Iodine Deficiency During Pregnancy Impacts Children’s Brain Development .

You probably know that pregnant women are encouraged to take additional vitamins and minerals for the sake of their baby’s development. Folic acid, calcium, and iron have long been considered the holy trinity of prenatal wellness. But here’s one you may not be so familiar with: iodine.

Iodine is Necessary for Good Health

Though its health benefits have long been known, new research is now indicating thatiodine deficiency in pregnant women can have significant negative effects on unborn children’s brain development.

Iodine is an important mineral necessary for making thyroid hormones — the hormones that regulate growth and development. According to the National Institutes of Health, thyroid hormones, and thus iodine, are also necessary for adequate bone and brain development from pregnancy through infancy.[1]

New Findings Suggest Many Pregnant Women Are Deficient

According to a new report from the American Academy of Pediatrics (AAP), approximately one third of pregnant women are at least mildly deficient in iodine.[2] This deficiency can bedangerous to the unborn baby and could negatively affect the child’s metabolism, leading to impairments in his or her motor skill and cognitive functions and, sometimes, irreversible mental damage. According to the journal Nutrients, “Iodine deficiency can be defined as the world’s greatest single cause of preventable brain damage.”[3]

The Rise of Supplements

Inspired by the findings of this study, news sources that have historically discouraged supplement use, such as Reuters and AAP’s own Pediatrics journal, are now encouraging pregnant and nursing women to take iodine supplements.[4] They suggest that pregnant and nursing women ingest at least 290 micrograms of iodine each day.

Pediatricians maintain that women should only use supplements in addition to, not as replacements for, an iodine-rich diet. AAP still recommends that pregnant and nursing women ingest iodine naturally as much as possible. However, the primary sources of dietary iodine — dairy, seafood, and iodized salt — may not be appropriate for everyone, including vegans and those who wish to avoid hormone additives, toxic metals, and other chemicals found in those food sources; making supplemental iodine even more important.

By simply adding nascent iodine, the best form of supplemental iodine, to their prenatal care routines, pregnant women will have one less nutritional need to worry about. Be aware that, like everything, there is an upper limit to how much iodine you should consume and no point in consuming more than your body needs.[5]

-Dr. Edward F. Group III, DC, ND, DACBN, DCBCN, DABFM

Updated September 2014

Article References:

  1. National Institutes of Health. Iodine: Fact Sheet for Consumers. National Institutes of Health. Office of Dietary Supplements. Fact Sheet. June 24, 2011.
  2. Council on Environmental Health. Iodine Deficiency, Pollutant Chemicals, and the Thyroid: New Information on an Old Problem. Pediatrics. Vol. 133 No. 6 June 1, 2014. pp. 1163-1166. doi: 10.1542/peds.2014-0900.
  3. Paolo Ghirri, Sara Lunardi, and Antonio Boldrini. Iodine Supplementation in the Newborn.Nutrients. January 2014; 6(1): 382-390.
  4. Andrew M. Seaman. Pregnant women should take iodide supplement: docs. Reuters. May 26, 2014.
  5. Kara J. Connelly, MD, Bruce A. Boston, MD, Elizabeth N. Pearce, MD, David Sesser, David Snyder, MD, Lewis E. Braverman, MD, Sam Pino, Stephen H. LaFranchi, MD. Congenital Hypothyroidism Caused by Excess Prenatal Maternal Iodine Ingestion. The Journal of Pediatrics. Volume 161, Issue 4, Pages 760-762, October 2012.

Toward a New Drug for Multiple Sclerosis

Positive new data have been released on a drug candidate for relapsing multiple sclerosis that was first discovered and synthesized at The Scripps Research Institute (TSRI).

According to the results from a six-month Phase 2 study of 258 multiple sclerosis patients, the drug candidate RPC1063 reduced the annualized relapse rate of participants with multiple sclerosis by up to 53 percent, compared with placebo. The potential therapy also decreased the emergence of new brain damage seen by magnetic resonance imaging (MRI) by more than 90 percent.

In addition, safety results suggest a favorable risk-benefit profile. More than 98 percent of patients remained on the drug regimen—an important metric as existing drugs for multiple sclerosis are often difficult for patients to tolerate.

RPC1063 was first discovered by a “hit” from an National Institutes of Health molecular library at Scripps Florida’s Molecular Screening Center. It was then synthesized and further developed in the laboratories of Scripps California Professors Ed Roberts and Hugh Rosen.

“These data support our labs’ approach at TSRI that discovery of fundamental mechanisms in chemical biology provides the foundation for intelligent intervention in disease processes,” said Rosen. “Meeting the needs of patients and their families is our high calling in biomedical science.”

Patrick Griffin, chair of the Department of Molecular Therapeutics and director of the Translational Research Institute at Scripps Florida, added, “This development is an exciting outcome resulting from research within the Scripps Florida Molecular Screen Center. We expect many other programs that Scripps Florida has been involved in will have similar potential to improve human health.”

The new RPC1063 findings were presented September 13, 2014 at the MS Boston 2014 meeting.

Receptos, a San Diego biopharmaceutical company that licensed the technology from TSRI, is developing RPC1063 for approval by the U.S. Food and Drug Administration. The drug candidate is currently in a Phase 3 randomized, double-blind study involving 1,200 relapsing multiple sclerosis patients. The trial is expected to be completed in 2017.

The mechanism of RPC1063 (Sphingosine 1-Phosphate Receptor modulation) may also be significant in the treatment of other autoimmune diseases. An ongoing Phase 2 study (called Touchstone) for the treatment of moderate-to-severe ulcerative colitis is fully enrolled, with results expected by the end of this year.


Cosmic study ‘underestimated’ dust


South Pole Telescope facility
BICEP’s South Pole telescope targeted what the team hoped was a relatively clean part of the sky
One of the biggest scientific claims of the year has received another set-back.

In March, the US BICEP team said it had found a pattern on the sky left by the rapid expansion of space just fractions of a second after the Big Bang.

The astonishing assertion was countered quickly by others who thought the group may have underestimated the confounding effects of dust in our own galaxy.

That explanation has now been boosted by a new analysis from theEuropean Space Agency’s (Esa) Planck satellite.

In a paper published on the arXiv pre-print server, Planck’s researchers find that the part of the sky being observed by the BICEP team contained significantly more dust than it had assumed.

This new information does not mean the original claim is now dead. Not immediately, anyway.

Cosmic ‘ripples’

The BICEP and Planck groups are currently working on a joint assessment of the implications, and this will probably be released towards the end of the year.

However, if the contention is eventually shown to be unsupportable with the available data, it will prove to be a major disappointment, especially after all the initial excitement and talk of Nobel Prizes.

Planck artist impression
The Planck satellite was launched in 2009 to map the Cosmic Microwave Background

What BICEP (also known as BICEP2) claimed to have done was find the long-sought evidence for “cosmic inflation“.

This is the idea that the Universe experienced an exponential growth spurt in its first trillionth of a trillionth of a trillionth of a second.

The theory was developed to help explain why deep space looks the same on all sides of the sky – the notion being that a very rapid expansion in the earliest moments could have smoothed out any unevenness.

Inflation makes a very specific prediction – that it would have been accompanied by waves of gravitational energy, and that these ripples in the fabric of space-time would leave an indelible mark on the “oldest light” in the sky – the famous Cosmic Microwave Background (CMB).

The BICEP team said its telescope at the South Pole had detected just such a signal.

Cosmic ‘ripples’

It is called B-mode polarisation and takes the form of a characteristic swirl in the directional properties of the CMB light.

But it is a fiendishly difficult observation to make, in part because the extremely faint B-mode polarisation from nearly 14 billion years ago has to be disentangled from the polarisation being generated today in our Milky Way Galaxy.

BICEP2 data
BICEP sought characteristic swirls in the polarisation of the Universe’s oldest light

The main source of this inconvenient “noise” is spinning dust grains.

These countless particles become trapped and aligned in the magnetic fields that thread through our galaxy.

As a consequence, these grains also emit their light with a directional quality, and this is capable of swamping any primordial background signal.

The BICEP team’s strategy was to target the cleanest part of the sky, over Antarctica, and it used every piece of dust information it could source to do the disentanglement.

What it lacked, however, was access to the dust data being compiled by Europe’s Planck satellite, which has mapped the microwave sky at many more frequencies than the American team.

This allows it to more easily characterise the dust and discern its confounding effects.

Planck dust polarisation maps
Planck’s Northern (L) and Southern (R) sky projections. Note the parts of the sky that are clearer of dust (dark blue). The black box in the Southern projection is where BICEP looked

The Planck report in the arXiv paper details dust polarisation properties across a great swathe of sky at intermediate and high galactic latitudes.

Only a very small portion of those fields is relevant to BICEP, but the results are not encouraging. There is significantly more dust in BICEP’s “southern hole” than anticipated.

Indeed, most of the American signal – perhaps all of it – could have been attributed to dust.

“It’s possible, but the error in our measurement is quite high,” Planck scientist Dr Cécile Renault told BBC News.

“The conclusion really is that we need to analyse the data together – BICEP and Planck – to get the right cosmological [versus] galactic signal. It’s really too early to say.”

The American group had already downgraded confidence in its own result when it finally published a paper on the inflation claim in Physical Review Letters in June.

In the eyes of many commentators, the new Planck analysis will shake that confidence still further.

‘Premature’ announcement

The Planck researchers themselves promise to report back on their own search for a primordial polarisation signal very soon (probably at the same time as the joint paper with BICEP). Their approach is different to the American one

“Planck has wider spectral coverage, and has mapped the entire sky; BICEP2 is more sensitive, but works at only one frequency and covers only a relatively small field of view,” explained Prof Peter Coles from Sussex University, who has been tracking the developing story on his blog, In The Dark.

“Between them they may be able to identify an excess source of polarisation over and above the foreground, so it is not impossible that a gravitational wave component may be isolated. That will be a tough job, however, and there’s by no means any guarantee that it will work. We will just have to wait and see.”

But what can be said now, adds Prof Coles, is that BICEP’s March claim “was premature, to say the least”.

Even if the American and European approaches turn out to be unsuccessful this time, these groups will have pointed the way for future observations that are planned with superior technology. Planck has actually now identified parts of the sky that have less dust than the area probed by BICEP.

“If you look at the maps we’ve produced, the more blue parts are where you should go look for the primordial signal,” explained Dr Renault.

How lasers revealed a lost city in the jungle

Angkor Wat temple

Deep in the Cambodian jungle lie the remains of a vast medieval city, which was hidden for centuries. New archaeological techniques are now revealing its secrets – including an elaborate network of temples and boulevards, and sophisticated engineering.

In April 1858 a young French explorer, Henri Mouhot, sailed from London to south-east Asia. For the next three years he travelled widely, discovering exotic jungle insects that still bear his name.

Today he would be all but forgotten were it not for his journal, published in 1863, two years after he died of fever in Laos, aged just 35.

Mouhot’s account captured the public imagination, but not because of the beetles and spiders he found.

Readers were gripped by his vivid descriptions of vast temples consumed by the jungle: Mouhot introduced the world to the lost medieval city of Angkor in Cambodia and its romantic, awe-inspiring splendour.

“One of these temples, a rival to that of Solomon, and erected by some ancient Michelangelo, might take an honourable place beside our most beautiful buildings. It is grander than anything left to us by Greece or Rome,” he wrote.

His descriptions firmly established in popular culture the beguiling fantasy of swashbuckling explorers finding forgotten temples.

Today Cambodia is famous for these buildings. The largest, Angkor Wat, constructed around 1150, remains the biggest religious complex on Earth, covering an area four times larger than Vatican City.

It attracts two million tourists a year and takes pride of place on Cambodia’s flag.

Find out more

Dr Dan Penny finds medieval carvings under a stone bridge in the Cambodian jungle

Follow the archaeological team in Cambodia as they uncover the mysteries of Angkor Wat. Watch Jungle Atlantis on Thursday 25 September at 20:00 BST on BBC Two or catch it later on the BBC iPlayer.

But back in the 1860s Angkor Wat was virtually unheard of beyond local monks and villagers. The notion that this great temple was once surrounded by a city of nearly a million people was entirely unknown.

It took over a century of gruelling archaeological fieldwork to fill in the map. The lost city of Angkor slowly began to reappear, street by street. But even then significant blanks remained.

Then, last year, archaeologists announced a series of new discoveries – about Angkor, and an even older city hidden deep in the jungle beyond.

An international team, led by the University of Sydney’s Dr Damian Evans, had mapped 370 sq km around Angkor in unprecedented detail – no mean feat given the density of the jungle and the prevalence of landmines from Cambodia’s civil war. Yet the entire survey took less than two weeks.

Their secret?

Lidar – a sophisticated remote sensing technology that is revolutionising archaeology, especially in the tropics.

Mounted on a helicopter criss-crossing the countryside, the team’s lidar device fired a million laser beams every four seconds through the jungle canopy, recording minute variations in ground surface topography.

The findings were staggering.

Image showing what is beneath the ground at AngkorLidar technology has revealed the original city of Angkor – red lines indicate modern features including roads and canals

The archaeologists found undocumented cityscapes etched on to the forest floor, with temples, highways and elaborate waterways spreading across the landscape.

“You have this kind of sudden eureka moment where you bring the data up on screen the first time and there it is – this ancient city very clearly in front of you,” says Dr Evans.

These new discoveries have profoundly transformed our understanding of Angkor, the greatest medieval city on Earth.

Phra Sav Ling Povn, palace of the leprous king, near the great temple of Angkor Wat, circa 1930
Phra Sav Ling Povn, palace of the leprous king, near Angkor Wat, circa 1930

At its peak, in the late 12th Century, Angkor was a bustling metropolis covering 1,000 sq km. (It would be another 700 years before London reached a similar size.)

Angkor was once the capital of the mighty Khmer empire which, ruled by warrior kings, dominated the region for centuries – covering all of present-day Cambodia and much of Vietnam, Laos, Thailand and Myanmar. But its origins and birthplace have long been shrouded in mystery.

A few meagre inscriptions suggested the empire was founded in the early 9th Century by a great king, Jayavarman II, and that his original capital, Mahendraparvata, was somewhere in the Kulen hills, a forested plateau north-east of the site on which Angkor would later be built.

But no-one knew for sure – until the lidar team arrived.

The lidar survey of the hills revealed ghostly outlines on the forest floor of unknown temples and an elaborate and utterly unexpected grid of ceremonial boulevards, dykes and man-made ponds – a lost city, found.

Relief map of Mahendraparvata

Most striking of all was evidence of large-scale hydraulic engineering, the defining signature of the Khmer empire.

By the time the royal capital moved south to Angkor around the end of the 9th Century, Khmer engineers were storing and distributing vast quantities of precious seasonal monsoon water using a complex network of huge canals and reservoirs.

Harnessing the monsoon provided food security – and made the ruling elite fantastically rich. For the next three centuries they channelled their wealth into the greatest concentration of temples on Earth.

One temple, Preah Khan, constructed in 1191, contained 60t of gold. Its value today would be about £2bn ($3.3bn).

But despite the city’s immense wealth, trouble was brewing.

At the same time that Angkor’s temple-building programme peaked, its vital hydraulic network was falling into disrepair – at the worst possible moment.

The end of the medieval period saw dramatic shifts in climate across south-east Asia.

Tree ring samples record sudden fluctuations between extreme dry and wet conditions – and the lidar map reveals catastrophic flood damage to the city’s vital water network.

With this lifeline in tatters, Angkor entered a spiral of decline from which it never recovered.

In the 15th Century, the Khmer kings abandoned their city and moved to the coast. They built a new city, Phnom Penh, the present-day capital of Cambodia.

Life in Angkor slowly ebbed away.

Angkor Wat

When Mouhot arrived he found only the great stone temples, many of them in a perilous state of disrepair.

Nearly everything else – from common houses to royal palaces, all of which were constructed of wood – had rotted away.

The vast metropolis that once surrounded the temples had been all but devoured by the jungle.

Combo Therapy Best for COPD

A combination drug therapy aimed at opening the airways and reducing inflammation appears to be the best treatment for older adults with chronic obstructive pulmonary disease (COPD), especially those with asthma, a new study finds.

COPD patients who received a combination of long-acting beta agonists and inhaled corticosteroids were less likely to die or require hospitalization because of their breathing disorder, compared to people receiving only one of the two medications, Canadian researchers report.

The study findings were published in the Sept. 17 issue of the Journal of the American Medical Association.

The findings go against the official guidelines for treating COPD, but actually support what most chest physicians are doing in the clinic, said lead author Dr. Andrea Gershon, a scientist with the Sunnybrook Health Sciences Center and the Institute for Clinical Evaluative Sciences in Toronto.

Current treatment guidelines call for COPD patients to first receive a long-acting beta agonist, which relaxes the muscles of the airways and widens them, resulting in easier breathing. If that doesn’t work, physicians then can add an inhaled corticosteroid, which reduces inflammation.

“We found the combination therapy appeared to be more effective, and we found that a lot of people are being started on this combination therapy straight away,” Gershon said. “Maybe doctors have had an intuitive sense of these benefits, or maybe drug companies had really good marketing.”

Further, researchers found that the combination therapy did not compound a person’s risk of side effects from either drug, most notably osteoporosis and pneumonia.

“I suspect when doctors read this, they are going to skip that first step and go straight to combination drug therapy,” said Dr. Norman Edelman, senior medical advisor to the American Lung Association.

COPD is the third leading cause of death worldwide, researchers said in background information. The disease makes it progressively more difficult for patients to draw a breath, with symptoms slowly worsening over time.

The study involved government health data in Ontario on almost 12,000 people with COPD between 2003 and 2011, including 8,712 patients newly placed on combination therapy and 3,160 new users of long-acting beta agonists.

The records involved real-world situations, with doctors treating patients according to their best judgment, Edelman noted.

“It’s one thing to perform a drug trial and select patients very carefully and see how your drugs perform, and another to look back and see how people have done in the real world with real doctors,” he said.

Researchers found that about 37.3 percent of people died while using beta agonists alone, compared with 36.4 percent of people using the combination therapy.

Similar results occurred for hospitalizations caused by COPD — about 30.1 percent for people on the single drug, versus 27.8 percent for people taking the combination.

Overall, the use of combination therapy reduced risk of death or hospitalization by 3.7 percent, compared with beta agonists alone, the study found.

The greatest difference was among COPD patients who had also been diagnosed with asthma. Overall, those on combination therapy had a 6.5 percent reduced risk of either death or hospitalization compared with those taking a single drug.

The researchers noted, however, that the combination therapy appeared to be less effective for people who are using inhaled long-acting anticholinergic medication, a different class of COPD medication that works by inhibiting the transmission of certain nerve impulses to help reverse airway resistance.

Those who received the combination therapy and had never taken a long-acting anticholinergic had an 8.4 percent reduced risk of death or hospitalization.

The findings are likely to reassure most physicians that they already are doing the right thing, given that many already are prescribing combination therapy, said Dr. Darcy Marciniuk, the immediate past president of the American College of Chest Physicians and head of the division of respirology, critical care and sleep medicine at the University of Saskatchewan in Saskatoon, Canada.

Before paring down their patient sample for research purposes, the Canadian researchers determined that doctors had started 34,289 new patients on combination therapy during the period in question, compared with 3,258 who were prescribed beta agonists alone.

“About 10 times more people were started on combination therapy than were started on the single therapy,” Marciniuk said. “That speaks for itself.”

SOURCES: Andrea Gershon, M.D., M.Sc., Sunnybrook Health Sciences Center and the Institute for Clinical Evaluative Sciences, Toronto; Norman Edelman, M.D., senior medical advisor, American Lung Association; Darcy Marciniuk, M.D., F.C.C.P., immediate past president, American College of Chest Physicians; Sept. 17, 2014, Journal of the American Medical Association

Graphene imperfections key to creating hypersensitive ‘electronic nose’

Researchers have discovered a way to create a highly sensitive chemical sensor based on the crystalline flaws in graphene sheets. The imperfections have unique electronic properties that the researchers were able to exploit to increase sensitivity to absorbed gas molecules by 300 times.

The study is available online in advance of print in Nature Communications.

Amin Salehi- Khojin, asst professor of mechanical and industrial engineering in the lab with Mohammad Asadi, graduate student and Bijandra Kumar, post doc where they are doing research in graphene sensors. Photo: Roberta Dupuis-Devlin/UIC Photo Services

When a graphene lattice or sheet is formed, its polycrystalline structure has random boundaries between the single-crystal grains. The properties of the lattice are significantly affected by these “grain boundaries,” said Amin Salehi-Khojin, UIC assistant professor of mechanical and and principal investigator on the study.

In many applications, grain boundaries are considered faults because they scatter electrons and may weaken the lattice. But Salehi-Khojin and his colleagues showed that these imperfections are important to the working of graphene-based gas sensors. They created a micron-sized, individual graphene grain boundary in order to probe its and study its role in gas sensing.

Their first discovery was that gas molecules are attracted to the grain boundary and accumulate there, rather than on the graphene crystal, making it the ideal spot for sensing gas molecules. A grain boundary’s electrical properties attract molecules to its surface.

A theoretical chemistry group at UIC, led by Petr Kral, was able to explain this attraction and additional electronic properties of the grain boundary. The irregular nature of the grain boundary produces hundreds of electron-transport gaps with different sensitivities.

“It’s as though we have multiple switches in parallel,” said graduate student Poya Yasaei, first author on the paper. “Gas molecules accumulate on the grain boundary; there is a charge transfer; and, because these channels are all paralleled together, all the channels abruptly open or close. We see a very sharp response.”

Researchers have been trying to develop a highly sensitive and robust sensor for decades, said UIC postdoctoral fellow Bijandra Kumar, a co-author on the paper.

“We can synthesize these grain boundaries on a micrometer scale in a controlled way,” Kumar said. “We can easily fabricate chip-scale sensor arrays using these for real-world use.”

Salehi-Khojin said it should be possible to “tune” the electronic properties of graphene grain-boundary arrays using controlled doping to obtain a fingerprint response—thus creating a reliable and stable “electronic nose.”

With the grain boundary’s strong attraction for and the extraordinarily sharp response to any charge transfer, such an electronic nose might be able to detect even a single gas molecule, Salehi-Khojin believes, and would make an ideal sensor.

Vitamin D hailed in the fight against heart disease, Alzheimer’s disease and diabetes

Scientific research bodies extolling the amazing virtues of the prohormone vitamin D have been published in rapid succession to explain the preventive mechanism shown to prevent cardiovascular disease, diabetes and Alzheimer’s disease. Three independent reviews demonstrate that maintaining a vitamin D blood level between 50 and 70 ng/mL can provide optimal protection against many chronic diseases.

Researchers’ publishing in the journal Nutrition, Metabolism & Cardiovascular Diseases provide evidence that vitamin D is intrinsically involved in the homeostasis of the cardiovascular system. Disruption of the body’s natural stasis system contributes to diabetes, obesity, elevated blood lipids, high blood pressure, endothelial dysfunction, stroke and risk of coronary artery disease. Scientists advise supplementation of 4,000 to 8,000 IU of vitamin D per day to achieve optimal levels, far above the anemic 400 IU currently recommended.

Scientists at the University of Miami’s School of Medicine demonstrate a direct genetic link between low vitamin D levels and the development of amyloid proteins in the brain, commonly associated with Alzheimer’s disease. Reporting in the journal Neurobiology of Aging, researchers looked at gene signaling in relation to the vitamin D receptor in 492 late onset Alzheimer’s patients and 496 control subjects.

Vitamin D controls genetic receptors to guard against chronic disease

When vitamin D receptors were not activated on the surface of individual cells due to poor vitamin D saturation in the blood, precise gene signaling went awry that halted normal clearance of the dementia-related protein clumps. The team conducting the study concluded “Our findings are consistent with epidemiology studies suggesting that vitamin D insufficiency increases the risk of developing Alzheimer’s disease.”

Researchers in Spain evaluated the vitamin D status of 1,226 individuals in 1996. The participants were again tested eight years later, and vitamin D levels were contrasted with development of diabetes over the course of the study. The results, published in the journal Clinical Nutrition, found that those with vitamin D blood levels above 18.5 ng/mL had an 83 percent lower risk of developing type 2 diabetes during the eight-year period. No one in the study with a vitamin D score over 30 ng/mL developed type 2 diabetes.

It has become very clear from countless research studies published over the past decade that vitamin D qualifies among the most crucial and essential hormone-based nutrients. And still millions of people continue to place themselves at unnecessary risk by ignoring this information.

Most people above the age of twenty-one should supplement with a minimum of 2,000 IU of vitamin D every day and have their blood tested to ensure they reach the optimal range of 50 to 70 ng/mL. Extensive research provides more than sufficient evidence that maintaining a proper vitamin D level can dramatically lower the risk of heart disease, Alzheimer’s disease diabetes and many other chronic illnesses.

Sources for this article include:

10 Ways To Help Your Overactive Bladder

Having an overactive bladder is more likely to happen as you age, and in women after they have had children. Your bladder is shaped like an upside-down pear and holds about one and one-half to two cups (400 to 600 milliliters) of urine when full. 1,2

Beneath your bladder lie your pelvic floor muscles. These keep all your pelvic organs in the right place and help keep the urethra (the tube which urine comes out of) closed.

There is also a band of muscles that circle the urethra called the urethral sphincter. These muscles are crucial for bladder control and are meant to remain tightly closed for most of the day, preventing urine leakage.

People with an overactive bladder often have loss of bladder control, also called urinary incontinence. The amount of urine lost can range from just a few drops to gushing waterfall proportions.

Stress incontinence is the most common type of incontinence. A laugh, cough, or misplaced jumping jack is enough to open the floodgates. People with urge incontinence are inflicted with a frequent and sudden need to urinate, regardless of how much urine is in the bladder.
We realize that peeing when you least expect it affects how you live your life. So read on for 10 ways to help your overactive bladder! 3

1. Try to avoid caffeine, carbonated drinks, sugar, alcohol, and spicy or acidic foods.
Why? Well caffeine is a diuretic which makes you need to use the bathroom more often. Carbonated drinks and sugar are thought to stimulate the bladder. Alcohol switches off the ability of your body to concentrate urine, meaning you tend to urinate more dilute, watery urine, which dehydrates you, making your thirstier, so you drink more. And those chilies not only bring fire to your mouth, they also wreak havoc in your bladder.

Sadly, even chocolate is a bit of a baddie, as it contains both sugar and caffeine – although we promise not to tell if you just have to have a teensy, tiny bit every now and then!

2. Losing weight may improve your bladder control.

Excess weight puts extra stress on your pelvic floor muscles and contributes to an overactive bladder and loss of bladder control. If you can lose even a small amount of weight, it will help out your bladder.

The best weight loss plans are always those that set realistic goals combined with healthy eating habits and physical activity. Fad diets, although often successful short-term, rarely achieve sustainable weight loss, because once you tire of the diet, you often revert to ingrained unhealthy eating habits.

Check out our Obesity and Weight Loss guide for more information.

3. Pelvic floor exercises can help immensely.

You can’t see your pelvic floor muscles, but just like the muscles in your arms and legs, they lose their strength if they are not exercised.

Pelvic floor exercises (sometimes called Kegel exercises) help strengthen the pelvic floor when done consistently at least twice a day. Imagine you are holding back gas. Squeeze and lift the rectal area without tightening your buttocks or belly. Try and hold it for a count of five before relaxing. Increase to 10 seconds per contraction over a period of a couple of weeks. Try to complete 20 repetitions twice a day. Throw in some quick contractions (only hold for one second then release) as well to mix it up. 4

4. Carefully managing your fluid intake can be beneficial.

Drinking too much fluid puts pressure on your bladder, and makes you need to urinate. Drinking too little means your urine becomes concentrated, which irritates your bladder, also making you want to run to the restroom!

Finding a nice happy balance can be tricky, but the best thing to do is to drink small glassfuls of fluid throughout the day and avoid guzzling gallons in one sitting.

Aim to drink four to eight 8 ounce glasses of water a day.
Look at your urine and aim for a nice light yellow color. Dark urine is a sign that you are not drinking enough. Colorless urine is a sign of drinking too much.
Try to drink only during the day and stop two to three hours before you go to bed.
Drink mainly water.
5. Smoking may increase the urge to urinate.

Smoking irritates the lining of the bladder, and also makes you cough, both of which are unhelpful if you have an overactive bladder.

It is a good decision for both general health reasons and overactive bladder reasons to stop smoking. We know it can be a difficult thing to do, but don’t beat yourself up about failed attempts, just set a date on the calendar to have another go. Our Quit Smoking center has some helpful advice. 5

6. Get your bladder back into a good routine by emptying it at set times.

You can retrain your bladder to only go at certain times. Basically, retraining involves emptying your bladder to a set schedule. Initially, you might go every hour. Gradually over a period of days and weeks, you extend the period of time between using the bathroom to several hours. Followed over six to eight weeks, this program requires a lot of determination, but success rates are good. Talk with your doctor to determine if bladder retraining is suitable for you. 6

7. Keeping a “bladder diary” may help identify triggers.

Unfortunately you won’t find any juicy gossip in this diary, but it will help both you and your doctor identify any triggers for your overactive bladder and establish just how often you visit the bathroom each day.

Document exactly what kind of fluids you drink and their volume. Write down the type and quantity of food you eat. Record the number of trips to the bathroom and rate your trips as successful (no urine leakage) or not. Indicate what you were doing when leakage or the urge to urinate occurred (ie, running, sneezing, jumping jacks). 7

8. Use incontinence pads to avoid embarrassing accidents.

No matter how fast you can run, sometimes that bathroom is just a little bit too far in the distance. Don’t let yourself get caught out, when there is a fantastic range of products out there to satisfy even the most fashion conscious overactive bladder sufferer.

Incontinence products have super powers of absorbency and won’t leak or become lumpy when they get wet. They help control odor and minimize contact between urine and your skin, preventing the development of rashes.

A huge range of incontinence products is available, from discrete pads with little bulk that can be slipped into underwear, to disposable adult-sized underwear with in-built absorbency and easy-tear sides. Gender-specific products account for the different requirements of men and women, and there are many reusable and washable options available. Common brands include Attends, Tena, Depend, and Poise.

9. Seek help from a qualified physiotherapist if you have incontinence, or pain that doesn’t go away after giving birth.

Vaginal childbirth can damage the ligaments, nerves, and pelvic floor muscles that support the vagina, bladder and urethra. 8 While pelvic floor exercises may help some women after birth, many need more intensive physical therapy.

Talk to a qualified physical therapist who specializes in pelvic floor therapy if you have any incontinence or pain that doesn’t go away after giving birth. Embarking on proper rehabilitation soon after having your baby may avoid more serious gynecological problems later on. 9

10. Don’t live the rest of your life with your legs crossed. Be kind to yourself and seek your doctor’s advice.

Approximately 80% of those affected by urinary incontinence can be cured or improved, yet only one in 12 people with incontinence issues seek help. Talk to your doctor about your bladder control. 10

Your doctor can investigate and establish a cause for your overactive bladder. Treatment can then be tailored to this cause and may involve medications, bladder retraining, pelvic floor exercises, absorbent products, surgery, or combinations of these options. 10


Click to access BladderRetraining10.11.pdf

Click to access OnlineUroLog.pdf

CDC warns universities to prepare for Ebola pandemic

American colleges and universities are now on high alert and are being instructed to take extra precautions against the potential spread of incoming Ebola. Students traveling abroad to Ebola-stricken countries like Liberia, Guinea, Nigeria or Sierra Leone run the risk of bringing the virus back to US campuses. The Centers for Disease Control (CDC) is now urging all US colleges to implement additional safety measures to prevent accidental spread of Ebola.

CDC officials are encouraging university staff members to ask returning students important questions about possible symptoms, including suspicious fever, body aches, headaches, diarrhea, unexplained bleeding and bruising. Any student returning from an Ebola-stricken country within the past 21 days is to be closely monitored upon returning to the US. (Ebola has a maximum incubation period of 21 days before symptoms appear.)

The CDC is even instructing students to monitor their temperature twice daily for a 21-day period, regardless of their symptoms. The CDC is essentially warning universities to prepare for a potential Ebola pandemic.

“If a student, faculty, or staff member has had a high- or low-risk exposure, state or local public health authorities should be notified, and school officials should consult with public health authorities for guidance about how that person should be monitored,” the CDC advises.

The CDC instructs any student with a fever of 101.5°F or higher to seek immediate medical care, while warning the hospital and doctors beforehand for special safety preparations. Students are also advised not to take public transportation within a 21-day period.

The countries most affected by Ebola outbreaks, Liberia, Guinea and Sierra Leone, send nearly 400 students each year to American colleges and universities. Nigeria sends an additional 7,000 students yearly.

Is America’s medical system better equipped to handle Ebola outbreak?

In a recent interview with The New York Times, Robert Winfield, the University of Michigan’s Chief Health Officer, stated, “We’re walking a line of trying to be vigilant and have a safe environment, without raising the kind of alarm that would unnecessarily escalate the stigma and isolation of people.” So far, no cases of Ebola have been isolated.

Epidemiology Professor Eden Wells, associate director of the University’s Preventive Medicine Residency Program, commented, “Yes, we probably will have someone arrive on a plane (with Ebola). But we have a public health system in place that we could immediately isolate the patient and quarantine anyone who was exposed, and that’s been quite effective. So we would not see the spread or the problems that we’ve seen in this area.”

Professor Wells believes that US officials will use quarantine to prevent outbreaks as large as the ones seen in West Africa, where over 2,000 people have died.

“There’s a lot of fear. When the locals are becoming ill, they are returning to their villages and places they feel comfortable. Unfortunately, that can lead to spread.” Wells believes that during an outbreak it’s better to register for treatment and not be scared of medical quarantine. He points out that the four cases of Ebola treated in the US have been successful, allowing two patients to return to their normal lives.

America might be more susceptible to outbreak than experts think

If an outbreak were to spread from a US university, a peaceful quarantine could turn into a state of martial law. Entire campuses could be locked down like what’s going on in villages in Liberia. Pictures show armed guards keeping people from accessing nearby airports.

In the US, the National Guard may be called in to enforce boundaries and restrict travel, as the federal government takes over, dispersing hazmat suits that they recently obtained by the hundreds of thousands.

At this point, it may be even more dangerous to be registered for medical treatment. Americans would quickly respond in fear and panic. Non-infected and suspected persons could be misdiagnosed and thrown into quarantine zones where they then get the virus from those who are infected. Along with that, hospitals in America are already brimming with patients. If an outbreak started like it did in West Africa, America wouldn’t be any better equipped to face the problem. If anything, the immune-system-suppressed general population in the US, living on processed and fast foods, would be more susceptible to the wrath of a viral pandemic.

Learn all these details and more at the FREE online Pandemic Preparedness course at



Biologic Eases Subset of Severe Asthma

For severe eosinophilic asthma, the novel monoclonal antibody mepolizumab cut exacerbations whether given as an injection or infusion and reduced steroid use in patients dependent on them, two trials showed.

The drug, which targets interleukin-5 (IL-5) to inhibit eosinophilic inflammation,cut exacerbations by 47% with intravenous dosing and by 53% with subcutaneous dosing when compared with placebo (0.93 and 0.81 versus 1.75 per year, both P<0.001), Hector G. Ortega, MD, ScD, of GlaxoSmithKline, found in the MENSA trial.

Mepolizumab injections more than doubled the likelihood of glucocorticoid dose strata reduction compared with placebo, with a median 50% dose reduction from baseline versus none with placebo (P=0.007), Elisabeth H. Bel, MD, PhD, of the University of Amsterdam, and colleagues found in a second study, dubbed SIRIUS. Investigators in both trials said that safety issues with the drug were no different from placebo.

Both trials were reported online in the New England Journal of Medicine in conjunction with presentation at the European Respiratory Society meeting in Munich.

Three prior trials had already shown that anti-IL-5 drugs helped in asthma cases targeted by sputum eosinophil levels, Parameswaran Nair, MD, PhD, of McMaster University in Hamilton, Ontario, noted in an accompanying editorial.

The two new trials provided some clinical observations with “important practical applications,” though, he wrote.

“First, the subcutaneous administration of a lower dose of the drug (100 mg) than was previously reported was shown to be efficacious,” he noted.

“Second, characterization of the eosinophilic phenotype on the basis of a blood eosinophil count of more than 300 cells per microliter despite concurrent treatment with high doses of glucocorticoids was sufficient to select patients who were likely to have a response to this therapy.

“Both these observations make it potentially simple and easy for practitioners to identify patients who are likely to benefit and administer the drug to them.”

Some previous studies that had tried to identify candidates for treatment based on clinical characteristics alone had failed.

Sputum eosinophil counts have been used since, but their greater sensitivity to change than blood eosinophil levels comes at a cost in convenience.

“Although persistent blood eosinophilia may be sufficient to identify patients who are likely to have a response to this treatment, whether this biomarker is sufficient or is as effective as airway eosinophilia in monitoring the response to treatment remains to be seen,” Nair pointed out.

Administration Route

The Mepolizumab as Adjunctive Therapy in Patients with Severe Asthma (MENSA) trial included 576 patients with recurrent asthma exacerbations and eosinophilic inflammation (at least 150 eosinophil cells/microliter in the peripheral blood at screening or at least 300 per microliter at some time in the prior year) despite high doses of inhaled glucocorticoids (at least the equivalent of 880 mcg of fluticasone propionate per day).

Patients were randomly assigned to double-blind treatment atop their pre-existing asthma therapy regimen with placebo or mepolizumab as either a 75-mg intravenous dose or a 100-mg subcutaneous dose, every 4 weeks for 32 weeks.

Among the secondary outcomes, IV mepolizumab reduced exacerbations necessitating an emergency department visit or hospitalization by 32%, while the subcutaneous route reduced that rate by 61% compared with placebo.

Lung function at week 32 showed 100 mL greater mean increase from baseline in forced expiratory volume in 1 sec (FEV1) on IV mepolizumab and 98 mL greater mean increase on subcutaneous mepolizumab than with placebo (P=0.02 and P=0.03, respectively).

Quality of life improvements were fairly similar between IV and subcutaneous mepolizumab groups, at 6.4 and 7.0 points over placebo group on the St. George’s Respiratory Questionnaire score, both exceeding the minimal clinically important change threshold of 4 points and statistical significance at P<0.001.

The improvements in the five-item Asthma Control Questionnaire (ACQ-5) score were similar at 0.42 points and 0.44 points greater, respectively, than placebo, which met statistical significance but not the clinically important threshold of 0.5 points.

Nair cautioned, though, that the findings could have been an artifact of participating in a clinical trial. Specifically, he suggested that the high baseline exacerbation rate (mean 3.6 per year) might have meant doses of inhaled glucocorticoids and long-acting bronchodilators were not optimized prior to enrollment.

“Although the magnitudes of the reductions in exacerbations with the two routes of administration … were similar and greater than the reduction achieved with placebo, it is remarkable that the patients receiving placebo had a 50% reduction, as compared with their baseline rate,” he wrote.

Lack of adherence is the top reason for poor asthma control even in well characterized populations, he pointed out.

Standard therapies, judiciously used, and as guided by sputum cell counts have been shown to cut exacerbations to a degree clinically equivalent to biologic therapies “and are likely to be more cost-effective,” Nair wrote.

“This finding would suggest that most patients in this clinical trial might have had improvement in symptoms without mepolizumab simply by the institution of good clinical practice, as recommended by current international guidelines.”

But the severe asthma population truly dependent on systemic glucocorticoids for control do desperately need better therapies, he acknowledged.

Steroid Reduction

The Steroid Reduction with Mepolizumab Study (SIRIUS) trial included 135 patients with severe eosinophilic asthma randomized to 100 mg subcutaneous mepolizumab or placebo, every 4 weeks for 20 weeks.

After first establishing the lowest dose of maintenance oral glucocorticoids associated with acceptable asthma control, those doses were reduced by 1.25 to 10 mg per day every 4 weeks during weeks four to 20 on the basis of asthma control and symptoms of adrenal insufficiency.

The odds of a drop in the glucocorticoid dose strata — 90% to 100%, 75% to less than 90%, 50% to less than 75%, or more than 0% to less than 50% reduction versus no decrease, uncontrolled asthma in the last 4 weeks, or withdrawal — was 2.39-fold higher with mepolizumab (95% CI 1.25-4.56).

But despite that reduced glucocorticoid dose, mepolizumab reduced the annualized rate of exacerbations by a relative 32% (1.44 versus 2.12, P=0.04).

The monoclonal antibody also cut asthma symptoms by a clinically-important 0.52 points on the ACQ-5 versus placebo (P=0.004).

However, “the mean percentage reduction in the dose of glucocorticoids (50%) and the proportion of patients who had this reduction (54%) were lower than reductions that have been reported for higher doses of the drug (750 mg) administered intravenously in patients with sputum eosinophilia (87% dose reduction and 100% of patients, respectively),” Nair pointed out.

“However, these studies do not suggest that all patients with uncontrolled asthma who have peripheral blood eosinophilia will require an expensive anti-IL-5 therapy for clinical benefit,” Nair wrote.

Still, he called it reasonable to consider such a biologic for patients with severe asthma with elevated eosinophil count in sputum or blood despite high doses of systemic glucocorticoids, regardless of their atopic status.

When top-line results from the two trials were released by drugmaker GlaxoSmithKline in March, the company said it hoped to file for approval of mepolizumab by the end of 2014.

Whether mepolizumab dose adjustment by airway eosinophils level would have been better, and what is the most effective dose, route, and frequency of administration still need to be determined, Nair noted.