,000 people in the UK are thought to be infected with the blood-borne virus, which can cause severe liver damage in up to 20 per cent of patients. HCV is ten times easier to contract than HIV, with prisoners and drug users particularly vulnerable to infection.

Dr John McLauchlan said: “With Hepatitis C rates continuing to rise and place an increasing strain on healthcare resources, it’s crucial that we attack this disease on as many fronts as possible. By creating a well-structured resource, we hope that it will stimulate both clinical and fundamental research into HCV infection in the UK and form the basis for many future studies.”


Sad news from Scope today on our heroic soldiers returning home from the Iraq war, Lisa Steakley reported on the Standford blog that some of the veterans are plagued with mental illness and substance abuse problems, the author writes;

An estimated 30 percent of Iraq war veterans have been diagnosed with mental health issues and research shows their conditions often become more serious, instead of improving, a year after leaving the battlefield.

Do read her article here .

In other news from Hepatitis Central ;

Are Early Menopause and Hepatitis C Treatment Response Connected?
Compared to women in their childbearing years, menopausal women have a disadvantage in the battle against Hepatitis C. However, those who begin menopause prematurely have an even greater hurdle to overcome. Read more.

On this blogs web site you can view additional data on women, HCV and  antiviral therapy.  

NATAP has also put together a nice page on Boceprevir and Telaprevir.

Todays Healthy You .
20 April 2011
Eating raw or undercooked mollusks may pose a safety hazard if they are harvested from waters polluted with pathogenic microbes, so U.S. Department of Agriculture (USDA) scientists are studying ways to enhance the food...

A Warning For Patients With Liver Disease
Eating raw or undercooked oysters can be fatal for some people. Vibrio are naturally occurring bacteria in marine and estuarine waters throughout the world.
Eating raw or undercooked oysters is one way people become infected with Vibrio bacteria. While this bacterium may cause gastrointestinal illness in healthy people, individuals with liver disease such as cirrhosis, chronic medical conditions such as kidney disease, iron disorders, or diabetes or those whose immune systems are compromised are at a high risk of severe or fatal infection.
 While those individuals may enjoy fully cooked seafood, they should not eat raw or undercooked shellfish. For more information on Vibrio and the risks of eating raw oysters and clams, go to  
When treating HCV 99% , if not all of us need an antidepressant, so I thought this might be of some interest to anyone finishing up therapy.

Antidepressant Discontinuation Syndrome - Start Slow? Stop Fast?
SAN DIEGO – The risk of discontinuation syndrome is small when antidepressant treatment is suddenly stopped, but the symptoms – though somewhat brief – are still unpleasant for patients, according to Dr. Kurt Kroenke.

Unfortunately, he said, there are no firm data that predict who might develop discontinuation syndrome, which drugs are likely to cause it, or whether medication tapering can avoid it.
"If you just immediately stop an antidepressant, you can expect to have a 5%-15% incidence of discontinuation syndrome," Dr. Kroenke said at the annual meeting of the American College of Physicians. "It usually starts within a few days and stops within a few weeks," but it’s no picnic for patients.
FINISH is the acronym that describes this syndrome, said Dr. Kroenke, an internist at Indiana University, Bloomington. Patients experience flulike symptoms, insomnia, nausea, imbalance, strange sensory dysesthesias, and hyperarousal or anxiety.

The syndrome is probably less likely if a patient is switching to another drug rather than ceasing medication altogether, but no studies have determined the best way to implement either change. "It’s not clear if a long taper is better than a short taper, or even if discontinuation syndrome is something that’s dose related," he said. "If you’re on 200 mg of sertraline and you stop, as opposed to 50 mg, we can’t say the higher dose equals an increased risk."

Some studies seem to suggest that the risk is highest with paroxetine. "Fluoxetine probably has the lowest risk because of its long half-life. Venlafaxine is associated with an intermediate risk and all the others fall somewhere below that," Dr. Kroenke said.

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial provides the largest single body of evidence on antidepressant switching (Am. J. Psychiatry 2006;163:1905-17). The methodology in the trial, which involved four levels of treatment and seven antidepressants, was basically simple, Dr. Kroenke said. "You either discontinued one medication and immediately began another or you decreased the first medication while initiating the second at a low dose, doing this taper/titration over 1 week. It doesn’t get much simpler than that." Most investigators in the study chose the first option, he said.
"Having said that, I would probably go for some version of option two, and if the patient is on a higher dose, I might spend a week tapering one while titrating the other."

In a few specific situations, Dr. Kroenke said he strongly favors the taper/titrating method. "I always consider tapering if I’m working with paroxetine or venlafaxine, especially if it’s at a higher dose and has been taken for a long duration," he said. "And definitely if the patient has experienced discontinuation syndrome in the past."
Dr. Kroenke said he has consulted for, and received honoraria from, Eli Lilly and Forest.

A little on Calcium

"You could argue that this demonstrates the risks in 'blind dosing' (everybody gets x whether they n..."
J Brown, MD wrote
"I concur with Dr. Baker. Is the increased risk of cardiovascular disease due to arterial calcifica..."
lizt wrote
"Seriously, how do you not know that you need vitamin K to keep calcium away from the heart and into..."
Milnacipran Plus Pregabalin Adds Relief for Fibromyalgia Patients .
NATIONAL HARBOR, MD. – Fibromyalgia patients who failed to respond to pregabalin showed significant symptom improvement when milnacipran was added to their regimen compared with those who continued taking pregabalin alone, a study involving 332 patients has shown.

The open-label study was the first randomized, controlled trial to show the benefits of adding milnacipran (MLN) to existing pregabalin (PGN) therapy in fibromyalgia patients, according to Dr. Mildred Farmer of Meridien Research in St. Petersburg, Fla., and colleagues. Pregabalin was approved for treating patients with fibromyalgia in 2007; milnacipran was approved for the indication in 2009.

The patients, aged 18-70 years, had baseline Visual Analog Scale (VAS) pain scores of 40 or higher, and they failed to improve on PGN alone during a 4- to 12-week PGN run-in period.
After the run-in period, patients were randomized to 300 or 450 mg/day of PGN (which served as the control group) or a PGN treatment plus 100 mg/day of milnacipran.

After 11 weeks, significantly more patients in the MLN group reported their symptoms were "much improved" or "very much improved" compared with the control group, based on Patients’ Global Impression of Change scale scores. Patients in the MLN group also showed significant improvements in physical and mental function, fatigue, and cognition compared with controls, based on scores on the Multiple Ability Self-Report Questionnaire (–3.69 vs. 1.19).

In addition, "patients receiving MLN added to PGN had significantly greater improvements in VAS 1-week recall pain scores than patients treated with PGN alone," Dr. Farmer said at the annual meeting of the American Academy of Pain Medicine.

The incidence of serious adverse events was not significantly different between the MLN and PGN groups (2.7% vs. 3.4%), nor was the rate of discontinuation significantly different between the two groups (15% vs. 9%). The most common treatment-emergent adverse events in the MLN group were nausea (10%), fatigue (10%), and constipation (10%). Overall, the incidence of adverse events was consistent with, or less than, the adverse events listed in the prescribing information for MLN and PGN, the researchers noted.
No patients in either group had clinically significant increases or decreases in systolic blood pressure.
The results were limited by the open-label nature of the study. However, the data suggest that fibromyalgia patients with an incomplete response to PGN alone might benefit from the addition of MLN. "Milnacipran and pregabalin appear to be complementary in their actions in fibromyalgia patients," Dr. Farmer said.
The study was sponsored by Forest Laboratories and Cypress Bioscience. Two of the study coauthors were employed by these companies. Dr. Farmer is the chief principal investigator and medical director of Meridien Research
Johnson & Johnson posted better-than-expected quarterly earnings on Tuesday, as rebounding sales of prescription drugs overshadowed declining revenue from over-the-counter medicines that have been plagued by recalls.

Hall Of Shame

Fake News Sites Link To Acai Berry Diet Scam, Say Feds

Consumers searching for unbiased journalism on the acai berry diet clicked their way into a scam, according to federal regulators who have filed lawsuits in six states in an attempt to shut down the alleged Internet tricksters.
The Federal Trade Commission announced Tuesday it has asked federal courts to stop a wave of fake news sites that entice consumers to buy the unproven weight-loss products.
The sites violate federal law by using the logos of major news outlets to mislead consumers into thinking they're reading real news reports, according to the court filings. In reality, the sites are advertisements.
Over the past seven days, the FTC filed complaints in federal courts in Illinois, Michigan, New Jersey, New York, Georgia and Washington. The complaints named 10 website operators and asked the courts to freeze their assets.
The defendants paid more than $10 million to advertise their fake news sites, the FTC said. It's not clear whether the defendants allegedly running the sites are connected, although content on the sites is similar or the same, said FTC attorney Steven Wernikoff in Chicago..continue reading...

From Berkeley
Açaí Juice
In the nutraceutical or nutritional supplements market, there is never any shortage of bandwagons. One of the loudest and largest these days is the açaí bandwagon. Harvested from a Brazilian palm, açaí (ah-SAH-ee) berries are a dietary staple in Brazil and have also been used medicinally by Amazonian tribes. Açaí juice was introduced in the U.S. in 2001, and there are now more than 50 new food and drink products containing açaí. As a juice, pulp, powder, or capsule, it is marketed as a magic path to weight loss, a wrinkle remover, a way to cleanse the body of "toxins," and indeed just a plain old miracle cure. It is often combined with other ingredients, such as glucosamine, so that the claims for benefits multiply exponentially.

Offers for açaí have flooded the nation’s email boxes. On the Internet you’ll find a bouquet of endorsements from such celebrities as Oprah, Nicholas Perricone (the TV "skin doctor"), and Rachael Ray (the TV chef), plus statements by these same celebrities denying any such endorsement, or at least any endorsement of a particular brand, except that Dr. Perricone sells a brand of his own. You will also find a war of words among makers of açaí products, each one claiming safety and effectiveness for its particular formulation, and warning of scams by others.

Since açaí came on the market there have been a few studies pointing to potential benefits. Like many other fruits, açaí berries are high in antioxidants (molecules that quell cell-damaging free radicals) and other interesting compounds. But these were lab studies, and the results may not apply to humans. There is no scientific basis for weight-loss claims or any other health claims for açaí. The term "antioxidant" has become a sales tool.

Consumer protection groups such as the Center for Science in the Public Interest (CSPI) and the Better Business Bureau (BBB) have now come out against açaí marketers. "If Bernard Madoff were in the food business," said a CSPI nutritionist, "he’d be offering ‘free’ trials of açaí-based weight-loss products." Online ads regularly promise a free trial, saying that all you have to pay is shipping and handling. The catch is that you must supply your credit card number, and you’ll automatically be signed up for $50 monthly shipments that will prove hard to cancel.

We urge you not to give your credit card number to anybody selling açaí products. Hundreds of complaints have been registered, and you may never get your money back. Beware of web-sites warning you of açaí scams—far from helping you get your money back, most turn out to be just sales pitches for more açaí.
There is no magic berry for weight loss or good health. Açaí berries are no doubt a good food, like other berries, but why pay a fortune for them or supplements containing them?

Enjoy The Day !

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