Needle-Exchange Programs Limit Spread of Hepatitis C

By Amy Norton

NEW YORK (Reuters Health) Jun 29 - Programs that give drug users clean needles or safer drug substitutes can cut the spread of hepatitis C, a new study suggests.

In the U.S., most of the roughly 18,000 new infections each year occur when drug users share tainted needles or syringes. Studies have found that clean-needle programs reduce needle-sharing and seem to protect against infection with HIV. The same appears true of programs that get addicts into treatment with methadone.

There has been little evidence that these programs help cut the spread of hepatitis C. But the new findings, published online May 25th in Addiction, suggest that needle and opiate-substitution programs can make a difference in hepatitis C risk, according to senior researcher Matthew Hickman at the University of Bristol in the UK.

Combining the results from six previous studies of UK programs, Hickman's team found that drug users with the highest "coverage" from clean-needle programs were about half as likely to acquire HCV infection as other users.

Among users who said they got enough clean needles to cover all of their injections, just under 4% became HCV-positive. That compared with 7% of drug users who didn't get clean needles for all their injections.

Similarly, the rate of new hepatitis C infection was 3% among drug users who were currently taking an opiate substitute (usually oral methadone), versus 7% among those not on treatment.

Drug users participating in both types of programs fared best of all, with a new infection rate of 2%.

"The implication is that hepatitis C transmission can be reduced by opiate substitution therapy and needle and syringe programs, especially their combination," Hickman told Reuters Health in an email.

While the study looked only at UK programs, it's likely the results would be similar in other countries, he said.

The study has its limits. Its findings are based on observational studies and small numbers. The researchers had usable information on 919 program participants across the six study sites, and there were 40 cases of new hepatitis C infection.

Still, Hickman said the study starts to fill a gap in the knowledge of how well injection drug use programs are working.

SOURCE: http://bit.ly/lMvRUW

Emerging therapies for hepatitis C offer a significant increase in SVR and bring treatment complexity

Hepatitis C Treatment Changing Rapidly With Approvals of Two New Drugs


by Rosemary Frei

On the heels of data presented at the 46th annual meeting of the European Association for the Study of the Liver (EASL) meeting and this year’s Digestive Disease Week meeting came the FDA approval of two new drugs designed to boost the effectiveness of peginterferon-ribavirin therapy for patients with chronic hepatitis C virus (HCV) genotype 1 infection. On May 13, the FDA approved boceprevir (Victrelis, Merck) followed days later by the approval of telaprevir (Incivek, Vertex/Tibotec), marking an eagerly anticipated revolution in the management of patients with HCV.

Cascade of Data

Data on the new drugs have not been in short supply. An article published last year in The New England Journal of Medicine on the use of telaprevir for previously treated patients with chronic HCV genotype 1 infection brought this new class of agents—inhibitors of HCV protease—into the spotlight (McHutchison JG et al. 2010;362:1292-1303). The results of the randomized, double-blind phase II study—known as PROVE3 (Protease Inhibition for Viral Evaluation 3)—indicated that the addition of telaprevir for as few as 12 weeks significantly increased sustained virologic response (SVR).

Two Phase III studies published in March indicated that boceprevir also boosted efficacy in as few as 24 weeks. Results of the RESPOND-2 (Retreatment with HCV Serine Protease Inhibitor Boceprevir and Peginterferon/Rebetol 2) trial indicated that the three-drug cocktail nearly tripled SVR rates in previously treated patients (Bacon BR et al. N Engl J Med 2011;364:1207-1217). Furthermore, data from the SPRINT-2 (Serine Protease Inhibitor Therapy 2) trial also showed that SVR rates in treatment-naïve patients are boosted significantly with the addition of boceprevir (Poordad F et al. N Engl J Med 2011;364:1195-1206).

Final results from the Phase III REALIZE (Re-treatment of Patients with Telaprevir-based Regimen to Optimize Outcomes) trial also were presented at the EASL meeting. These data included all three major subgroups of patients who were not cured with a prior course of interferon-based therapy, including null responders.

All of the boceprevir studies were paid for by Merck, and the telaprevir studies were sponsored by Vertex and its collaborator, Tibotec.

Stephen H. Caldwell, MD, professor of medicine and director of hepatology, University of Virginia Health System, Charlottesville, pointed out that the emerging therapies for hepatitis C offer a significant increase in sustained viral eradication but also bring treatment complexity, side effects and expense.

“Emerging from the myriad of study names are new monitoring recommendations and prognostic indicators that will take time to really understand,” Dr. Caldwell said. “We should recall that the best-performed studies are closely monitored, often at a level unachievable in clinical practice. Clearly, the field has changed rapidly in a very short period of time. Careful assessment and thoughtful consideration will be key to optimizing success and minimizing failure,” he said.

Boceprevir Trials

In a poster presented at the EASL meeting, John M. Vierling, MD, and colleagues from Baylor College of Medicine in Houston analyzed the relationship between patients’ response during the lead-in period in the boceprevir trials and overall SVR rates. The investigators defined response during the lead-in period as at least a 1.0-log10 reduction in HCV RNA. Data from the SPRINT-2 and RESPOND-2 trials were combined for this study.

The researchers found a steady, stepwise increase in the percentage of patients achieving SVR after at least 24 weeks of triple-agent therapy based on the level of decrease in viral load after the four-week lead-in period with peginterferon-ribavirin alone. The pattern was particularly noticeable among non-black patients. Overall, the advantage of adding boceprevir was greatest for patients with less responsiveness to interferon.

“Patients in the boceprevir arms with a poor response to interferon had sufficiently high rates of SVR as compared with the control group. … [This] dispels concern that the addition of boceprevir to the treatment regimen would be the equivalent of functional monotherapy,” the investigators noted. “However, patients who have a poor response to the interferon may need to be monitored closely to determine who may benefit from better therapies, once they are available.”

They add that conversely, addition of boceprevir may not boost SVR rates among patients with undetectable HCV RNA levels after the lead-in period, but that “in the majority of these patients, total treatment duration is shortened to 28 weeks.”

The four most common treatment-related adverse events (AEs) in the RESPOND-2 and SPRINT-2 studies were fatigue, headache, nausea and anemia. In RESPOND-2, treatment discontinuation due to anemia occurred in 3% of boceprevir patients in 48-week treatment only. None of the controls discontinued due to anemia. The respective numbers for SPRINT-2 were 2%, 2% and 1%. Erythropoietin was allowed for the treatment of anemia at the discretion of the investigators, and in RESPOND-2 was used by 41% and 46% of boceprevir patients in the response-guided and 48-week treatment arms, respectively, compared with 21% of patients in the control arm. In SPRINT-2, the respective numbers were 43%, 43% and 24%. (P values were not supplied.)

Fred Poordad, MD, chief of hepatology and liver transplantation at the Comprehensive Transplant Center at Cedars-Sinai Medical Center in Los Angeles, and lead investigator of the SPRINT-2 trial, gave a talk at the EASL meeting outlining the utility of using an interleukin (IL)-28B polymorphism as a baseline predictor of four- and eight-week response to triple-agent therapy. Dr. Poordad and colleagues from the SPRINT-2 and RESPOND-2 trials examined on SVR rates in patients with three different IL-28B polymorphisms: cysteine–cysteine, thymine–thymine and cysteine–thymine. They determined that the cysteine–cysteine polymorphism is associated most strongly with SVR response; patients with this polymorphism may be eligible for short-duration therapy.

Dr. Poordad’s team also found that lead-in response is a stronger predictor of SVR than any other single baseline characteristic, including IL-28B polymorphism. They concluded that because IL-28B polymorphism status and lead-in response “are powerful predictors of SVR,” the optimal approach may be to use both.

“Taken together, these data showed that the addition of boceprevir to peginterferon and ribavirin achieved significantly higher SVR rates in patients with chronic HCV genotype 1 compared with peginterferon and ribavirin alone, and that nearly half of all patients were eligible to receive a shorter duration of therapy,” Dr. Poordad said.

Telaprevir Trials

The REALIZE trial was a randomized, double-blind, placebo-controlled study of people who were previously treated unsuccessfully for HCV infection.

Subjects were randomized 2:2:1 into two telaprevir-based treatment arms—a “lead-in” arm and a “simultaneous-start” arm—and a control arm, which comprised 48 weeks of treatment with peginterferon-ribavirin alone. The lead-in arm included a four-week lead-in period of treatment with peginterferon-ribavirin followed by the addition of telaprevir for 12 weeks, then followed by 32 weeks of treatment with peginterferon-ribavirin alone. The simultaneous-start arm involved 12 weeks of triple-combination therapy, followed by 36 weeks of peginterferon-ribavirin alone.

Forty-eight percent (316 of 662) of the patients had advanced liver fibrosis or cirrhosis, and 89% (586 of 662) had a high HCV RNA load (≥800,000 IU/mL) at study entry.

The primary end point in all three groups was SVR. The results were analyzed based on three subgroups of patients: patients with undetectable levels of HCV RNA during at least 42 weeks of prior treatment that later became detectable (prior relapsers); patients who achieved at least a 2-log10 decrease in HCV RNA by week 12 of treatment but who did not achieve undetectable levels by week 24 (prior partial responders); and, those who did not achieve a 2-log10 decrease in HCV RNA by week 12 of treatment (prior null responders).

SVR rates for all patients in the telaprevir treatment arms were significantly greater compared with patients in the control group (Table; P<0.001). This held true for patients in the two telaprevir-containing arms combined, among which 86% (245 of 286) of the prior relapsers achieved SVR, 57% (55 of 97) of prior partial responders had an SVR and 31% (46 of 147) of the prior null responders had an SVR.

Click Here Or On Tabel To Enlarge

Table. SVR Rates in the REALIZE Trial

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“We believe the data showed that an immediate start of a 12-week telaprevir-based regimen substantially improved viral cure rates in all three major subgroups of people who were not cured with currently available medicines,” said Robert Kauffman, MD, PhD, senior vice president and chief medical officer, Vertex Pharmaceuticals.

The most common AEs in the telaprevir studies were fatigue, pruritus, nausea, headache, rash and anemia. Anemia occurred in 36% of patients in the treatment lead-in arm, 30% of subjects in the simultaneous-start arm and 15% in the control arm; erythropoietin treatment was not allowed in the study. Rash was present in 36% of patients in the lead-in arm, 37% in the simultaneous-start arm and 19% of the control arm. Three percent of patients in the telaprevir-treatment arms discontinued all treatment because of anemia and 3% did so because of rash. (No P values were provided.)

Retrospective analyses of IL-28B polymorphisms in patients treated with telaprevir also were presented at the EASL meeting. Data from the ADVANCE (A New Direction in HCV Care: A Study of Treatment-Naive Hepatitis C Patients with Telaprevir) trial, a Phase III study of treatment-naïve patients with HCV, indicated that the cysteine–cysteine variation of the IL-28B polymorphism is associated with the highest SVR rates, at 90% compared with 73% among patients with the thymine–thymine polymorphism and 71% among individuals with the cysteine–thymine polymorphism.

Retrospective analysis of data from REALIZE indicated that the cysteine–cysteine variant also is associated with the highest SVR rates, at 79% compared with 61% for the thymine–thymine polymorphism and 60% for the cysteine–thymine polymorphism.

Additionally, interim results from a Phase II study of treatment-naïve HCV patients with the combination of telaprevir, peginterferon-ribavirin and the polymerase inhibitor VX-222 (Vertex) also were presented at the meeting. Of patients who received a combination of the four agents, 90% had undetectable HCV RNA after 12 weeks. In another group of patients who received a combination of the four agents with a lower dose of VX-222, 83% showed undetectable levels of HCV RNA.

“Boceprevir and telaprevir will greatly improve our ability to eradicate hepatitis C from both treatment-naïve as well as treatment-experienced patients,” commented Donald M. Jensen, MD, professor of medicine and director of the Center for Liver Disease, University of Chicago Medical Center, who wrote an editorial accompanying the published results of RESPOND-2 and SPRINT-2 (N Engl J Med;2011;364:1272-1274). “However, this success will come at a cost—an increase in side effects and some increase in treatment complexity.”

Series Editor

Tarun Mullick, MD Clinical Faculty Rush-Copley Medical Center Aurora, Illinois

Clinical Staff

Delnor Hospital Geneva, Illinois Provena Mercy Medical Center Aurora, Illinois

Commentary by Dr. Mullick

For the past decade, treatment with pegylated interferon and ribavirin for hepatitis C virus (HCV) genotypes 2 and 3 was able to provide a sustained virologic response (SVR) of approximately 80% after 24 weeks of treatment. However, the more difficult to treat HCV genotype 1 not only requires 48 weeks of treatment with pegylated interferon and ribavirin, but also is associated with an SVR ranging from 40% to 50%.

The problem with pegylated interferon and ribavirin and prior therapies was that they do not target the virus directly in a way that effectively puts the virus in a dormant state. Until now, therapies for patients with HCV genotype 1 infection were limited in their efficacy.

With the arrival of two new HCV protease inhibitors, telaprevir and boceprevir, we now have drugs available that target the virus in a more direct and effective manner. In combination with pegylated interferon and ribavirin, the new protease inhibitors cut the duration of treatment to 24 weeks and achieve an SVR approaching 80%!

The potential for side effects exists for each of the new drugs, with rash and bone marrow–related issues among them. Overall, however, this is the largest breakthrough in hepatitis C treatment in a decade.

By the time other future therapies become available, these medications will likely have treated 80% of patients with HCV infection. These drugs have the potential to dramatically reduce the number of HCV patients who develop cirrhosis, liver cancer and who require liver transplant for this disease.

Fantastic!
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Dr. Jensen is on the advisory boards of Merck and Vertex Pharmaceuticals. Dr. Poordad receives consulting fees from Merck, Tibotec and Vertex Pharmaceuticals, among other pharmaceutical companies, and receives grant support and payment for development of educational presentations from Merck.

Turkish scientists develop drugs against Hepatitis C, AIDS

They said medicine against Human Immunodeficiency Virus could prolong lifetime of patients up to 20-25 years by turning AIDS into a chronical disease.

Turkish scientists working in the United States have developed drugs against Hepatitis C and Acquired Immune Deficiency Syndrome (AIDS).

Dr. Ercem Atillasoy and Dr. Dalya Guris, Turkish doctors working at Merck Search Laboratory in Pennsylvania, said the medicine they developed against Hepatitis C achieved full treatment of resistant patients.

They said medicine against Human Immunodeficiency Virus (HIV) could prolong lifetime of patients up to 20-25 years by turning AIDS into a chronical disease.

Atillasoy said the medicine called "Protease Inhibitor" got license from FDA in the United States and expected to get license in Europe soon. He said the treatment aims at eliminating the enzyme preventing reproduction of the virus.

Atillasoy said, "there was no specific medicine against Hepatitis C so far. This medicine directly aims at destroying the disease. A combined modality therapy, like that in cancer treatment, is in question with this medicine. This new medicine increases the success in defeating Hepatitis C after being added to the treatments used so far. "

Atillasoy said there would not be need anymore for liver transplantation with the medicine, this is a milestone in Hepatitis C treatment" he underlined.

Atillasoy also said with a medicine developed against HIV, causing AIDS, the disease would not be fatal anymore but chronical.

"License has been given to the medicine in the United States and in Europe. The medicine prevents virus to enter the DNA of the cell. The medicine does not present full treatment against the disease, it has to be used lifetime." Atillasoy said.

Dr. Dalya Guris of the Merck Research Laboratory said works were also underway to find a vaccine against muscle cancer.

Guris said the medicine would be presented to use within 1-2 years after FDA approval.
http://www.worldbulletin.net/?aType=haber&ArticleID=75785

European Research Consortium wants to develop novel vaccination against hepatitis C

Innovative vaccines with nanotechnology
European Research Consortium wants to develop novel vaccination against hepatitis C
HCVAX is a European joint project that reaches out to develop a vaccine against hepatitis C based on nanotechnology. The German Helmholtz Centre for Infection Research (Helmholtz-Zentrum für Infektionsforschung, HZI) in Braunschweig and its department "Vaccinology and Applied Microbiology" is now a part of the transnational consortium with researchers from Germany, France and Switzerland.

More than 170 million people are infected with the hepatitis C virus (HCV) worldwide. Also in Europe this form of hepatitis is a big problem with three per cent of the population affected. The virus is transmitted in operations such as transplantations or by the re-use of syringes for drug usage. Anti-viral treatments are very expensive, have serious side effects and are only effective for some patients. Most of the patients carry the infection for the rest of their lives, with the threat of later developing liver cirrhosis and cancer. Certainly, the most effective way to combat hepatitis C would be a vaccine against the virus – but to date no efficacious vaccine exists.

"We will pursue a completely new approach to develop a HCV vaccine," says Prof. Carlos A. Guzmán, head of the Vaccinology Department at the HZI. With the help of innovative, biocompatible nanogels part of the genetic information of the virus is brought into the body by so-called "RNA replicons". The synthetic nanogels have a diameter of only a few nanometres and are composed of a biopolymer matrix. Immune cells will take up the nanogels with the genetic information and will produce harmless components of HCV. The immune cell then responds to those foreign structures and will generate memory cells: with this, the vaccination would be successful and from then on one would be protected against an infection with pathogen HCV.

By using novel drug amplifiers, so-called adjuvants, the immune response shall be more efficient and targeted. "The HZI has a long-standing expertise in this field. We will incorporate this knowledge into the project to develop more effective vaccines," says Guzmán. "We want to identify those adjuvants that are most eligible for a use in the nanogel composition. The targeted transport to certain defence cells shall guarantee an optimal immune response."

To exclude side effects, potential vaccine candidates have to be tested in several systems. Promising structures will then be selected for further clinical development.

The consortium consists of two companies, three academic institutions and one clinic. They combine their expertise on the field of nanotechnology, biochemistry, immunology, vaccine development and clinical research. "Beyond that we expect that these novel vaccination strategies can be expanded onto the clinical management of other diseases," says Guzmán.

Funding is granted for the next three years from the "EuroNanoMed Joint Transnational Initiative" of the European Union. The German Ministry for Research and Education is funding the project in Germany.

The Partners:

Federal Department of Economic Affairs (Eidgenössisches Volkswirtschaftsdepartement), Mittelhäusern, Switzerland (coordinator)

Medipol SA, Lausanne, Switzerland

Institut Pasteur, Paris, France

Helmholtz Centre for Infection Research (Helmholtz-Zentrum für Infektionsforschung GmbH), Braunschweig, Germany

EDI GmbH, Reutlingen, Germany

Hôpital Cochin, Paris, France

June 2011 Webcast;Chronic Viral Hepatitis - Screening/Treatment and Transplant

Educational Webcast and Video Podcast of a selection of presentations of the AASLD/CDC SINGLE TOPIC CONFERENCE - Chronic Viral Hepatitis - Strategies to Improve Effectiveness of Screening and Treatment

To view these presentations you must register, the process is quick. During the registration when in doubt type in "none" to proceed. Once you begin to view/hear the webcast click on "Presentation on the sidebar to view slides and data". This is worth the effort folks.

Register Now.

Few Examples Of Data;
Burden of HBV and HCV Disease
Impact of Therapy on Disease Outcomes
Preventing and Monitoring Viral Hepatitis Infections
Introduction and Opportunities for Viral Hepatitis Prevention

Transplant;
Hepatitis B and C in liver transplantation
MELD/PELD
Long Term Complications/Post Transplant Malignancy

Infections

Immunosuppression/Transplant Immunology
Surgical Complications/Live Donors

AASLD is delighted to announce the Educational Webcast and Video Podcast of a selection of presentations of the AASLD/CDC SINGLE TOPIC CONFERENCE - Chronic Viral Hepatitis - Strategies to Improve Effectiveness of Screening and Treatment that was held in Atlanta in June 2011. These expert talks can be accessed from home/office computers and even on iPod Video, iPhone or iPad.

Click here to read more

In order to access webcasted presentations and video podcasts you either need to use the username and password you have received by email or upon registration by clicking on Register Now.
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Hepatitis C; Effects of interferon on development/progression of hepatocellular carcinoma

Int J Cancer. 2011 Sep 1;129(5):1254-64. doi: 10.1002/ijc.25767.
Epub 2011 Jan 6.
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Effects of interferon treatment on development and progression of hepatocellular carcinoma in patients with chronic virus infection: A meta-analysis of randomized controlled trials.

Zhang CH, Xu GL, Jia WD, Li JS, Ma JL, Ge YS.

Source

Graduate School of Tianjin Medical University, Tianjin, People's Republic of China; Centre for the Study of Liver Cancer and Department of Hepatic Surgery, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui, People's Republic of China.

Abstract

Available literature on the effects of interferon (IFN) treatment on development and progression of hepatocellular carcinoma (HCC) in patients with chronic virus infection reports controversial results. The primary objective of this meta-analysis was to evaluate the effect of IFN on HCC risk in patients with chronic hepatitis C virus (HCV) or hepatitis B virus (HBV) infection; IFN's efficacy on local tumor progression and survival of advanced HCC patients was also assessed.

All randomized controlled trials (RCTs) comparing IFN with no antiviral treatment were selected. Finally, we identified 11 RCTs including 1,772 patients, who met our inclusion criteria to perform this meta-analysis. Our analysis results showed that IFN significantly decreased the overall HCC incidence in HCV-infected patients [relative risk (RR) = 0.39; 95% confidence interval (CI) = 0.26-0.59; p = 0.000], subgroup analysis indicated that IFN decreased HCC incidence in HCV-related cirrhotic patients evidently (RR = 0.44; 95% CI = 0.28-0.68; p = 0.000); but HCC incidence in nonresponders to initial antiviral therapy did not reduce by maintenance IFN therapy (RR = 0.96; 95% CI = 0.59-1.56; p = 0.864). Analysis results also demonstrated that IFN did not significantly affect the overall rate of HCC in HBV-infected patients although there was a trend favoring IFN therapy (RR = 0.23; 95% CI = 0.05-1.04; p = 0.056). Besides, IFN did not improve one-year overall survival of advanced HCC patients significantly (RR = 1.61; 95% CI = 0.96-2.69; p = 0.072); however, a quantitative analysis on local tumor progression could not be performed owing to lack of unified definitions among trials included in our study.

By this meta-analysis, we conclude that IFN therapy is effective in reducing overall HCC risk in chronic HCV-infected patients; using it in this subpopulation seems promising, but its administration in other subpopulations still requires further exploration.

Copyright © 2010 UICC.

PMID:

21710498

[PubMed - in process]

Inflammation and Diet: Inflammatory and Anti-Inflammatory Foods

Inflammation and Diet: Inflammatory and Anti-Inflammatory Foods

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by Brooke Douglas, R.D

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Inflammation is the normal and natural response to body injury; however, unnecessary and chronic inflammation can wreak extreme havoc on the body and promote illness. Many times chronic inflammation goes unnoticed for years but eventually may lead to serious illness including heart disease, stroke, cancer, diabetes, sleep and mood disorders, arthritis and Alzheimer’s. Due to the increase in chronic disease, the anti-inflammatory diet has gained popularity and media attention. In general, the anti-inflammatory diet is similar to the Mediterranean style of eating and is designed to reduce risk of age-related disease and improve overall health.

Dietary Factors Contributing to Inflammation

One of the largest players in the fight against chronic inflammation is excess body weight. The inflammatory state is a vicious cycle starting with infection or illness that produces inflammation, then insulin resistance followed by weight gain and more inflammation. When an individual starts to gain weight, it can become difficult to get the body out of this constant inflammatory pathway. Typically drastic nutrition and exercise changes are needed. The modern diet contributes to inflammation through a variety of body mechanisms that are not completely understood. Eating too many fried foods, processed foods, omega-6 fats, saturated fat, refined sugar and trans fats have all been linked to increased pro-inflammatory chemicals and hormones that cause cell damage.

Foods to Eat

The anti-inflammatory diet promotes well-balanced eating, but for true success it must be a lifestyle change and not a temporary fix. Due to the anti-inflammatory effects, omega-3 fatty acids such as fresh oily fish, walnuts, ground flaxseed and fortified eggs are the staples. The primary source of fat is extra virgin olive oil. Only lean meats (turkey/chicken breast meat and seafood) and vegetable proteins (soybeans, tofu, and soy milk) are allowed. Because of their high levels of antioxidants, a colorful variety of fresh fruits and vegetables are strongly encouraged along with a variety of nuts, 100% whole wheat grains, beans and legumes. Herbs and spices such as garlic, turmeric, ginger, cinnamon, red pepper, cayenne, basil, oregano, paprika and chili peppers play a key role in flavoring foods. As far as beverages, 2-4 servings of green, white and/or oolong tea are recommended and red wine is allowed in moderate amounts (1 glass daily).

Foods to Avoid

The first step in following the anti-inflammatory diet is to eliminate refined, white sugar found in most breads, white potatoes, crackers, chips and other snack foods and sugary beverages. All fast food should be avoided. Foods which are high in ‘pro-inflammatory’ fats include some margarines, all fatty meats, all processed meats, all fried foods, regular cheese, vegetable shortening and products containing partially hydrogenated vegetable oils. In order to further avoid the damaging ‘pro-inflammatory’ fats, the anti-inflammatory diet plan suggests avoiding all dairy products, unless they are the skim/fat-free/non-fat variety. Be sure to obtain calcium from other sources or supplements, if dairy products are avoided. Excess sugar and derivatives are not recommended. But artificial sweeteners are allowed.

Does it Work?

Many aspects of the diet have been associated with better health. Research has shown cultures who eat a diet high in fruits, vegetables, nuts, seeds, fatty fish and healthy oils have lower rates of chronic disease. Keep in mind that the overall pattern of eating, maintaining a healthy weight and being physically active are the three most important factors in reducing inflammation. The inclusion or elimination of certain foods and nutrients are important but improvement will be blunted if you do not look at the big picture!

On a more serious note:

Inflammation is considered the ‘silent’ killer. The problem occurs when chronic inflammation occurs inside our body and we can’t see it or feel it. This chronic inflammation does not allow for natural repair and healing caused by the damaging ‘pro-inflammatory’ (saturated and trans) fats. Being overweight or obese increases inflammation. Inflammation is a cause of many diseases, such as Rheumatoid Arthritis, Diverticulosis, Crohn’s disease, some kidney diseases, chronic skin problems, and many forms of cardiovascular disease.

The most popular lab test used to confirm inflammation is the C-reactive protein test (CRP),  although, the CRP test can’t diagnose where in the body, or why the inflammation is occurring.

Preventing inflammation

The first step is to maintain a normal body weight and get enough sleep. Skimping on sleep can increase the level of stress hormones and CRP in our blood. Frequent exercise and smoking cessation also help, as does practicing stress reduction techniques, such as prayer or mediation.

As part of a healthy diet, eat the following each week (not necessarily daily) to assist in lowering chronic inflammation:

• Several servings of: Green leafy vegetables, Flaxseed, Canola oil
• Therapeutic dose of Omega-3 fatty acids: >3,000 mg of EPA and DHA combined.
• Foods high in selenium and zinc may help as well.
• Selenium is found in: grains, onions, meat and milk.
• Zinc is found in: oysters, shellfish, herring, liver legumes, milk (non-fat), wheat bran.
• Vitamins C, E, and A in foods are also are useful antioxidants in the fight against inflammation.
• Vitamin C is found in: yellow peppers, citrus fruits and juices, broccoli, Brussels sprouts, strawberries, cantaloupe, tomatoes
• Vitamin E is found in plant products, such as vegetables, fruits, grains, and oils.
• Vitamin A is found in dark green leafy and yellow-orange fruits and vegetables. Especially rich sources include: carrots, greens, spinach, orange juice, sweet potatoes and cantaloupe.
• 2-3 servings of fatty fish, such as: Tuna, Salmon, Mackerel, Trout, Sardines
• Fiber: fruit, vegetables, nuts (especially almonds/pecans), dried beans. High fiber helps normalize the inflammatory response that occurs following a rapid increase/decrease in blood sugar levels.
• Antioxidants: eat 9 – 12 servings of fruit/veggies daily. Eat dark chocolate (in moderation), fresh herbs, and green tea.

If you would like to schedule a nutrition consult, contact Brooke at http://www.nutritionauthority.com/ or call 253-227-8284. Let a ‘Registered Dietitian’ help you clear up any nutrition confusion you may have. Brooke can personalize a ‘nutrition lifestyle plan’ to meet your specific needs. Most insurance is accepted.

Metformin; Preventing diabetes in at-risk patients

ADA: Prophylactic Metformin Cuts Medical Costs

SAN DIEGO -- Starting patients on metformin and lifestyle interventions are both cost-effective means of preventing diabetes in at-risk patients, researchers said here.