Stress: It Should Never Be Ignored.

Story at-a-glance

  • In a recent study of stressed individuals, those who said that their health was extremely affected by stress had more than twice the risk of having or dying from a heart attack
  • Chronic stress, even at low levels, may damage your heart, impair your immune system, hinder your digestion and raise your risk of chronic disease
  • Stress turns dangerous when it is either extremely severe or long-term; it is the latter that poses a risk to many Americans, who live in a chronically elevated state of stress and anxiety
  • Keeping your stress levels under control should be an ongoing commitment, like preparing healthy meals and exercising
  • stress

Your stress level is a major player in your overall health, impacting your risk of chronic health conditions like heart disease, depression and obesity.

But unlike other more obvious risk factors, like over-indulging in junk food or not exercising, stress is more insidious, subtly sneaking up on you over time, increasing your risk of health problems even as you don’t noticeably feel sick or realize that your late-night work habits and financial worries are slowly zapping away your vitality.

That said, you may very well feel stressed, and if you do, this is a warning sign that should not be ignored.

People Who Believe Their Health Is Affected By Stress Are Twice as Likely to Have a Heart Attack

In a recent study of stressed individuals, those who said that their health was “extremely” affected by stress had more than twice the risk of having or dying from a heart attack, compared to those who believed stress had no impact on their health.1

This could mean that these individuals were highly in tune with their bodies, and correctly perceived that stress was wearing them down. On the other hand, it could also be an example of the mind-body connection, in that if you believe stress is harming your health, it increases the likelihood that it will.

Either way, this is a significant increase in heart attack risk, so if you currently feel stressed to the point that you believe it is affecting your health, it’s time to take stress relief very seriously.

Severe Stress Can Raise Your Heart Attack Risk by 21 Times

Losing a significant person in your life raises your risk of having a heart attack the next day by 21 times, and in the following week by 6 times.2 The risk of heart attacks begins to decline after about a month, perhaps as levels of stress hormones begin to level out.

The study did not get into the causes of the abrupt increase in risk of cardiovascular events like a heart attack, but it’s likely related to the flood of stress hormones your body is exposed to following extreme stress.

For instance, adrenaline increases your blood pressure and your heart rate, and it’s been suggested it may lead to narrowing of the arteries that supply blood to your heart, or even bind directly to heart cells allowing large amounts of calcium to enter and render the cells temporarily unable to function properly.

Interestingly, while your risk of heart attack increases following severe stress, so does your risk of what’s known as stress cardiomyopathy — or “broken heart syndrome” — which is basically a “temporary” heart attack that occurs due to stress.

This stress and the subsequent release of stress hormones are thought to “stun” or “shock” the heart, leading to sudden heart muscle weakness. This condition can be life-threatening and requires immediate medical attention, however it is often a temporary condition that leaves no permanent damage.

When your body is under the stress response, whether acute or chronic, your cortisol and insulin levels rise. These two hormones tend to track each other, so when your cortisol is consistently elevated under a chronic low-level stress response, you may experience difficulty losing weight or building muscle. Additionally, if your cortisol is chronically elevated, you’ll tend to gain weight around your midsection, which is a major contributing factor to developing diabetes, heart disease and metabolic syndrome.

Ignoring Your Stress Can Devastate Your Health

We all experience stress sometimes, and this isn’t necessarily a bad thing. Some stress, like exercise, is beneficial. Likewise, the stress response can work to your advantage in some cases to give you a burst of energy and focus when you’re facing a challenge, be it warding off an attacker or completing an assignment with a tight deadline.

Stress turns ugly when it is either extremely severe, such as facing combat or another traumatic scenario, or long-term. It is the latter that poses a risk to many Americans, who live in a chronically elevated state of stress and anxiety. Over time, chronic stress may impair your immune system and cause a number of detrimental events in your body, including:

Decreased nutrient absorption

Elevated cholesterol

Increased food sensitivity

Decreased oxygenation to your gut

Elevated triglycerides


As much as four times less blood flow to your digestive system, which leads to decreased metabolism

Decreased gut flora populations

Decreased enzymatic output in your gut – as much as 20,000-fold!


Further, when your body remains in a stress-induced ‘fight-or-flight’ mode for too long, one of the most common consequences of this scenario is that your adrenal glands, faced with excessive stress and burden, become overworked and fatigued. This can lead to a number of related health conditions, including fatigue, autoimmune disorders, skin problems and more. Stress has also been linked to cancer by down-regulating immunosurveillance, potentially triggering the growth of tumors, and even activating multidrug resistance genes within cancer cells. In fact, stress, and by proxy your emotional health, is a leading factor in virtually any disease or illness you can think of.

Are You Tending to Your Emotional Health?

Keeping your stress levels under control has to be an ongoing commitment, like preparing healthy meals and exercising. Unfortunately, many fall into a vicious trap where their strategies for dealing with stress center on unhealthy activities, like watching TV, drinking alcohol, or eating junk foods; many also simply fail to address their emotional health at all, a serious mistake for your well being and physical health.

What you do for stress relief is a personal choice, as your stress management techniques must appeal to you and, more importantly, work for you. If a round of kickboxing helps you get out your frustration, then do it. If meditation is more your speed, that’s fine too. Even having a good cry now and then may be beneficial, as tears that are shed due to an emotional response, such as sadness or extreme happiness, contain a high concentration of adrenocorticotropic hormone (ACTH) — a chemical linked to stress.

One theory of why you cry when you’re sad is that it helps your body release some of these excess stress chemicals, thereby helping you feel more calm and relaxed. Energy psychology techniques such as the Emotional Freedom Technique (EFT) can be very effective as well by helping you to actually reprogram your body’s reactions to the unavoidable stressors of everyday life. This is important as, generally speaking, a stressor becomes a problem when:

  • Your response to it is negative
  • Your feelings and emotions are inappropriate for the circumstances
  • Your response lasts an excessively long time
  • You’re feeling continuously overwhelmed, overpowered or overworked

When you use EFT, simple tapping with the fingertips is used to input kinetic energy onto specific meridians on your head and chest while you think about your specific problem — whether it is a traumatic event, an addiction, pain, etc. — and voice positive affirmations. This combination of tapping the energy meridians and voicing positive affirmation works to clear the “short-circuit” — the emotional block — from your body’s bioenergy system, thus restoring your mind and body’s balance, which is essential for optimal health and the healing of chronic stress.



Improving Your Sleep Hygiene Pays Off in Health Dividends.

Research Again Confirms Links Between Poor Sleep, Weight Gain, and Cancer

Story at-a-glance

  • Getting sufficient amounts of restful sleep is an absolutely crucial component of optimal health and disease prevention
  • Poor sleep can interfere with your melatonin production, and is associated with an increased risk of insulin resistance and weight gain. These three factors all contribute to cancer development
  • One recent study found that men who don’t sleep well are twice as likely to develop prostate cancer compared to those who do; another study linked insufficient sleep to an increased risk of aggressive breast cancer and recurrence in women
  • Lack of sleep decreases levels of your fat regulating hormone leptin while increasing the hunger hormone ghrelin. The resulting increase in hunger and appetite can easily lead to overeating and weight gain
  • Researchers have also noted a link between night shift workers and higher rates of breast, prostate, colorectal cancer, and non-Hodgkin’s lymphoma. Working the night shift also raises your risk of diabetes and obesity

Sleep deprivation is such a pervasive condition in these days of artificial lights and non-stop entertainment, that you might not even realize you’re not getting enough sleep. It’s important to recognize that sleep is an absolutely crucial component of optimal health and disease prevention.

For example, the link between impaired sleep and cancer has been repeatedly confirmed. Tumors grow two to three times faster in laboratory animals with severe sleep dysfunctions, primarily due to disrupted melatonin production.

Melatonin inhibits the proliferation of a wide range of cancer cell types, as well as triggering cancer cell apoptosis (self-destruction). The hormone also interferes with the new blood supply tumors required for their rapid growth (angiogenesis).

Poor sleep is also associated with an increased risk of insulin resistance and weight gain—two additional factors that also play an important role in cancer development.

Less Sleep = Higher Risk of Cancer

Most recently, a study published in the journal Cancer, Epidemiology, Biomarkers & Prevention1 found that men who had trouble sleeping were twice as likely to develop prostate cancer compared to those who slept well. According to the featured article:2

“This association was even stronger in cases of advanced prostate cancer, and the risk increased relative to the severity of the sleep problems… The lead researcher, Lara Sigurdardottir, Ph.D., expects that, ‘If our results are confirmed in future studies, sleep may become a potential target for intervention to reduce the risk of prostate cancer.”

Another recent study3 found that insufficient sleep may be a contributing factor in both the recurrence of breast cancer, and more aggressive forms of breast cancer among post-menopausal women. According to the study’s co-author Dr. Li Li:4

“Short sleep duration is a public health hazard leading not only to obesity, diabetes and heart disease, but also cancer… 

Effective intervention to increase duration of sleep and improve quality of sleep could be an under-appreciated avenue for reducing the risk of developing more aggressive breast cancers and recurrence.”

Sleeping less than six hours per night has also been implicated as a risk factor for colorectal adenomas, which may develop into cancer if left untreated. In fact, those who slept less than six hours a night were found to have a 50 percent increased risk compared to those who got seven hours or more of sleep per night.5

Insulin resistance and disrupted melatonin production are two potent mechanisms through which chronic sleep problems affect your cancer risk. The fact that poor sleep can have such a dramatic impact on insulin resistance is why I keep repeating that you simply cannot be optimally healthy unless you also sleep well—even if you eat right and exercise…

Insulin Resistance Drives Both Weight Gain and Cancer

In one 2005 study6 aptly titled: “Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes,” the authors note that “sleep exerts marked modulatory effects on glucose metabolism.” Lack of sleep also decreases levels of the fat regulating hormone leptin while increasing the hunger hormone ghrelin. The resulting increase in hunger and appetite can easily lead to overeating and weight gain.

According to a recent study in the journal Sleep,7 later bedtimes correlate to greater weight gain even in healthy, non-obese people.

Late-night snacking further increases that risk, which shouldn’t come as a great surprise. In fact, avoiding food at least three hours prior to bedtime is one of my standard recommendations as it helps to make sure that your body is burning fat as its primary fuel which will keep you lean. As reported in Medical News Today:8

“Andrea Spaeth and team had one group of participants sleeping just from 4 a.m. to 8 a.m. each night for five nights running, and compared them to a control group who were in bed from 10 p.m. to 8 a.m. The investigators found that those who slept much less consumed more food, and therefore calories, compared to the normal-hours sleepers… Lead author, Andrea Spaeth… said:

‘Although previous epidemiological studies have suggested an association between short sleep duration and weight gain/obesity, we were surprised to observe significant weight gain during an in-laboratory study.'”

The link between insulin resistance/weight gain and cancer may be of particular concern for women… Breast cancer is the most common cancer in women, and obese women are thought to be up to 60 percent more likely to develop cancer than those of normal-weight. The reason for this increased risk is because many breast cancers are fueled by estrogen, a hormone produced in your fat tissue. So the more body fat you have, the more estrogen you’re likely to produce.

How Working the Night Shift May Affect Your Health

Confirming the need for regular sleep during night-time hours, researchers have also noted a link between night shift workers and higher rates of breast, prostate, colorectal cancer, and non-Hodgkin’s lymphoma. Working the night shift also raises your risk of diabetes and obesity.

A Danish study published in the journal Occupational and Environmental Medicine,9 found that women who worked night shifts were significantly more likely to develop breast cancer compared to those who did not work nights.

After taking confounding effects into account, such as use of birth control pills, childbirth, hormone replacement therapy, age, and sunbathing, women who worked nights had an overall 40 percent higher risk of breast cancer. As reported by Time Magazine last year:10

“The effect was cumulative: women who worked at least three night shifts a week for six years had twice the risk of breast cancer as those who worked one to two night shifts a week. Most surprising, though, was the fact that women who worked night shifts and described themselves as being ‘morning’ people — that is, they preferred to wake up early, rather than stay up late at night — had a four times higher risk of breast cancer than women who worked during the day.”

Interestingly, this study was also able to discount vitamin D deficiency as a culprit, as night shift workers were found to have greater levels of sun exposure compared to those working indoors during the day. This suggests that hormone disruptions (such as the insulin, leptin, ghrelin and melatonin disruptions discussed above) play a key role in cancer development that vitamin D alone cannot counteract. So again, a healthy lifestyle simply isn’t complete without enough proper sleep.

What You Need to Know About Sleeping Pills

According to a recent report by The Sleep Council,11 nearly half of those polled responded that stress and worry keep them tossing and turning at night, and nearly seven million Americans resort to sleeping pills in order to get some rest. While it may be tempting to look for a pill to quickly help you sleep, they will not address any of the underlying causes of insomnia.

In fact, researchers have repeatedly shown that sleeping pills don’t work, but your brain is being tricked into thinking they do… In one meta-analytic study, they found that, on average, sleeping pills help people fall asleep approximately 10 minutes sooner. From a biomedical perspective, this is an insignificant improvement.

On average, sleeping pills increase total sleep time by about 15-20 minutes. But here is the catch: This study also discovered that while most sleeping pills created poor, fragmented sleep, they also created amnesia, so upon waking, the participants could not recall how poorly they’d actually slept! Worse yet, sleeping pills have also been linked to a wide variety of health hazards, including a nearly four-fold increase in the risk of death, along with a 35 percent increased risk of cancer.

Additionally, most people do not realize that over-the-counter (OTC) sleeping pills — can have a half life of about 18 hours. So, if you take them every night, you’re basically sedated much of the time. Not surprisingly, they’re associated with cognitive deficits in the morning. Trust me, there are far better, safer and more effective ways to get a good night’s sleep…

Tips to Help You Sleep Better

There are many variables that impact how well you sleep. I suggest you read through my full set of 33 healthy sleep guidelines for all of the details, but to start, making some adjustments to your sleeping area can go a long way to ensure uninterrupted, restful sleep.

  1. Cover your windows with blackout shades or drapes to ensure complete darkness. Even the tiniest bit of light in the room can disrupt your pineal gland’s production of melatonin and the melatonin precursor serotonin, thereby disrupting your sleep cycle.

So close your bedroom door, get rid of night-lights, and refrain from turning on any light during the night, even when getting up to go to the bathroom. If you have to use a light, install so-called “low blue” light bulbs in your bedroom and bathroom. These emit light that will not suppress melatonin production.

  1. Keep the temperature in your bedroom at or below 70 degrees F (21 degrees Celsius). Many people keep their homes and particularly their upstairs bedrooms too warm. Studies show that the optimal room temperature for sleep is quite cool, between 60 to 68 degrees F (15.5 to 20°C). Keeping your room cooler or hotter can lead to restless sleep.
  2. Check your bedroom for electro-magnetic fields (EMFs). These can also disrupt your pineal gland’s production of melatonin and serotonin, and may have other negative effects as well. To do this, you need a gauss meter. You can find various models online, starting around $50 to $200. Some experts even recommend pulling your circuit breaker before bed to kill all power in your house.
  3. Move alarm clocks and other electrical devices away from your head. If these devices must be used, keep them as far away from your bed as possible, preferably at least three feet.
  4. Reduce use of light-emitting technology, such as your TV, iPad, and computer, before going to bed. These emit the type of light that will suppress melatonin production, which in turn will hamper your ability to fall asleep, as well as increase your cancer risk (melatonin helps to suppress harmful free radicals in your body and slows the production of estrogen, which can contribute to cancer). Ideally, you’ll want to turn all such light-emitting gadgets off at least one hour prior to bedtime.

As previously discussed by Dr. Rubin Naiman, a leader in integrative medicine approaches to sleep and dreams, sleep is the outcome of an interaction between two variables, namely sleepiness and what he refers to as “noise.” This is any kind of stimulation that inhibits or disrupts sleep. In order to get a good night’s sleep, you want your sleepiness level to be high, and the “noise” level to be low. Under normal conditions, your sleepiness should gradually increase throughout the day and evening, peaking just before you go to bed at night. However, if noise is conceptually greater than your level of sleepiness, you will not be able to fall asleep.


As you can see, you can have the healthiest diet on the planet, doing vegetable juicing and using fermented veggies, be as fit as an Olympic decathlete, be emotionally balanced, but if you aren’t sleeping well it is just a matter of time before it will adversely, and potentially seriously, affect your health. Sure, we all lose sleep here and there, and your body can adjust for temporary shortcomings, but if you develop a chronic pattern of sleeping less than five or six hours a night, then you’re increasing your risk of a number of health conditions, including insulin resistance and diabetes, weight gain, heart disease, and cancer.

To make your bedroom into a suitable sleep sanctuary, begin by making sure it’s pitch-black, cool, and quiet. Remember, even the tiniest bit of light can disrupt your pineal gland’s production of melatonin and serotonin. For this reason, I highly recommend adding room-darkening blinds or drapes to your bedroom, or if this is not possible wear an eye mask to block out any stray light.

If you’re even slightly sleep deprived I encourage you to implement some of these tips tonight, as high-quality sleep is one of the most important factors in your health and quality of life.



Circulating BRAF may aid in papillary thyroid cancer diagnosis, follow-up.

The evaluation of circulating BRAF V600E has the potential for use in the diagnosis and follow-up of patients with papillary thyroid carcinoma, according to researchers in Italy.

To determine whether the BRAF V600Emutated allele in cell-free DNA has a role in the diagnosis and follow-up of papillary thyroid carcinoma, researchers detected the allele and quantified it by an allele-specific real-time quantitative polymerase chain reaction assay in plasma from 103 patients affected by nodular goiter. Forty-nine healthy patients and 16 patients with non-nodular thyroid diseases were included as controls for the study.

The percentage of circulating BRAF V600Ewas significantly different between patients and controls and throughout different cytological categories of ultrasound-assisted fine needle aspiration(FNA). Specifically, percentages were higher among patients with follicular lesions (18.7%; P<.001) and those considered suspicious of malignancy (27.1%; P=.001) vs. controls.

Further, patients with a histopathological diagnosis of papillary thyroid carcinoma displayed a greater percentage of circulating BRAF V600E(P=.035) vs. those with benign histology, according to data.

Blood was drawn from 19 patients 3 to 6 months after surgery and after radioactive iodine treatment when necessary. Among these, circulating percentages of BRAF V600E were significantly lower than in presurgical samples (P<.001).

Using the receiver operating characteristic curve analysis, researchers also reported that the diagnostic performance of circulating BRAF V600E resulted in an area under the curve of 0.797, with maximum specificity of 65% and sensitivity of 80%. They assessed the predictive value of BRAF V600E in patients with follicular lesions; the positive predictive value was 33% and the negative predictive value was 80%.

“The use of BRAF V600E as a circulating marker could have several important clinical applications. In the diagnostic setting, it would integrate the data obtained from cytological analysis of FNA, providing more complete information in particular cases such as multinodular goiters where it is not possible to sample all nodules by FNA,” researchers wrote. “The availability of circulating markers could play an important role also in the short- and long-term follow-up of patients with previous thyroid cancer.”

Further research is warranted before this can be implemented in clinical settings, they wrote.

Source: Endocrine Today


Thyroid status awareness may reduce CV risk in hypopituitarism.

Data from a 20-year retrospective observational study conducted by researchers in Denmark suggest a need for improved thyroid status awareness in patients who also have hypopituitarism to reduce cardiovascular risk factors.

Researchers included patients with growth hormone deficiency who were started on replacement therapy between 1993 and 2009 (n=208). Based on baseline free thyroxine levels and treatment with or without levothyroxine, patients were categorized asthyroid-stimulating hormone sufficient (free T4 >12 pmol/L and not treated with levothyroxine) or TSH deficient (free T4 ≤12 pmol/L and treated with levothyroxine). Those who were TSH deficient were further divided into tertiles based on baseline free T4 levels: <13.1 pmol/L (first tertile; lowest); 13.1 pmol/L to 16.7 pmol/L (second tertile; intermediary); ≥16.8 pmol/L (third tertile; highest).

At baseline, serum free T4 was negatively associated to BMI and waist circumference. However, free T4 was positively associated with HDL, independent of age, sex and insulin-like growth factor I standard deviation score, researchers wrote.

Patients categorized in the first tertile of TSH deficiency displayed greater BMI (P=.02), total fat (P=.03), total cholesterol (P=.05), triglycerides (P<0.01), waist circumference (P=.01) and lower HDL (P=.03) compared with patients labeled as TSH sufficient.

After 4.1 years of follow-up, IGF-I, lean body mass and plasma glucose increased in all subgroups (P<.01), according to data. Changes to follow-up baseline free T4 were negatively correlated to changes in BMI, lean body mass, total cholesterol and LDL (all P<.05, adjusted for changes in IGF-I and GH and hydrocortisone dose), the researchers added. Patients in the first tertile of TSH deficiency were the only group to demonstrate a continued negative correlation to changes in total cholesterol and LDL.

“In this retrospective study of thyroid status and cardiovascular risk factors in GH-deficient patients, free T4 was negatively associated to BMI, waist and hip circumference, apparently explained by a worse profile in TSH-deficient patients with the lowest free T4, and as the patients came closer to euthyroid status, so did some cardiovascular risk factors get closer to normality,” researchers wrote.

Source: Endocrine Today



Omega-3 fatty acids may help reduce risk of hip fracture in postmenopausal women.

The risk of hip fractures in postmenopausal women may be reduced through consuming more omega-3 polyunsaturated fatty acids, according to a study published in the Journal of Bone and Mineral Research.

“We don’t yet know whether omega-3 supplementation would affect results for bone health or other outcomes,” Tonya Orchard, PhD, RD, LD, from Ohio State University, stated in a press release. “Though it is premature to make a nutrition recommendation based on this work, I do think this study adds a little more strength to current recommendations to include more omega-3s in the diet in the form of fish, and suggests that plant sources of omega-3 may be just as important for preventing hip fractures in women.”

Using blood samples and fracture records from the Women’s Health Initiative, Orchard and colleagues analyzed 324 matched pairs comprising participants who had either broken their hip before Aug. 15, 2008 or had never broken their hip, according to the release. They found α-linolenic acid and eicosapentaenoic acid were associated with significantly reduced hip fracture risk, but docosahexaenoic acid was not. Further, the participants who had the highest ratio of omega-6 to omega-3 polyunsaturated fatty acids had nearly double the hip fracture risk than participants with the lowest ratios.


Orchard TS. J Bone Miner Res. 2013;doi:10.1002/jbmr.1772.

Source: Endocrine Today

Prepregnancy diabetes increased risk for MRSA postpartum.

Women with diabetes before pregnancy may be at higher risk for invasive methicillin-resistant Staphylococcus aureus early postpartum before hospital discharge, researchers from the University of California, Los Angeles, reported.

“There are few published reports on the epidemiology of invasive MRSA infections among postpartum women at the national level,” the researchers wrote in the American Journal of Infection Control. “Using data from the Nationwide Inpatient Sample, we previously estimated that there were approximately 2,600 cases of invasive MRSA infection diagnosed each year in obstetric inpatients.”

The researchers also used data from the Nationwide Inpatient Sample for this study. From 2005 to 2008, there were 3,531,821 deliveries that were included in the analysis, and there were 563 invasive MRSA infections postpartum before discharge. They identified 28,949 women with prepregnancy diabetes, and 17 of the MRSA infections occurred in these women.

On a multivariable analysis, prepregnancy diabetes was associated with MRSA infection (OR=3.4; 95% CI, 1.9-6), and the risk persisted after adjusting for obesity. There also may be a higher risk among women who had diabetic complications (OR=1.5; 95% CI, 0.3-6), but the data do not allow for definite conclusion about this, the researchers wrote.

“These results are preliminary and merit further examination,” the researchers wrote. “Investigation of the relationship between diabetes and MRSA infection in a setting that allows for tracking of patients across multiple hospital admissions and ambulatory care visits would be particularly instructive. However, when combined with previous research showing increased risk of certain infections in diabetic persons, it seems likely that diabetic women are at increased risk of MRSA infection compared with other women admitted for delivery of an infant.”

Source: Endocrine Today

Quality improvement initiatives required to reduce repeat lipid testing.

One-third of patients with coronary heart disease who reached target LDL levels underwent repeat lipid panels, suggesting that quality improvement efforts are needed to decrease unnecessary testing.

Salim S. Virani, MD, PhD, of the Michael E. DeBakey VA Medical Center and a researcher at the Health Services Research and Development Center of Excellence in Houston, and colleagues evaluated the number of patients with LDL levels lower than the Adult Treatment Panel III (ATP III) guideline-recommended LDL treatment target of 100 mg/dL who underwent repeat lipid testing within 11 months without medication intensification. They used data from patients with CHD in a VA network of seven medical centers with associated community-based outpatient clinics.

 “In these patients, repeat lipid testing may represent health resource overuse and possibly waste of health care resources,” the researchers wrote.

Potential waste of resources

Virani and colleagues identified 27,947 patients with CHDand LDL levels less than 100 mg/dL — 9,200 (32.9%) of whom underwent repeat lipid testing without intensification of treatment during the next 11 months. This translated to 12,686 repeat panels, with a mean of 1.38 additional tests per patient, according to study results.

“With a mean lipid panel cost of $16.08 based on Veterans Health Administration laboratory cost data, this is equivalent to $203,990 in annual costs for one VA network,” the researchers wrote.

“These results represent health care resource overuse and possibly their waste,” Virani told Cardiology Today. “Apart from the costs associated with these lipid panels, this also carries with it the cost for the patient’s time to undergo a repeat blood test and cost for the health care provider’s time to follow-up on these results after redundant testing and to inform the patient about these results.”

After adjustment for facility level clustering, data showed that those with a history of diabetes (OR=1.16; 95% CI, 1.10-1.22), hypertension (OR=1.21; 95% CI, 1.13-1.30), higher burden of illness (OR=1.39; 95% CI, 1.23-1.57) and more frequent primary care visits (OR=1.32; 95% CI, 1.25-1.39) had higher odds of undergoing repeat testing. In contrast, patients treated at a teaching facility (OR=0.74; 95% CI, 0.69-0.80) or from a physician provider (OR=0.93; 95% CI, 0.88-0.98) and patients with a medication possession ratio of 0.8 or higher (OR=0.75; 95% CI, 0.71-0.80) were less likely to have a repeat lipid panel.

The researchers also assessed 13,114 patients with CHD who met the ATP III optional treatment target of less than 70 mg/dL. In this population, 8,177 (62.4%) with LDL levels less than 70 mg/dL underwent repeat lipid testing during 11-month follow-up.

“This represents an area of redundant testing in patients and represents an opportunity to improve health care efficiency and reduce health care waste,” Virani said.


In an invited commentary, Joseph P. Drozda Jr., MD, of the Center for Innovative Care, Mercy, in Chesterfield, Mo., lauded the researchers’ study, noting that, with the implementation of electronic health records, future reports will likely identify other areas that require improvement and where waste can be reduced.

“This well-conceived study on a large clinical database, which has the advantage of containing pharmacy data for use in tracking medication adherence, delivers an important message regarding a type of waste that is likely widespread in health care and that goes under the radar because it involves a low-cost test. However, it is precisely these low-cost, high-volume tests and procedures that need to be addressed if significant saves from reduction of waste are to be realized,” he wrote.

For more information:

Drozda JP. JAMA Intern Med. 2013;doi:10.1001/jamainternmed.2013.6808.

Virani SS. JAMA Intern Med. 2013;doi:10.1001/jamainternmed/2013.8198.

Source: Endocrine Today



Respiratory infections may increase infants’ risk for diabetes.

Respiratory infections in early childhood, especially in the first year of life, may be a risk factor for the development of type 1 diabetes, according to data.

In a prospective cohort study conducted in Munich, researchers examined data for 148 children at high risk for developing type 1 diabetes with documentation of 1,245 infectious events in 90,750 person-days during their first 3 years of life. Documentation was collected from the ongoing BABYDIET study, a German dietaryintervention study that tests the effects of delayed gluten exposure on the development of islet autoimmunity in children at increased risk for diabetes, researchers wrote.

The HR for islet autoantibody seroconversion associated with respiratory infections was increased during the first 6 months of life (HR=2.27; 95% CI, 1.32-3.91) and for those aged 6 to 11.9 months (HR=1.32; 95% CI, 1.08-1.61).

According to data, a higher number of respiratory infections were reported in the 6 months before islet autoantibody seroconversion and also were associated with an increased HR (HR=1.42; 95% CI, 1.12-1.80), the researchers wrote.

“While there were no islet autoantibody seroconversion events observed in the first 6 months of life, the incidence rates of seroconversion per 100 person-years were 8.51 in the second-half year, 4.07 in the second year, and 3.67 in the third year of life. The mean incidences of the three infection categories also increased considerably after the first 6 months of life and remained relatively constant thereafter, with a slight decline in the third year of life,” researchers wrote.

Besides these findings, there is some evidence connecting short-term effects of infectious events and the development of autoimmunity, they wrote.

Source: Endocrine Today



Baseline glycemic state influences exercise-induced glycemic control.

Recent data suggest that the extent of exercise-induced improvements in glycemic control might depend on glycemic levels prior to training.

According to a research letter published inJAMA Internal Medicine, these findings demonstrate that moderate-intensity aerobic exercise can improve glycemic control. However, patients with ambient hyperglycemia are more likely to be nonresponders, according to data.

Thomas P. J. Solomon, PhD, of the Centre of Inflammation and Metabolism, Copenhagen, Denmark, and colleagues studied body composition, aerobic fitness and glycemic control in 105 overweight or obese patients (mean BMI, 33 kg/m2; mean age, 61 years) with impaired glucose tolerance (n=56) or type 2 diabetes (n=49) before and after a 12- to 16-week aerobic exercise training period. Their goal was to determine whether the baseline pre-training glycemic state affected post-exercise changes in glycemic control.

The researchers observed significant improvements in body weight (−4.6 kg), whole-body adiposity (−1.9%), VO2max (0.23 L per minute), fasting plasma glucose (−0.35 mmol/L), and 2-hour OGTT (−0.8 mmol/L) following exercise training, according to data.

Although pre-training FPG levels did not affect exercise-induced changes in glycemic control, the researchers wrote that there was a nonlinear quadratic relationship between pre-training 2-hour OGTT and exercise-induced changes in the 2-hour glucose response (P=.06).

Furthermore, patients with a pre-training 2-hour OGTT level <13.1 mmol/L demonstrated greater exercise-induced decreases in 2-hour glucose level (P<.001) compared with patients with a pre-training 2-hour OGTT level >13.1 mmol/L who had less significant improvements in 2-hour glucose level (P=.07).

Patients with a pre-training HbA1c level <6.2% displayed an exercise-induced decrease in HbA1c (P=.005) compared with patients who had a pre-training HbA1c level >6.2% who demonstrated smaller exercise-induced improvements in HbA1c levels (P=.04), the researchers wrote.

“The clinical relevance of these new findings is paramount and highlights the need to understand the metabolic ‘nonresponder,’” they wrote.

Source: Endocrine Today



Breakthrough Could Lead to ‘Artificial Skin’ That Senses Touch, Humidity and Temperature.

touchUsing tiny gold particles and a kind of resin, a team of scientists at the Technion-Israel Institute of Technology has discovered how to make a new kind of flexible sensor that one day could be integrated into electronic skin, or e-skin. If scientists learn how to attach e-skin to prosthetic limbs, people with amputations might once again be able to feel changes in their environments.

The findings appear in the June issue ofACS Applied Materials & Interfaces.

The secret lies in the sensor’s ability to detect three kinds of data simultaneously. While current kinds of e-skin detect only touch, the Technion team’s invention “can simultaneously sense touch, humidity, and temperature, as real skin can do,” says research team leader Professor Hossam Haick. Additionally, the new system “is at least 10 times more sensitive in touch than the currently existing touch-based e-skin systems.”

Researchers have long been interested in flexible sensors, but have had trouble adapting them for real-world use. To make its way into mainstream society, a flexible sensor would have to run on low voltage (so it would be compatible with the batteries in today’s portable devices), measure a wide range of pressures, and make more than one measurement at a time, including humidity, temperature, pressure, and the presence of chemicals. In addition, these sensors would also have to be able to be made quickly, easily, and cheaply.

The Technion team’s sensor has all of these qualities. The secret is the use of monolayer-capped nanoparticles that are only 5-8 nanometers in diameter. They are made of gold and surrounded by connector molecules called ligands. In fact, “monolayer-capped nanoparticles can be thought of as flowers, where the center of the flower is the gold or metal nanoparticle and the petals are the monolayer of organic ligands that generally protect it,” says Haick.

The team discovered that when these nanoparticles are laid on top of a substrate — in this case, made of PET (flexible polyethylene terephthalate), the same plastic found in soda bottles — the resulting compound conducted electricity differently depending on how the substrate was bent. (The bending motion brings some particles closer to others, increasing how quickly electrons can pass between them.) This electrical property means that the sensor can detect a large range of pressures, from tens of milligrams to tens of grams. “The sensor is very stable and can be attached to any surface shape while keeping the function stable,” says Dr. Nir Peled, Head of the Thoracic Cancer Research and Detection Center at Israel’s Sheba Medical Center, who was not involved in the research.

And by varying how thick the substrate is, as well as what it is made of, scientists can modify how sensitive the sensor is. Because these sensors can be customized, they could in the future perform a variety of other tasks, including monitoring strain on bridges and detecting cracks in engines.

“Indeed,” says Dr. Peled, “the development of the artificial skin as biosensor by Professor Haick and his team is another breakthrough that puts nanotechnology at the front of the diagnostic era.”

The research team also included Meital Segev-Bar and Gregory Shuster, graduate students in the Technion’s Russell Berrie Nanotechnology Institute, as well as Avigail Landman and Maayan Nir-Shapira, undergraduate students in the Technion’s Chemical Engineering Department.