Monday, July 25, 2011

Monday Hepatitis News;Stanford researchers urge caution on use of AIDS regimen

New On The Blog
Hepatitis C-24wks pegylated interferon plus ribavirin effectively treat patients with HCV genotype 6a
Women with hepatitis have an increased risk for complications during pregnancy
Audio;Recommendations Chronic Hepatitis C Infection;Case Vignette
Hepatitis C Drug Incivek (telaprevir); What are the side effects ?
News; Hepatitis Weekend Round-Up

Hepatitis C Testing Practices and Prevalence in a High-risk Urban Ambulatory Care Setting
W. N. Southern; M.-L. Drainoni; B. D. Smith; C. L. Christiansen; D. McKee; A. L. Gifford; C. M. Weinbaum; D. Thompson; E. Koppelman; S. Maher; A. H. Litwin
Authors and Disclosures
Posted: 07/25/2011; J Viral Hepat. 2011;18(7):474-481. © 2011 Blackwell Publishing
Do hepatitis C testing practices differ in high-risk urban areas? This study takes a look.
An estimated 3.2 million persons are chronically infected with the hepatitis C virus (HCV) in the U.S.,[1] roughly three times as many as are infected with HIV.[2] HCV infection is thought to cause approximately 40% of chronic liver disease[3] and the majority of hepato-cellular carcinoma[4] Although the prevalence of anti-HCV is estimated at 1.6% in the U.S.,[1] urban populations bear a disproportionate burden of infection and inner city prevalence has been reported as high as 8.3%.[5] Effective treatment for HCV infection is available,[6–10] but the majority of those infected are not aware of their status.[11–15] Although testing for patients at high risk is recommended,[3,9,10,16,17] optimal testing strategies have not been described.[18] To inform the discussion of testing strategies, we sought to examine the associations between patient characteristics and HCV testing practices among physicians, and estimate the prevalence of HCV infection in a high-risk urban population.........
Journal of Viral Hepatitis, July 2011

Many with Hep C not diagnosed
Full story
Nelson health practitioners say a large chunk of people may not have been diagnosed with or treated for the "silent epidemic" of hepatitis C. They are making efforts to remove the stigma as World Hepatitis C awareness day approaches on July 28.

Hepatitis C a serious disease but can be cured
by Davia L.
The Marietta Daily Journal
July 25, 2011 12:00 AM

Approximately four million Americans have Hepatitis C, according to Dr. Norman Gitlin, chief hepatology and professor of medicine at Emory University.

Hepatitis strains vary, he said, and are transmitted different ways. For example, Hepatitis A is picked up through fecal or oral transmission (for example, ingesting contaminated food) and B mostly through IV drugs and unsafe sex. Vaccines for available for both.

Hepatitis C was named in 1992 and there is no vaccine against it, he said. "Up until now people did not know about it and were reluctant to be treated," Dr. Gitlin said. "But, treatment can now cure the disease in a majority of cases."

Those at risk for Hepatitis C include people who have had blood transfusions before 1992, used IV drugs, have tattoos and body piercing, and have experienced nasal inhalation of cocaine, he said. Dr. Gitlin said many of those infected do not show symptoms, which include weakness and insomnia. "By the time you get symptoms, it's usually means your disease has progressed with a severe form of cirrhosis or severe liver damage," he said, adding 54 percent of liver transplants in America are due to end-stage hepatitis C. "I think every American over the age of 25 should have one routine screening," he said. "If you have risk factors, there is no question you should be screened."

The doctor points out blood donors are automatically screened for the virus. Baby boomers are among the fastest-rising groups with the virus, something Dr. Gitlin attributes to "wild" living in the 1960s and '70s. He said behaviors such as sharing needles are the culprit. "Some people got it and were unaware of it," he said. "It's a little late in the game." New drug therapies have helped to not only successfully treat the disease, but do so in shorter duration of time. One of these drugs, Incivek, was approved by the FDA (according to information provided by Vertex Pharmaceuticals Incorporated).

Standard treatment for Hepatitis C includes taking pegylated interferon shots once a week and ribavirin twice daily. With the addition of Incivek, Dr. Gitlin said patients have had dramatic improvements. He said there is a 70 to 92 percent cure rate with the patient being fully recovered in six to 12 months. Quinton Moore, 62, of knows firsthand the dangers of Hepatitis, as he has contracted both A and C.

The Decatur resident said he contracted A as a young man but "rested up" and it went away. The second time was life-threatening. Upon arriving at his commercial construction job one morning in 2004, Moore said he discovered an electrician on the floor with the ladder turned over. "His head was busted open," Moore recalled. He said the man was unconscious and bleeding. In an attempt to stop the bleeding, Moore said placed his hand - which had cuts and were not protected with gloves - behind the man's head. He learned later on the man might have also been a heavy drug user.

After some time, Moore said his weight began to drop. He is 6 feet tall and is normally around 185 to 195 pounds. He said he and his boss had an arrangement that if his weight ever fell below 180, Moore would take time off. He said he continued to lose weight but did not know why.

Moore eventually started his own construction company and in 2008, a routine doctor's appointment led him to discover his illness. He said blood tests detected a high count of liver enzyme and he was tested for Hepatitis C.

When the test came back positive, Moore said his doctor advised him to seek medical treatment. He was in the high end of the third stage of the disease. Moore said, "Once you get (Stage 4), you generally don't recover from it." Moore underwent a clinical trial with the triple therapy of Incivek, pegylated interferon and ribavirin. He said he suffered some side effects - rashes, high temperatures, insomnia - but he was cleared of the disease within six months. He continued to undergo detection testing for the disease, but as of January there have been no traceable amounts of the virus. Moore said he now weighs 225. "I feel real optimistic about the future," the retiree said. "I got really good treatment from the doctors." He now plans to move to Florida with his wife, Brenda. He said, "I've got a few (more) decades to enjoy life."Because people are unaware of Hepatitis C and since doctors don't automatically screen for it, Dr. Gitlin says to request a screening, especially since it is curable.

"You don't do an ostrich and put your head in the sand," he said. "You should be screened and see a doctor about it."World Hepatitis Day is observed annually on July 28.

According to the World Hepatitis Alliance, the day provides an international focus for patients groups and people living with hepatitis B and C. For more information, visit www.worldhepatitis .

Stanford researchers urge caution on use of AIDS regimen
Stanford researchers are urging caution in the use of one of the AIDS drug regimens recommended by the World Health Organization, saying this particular mix of medications has a relatively high failure rate and could lead to problems with drug resistance.
In 2010, the WHO revised its list of recommended drug regimens for newly diagnosed patients, suggesting four different combinations; each contains tenofovir plus two other drugs. Postdoctoral scholar Michele Tang, MD, and her colleagues reviewed all the available literature on these regimens and found that one combination, which included lamividine (3TC) and nevapirine (NVP), performed very poorly, even compared to some of the older drug cocktails.....


Pro-pot lobby returns
The folks who brought you out-in-the-open pot-smoking are back! And this time they want you to approve the use of medical marijuana to treat all manner of disease.
There is legislation pending on Beacon Hill that would legalize the use of medical marijuana. But if the Legislature doesn’t act before next spring, the State House News Service reports that some supporters plan to pursue a ballot campaign...

Hinch regrets his wild boozy days
Gagged radio broadcaster Derryn Hinch, when confronted with his cancer-riddled liver that was also destroyed by cirrhosis, admits he was an idiot during his heavy drinking days.
Hinch was followed by a 60 Minutes crew in the lead-up to and after his life-saving liver transplant operation earlier this month and said seeing his ravaged liver was as confronting as anything you could face.

"I was a f*****g idiot, an absolute f*****g idiot," Hinch told Nine's current affairs show.


China's Simcere, Merck to form JV
NEW YORK -- China's Simcere Pharmaceutical Group inked a deal with Merck & Co Thursday to form a joint venture, aiming at serving China's rapidly expanding health care needs.
The strategic partnership will merge extensive resources and expertise of a global health care company and a leading Chinese pharmaceutical company in support of their goals in development, registration, manufacturing and sales capabilities, according to the agreement.
Their initial focus will be branded pharmaceutical products for cardiovascular and metabolic diseases.
Merck is proud to partner with Simcere and is committed to enhancing health care in China. The innovative partnership steps up Merck's business expansion, and also tallies with Chinese government's effort to facilitate the access to quality medicines, president of Merck's Global Human Health said at the signing ceremony in New Jersey.
The agreement marks another "milestone" in the company's history and seeks to address enormous challenges of the Chinese health care system and to meet the needs of Chinese patients and health care stakeholders, said Jinsheng Ren, chairman and CEO of Simcere.
Simcere Pharmaceutical Group, founded in 1995, is China's leading pharmaceutical company specializing in development, manufacturing and marketing of branded generic and proprietary pharmaceutical, and is dedicated to the treatment of diseases with high incidence and/or mortality rates.

Healthy You

Vitamin E
This fat-soluble vitamin discovered at UC Berkeley more than 80 years ago has been a star among nutrients for at least 25 years. Vitamin E is an important antioxidant that exists in several forms, the most potent of which is alpha tocopherol, the form usually found in Vitamin E supplements. Like other antioxidants, Vitamin E protects cells against the effects of free radicals, which are potentially damaging by-products of life processes. Free radicals can damage cells and may contribute to the development of heart disease and cancer. Vitamin E may play a role in immune function. The RDA for vitamin E is just 15 milligrams (about 23 IU) a day. The upper limit is 1,000 milligrams (about 1,500 IU) a day.

In 1994, reacting to promising research, the Wellness Letter began recommending vitamin E supplements as a possible way to reduce the risk of heart disease, cancer, and other disorders. After reviewing subsequent clinical trials that had yielded disappointing or conflicting results, we softened our endorsement of vitamin E supplements. In 2004 a much-publicized meta-analysis from Johns Hopkins Medical Institutions concluded that high doses of vitamin E (more than 400 IU a day) taken long term may slightly increase the overall risk of dying—by about 4%. Lower doses of vitamin E (200 IU or less) did not increase the risk. Three other meta-analyses on vitamin E found no increased risk.

Claims, purported benefits: Helps prevent cancer, heart disease, cataracts; boosts immunity.

Bottom line: While vitamin E from foods is important for health, there’s little or no clinical research showing that vitamin E supplements are beneficial. Nearly all the clinical trials on vitamin E from the past few years have yielded negative, inconclusive, or neutral results. Get vitamin E from foods—nuts, seeds, vegetable oils, whole grains, and leafy greens. There is no reason to take vitamin E supplements.

Answering Your Questions About Immunity
Your immune system is crucial in maintaining your health—so it's important to keep it in good order. But how do you do that? People talk about boosting immunity as if it were a task similar to building muscles or reducing blood cholesterol. Hundreds of ads for supplements and other products promise to boost immunity. But keeping your immune system in good shape is a complicated task. "How do I boost immunity?" is really the same question as "What can I do to stay well?"

How does the immune system fight disease?
Because war is a handy metaphor for the human body's reaction to disease, science writers like to describe the immune system in militaristic terms—the body's department of defense. But unlike the Armed Forces, the immune system has no headquarters or commander-in-chief. And its operations are usually swifter and more efficient than any army's could be.

Rather than "making war," your immune system is really more like an immigration service: a highly differentiated cellular bureaucracy that supervises your biological commerce with the outside world, sorts through billions of pieces of information about incoming materials, and takes routine action as required. Only occasionally does it declare an emergency.
The immune system's basic task is to recognize "self" (the body's own cells) and "nonself" (an antigen—a virus, fungus, bacterium, or any piece of foreign tissue, as well as some toxins). To deal with nonself or antigens, the system manufactures specialized cells—white blood cells—to recognize infiltrators and eliminate them. We all come into the world with some innate immunity. As we interact with our environment, the immune system becomes more adept at protecting us. This is called acquired immunity.

What are the parts of the system?
Among the primary components of the immune system are a variety of white blood cells. These constitute a communications network that helps organize the immune response.
Most people are surprised to learn that the skin, including the mucous membranes, is among the most vital components of immunity. The skin not only forms a wall against intruders, but actually alerts the white blood cells if the wall is breached by invading organisms (through a wound, for instance). The protection afforded by the intact skin is why it's nearly impossible to catch a disease from a toilet seat, for example.

Most infectious agents get inside the body when we inhale them or swallow them; a few can enter through the genitals. They make their way into the blood and move rapidly through the body. The immune system has its own circulatory system called lymphatic vessels, which allow white blood cells to catch intruders. Other important parts of the immune system include the tonsils and adenoids, thymus, spleen, lymph nodes, appendix, certain areas of the small intestine, and bone marrow.

What do the white cells do?
Many mature white blood cells are highly specialized. The so-called T lymphocytes (T stands for thymus-derived) have various functions, among them switching on various aspects of the immune response, and then (equally important) switching them off. Another lymphocyte, the B cell, manufactures antibodies. A larger kind of white cell, the scavenger called the phagocyte (most notably the macrophage), eats up all sorts of debris in tissue and the bloodstream, and alerts certain T cells to the presence of antigens.

In addition, there are killer, suppressor, and helper T cells. Killer T cells, stimulated by helper T cells, zero in on cells infected by antigens, or turn against the body's own cells when, as in the case of cancer, they begin to proliferate abnormally. Another class of lymphocyte killer cell is called "natural" because, unlike T and B cells, it doesn't need to recognize a specific antigen. Most healthy cells are of no interest to natural killer cells, but cancer cells and cells invaded by viruses may be vulnerable to their search-and-destroy missions.

What makes a person immune to various diseases?
Thanks to the lymphocytes, the immune system possesses a memory, or a sense of history. The lymphocytes manufacture antibodies (proteins circulating in the blood) that attack intruders. Once you have produced antibodies to a certain microbe—a specific flu virus, for example—that particular virus cannot make you sick again, because you have cells that immediately recognize it and produce the antibodies that destroy it. The immunity may last for years, sometimes for life. This is "acquired immunity."

Science has also developed vaccines. It all began in the late eighteenth century, when the English physician Edward Jenner observed that people who caught a mild disease called cowpox never got smallpox, which is related to it. Using a boy who had not had either disease, Jenner tried inoculation: he scraped the child's skin and applied secretions from cowpox sores, and the boy got cowpox. When Jenner later inoculated him with smallpox matter, the boy did not develop smallpox. (Such human experimentation would land Dr. Jenner in court today.)
Creating immunity by injecting healthy people with dead or altered disease-causing microbes has prevented millions of deaths from measles, polio, diphtheria, flu, smallpox, tetanus, yellow fever, and many other diseases. Vaccines truly are immune-system boosters.

Does loss of sleep depress immunity?
It can. But losing sleep for a few nights won't necessarily make you ill. Many things boost or depress immunity temporarily. The number of immune cells rises and falls naturally in healthy people.

What foods boost immunity?
An adequate diet helps maintain immunity and keeps you healthy. The immune system needs such nutrients as protein, fatty acids, vitamins, and minerals. Severely malnourished people are particularly vulnerable to immune dysfunction, and they get sick more easily than other people and stay sick longer. What most people want to know, though, is whether one specific food or kind of food will boost immunity in otherwise healthy people on an adequate diet. The answer is generally no.

What supplements boost it?
So far there's no reason to believe that supplements will boost immunity in healthy people, except in the malnourished and many of the elderly. Though severe malnutrition is rare in the U.S., some groups, particularly the elderly, may be deficient in such nutrients as vitamin C, certain B vitamins, and zinc. Studies suggest that raising nutrient intakes to adequate levels can enhance immunity, and there is some evidence that elderly people stay healthier if they take a multivitamin/mineral pill. In contrast, other research suggests that megadoses of certain nutrients can significantly suppress some immune responses.

Consider zinc, for instance, found in meat and grains, and often promoted as an ideal immune-system booster when taken as a supplement. While some studies show that zinc supplements can boost immunity and promote wound-healing in the elderly, high intakes can actually suppress the immune response.

A diet low in beta carotene can depress immunity, but it's not clear that beta carotene supplements can correct the situation, or what levels of supplementation would be helpful. Among the agents that have been shown to stimulate immunity in experiments are bacteria such as those in yogurt, but it's far from certain that consuming yogurt (with or without live cultures) will promote resistance to disease.

What about vitamin C?
This vitamin is necessary to good health and no doubt to immune function. But numerous studies have shown that vitamin C supplements have minimal or no effect on the immune response, unless you are deficient in C.

Does exercise boost immunity?
Some research shows that sedentary people don't have as vigorous an immune system as those who exercise. Moderate exercise (for example, a moderate walking program undertaken by previously sedentary people) seems to improve immune function. But there is also evidence that overdoing exercise may depress the immune system: high-intensity or prolonged endurance exercise steps up the output of two so-called stress hormones, adrenaline and cortisol, both of which can depress various components of the immune system.
Olympians and other highly trained athletes often report that after intense competition and training they are more susceptible to colds. Yet such news should not deter athletes from competing or exercisers from exercising.

The health benefits of exercise are clear. Regular aerobic exercise is good for the heart. Weight-bearing exercise builds bone and muscle. The idea that your immune cells might not show a response to your exercise program should not deter you from exercising or from beginning an exercise program if you are sedentary.

Can emotions affect the immune system?
States of mind surely affect health, and extreme emotional stress may damage immunity and bring on illness. But research into the link between mind and immunity is in its early stages and has produced very little solid evidence so far—and not much advice about how to protect the immune system from the ill effects of emotional stress. An experiment may show that extreme grief depresses human T cells, for instance, but we don't know if the rest of the system is harmed, or whether the fluctuation means much.

Still, reports of increased illness and even death among the recently bereaved are common. Cancer patients with a "fighting spirit" seem to live longer than those who are despondent, but this may or may not prove something about immune function. Good social support is thought to improve immunity in people under stress.

Immune cells and nerve cells do interact. For example, when fighting an infection, immune cells are able to stimulate the brain to transmit the impulses that produce fever. Receptors for many of the chemicals released during stress, such as epinephrine and norepinephrine, have been observed on the surface of lymphocytes found near nerve terminals in the lymph nodes and spleen. This suggests that what goes on in the brain can interact with the immune system to suppress or, conversely, enhance it.

What does smoking do to immunity?
Part of the reason smokers are at risk for lung cancer and respiratory diseases may be that smoking suppresses immune cells. When smokers quit, immune activity begins to improve within 30 days.

When and why does the immune system malfunction?
The immune system has so many built-in fail-safes that, in theory at least, we should rarely fall ill. But, in fact, we do. Harmful agents such as HIV can baffle our defenses. The system can simply be overwhelmed by the number and toxicity of viruses, bacteria, or other foreign cells and toxins.

Though the immune system defends us against cancer, it is subject to cancer. Leukemia is a cancer of the white blood cells; multiple myeloma affects certain lymphocytes that produce antibodies. Cancers of the lymph system include lymphoma and Hodgkin's disease. Some of these cancers can now be successfully treated.
Sometimes the gatekeepers of the system go crazy, mistaking a basically inoffensive intruder such as pollen, dust, or a bit of bee venom for an enemy and causing the body to go into the red alert known as an allergic reaction. In addition, the immune system can mistake the body's own cells and tissues for "nonself" and attack them, as in auto-immune diseases like rheumatoid arthritis and systemic lupus.

The immune system will also reject and kill potentially lifesaving organ and tissue transplants, unless some way can be found to circumvent the reaction. Though in theory a pregnant woman's immune system should attack the fetus—which is nonself—it doesn't. This is because the fetus itself produces a substance that shields it from the maternal defense system.

So how can I nurture my immune system?
Perhaps the most direct action you can take is to consume a varied, balanced diet of vegetables, fruits, whole and fortified grains, and dairy products, with small amounts of fish and meat if you wish. A basic daily multivitamin/mineral supplement is usually a good idea for older people. Beware of any supplement, however, that promises to boost immunity: protein supplements, enzyme supplements, and the whole range of specific vitamins and minerals, antioxidants, and nostrums that claim to boost immunity don't strengthen it.
Regular moderate exercise is associated with good health and longevity and will benefit your cardiovascular system, whether it boosts immunity or not. Getting adequate sleep is also helpful. And, of course, don't smoke.

From Medscape Medical News
Omega-3 Supplements May Lower Anxiety
Deborah Brauser
Authors and Disclosures

July 22, 2011 — Increasing omega-3 intake may lower both anxiety symptoms and proinflammatory cytokines in healthy young adults, new research suggests.
In a small randomized controlled trial of medical students, those who received omega-3 supplements for 3 months showed a 20% reduction in anxiety scores and a 14% reduction in stimulated interleukin 6 (IL-6) production.

According to the investigators, the study "provides the first evidence that omega-3 may have potential anxiolytic benefits for individuals without an anxiety disorder diagnosis."

Dr. Janice Kiecolt-Glaser
"We were impressed by the magnitude of the anxiety effect and the evidence for its anti-inflammatory effects, suggesting that it might have broader benefits," lead study author Janice Kiecolt-Glaser, PhD, professor of psychiatry and psychology and S. Robert David Chair of Medicine at the Institute for Behavioral Medicine Research at Ohio State University College of Medicine (OSUMC) in Columbus, told Medscape Medical News.
She noted that the significant reduction in IL-6 is especially important because the young study population had low rates to begin with.
"So our findings could possibly be much more significant in a group that was older and had more health problems."

The study was published online July 19 in Brain, Behavior and Immunity.
Fish Oil Benefits the Body

"Chronic inflammation has been linked to a broad spectrum of health problems, including cardiovascular disease, stroke, and rheumatoid arthritis," write the researchers.
"Large population studies suggest that greater fish consumption may help control or protect against the onset of these and other inflammatory conditions," they add.
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are 2 key omega-3 polyunsaturated fatty acids (PUFAs) found in fish oil, which may also benefit mood.
In fact, previous research, including a study reported on last year by Medscape Medical News, has suggested that omega-3 can lower depressive symptoms in patients diagnosed as having clinical depression.

Because both depression and anxiety have been found to increase the production of proinflammatory cytokines, the current investigators hypothesized that giving omega-3 PUFA supplementation to healthy subjects would lead to a decrease in this production.
Secondary outcome measures were lowered anxiety and depressive symptoms, as well as lowered negative mood symptoms associated with taking stressful exams.
A total of 68 first- and second-year medical students (56% male; mean age, 23.65 years) were enrolled and randomized to receive 3 times daily either omega-3 supplement capsules (consisting of 2085 mg of EPA and 348 mg of DHA, n = 34) or fish-flavored placebo capsules (n = 34) for 12 weeks.

"We chose the 7:1 EPA/DHA balance because of evidence that EPA has relatively stronger anti-inflammatory and antidepressant effects than DHA," explain the investigators.
"The supplement was probably about 4 or 5 times the amount of fish oil you'd get from a daily serving of salmon," added coauthor Martha Belury, PhD, RD, professor of human nutrition at Ohio State University, in a release.

All participants were interviewed 6 times, and serial blood samples were scheduled to be taken during lower-stress days and on the days before major exams.
In addition, the Center for Epidemiological Studies Depression Scale and Beck Anxiety Inventory were administered at all visits.

Reduced Anxiety, Cytokines
Results showed no significant differences between stress and nonstress days across all outcomes for either group.

"Thus, the ability of omega-3 supplementation to dampen stress response could not be tested," write the researchers.

They note that this was probably due to a sudden change in the medical school's curriculum. Instead of distributing the major tests during a 3-day period, as done in the past, the exams were given throughout the year.

"This group was notably unstressed, which was a severe disappointment and a study limitation. We just didn't get the stress effect we had expected," said Dr. Kiecolt-Glaser.
Still, the treatment group showed a significantly greater reduction in anxiety symptoms at 20% than did the placebo group (P = .04).
They also had a greater decrease in their amounts of stimulated IL-6 production (0.15 units lower, P = .04).
"Anything we can do to reduce cytokines is a big plus in dealing with the overall health of people at risk for many diseases," said coauthor Ron Glaser, PhD, professor of molecular virology, immunology, and medical genetics at OSUMC.
There were no significant changes in depressive symptoms for either group.
"Again, this was not a depressed group, and without more severe depression, you may not see an effect," said Dr. Kiecolt-Glaser.

"Overall, that both anxiety and inflammation were altered is notable, especially in a group that was not clinically anxious," she added.
Even so, the investigators are not yet ready to suggest that everybody should start taking fish oil pills.

"It may be too early to recommend a broad use of omega-3 supplements throughout the public, especially considering the cost and the limited supplies of fish needed to supply the oil. [Instead], people should just consider increasing their omega-3 through their diet," said Dr. Belury.
Dr. Kiecolt-Glaser reported that the investigators have just finished another trial that examined the effects of increasing omega-3 in a population between the ages of 40 and 85 years who have an average body mass index of 30.

Omega-3 for All Psychiatric Disorders?

"This study reveals 2 remarkable, clinically solid findings," Capt. Joseph R. Hibbeln, MD, acting chief, Section on Nutritional Neurosciences at the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health (NIH), Bethesda, Maryland, told Medscape Medical News.

The first, "which cannot be understated," is the reduction of anxiety scores in a normative population, said Dr. Hibbeln, who was not involved with this study.
"Many trials of omega-3 fatty acids in depression have confused the field because it's very difficult to reduce depression in people who don't have the disorder. And it's also very difficult to reduce anxiety in those who don't have clinically manifest anxiety," he explained.
"The second was that they probed the question of whether or not omega-3 fatty acids at least work in part through changes in the immune system and neural-immune interactions by measuring the effects of cytokine release in the patients' white blood cells ex vivo."
He noted that the "very marked decrease" in cytokine production in the treatment group was impressive.

"This is absolutely consistent with the hypothesis that one of the mechanisms of action for omega-3 fatty acids is not necessarily central but is through down-regulating the immune system. The study begs the question: is increased anxiety a manifest symptom of omega-3 fatty acid deficiencies? And their answer is yes."

Dr. Hibbeln said that the current 2010 US Department of Agriculture Dietary Guidelines recommend omega-3 PUFAs for the protection of heart disease and for pregnant mothers to prevent deficiencies in their offspring.

In 2006, the treatment committee for the American Psychiatric Association (APA), of which he was a member, issued recommendations that all patients with a psychiatric disorder should take at least 1 gram a day of omega-3 PUFAs to prevent the medical complications that often co-occur for them, such as cardiovascular disease and metabolic problems.
"This paper should be another signal that the practicing psychiatrist should follow the 2006 APA recommendations," concluded Dr. Hibbeln.

The study was funded in part by a grant from the National Center for Complementary and Alternative Medicine, which is part of the NIH. The study authors and Dr. Hibbeln have disclosed no relevant financial relationships.
Brain Behav Immun. Published online July 19, 2011.

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