Showing posts with label wellness. Show all posts
Showing posts with label wellness. Show all posts

Friday, January 13, 2012

Morning HCV News Ticker:Walgreen Overcharging For Generics ?

Norman Rockwell, 1930, At the Breakfast Table

Walgreen Co., the biggest U.S. drugstore chain, and generic drugmaker Par Pharmaceutical Cos. (PRX) swapped prescription-drug tablets for more expensive capsules to boost profits, a union benefits fund claimed in a lawsuit.

“Walgreen’s and Par engaged in at least two widespread schemes to overcharge insurance companies, self-insured employers and union health and welfare funds,” the United Food & Commercial Workers Unions & Employers Midwest Health Benefits Fund said in a complaint filed yesterday in federal court in Chicago.

The drugs involved included generic versions of Zantac and Prozac, according to the complaint. The fund and other third- party payers paid millions of dollars more for the capsules than they would have for the correctly prescribed tablets, said the fund, which is seeking to sue on behalf of all third-party payers in the U.S. from 2001 to 2006.

The companies’ actions violated federal racketeering laws, according to the complaint. The fund is asking for unspecified cash damages.

Vivika Panagiotakakos, a spokeswoman for Deerfield, Illinois-based Walgreen, declined to comment on the filing.

In 2008, Walgreen agreed to pay $35 million to settle claims by the U.S. and 42 states that it was overcharging state Medicaid programs for ranitidine -- a generic form of the antacid Zantac -- and for fluoxetine, a generic form of the antidepressant Prozac.

Whistle-Blower Lawsuit

The Chicago case relies in part on that accord, which ended a 2003 whistle-blower lawsuit as well a lawsuit filed against the drugmaker in 2006.

The media relations department of Woodcliff Lake, New Jersey-based Par didn’t immediately reply to an e-mailed request for comment on the suit after regular business hours.

The case is United Food and Commercial Workers Unions and Employers Midwest Health Benefits Fund v. Walgreen Co. (WAG), 12-cv- 00204, U.S. District Court, Northern District of Illinois (Chicago).

To contact the reporter on this story: Andrew Harris in Chicago at aharris16@bloomberg.net

To contact the editor responsible for this story: Michael Hytha at mhytha@bloomberg.net


Doc In AstraZeneca Bribe Scandal Commits Suicide
A key figure in a scandal in which AstraZeneca was indicted in Serbia over allegations of offering bribes to physicians has committed suicide. Nenad Borojevic, who was the former director of the Serbian Institute of Oncology and Radiology Nenad Borojevic, was found hanging from a tree in a forest in Belgrade, according to media reports..continue reading

Hepatitis C Worldwide

Hep C threat to health services
The large number of people in Ireland with hepatitis C poses serious implications for the national health services in the future, the Health Protection Surveillance Centre (HPSC) has warned.

A recent study has estimated that between 20,000 and 50,000 people in Ireland are now chronically infected with hepatitis C.

HPSC Director Dr Darina O’Flanagan said this would have serious implications for health services in the future as a significant proportion of those with hepatitis C would go on to develop cirrhosis, liver failure and hepatocellular carcinoma. “In this regard, the anticipated publication of the National Hepatitis C Strategy in 2012 is to be welcomed,” the public health specialist commented.

She said once again, very large numbers of cases of hepatitis C were reported in 2010, with over 1,200 cases reported for the first time in that year.
Dr O’Flanagan made her comments in the HPSC Annual Report 2010 published recently.

The number of cases of hepatitis C reported in 2010 was very similar to 2009, with 1,239 notifications (29/100,000 population) compared to 1,241 in 2009). Some 67 per cent of cases (833) were male, and the highest notification rates were in young to middle-aged adults. Seventy-two per cent (896) of cases were aged between 25 and 44 years old.

The geographic distribution of cases was skewed, with the HSE-East reporting 76 per cent of all cases notified in 2010. The highest notification rates were also in the HSE-East (63/100,000 population, 940 cases).

According to the data, available for 59 per cent of cases (728), the most common risk factors reported were injecting drug use (76 per cent or 550), being an asylum seeker/born in an endemic country (9 per cent or 63 cases), sexual exposure (5 per cent, 38) and receipt of blood or blood products (3 per cent, 19). lloyd.mudiwa@imt.ie

Hepatitis E

China approves hepatitis E vaccine

BEIJING, Jan. 11 (Xinhua) -- China has approved a hepatitis E vaccine, claimed to be the world's first, said the Ministry of Science and Technology Wednesday.

The vaccine received the certificate for medicine production in December 2011, according to the State Food and Drug Administration.

A team of researchers from Xiamen University and Xiamen Innovax Biotech Co. Ltd. in southeast China's Fujian province had worked for 14 years to develop the vaccine, and the 863 program, the government-funded high-tech development initiative, began to sponsor the research in 2005, said the ministry statement.

The country will apply the vaccine to high-risk members of the population and work with international organizations to introduce it to other countries, the statement said.

The hepatitis E virus is shed in feces and spread via tainted water and food. According to the World Health Organization, one third of the global population is estimated to be infected by the virus and countries in South and East Asia report about 6.5 million infection cases every year.

In China, incidences of hepatitis E have increased notably and become the most common among all types of hepatitis infecting adults.

According to a research paper from the vaccine's development team published in The Lancet in August 2010, researchers conducted a trial involving 97,356 healthy participants in China. Half of them were given the vaccine and the other half a placebo.

The vaccine was given in three doses -- the second was given a month after the first and the third five months later.

Within a year of the third dose, 15 of the participants who were given placebos had contracted hepatitis E while no one in the vaccine group was infected, according to the report.

HIV

HIV transmission: 1 in 900 sex acts transmits virus

A heterosexual person infected with HIV will transmit the virus to their partner once in every 900 times the couple has unprotected sex, according to a new study conducted in Africa.

However, the exact number of sexual acts that are needed to transmit the virus can vary tremendously depending on the amount of the virus in the infected person's blood, said study researcher James Hughes, of the University of Washington in Seattle.

In fact, the amount of virus in the blood is the single most important factor in determining whether HIV is passed between sexual partners, the study found. For every tenfold increase in the concentration, there is about a threefold increase in the risk of transmission during a single sexual act.

People with very high blood concentrations of the virus (such as those who very recently acquired the infection) may need to have sex only 10 times to transmit the virus, Hughes said. "The average can be a little deceptive," Hughes said.

The new findings reinforce the idea that the best methods for reducing HIV transmission are those that decrease the concentration of the virus in the blood, as can be done with antiretroviral drugs, Hughes said. A study published last year found the drugs could reduce the transmission of HIV between partners by 96 percent.

The new study also confirmed condoms are highly effective in preventing HIV infection, reducing the risk of transmission by 78 percent. Male circumcision reduced the risk of HIV transmission by 47 percent.

HIV transmission

Earlier studies attempted to estimate the rate of HIV transmission, but were typically quite small, and did not measure the concentration of the virus in the blood throughout the entire study period.

The new study included 3,297 couples from sub-Saharan Africa that were "HIV-discordant," meaning one partner had HIV while the other did not. The HIV-infected partners in the study were tested periodically over the two-year study for the amount of HIV in their blood. Infected partners were also interviewed every month and asked how many times they had sex, and whether they used protection.

The uninfected partners were tested periodically to see whether they had acquired HIV. The researchers used genetic testing of the virus to confirm that any new HIV infections had been acquired from the study partner designated at the study's start.

Eighty-sixHIV transmissions occurred during the study period.

Men were about twice as likely to transmit HIV to women as women were to men. This increased risk of transmission could be attributed to higher virus concentrations in the blood of men compared with women, according to the study. In addition, women were more likely to have genital herpes, which increases susceptibility to HIV.

Condoms were reported to be used in 93 percent of sexual acts, but the researchers suspect their use was overreported. Therefore, condoms actually may be even more effective at preventing HIV transmission than the 78 percent reduction that the researchers estimated, Hughes said.

The AIDS epidemic

The study relied on self-reports, which might be wrong. However, errors in reports of the number of sexual acts would be unlikely to affect most of the study results, Hughes said.

The average risk of HIV infection per sexual act estimated in the study is consistent with what has been found by previous research, but there are many situations in which that number may not apply," said Dr. Myron Cohen, a professor of medicine, microbiology, immunology and public health at the University of North Carolina at Chapel Hill, who was not involved in the work.

That's because the participants included in the study are couples that have remained together and discordant over a long period of time. This indicates the couples might have some biological protection against transmission, Cohen said.

"The true estimation might be higher if you were studying different kinds of people," Cohen said.

While most of the findings are likely generalizable to other countries, the number of sexual acts needed to transmit the virus is likely specific to the African population studied, Hughes said. Previous studies in the United States have found a lower transmission rate.

In addition, the findings only apply to heterosexual couples, and not men who have sex with men, a group that is likely to have a much higher transmission rate, Hughes said.

Pass it on: The best way to reduce the risk of HIV transmission is to lower the amount of the virus in the blood.

Cancer


Table 1. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention

View Full Text Here...

The ACS publishes Nutrition and Physical Activity Guidelines to advise health care professionals, policymakers, and the general public about dietary and other lifestyle practices that reduce cancer risk.13 These Guidelines, updated in 2012 by the ACS Nutrition and Physical Activity Guidelines Advisory Committee, are based on synthesis of the current scientific evidence on diet and physical activity in relation to cancer risk.

ACS RECOMMENDATIONS FOR INDIVIDUAL CHOICES

Achieve and maintain a healthy weight throughout life.

• Be as lean as possible throughout life without being underweight.
• Avoid excess weight gain at all ages. For those who are currently overweight or obese, losing even a small amount of weight has health benefits and is a good place to start.
• Engage in regular physical activity and limit consumption of high-calorie foods and beverages as key strategies for maintaining a healthy weight.
Adopt a physically active lifestyle.
• Adults should engage in at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week, or an equivalent combination, preferably spread throughout the week.
• Children and adolescents should engage in at least 1 hour of moderate or vigorous intensity activity each day, with vigorous intensity activity occurring at least 3 days each week.
• Limit sedentary behavior such as sitting, lying down, watching television, or other forms of screen-based entertainment.
• Doing some physical activity above usual activities, no matter what one's level of activity, can have many health benefits.
Consume a healthy diet, with an emphasis on plant foods.
• Choose foods and beverages in amounts that help achieve and maintain a healthy weight.
• Limit consumption of processed meat and red meat.
• Eat at least 2.5 cups of vegetables and fruits each day.
• Choose whole grains instead of refined grain products.
If you drink alcoholic beverages, limit consumption.
• Drink no more than 1 drink per day for women or 2 per day for men

View Full Text Here...

Healthy You


Salt Shakedown -- How to avoid hidden sodium at the grocery store

Uploaded by on Jan 11, 2012

Join Johns Hopkins registered dietitian, Arielle Rosenberg, as she walks through the aisles and offers suggestions on how to lower salt intake -- but not compromise flavor.





Sugary soda ups risky fat deposits

By Kerry Grens

NEW YORK | Thu Jan 12, 2012 2:22pm EST

NEW YORK (Reuters Health) - Drinking a liter of regular cola every day increases the amount of fat in the liver and in the muscles and surrounding the organs in the belly, according to a new Danish study.

That kind of fat buildup has been linked in other studies to an increased risk of diabetes and heart disease.

"This study suggests that the adverse effects of sugary beverages go beyond just weight gain or fat gain. It's the gaining of the wrong fat in the wrong places," said Dr. Frank Hu, a professor at the Harvard School of Public Health, who was not involved in this study.

The researchers, led by Dr. Bjrn Richelsen at Aarhus University Hospital in Denmark asked people to drink either a liter of water, milk, diet cola or regular cola each day for six months.

The 47 people who participated in the study were all overweight or obese.

Richelsen said his team chose to study this group because they anticipated overweight or obese people would be more sensitive to dietary changes than people of normal weight.

At the end of the study the regular cola drinkers ended up with 25 percent more fat surrounding their organs, and just about doubled the amount of fat in the liver and muscle.

Such increases "are in most studies associated with an enhanced risk for developing the metabolic syndrome, type 2 diabetes...cardiovascular diseases, and non-alcoholic liver diseases," Richelsen told Reuters Health by email.

Metabolic syndrome is a group of health factors that is linked to an increased risk of diabetes, heart disease and stroke.

The type of fat Richelsen's group studied -- called ectopic fat -- is thought to be more dangerous to people's metabolic health than "subcutaneous" fat, the kind that collects under the skin.

"It is well-established that ectopic fat is 'unhealthy' and induces dysfunction of the organs involved," Richelsen said.

Hu said the results from Richelsen's experiment complement those that have surveyed people about their soda drinking habits.

"This study provides another piece of evidence to support the recommendations for the reduction of sugar-sweetened beverage consumption," Hu told Reuters Health.

DO SODA TAXES WORK?

The American Heart Association recommends drinking no more than about three cans of soda a week, while young men far exceed that, with about two cans a day on average (see Reuters Health report of August 31, 2011).

Some cities and states in the United States have batted around the idea of a tax on sugar-sweetened drinks to curb people's consumption.

Denmark has instituted a tax on sugary items, but Richelsen said it's not clear how it has impacted consumers.

One study at a hospital cafeteria found that raising the price of soda by 35 cents reduced sales by 26 percent (see Reuters Health report of June 18, 2010).

The current study, published in the American Journal of Clinical Nutrition, did not find that the cola drinkers gained more weight than the other groups.

Richelsen said it's possible that the people reduced the amount of calories they ate or drank to compensate for the extra calories in the pop.

The researchers point out in their study that the sugar in soda from Denmark is different from most sodas in the United States.

In Europe, the sweetener is sucrose, as opposed to the high fructose corn syrup used in the U.S.

"It is quite convincing from the scientific literature that it is the fructose part of the sugar molecule...that is the primary culprit in inducing fat synthesis in the liver," Richelsen said.

Given that there is extra fructose in high fructose corn syrup, Richelsen said, soda from the U.S. could lead to more pronounced problems with fat gain.

SOURCE: bit.ly/x5kwKU

Red wine-heart research slammed with fraud charges

American Journal of Clinical Nutrition, online December 28, 2011.

NEW YORK | Thu Jan 12, 2012 11:16am EST

NEW YORK (Reuters Health) - A University of Connecticut researcher who studied the link between aging and a substance found in red wine has committed more than 100 acts of data fabrication and falsification, the university said Wednesday, throwing much of his work into doubt.

Dipak K. Das, who directed the university's Cardiovascular Research Center, studied resveratrol, touted by a number of scientists and companies as a way to slow aging or remain healthy as people get older. Among his findings, according to a work promoted by the University of Connecticut in 2007, was that "the pulp of grapes is as heart-healthy as the skin, even though the antioxidant properties differ."

"We have a responsibility to correct the scientific record and inform peer researchers across the country," Philip Austin, the university's interim vice president for health affairs, said in a statement.

The university said an anonymous tip led to an investigation that began in 2008. A 60,000-page report -- the summary of which is available at bit.ly/xkyS4A -- resulted, outlining 145 counts of fabrication and falsification of data. Other members of Das' laboratory may have been involved, and are being investigated, the report continues.

UConn has "declined to accept $890,000 in federal grants awarded to" Das, according to the statement, and has begun dismissal proceedings. The university has alerted 11 journals that published Das' work, and has also worked on the case with the U.S. Office of Research Integrity, which investigates alleged misconduct by federal grant recipients.

The journals include Antioxidants & Redox Signaling, where Das was one of the editors in chief, and the Journal of Agriculture and Food Chemistry.

Although many scientists have been skeptical of various claims made about resveratrol, it has garnered significant commercial interest. GlaxoSmithKline bought Sirtris, a company that worked on the compound in 2008 for $720 million, but later discontinued work on one version of a drug that mimics its activity because of disappointing results.

A Las Vegas resveratrol maker called Longevinex has promoted Das' research, and he appears in a lengthy video touting the nutrient as the next aspirin.

Das also shared a 2002 patent on the use of another compound in grape skins called proanthocyanidin to prevent and treat heart conditions.

Other scientists have taken notice of Das' work, citing 30 of his papers more than 100 times each, according to Thomson Scientific's Web of Knowledge. Last year, he won an award from the International Association of Cardiologists.

Still, one aging researcher said the impact of the fraud on the field will be minimal.

"There are many investigators who are working on resveratrol," said Dr. Nir Barzilai, of Albert Einstein College of Medicine. "That doesn't mean we know the whole truth. But Rome wasn't built on Dr. Das."

Das, who could not be reached for comment, said in a 2010 letter to university officials that the investigation was a "conspiracy" against him. The work was "repeated by many scientists all over the world," he wrote.

"As you know, because of the development of tremendous amount of stress in my work environment in recent months, I became a victim of stroke for which I am undergoing treatment," he wrote in a separate letter.

(With reporting by Adam Marcus)

For You Reading Pleasure

Grand Rounds is a weekly summary of the best health blog posts on the Internet. Each week a different blogger takes turns hosting Grand Rounds, and summarizing the best submissions for the week.

Hosted this week by Thirty Three Charts

Medical Grand Rounds – January 10th, 2012

January 10, 2012

Welcome to this edition of Medical Grand Rounds. I scoured the web and pulled together what I think are some of the more interesting posts and news items of the past couple of weeks. I’ve tried to explore some voices that perhaps haven’t crossed your radar. We’ve got sociologists, medical students, IT gurus, medical futurists and even a couple of doctors. Some of the discussions have related posts that you might find interesting. Posts are not listed in any particular order.

The Weather, Arthritis and Woody Allen’s Orgasmatron

Ronan Kavanagh, Ronan Kavanagh’s Blog

Any post that invokes Woody Allen’s orgasmatron in furthering our understanding of rheumatology has my attention. Galway rheumatologist Ronan Kavanaugh offers some interesting history and touches on the debate surrounding the weather and our joints. I think that the history and debate surrounding this phenomenon could be fashioned as a compelling long-form article or book

Trap Door Days

Claire McCarthy, Thriving

If you don’t think that a doctor can be a patient (or parent) you might consider takin’ a walk in Claire McCarthy’s shoes. Understanding the pain and perspective of a parent who has lost a chronically ill child is something that few understand. And post offers an important look inside the mind of a mother who happens to be a pediatrician living each holiday with the memory of her greatest loss. Claire lives and writes at Thriving, Boston Children’s Hospital’s blog.

I think that it’s this type of narrative that helps the world understand truly the mind of a physician.

Read all submissions here....

Of Interest

32 Million Americans Have Autoantibodies That Target Their Own Tissues
Released: 1/13/2012 7:30 AM EST

Source: National Institute of Environmental Health Sciences (NIEHS)

Newswise — More than 32 million people in the United States have autoantibodies, which are proteins made by the immune system that target the body’s tissues and define a condition known as autoimmunity, a study shows. The first nationally representative sample looking at the prevalence of the most common type of autoantibody, known as antinuclear antibodies (ANA), found that the frequency of ANA is highest among women, older individuals, and African-Americans. The study was conducted by the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health. Researchers in Gainesville at the University of Florida also participated.

Earlier studies have shown that ANA can actually develop many years before the clinical appearance of autoimmune diseases, such as type 1 diabetes, lupus, and rheumatoid arthritis. ANA are frequently measured biomarkers for detecting autoimmune diseases, but the presence of autoantibodies does not necessarily mean a person will get an autoimmune disease. Other factors, including drugs, cancer, and infections, are also known to cause autoantibodies in some people.

“Previous estimates of ANA prevalence have varied widely and were conducted in small studies not representative of the general population,” said Frederick Miller, M.D., Ph.D., an author of the study and acting clinical director at NIEHS. “Having this large data set that is representative of the general U.S. population and includes nearly 5,000 individuals provides us with an accurate estimate of ANA and may allow new insights into the etiology of autoimmune diseases.” The findings appear online in the Jan. 11 issue of the journal Arthritis and Rheumatism.

Miller, who studies the causes of autoimmune diseases, explains that the body’s immune system makes large numbers of proteins called antibodies to help the body fight off infections. In some cases, however, antibodies are produced that are directed against one's own tissues. These are referred to as autoantibodies.

A multi-disciplinary team of researchers evaluated blood serum samples using a technique called immunofluorescence to detect ANA in 4,754 individuals from the 1994-2004 National Health and Nutrition Examination Survey (NHANES). The overall prevalence of ANA in the population was 13.8 percent, and was found to be modestly higher in African-Americans compared to whites. ANA generally increased with age and were higher in women than in men, with the female to male ratio peaking at 40-49 years of age and then declining in older age groups.

“The peak of autoimmunity in females compared to males during the 40-49 age bracket is suggestive of the effects that the hormones estrogen and progesterone might be playing on the immune system,” said Linda Birnbaum, Ph.D., director of NIEHS and an author on the paper.

The paper also found that the prevalence of ANA was lower in overweight and obese individuals than persons of normal weight. “This finding is interesting and somewhat unexpected,” said Edward Chan, Ph.D., an author on the study and professor of the Department of Oral Biology at the University of Florida.

“It raises the likelihood that fat tissues can secrete proteins that inhibit parts of the immune system and prevent the development of autoantibodies, but we will need to do more research to understand the role that obesity might play in the development of autoimmune diseases,” said Minoru Satoh, M.D., Ph.D., another author on the study and associate professor of rheumatology and clinical immunology at the University of Florida.

The researchers say the paper should serve as a useful baseline for future studies looking at changes in ANA prevalence over time and the factors associated with ANA development. The paper is the first in a series analyzing these data from the NHANES dataset, and exploring possible environmental associations with ANA.

Reference: Satoh M, Chan EKL, Ho LA, Rose KM, Parks CG, Cohn RD, Jusko TA, Walker NJ, Germolec DR, Whitt IZ, Crockett PW, Pauley BA, Chan JYF, Ross SJ, Birnbaum LS, Zeldin DC, Miller, FW. 2012. Arthritis and Rheumatism; doi: 10.1002/art.34380 [online 2012 January 11].

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The NIEHS supports research to understand the effects of the environment on human health and is part of NIH. For more information on environmental health topics, visit www.niehs.nih.gov. Subscribe to one or more of the NIEHS news lists (www.niehs.nih.gov/news/releases/newslist/index.cfm) to stay current on NIEHS news, press releases, grant opportunities, training, events, and publications.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH...Turning Discovery Into Health


Thursday, January 12, 2012

Slowly digested carbs reduces markers of inflammation in overweight and obese adults

New on the blog; Hepatitis C - Five Ways You Can Take Care of Your Liver


A diet rich in slowly digested carbs reduces markers of inflammation in overweight and obese adults
Such a diet also increases a hormone that helps regulate metabolism of fat and sugar

SEATTLE – Among overweight and obese adults, a diet rich in slowly digested carbohydrates, such as whole grains, legumes and other high-fiber foods, significantly reduces markers of inflammation associated with chronic disease, according to a new study by Fred Hutchinson Cancer Research Center. Such a "low-glycemic-load" diet, which does not cause blood-glucose levels to spike, also increases a hormone that helps regulate the metabolism of fat and sugar. These findings are published online ahead of the February print issue of the Journal of Nutrition.

The controlled, randomized feeding study, which involved 80 healthy Seattle-area men and women – half of normal weight and half overweight or obese – found that among overweight and obese study participants, a low-glycemic-load diet reduced a biomarker of inflammation called C-reactive protein by about 22 percent.

"This finding is important and clinically useful since C-reactive protein is associated with an increased risk for many cancers as well as cardiovascular disease," said lead author Marian Neuhouser, Ph.D., R.D., a member of the Cancer Prevention Program in the Public Health Sciences Division at the Hutchinson Center. "Lowering inflammatory factors is important for reducing a broad range of health risks. Showing that a low-glycemic-load diet can improve health is important for the millions of Americans who are overweight or obese."

Neuhouser and colleagues also found that among overweight and obese study participants, a low-glycemic-load diet modestly increased – by about 5 percent – blood levels of a protein hormone called adiponectin. This hormone plays a key role in protecting against several cancers, including breast cancer, as well as metabolic disorders such as type-2 diabetes, nonalcoholic fatty liver disease and hardening of the arteries.

"Glycemic load" refers to how the intake of carbohydrates, adjusted for total grams of carbohydrate, affects blood-sugar levels. Lentils or pinto beans have a glycemic load that is approximately three times lower than instant mashed potatoes, for example, and therefore won't cause blood-sugar levels to rise as quickly.

Study participants completed two 28-day feeding periods in random order – one featuring high-glycemic-load carbohydrates, which typically are low-fiber, highly processed carbs such as white sugar, fruit in canned syrup and white flour; and the other featuring low-glycemic-load carbohydrates, which are typically higher in fiber, such as whole-grain breads and cereals. The diets were identical in carbohydrate content, calories and macronutrients. All food was provided by the Hutchinson Center's Human Nutrition Laboratory, and study participants maintained weight and physical activity throughout.

"Because the two diets differed only by glycemic load, we can infer that the changes we observed in important biomarkers were due to diet alone," Neuhouser said.

"The bottom line is that when it comes to reducing markers of chronic-disease risk, not all carbohydrates are created equal. Quality matters," she said. "There are easy dietary changes people can make. Whenever possible, choose carbohydrates that are less likely to cause rapid spikes in blood glucose." These types of low-glycemic-load carbs include whole grains; legumes such as kidney beans, soy beans, pinto beans and lentils; milk; and fruits such as apples, oranges, grapefruit and pears. Neuhouser also recommends avoiding high-glycemic-load carbohydrates that quickly raise blood glucose. These include highly processed foods that are full of white sugar and white flour, and sugar-sweetened beverages and breakfast cereals.

###

The study was funded by the National Cancer Institute's Transdisciplinary Research on Energetics and Cancer (TREC) Initiative, a nationwide research consortium that aims to better understand the link between obesity and cancer. The Hutchinson Center houses the initiative's coordinating center.

At Fred Hutchinson Cancer Research Center, our interdisciplinary teams of world-renowned scientists and humanitarians work together to prevent, diagnose and treat cancer, HIV/AIDS and other diseases. Our researchers, including three Nobel laureates, bring a relentless pursuit and passion for health, knowledge and hope to their work and to the world. For more information, please visit www.fhcrc.org.

Wednesday, January 11, 2012

Hepatitis C - Five Ways You Can Take Care of Your Liver



Healthy You

Five Ways You Can Take Care of Your Liver

1-Manage Your Medications

When medicines are taken incorrectly – by taking too much or the wrong type or by mixing – the liver can be harmed.

Follow dosing instructions

Talk to a doctor or pharmacist often about the medicines you are taking

Making sure you take your prescription and over-the-counter (OTC) medicine, as well as vitamins, supplements, and alternative therapies properly is important for the health of your liver and for your overall health

Why is Managing your Medications important to liver health?

Every medicine, vitamin, supplement that you take passes through the liver, including all the medicines you take:

  • Over-the-counter medicines
  • Prescription medicines
  • Vitamins
  • Dietary supplements
  • Alternative medicines
Your liver is responsible for processing all of these substances. It is important to understand exactly how you should be taking your medications in order to avoid putting undue stress on your liver

Who is at risk for medication-related problems?
More people than ever before are taking medications to control chronic (long-lasting) medical conditions. The number of prescription and over-the-counter drugs continues to grow, and the number of conditions that can be treated with drugs is on the rise, too. Unfortunately, the potential for drug-related problems is also increasing. Drug-related problems include: adverse side effects, duplication (taking two or more drugs with the same effects), and interactions with other medications.

Prescription and OTC medications, supplements, vitamins, and alternative therapies all have potential interactions.

It is important to Manage Your Medications to prevent these negative drug interactions.

People who take a number of different medications, often for multiple conditions, are at risk for possible dangerous drug interactions and overdose. Older adults and children are also at risk because their bodies process medication differently. Both can be more sensitive to dosage amounts and side effects of medications than young and middle-aged adults. Before administering medications to children or older adults, ask your doctor for specific instructions.

Click Here : To Read More About Managing Your Medications

Source-How to Choose the Right Over-the-Counter Painkiller
Choosing a painkiller off the drug store shelf can be, well, painful. To offer some relief, Consumer Reports Health released its "Best Buy Drugs" -- a 22-page report that compares the effectiveness, safety and price of some of the top brands (and generics) for pain killing.

Acetaminophen
The drug known by most people as Tylenol is another mild pain reliever. It is not an NSAID, so it won't quell inflammation. However, it won't irritate the stomach, either

"Acetaminophen is better for people who have stomach troubles," Schmitz said. "It has been a good drug for children as well."

The drug is good for treating aches and pains not related to injury or inflammation. But because it's metabolized in the liver, it can have serious side effects if taken at high doses or with alcohol.

"The most significant danger of high doses acetaminophen is liver damage and even liver failure," said Dr. Doris Cope, professor and vice chairman of pain at the University of Pittsburgh School of Medicine.

Acetaminophen use should be avoided in people who have consumed alcohol or are dehydrated, or who have kidney or liver problems.

Because of its potential to cause serious harm at high doses, people should be careful when taking combination drugs that contain acetaminophen, according to Dr. Carol Warfield, chair of anesthesia, critical care and pain medicine at Beth Israel Deaconess Medical Center in Boston.
Certain prescription painkillers also contain acetaminophen, opening the door for unintentional overdoses.

"In a recent study, fewer than 15 percent of patients knew that commonly prescribed pain medications [such as Percocet and Vicodin] contained acetaminophen," said the University of Pittsburgh's Cope...Continue reading...

2- Nutrition

What does nutrition have to do with your liver?


Nutrition and the liver are interrelated in many ways. Some functions are well understood; others are not. Since everything we eat, breathe and absorb through our skin must be refined and detoxified by the liver, special attention to nutrition and diet can help keep the liver healthy. In a number of different kinds of liver disease, nutrition takes on considerably more importance.

Why is the liver so important in nutrition?

85-90% of the blood that leaves the stomach and intestines carries important nutrients to the liver where they are converted into substances the body can use.

The liver performs many unique and important metabolic tasks as it processes carbohydrates, proteins, fats and minerals to be used in maintaining normal body functions.

Carbohydrates, or sugars, are stored as glycogen in the liver and are released as energy between meals or when the body's energy demands are high. In this way, the liver helps to regulate the blood sugar level, and to prevent a condition called hypoglycemia, or low blood sugar. This enables us to keep an even level of energy throughout the day. Without this balance, we would need to eat constantly to keep up our energy.

Proteins reach the liver in their simpler form called amino acids. Once in the liver, they are either released to the muscles as energy, stored for later use, or converted to urea for excretion in the urine. Certain proteins are converted into ammonia, a toxic metabolic product, by bacteria in the intestine or during the breakdown of body protein. The ammonia must be broken down by the liver and made into urea which is then excreted by the kidneys. The liver also has the unique ability to convert certain amino acids into sugar for quick energy.

Fats cannot be digested without bile, which is made in the liver, stored in the gallbladder, and released as needed into the small intestine. Bile (specific bile "acids"), acts somewhat like a detergent, breaking apart the fat into tiny droplets so that it can be acted upon by intestinal enzymes and absorbed. Bile is also essential for the absorption of vitamins A, D, E, and K, the fat soluble vitamins. After digestion, bile acids are reabsorbed by the intestine, returned to the liver, and recycled as bile once again.

Diet For Advanced Liver Disease

Source-Cirrhosis and advanced liver disease

If your condition has progressed to cirrhosis, there are additional considerations you will need to make in your diet to support your liver, and asking to be referred for dietary advice is recommended.

The damage present in cirrhosis stops the liver working properly and affects its ability to store and release glycogen, a chemical which is used to provide energy when you need it. When this happens, the body uses its own muscle tissue to provide energy between meals. This can lead to malnutrition, muscle wasting and weakness. Around two in ten (20%) people with compensated cirrhosis and six to nine people out of ten (60 - 90%) with decompensated cirrhosis, will become malnourished as their disease progresses2,17.

Compensated cirrhosis
If you have compensated cirrhosis – where your liver is severely scarred but there are enough healthy cells in your liver to perform all of its functions adequately – you may feel quite well.

It is important to have a well-balanced diet to ensure you are getting enough carbohydrate, protein, fat, vitamins and minerals. Most people with cirrhosis need to take in more energy (kcals) and protein than healthy people of the same weight. You should aim to have a protein and a starch food with every meal, particularly breakfast and evening meals, and to eat 25-35kcal and 1-1.2g of protein for every kg of your body weight per day2.

If you are underweight then you will need to increase your energy and protein intake further. Snacking between meals can top up your calories and protein, as can the addition of a variety of supplements that your dietitian will recommend. A bedtime snack is especially effective.

Try to eat regularly, say every two to three hours. Suitable snacks include:

teacake toast crackers cereal fruit milky drinks Some people with cirrhosis may develop bone thinning (osteopaenia / osteoporosis). This is diagnosed by bone density scanning (DXA scan). If the scan shows you have this condition, it is likely that your doctor will provide you with supplements of vitamin D and /or calcium to reduce the risk of bone fracture9.

Decompensated cirrhosis
Cirrhosis may progress to become decompensated – where the liver is not capable of performing all of its normal functions resulting in a number of complications including, fluid retention and mental confusion (encephalopathy).

If you have decompensated cirrhosis you will need expert dietary advice. A high energy, high protein diet is likely to be recommended to help your liver function (35-40kcal and 1.5g of protein for every kg of your body weight per day)2. You may need supplemental drinks and some specific dietary measures to manage some of the complications of your cirrhosis. It is very important that you have a good diet; your doctors and dietitian are unlikely to suggest any dietary restrictions without careful assessment.

Fluid retention
Some people with cirrhosis get a build-up of fluid in the stomach area (ascites)26 and swelling of the feet and legs (oedema). These symptoms may be treated with drugs called diuretics (also known as water pills). Sometimes the excess fluid in the abdomen will be drained away using a tube, particularly if you are very uncomfortable.

Although you may feel bloated, it is important that you continue to drink enough fluids so that you don’t dehydrate.
You can help to control fluid retention by reducing the amount of common salt (sodium chloride) in your food26. However, while it is a good idea to cut out foods with a very high salt content, it can be harmful to change to a diet that is too low in salt without guidance from a dietitian.

Your taste buds become more sensitive to salt as you eat less of it. It is quite easy to cut down salt in the food you prepare yourself, but most of the salt we eat is added to foods by the manufacturers5. A dietitian can advise you on which foods you can eat and which you should avoid.
It is likely that you will be recommended to reduce the amount of sodium (salt) in your diet to around 5.2g of salt per day27.

Foods which you may think are low in salt can surprise you, reading the labels on the food you buy will help you to monitor your intake more carefully5.

Fresh foods should be eaten wherever possible as they are generally lower in salt than canned or processed foods. Try to buy foods labelled ‘low salt’ or ‘no added salt’. A quick way to tell if your food is high in salt is to look at the nutritional information on the label. Look for the amount of salt per 100g, if there is more than 1.5g salt per 100g (or 0.6g sodium) then it is high in salt, anything up to 0.3g salt or less per 100g (or 0.1g sodium) is low in salt.

Ideas for reducing your salt intake
Avoid adding salt to meals at the table. A small amount can be added during cooking if need be. Try making your own stock and not adding salt, as stock cubes, bouillon cubes and gravy granules can be high in salt5. Avoid packet and tinned soups if possible. Tinned vegetables, including baked beans, can be high in salt. Look for low-salt or no-salt versions. Frozen vegetables are lower in salt. Smoked and tinned fish, including salmon, tuna and pilchards in brine contain a lot of salt. Only have these occasionally or try the ones tinned in oil. Do not eat cured meats – including ham, bacon, sausages, and salami. Use cold cooked fresh meat, poultry or eggs instead. Full-fat hard cheese is an excellent source of protein, so include it in your diet but do not have it every day. Ready meals and sauces are high in salt so try to look for low salt alternatives and have these less often. Pasta and ‘cook-in’ sauces can be used if no other salt is added to the meal. Bovril, Marmite and all yeast extracts are high in salt and so should be avoided. Choose unsalted butter. Certain bottled waters are high in sodium – check the labels carefully.

Medications
It is also important to be aware that some prescription and over the counter medications have a high salt content. If the sodium content on the labeling of your medication is not clear, or you are unsure if it is suitable, then your pharmacist or doctor should be able to advise you28.

Salt is not the only way to make your food taste better, instead try: freshly ground black pepper lemon juice on fish or meat redcurrant jelly, apricots, rosemary or garlic for lamb apple or gooseberry sauce with pork ginger, garlic and spring onions with mixed vegetables olive oil and vinegar with salad and vegetables mustard powder or nutmeg with mashed potato various home-made sauces – such as onion sauce made with milk and garlic – used instead of gravy try using different types of onion – brown, red, spring onions, shallots or leeks toasted and ground sesame seeds added to pastries, breads and stir-fries washed and finely chopped coriander root in soups, stews and stock try adding fresh herbs, lime, garlic, chilli and ginger to pasta dishes, vegetables and meat.

Mental confusion (hepatic encephalopathy)
Some people with cirrhosis develop poor memory and concentration. They can become confused and may even lose consciousness. This happens because the damaged liver is unable to break down toxins from the bowel which then enter the bloodstream and are carried to the brain.

It can occur when a person with cirrhosis also has some other problem such as diarrhoea, vomiting, dehydration, constipation, infection or bleeding. The liver cannot cope with the extra stress. Treatment includes tackling the underlying medical problem and paying careful attention to diet, particularly to eating enough protein.

Historically people with hepatic encephalopathy were treated with a low protein diet. It is now recognised that this was the wrong approach and that a high protein diet will help to improve liver function29,30.

Many internet sites still wrongly suggest that those with hepatic encephalopathy should restrict dietary protein and some healthcare professionals working outside the specialist liver units may also not know about this change in management.

You are likely to be advised:
to spread your protein intake over the waking hours, eating four to six snack meals a day rather than one or two bigger main meals to eat a late-evening snack high in carbohydrate to help support your liver during the night poultry, fish, eggs and cheese are good sources of protein as an alternative to red meat starchy foods such as potatoes, rice, pasta and cereals help to provide energy slowly over a longer period. If your appetite is poor and you are not able to eat snacks, you may need to take high-protein and high-calorie drinks on the advice of your dietitian or doctor. See the ‘Coping with eating difficulties’ section. Controlling blood sugar If you have too much sugar (glucose) in your blood, it is known as hyperglycaemia. This can occur in some people with cirrhosis. You may be advised by your dietitian to follow a diet similar to the one used by people with diabetes. This means avoiding foods that are high in sugar but otherwise eating a well-balanced diet. It is important to eat enough calories and protein to keep well nourished; the energy lost by cutting down on sugar must be replaced from another source.

Link:
Low-Sodium Diet Guidelines

Salt - Today In The News

Salt Shakedown -- How to avoid hidden sodium at the grocery store

Uploaded by on Jan 11, 2012
Join Johns Hopkins registered dietitian, Arielle Rosenberg, as she walks through the aisles and offers suggestions on how to lower salt intake -- but not compromise flavor.




(Boston) Jan 11– A review article by researchers at Boston University School of Medicine (BUSM) debunks the widely-believed concept that hypertension, or high blood pressure, is the result of excess salt causing an increased blood volume, exerting extra pressure on the arteries. Published online in the Journal of Hypertension, the study demonstrates that excess salt stimulates the sympathetic nervous system to produce adrenalin, causing artery constriction and hypertension.
The research was led by Irene Gavras, MD, and Haralambos Gavras, MD, both professors of medicine at BUSM.
"The purpose of this paper is to correct an erroneous concept that has prevailed for many years, even though scientific evidence has mounted against it," said Irene Gavras, who is also a physician in Boston Medical Center's Hypertension practice.
The term "volume-expanded hypertension" implies that excess salt leads to the retention of extra fluid within the arterial circulatory system, causing an increase in blood volume and added pressure on the arterial walls. However, research has shown that conditions characterized by the expansion of blood volume from other causes, such as the secretion of antidiuretic hormone or the excessive elevation of blood sugar, do not cause a rise in blood pressure because the extra fluid is accommodated by the distention of capillaries and veins.
"The body's circulatory system is a highly flexible vascular system with the capacity to open up new capillaries and distend veins in order to accommodate increased fluid volume," said Irene Gavras.
Through a review of numerous studies, the researchers demonstrated that the mechanism of hypertension resulting from the excessive consumption and retention of salt stimulates the sympathetic nervous system in the brain to increase adrenaline production. The increased adrenalin being circulated throughout the body causes the arteries to constrict, which results in resistance to blood flow and a decrease in circulatory volume.
The over-activation of the sympathetic nervous system – part of the autonomic nervous system that helps maintain the body's homeostasis – has been recognized clinically as a characteristic of hypertension that accompanies renal failure, which is the most typical example of elevated blood pressure from excessive salt retention. Diuretics, which remove excess salt, are widely used to treat this type of hypertension. However, this study provides convincing evidence that the sympathetic nervous system should be the focus of further investigations into treatments for hypertension.
"The implication of our findings shows that the optimal treatment for hypertension, for cases associated with renal failure, should not only include diuretics but also the use of drugs that
This research was supported by a series National Institutes of Health (NIH) grants.
Originally established in 1848 as the New England Female Medical College, and incorporated into Boston University in 1873, Boston University School of Medicine today is a leading academic medical center with an enrollment of more than 700 medical students and more than 800 masters and PhD students. Its 1,246 full and part-time faculty members generated more than $335 million in funding in the 2009-2010 academic year for research in amyloidosis, arthritis, cardiovascular disease, cancer, infectious disease, pulmonary disease and dermatology among others. The School is affiliated with Boston Medical Center, its principal teaching hospital, the Boston and Bedford Veterans Administration Medical Centers and 16 other regional hospitals as well as the Boston HealthNet.

Liver Health - Dietary fiber


Diet For A Healthy Liver
A balanced diet with plenty of fruits, vegetables, animal protein with a fat - carbohydrate - protein ratio of 30% - 50% - 20% "unless specific problems such as diabetes, kidney disease etc dictate otherwise."

Eat from all the food groups: grains, protein, dairy, fruits, vegetables, fats, and foods that have a lot of fiber such as fresh fruits and vegetables, whole grain breads, rice and cereals.
Read more here....

Today In The News - Dietary fiber

Review confirms benefits of more roughage in the diet
We should all be eating more dietary fiber to improve our health - that's the message from a health review by scientists in India. The team has looked at research conducted into dietary fiber during the last few decades across the globe and now suggests that to avoid initial problems, such as intestinal gas and loose stool, it is best to increase intake gradually and to spread high-fiber foods out throughout the day, at meals and snacks. Writing in the International Journal of Food Safety, Nutrition and Public Health, the team offers fruit, vegetables, whole-grain foods, such as muesli and porridge, beans and pulses, as readily available foods rich in dietary fiber.
Dietary fiber, also known as roughage, is the general term of the non-digestible parts of the fruit and vegetable products we eat. There are two forms soluble and insoluble. Soluble (prebiotic, viscous) fiber that is readily broken down or fermented in the colon into physiologically active byproducts and gases. The second form is insoluble fiber, which is metabolically inert, but absorbs water as it passes through the digestive system, providing bulk for the intestinal muscles to work against and easing defecation.
Vikas Rana of the Rain Forest Research Institute, in Assam, India, and colleagues point out that research has shown that modern food habits have, it seems, led to an increase in the incidence of obesity, cardiovascular diseases, and type 2 diabetes. These are growing more common even in developing nations where a "western" diet of highly processed foods, high in sugars and saturated fats, beef and dairy products and low in dietary fiber is displacing more traditional options. The team suggests that evidence points to a loss of dietary fiber in the diet as being a major risk factor for health problems but one of the simplest to remedy without recourse to major changes in diet or the addition of supplements or so-called functional foods and nutraceuticals to the diet.
Given that dietary fiber has physiological actions such as reducing cholesterol and attenuating blood glucose, maintaining gastrointestinal health, and positively affecting calcium bioavailability and immune function, it is important for the current generation and future generations that this component of our diets be reasserted through education and information.
"Consuming adequate quantities of DF can lead to improvements in gastrointestinal health, and reduction in susceptibility to diseases such as diverticular disease, heart disease, colon cancer, and diabetes. Increased consumption has also been associated with increased satiety and weight loss," the team concludes. Given the ready availability particularly in the West and in the relatively richer parts of the developing world of vegetables, fruit and other foods high in dietary fiber it is a matter of recommending that people eat more dietary fiber rather than consistently taking the unhealthy low-fiber option throughout their lives.
 
"Dietary fiber and human health" in Int. J. Food Safety, Nutrition and Public Health, 2011, 4, 101-118

3-Stop Smoking

Smoking causes many health problems including heart disease, strokes and cancer. Smoking may also lead to a worsening of gum conditions and dry mouth associated with hepatitis C. There is some evidence that suggests higher rates of particular cancer types among smokers if they are also hepatitis C positive.

Smoking marijuana on a daily basis has also been significantly associated with the progression of fibrosis in people with hepatitis C.
.

Source - Alcohol, Tobacco, and Cannabis All May Promote Liver Disease Progression in People with Chronic Hepatitis C.

In 2008 a study suggested that cigarette smoking may enhance activity grade in patients with chronic hepatitis C, thereby increasing progression of fibrosis. This assumption mostly relies on epidemiological evidences in the absence of pathogenic studies.

Cigarette Smokers and Fibrosis


. In this older study authors looked at liver biopsies from 310 patients with chronic HCV who were under going their first liver biopsy. They then went on to compare those biopsies with the patients who were current cigarette smokers (176 patients) or former cigarette smokers (56 patients). Last but not least, biopsies from patients who had never smoked (77 patients).

They found that current and former smokers had more inflammation and scarring of their livers than did nonsmokers. This finding could not be explained by other factors, such as concurrent alcohol use, that are known to aggravate the inflammation and scarring in hepatitis C. The authors concluded that smoking cigarettes could worsen their liver disease.

Smoking and Liver Cancer

Cancer among males in BC and Canada

Issue: BCMJ, Vol. 53, No. 10, December 2011, page(s) 541-546 Articles
Gender differences in cancer incidence and mortality rates can be attributed in part to modifiable risk factors—smoking, alcohol consumption, and occupational exposure to carcinogens—that more commonly affect men than women, and to fewer screening opportunities for men..view study.
Researchers found a synergistic link between smoking and hepatitis C virus (HCV) infection, leading to a more than 136-fold increased risk of hepatocellular carcinoma (HCC) in men, according to a team at The University of Texas MD Anderson Cancer Center.

Published in 2008 in the International Journal of Cancer, researchers investigated HCC and the risk factors such as smoking in men and women who have HCV.

The Results:
· Men with HCV who smoke have a more than 136-fold increased risk of HCC.

· Women with HCV who consume large amounts of alcohol have a more than 13-fold increased risk of HCC.

Links

2011 Abstracts - Source Pubmed

2011- Smoking, hepatitis B virus infection, and development of hepatocellular carcinoma.

2011- Smoking as an independent risk factor for hepatocellular carcinoma: the Singapore Chinese Health Study.


4-Weight Gain: Maintaining A Healthy Weight


People with hepatitis C who are overweight increase the likelihood of fatty deposits in their liver. In some instances they will be advised to reduce their weight in order to avoid or improve fat-related liver abnormalities.
In addition, it is evident that patients with a normal weight have a higher response rate to hepatitis C therapy .
Overweight patients with a fatty liver who subsequently reduce their weight are likely to experience an improvement in fat-related liver abnormalities. Consequently, people with chronic hepatitis C should try to maintain a normal weight in order to avoid additional stress of their liver.

Fatty Liver And HCV

There are two different forms of steatosis (Fatty Liver) that may be found in people with HCV: Metabolic steatosis and HCV-induced steatosis

Metabolic steatosis can result from obesity, raised blood fat levels (hyperlipidemia), insulin resistance and type II diabetes and is similar to the type of fatty infiltration caused by excessive alcohol consumption and that is also found in Non-Alcoholic Fatty Liver (NASH).

Metabolic steatosis is not triggered by the hepatitis C virus; however the combination of this form of steatosis and the presence of HCV can lead to a more rapid progression of scarring or fibrosis.

HCV-induced steatosis is fatty infiltration that is directly caused by the presence of the virus. It is possible for people with HCV to have both forms of steatosis simultaneously.

Genotypes and Fatty Liver Disease:
Although it seems that all genotypes can trigger steatosis, the risk of developing steatosis is significantly higher for people with genotype 3. There is a complex reaction between the genotype 3 virus and liver cells that is not seen in other genotypes that makes this group at much higher risk of developing the condition. Around 40% of people with hepatitis C have steatosis, compared to about 14% to 31% of the general population. However, 60% - 80% of people with genotype 3 have moderate or severe steatosis

Link
AASLD: Fatty Liver May Benefit from Mediterranean Diet

In The News
 Jan 2012

Obesity, Hepatitis C Infection Linked to Liver Cancer Risk
People who are overweight and those infected with hepatitis C are at an increased risk of developing deadly liver cancer, say scientists.


Two recent Mayo Clinic studies offer a clearer picture of the rise of hepatocellular carcinoma (HCC), or liver cancer, which has tripled in the U.S. in the last three decades and has a 10 to 12 percent five-year survival rate when detected in later stages. "The studies illuminate the importance of identifying people with risk factors in certain populations to help catch the disease in its early, treatable stages," said W. Ray Kim, M.D., a specialist in Gastroenterology and Hepatology and principal investigator of one study.

Dr. Kim's research group looked at several decades of records in the Rochester Epidemiology Project, a database that accounts for an entire county's inpatient and outpatient care. The study found the overall incidence of HCC in the population (6.9 per 100,000) is higher than has been estimated for the nation based on data from the National Cancer Institute (5.1 per 100,000).

The study also found that HCC, which two decades ago tended to be caused by liver-scarring diseases such as cirrhosis from alcohol consumption, is now occurring as a consequence of hepatitis C infection. "The liver scarring from hepatitis C can take 20 to 30 years to develop into cancer. We're now seeing cancer patients in their 50s and 60s who contracted hepatitis C 30 years ago and didn't even know they were infected," noted Dr. Kim.

Eleven percent of cases were linked to obesity, in particular fatty liver disease. "It's a small percentage of cases overall. But with the nationwide obesity epidemic, we believe the rates of liver cancer may dramatically increase in the foreseeable future," Dr. Kim says. Another study looked exclusively at the Somali population, which is growing in the U.S., particularly in Minnesota, where as many as 50,000 Somalis have settled in the last two decades.

The East African country is known to have a high prevalence of hepatitis B, a risk factor for HCC. Researchers investigating records in the Mayo Clinic Life Sciences System confirmed that hepatitis B remains a risk factor, but they were surprised to find that a significant percentage of liver cancer cases in the population are attributable to hepatitis C, which had not been known to be significantly prevalent. The studies have been published in the January issue of Mayo Clinic Proceedings.

5- Reducing Stress

Source - Stress and hepatitis C

Living with a chronic illness can be stressful. A chronic illness like hepatitis C can add physical and emotional demands to your life. You may have to adjust to the physical demands of the illness and cope with negative feelings about your hepatitis C.

Feeling informed and in control may help you manage any stress you may feel about living with hepatitis C. Finding out information about hepatitis C and establishing a trusting relationship with your health care team can help you to feel informed and in control. Emotional support from others (family, friends, or others dealing with the same issues) can help you explore your feelings and give meaning to what is happening in your life.

Managing stress and maintaining emotional balance
There are a range of different techniques for managing stress. Different people find different techniques work best for them. Below are some common techniques for managing stress in your life.

Exercise
Physical exercise can often help to release tension and improves your overall level of health. Moderate and regular exercise is advised. For people living with a chronic illness like hepatitis C, it may be helpful to discuss exercise with your doctor before embarking on a new exercise regime.

Choose your attitude
Take some control over the thoughts that go through your mind.Talk yourself out of repeating negative or unhelpful self thoughts. See section below for more hints about developing a healthy attitude.

Relax
Relaxation means letting go of tension. For you this may mean spending time in the garden, listening to music, reading a book or pursuing a hobby.
Talk about how you feel
We all live and interact with other people and often cope better withour problems and life stresses by talking and sharing our feelings with other people. This can be as simple as talking with a neighbour or a friend. Many people also choose to see a trained counsellor, social worker or therapist to discuss how they are feeling and to get extra support.

Massage
Whether done by a trained professional or just a friend, a massage is a simple and inexpensive way of releasing tension from our bodies.

Meditation
Meditation is a technique that offers a structured way to reduce tension and stress. Although it may not provide an immediate release of stress, over time a meditation program will prepare you to handle physical and mental problems and recharge your system. Structured exercise and concentration programs such as Tai Chi and yoga are also very effective in reducing stress.

Diet and nutrition
When we experience stress and nervous tension our bodies use up large amounts of nutrients (vitamins and minerals). This can cause dietary deficiencies which in turn leave us tired, run down, irritable and less able to cope with stress. Maintaining a balanced diet is important to maintaining good health.

Change stressful circumstances
Often it isn’t possible to change the circumstances of your life that result in stress. However, it is sometimes possible to manage circumstances in ways that can make them less stressful for you or to avoid some situations altogether. Think about alternative ways family, work or daily routines could be managed so they produce less stress for you. Try developing an action plan of small changes you could make to family, work or daily routines that might make them less stressful. Talk to those involved in stressful family or work-related situations about how these situations could be managed to reduce pressure.

Developing a healthy attitude
Developing and maintaining a positive outlook on life, though often easier said than done, can help you deal with negative thoughts, manage stress and enhance your enjoyment of life.
Having a healthy attitude doesn’t mean you must always feel happy or only see the good aspects of life. Sometimes it is important to allow ourselves to feel sad, disappointed or ‘down.’ Having a healthy attitude means being honest and realistic about your life and trying to maintain an optimistic outlook most of the time.

Hints for developing a healthy attitude
Be honest and realistic. Do not build your attitude on thinking things are worse than they are or better than they are: live in the present. Acknowledge the past and potential futures but try not to be overly focused on them try to make positive thinking a habit. Practise turning negative thoughts into positive messages. Positive thinking is a learned skill learn what you can control and what you cannot. There are things you cannot control, such as the fact that you have hepatitis C. However, there are things you can control, such as your attitude and what you say to yourself about having hepatitis C remember to see the humorous side of life and to laugh.

Things to remember about stress:
be aware of physical and mental stress and recognise the signs. Stress is a problem if it is excessive or if you are not handling it properly you are not the only one who experiences the problems that lead to stress. These problems are a normal part of everyday life; Positive thinking is a learned skill identify situations that are stressful for you. Plan ways to deal with these situations or try to limit them in your life take time out to do something you enjoy and find relaxing talk to others about how you are feeling practice relaxation techniques try to maintain a healthy attitude and practice positive thinking.

Symptoms of stress
Some typical symptoms of stress include: insomnia; headache; neck, shoulder and back pain; heart palpitations; fatigue; irritability; panic attacks; loss of concentration; and low self-esteem. There is often a change in appetite and perhaps an increase in the use of drugs, alcohol or cigarette smoking.
Other symptoms of stress may include diarrhoea, abdominal cramps, urinary infrequency and trembling.

To date, surprisingly little long-term research has been done on the effects of stress. However, stress has been linked to ulcers, infertility, heart disease, mental health and cancer.

This Goes Without Saying : Avoid alcohol and drugs


Alcohol and Hepatitis C
By Peter Jaret

If you've been diagnosed with hepatitis C, your doctor has probably advised you to give up alcoholic beverages. For some people, this can be one of the most difficult lifestyle adjustments to make. But it's also one of the most important.
Several studies have shown that among people with hepatitis C, regular drinkers have higher levels of virus than nondrinkers, according to a report in the journal Hepatology. Studies also show that when people infected with the hepatitis C virus (HCV) stop drinking alcohol, levels of the virus decrease.
Researchers have found that alcohol causes the hepatitis C virus to multiply in the liver by increasing the activity of a protein that triggers the virus to make new copies of itself. These new copies speed the progress of the infection and raise the risk of liver damage.

Protecting your liver
There are other compelling reasons not to drink alcoholic beverages if you have hepatitis: One of the liver's jobs is to process alcohol. Too much alcohol can poison liver cells and cause a form of the disease called alcoholic hepatitis. If people continue to drink excessively, the condition can lead to permanent liver damage, or cirrhosis.
As you would expect, alcoholic hepatitis is frequently diagnosed in alcoholics. But it can also show up in some social drinkers because the liver's ability to process alcohol varies widely from person to person. Women, for instance, metabolize alcohol more slowly, so they seem to be at greater risk of suffering liver damage from drinking alcohol than men are.
If you've been diagnosed with hepatitis C, drinking alcohol adds to the strain on the liver, increasing the risk of damage to cells. That raises the danger of cirrhosis and liver cancer. If your liver has already been damaged by the virus, drinking can make things even worse.
For people being treated with interferon-alpha, there's another strong reason not to drink: The same scientists who showed that alcohol spurs the growth of the hepatitis C virus also found that alcohol weakens the effect of interferon-alpha. Drinking any amount of alcohol can interfere with treatment.

The Research

Scientific studies have proved beyond doubt that alcohol consumption speeds up the progression of the disease, Larry, Siu (2009) in the scientific study report Hepatitis C And Alcohol reports that:
“Numerous studies have demonstrated that alcohol consumption in varied quantities can enhance viral replication, increase oxidative stress, worsen cytotoxicity, and impair immune response. Consequently, alcohol abuse appears to reduce both sensitivity to interferon and adherence to treatment.”
The authors concluded that abstinence from alcohol could prevent chronic HCV from progressing to advanced liver disease - when the chance of cirrhosis, liver cancer or liver failure is much higher.

Take Care of You

Eat healthy meals

Exercise

Rest when you feel tired

Take only the medications recommended by your doctor

See a liver doctor regularly (hepatologists and gastroenterologists)

Keep all medical appointments

Talk to your doctor about hepatitis A and hepatitis B vaccines