Research Blogging - Health - English

Marijuana and Diabetes: Does Pot Make You Thin?

2013-05-22T14:01:05Z

Teasing out the insulin effect. On the face of it, the study seems to come out of left field: A group of researchers claimed that marijuana smokers showed 16 per cent lower fasting insulin levels than non-smokers. The study, called “The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults,” is in press for The American Journal of Medicine. The authors are a diverse group of medical researchers from Harvard, Beth Israel Deaconess Medical Center, and the University of Nebraska College of Medicine. The study concluded: “We found that marijuana use was associated with lower levels of fasting insulin and HOMA-IR [a measure of insulin resistance], and smaller waist circumference.” Of course, it was that last tidbit about waist circumference that was picked up by the media. “Why Pot Smokers Are Skinnier,” headlined the Atlantic. However, the important implications are not so much for weight control, or the discovery of some built-in offsetting mechanism for the marijuana munchies, but rather for insulin control and the treatment of diabetes. But in a clinical study, remarkable observations require remarkable documentation. What does the research actually say? There are problems with the study worth noting. While researchers took blood samples after a 9-hour fast to determine insulin and glucose levels, they relied on self-reporting for marijuana use data. And self-reporting for alcohol and drug use has its limitations as an investigative tool. Namely, lack of honesty. But let’s get beyond that for a moment: From a database of 4, 657 men and women who participated in the National Health and Nutrition Examination Survey, the researchers determined that 579 were current marijuana users, while 1, 975 were pot smokers in the past. The marijuana-smoking cohort tended to be young males who also smoked cigarettes. After running everything through a series of complicated multivariable-adjusted models, marijuana came out associated with lower insulin levels, and “lower waist circumference” than those who reported never using marijuana. And the results didn’t change much after adjusting for BMI numbers and excluding participants who actually had diabetes. Furthermore, the association was strongest in current smokers, “suggesting that the impact of marijuana use on insulin and insulin resistance exists during periods of recent use.” (It should also be noted that other health habits can effect glucose and insulin activity, including cigarettes, alcohol, and lack of physical activity.) The investigators don’t offer a solution to the increased appetite/decreased waistline conundrum they claim to have identified. “We did not find any significant associations between marijuana use, and triglyceride levels, systolic blood pressure, or diastolic blood pressure,” they concluded. We know marijuana has a complicated relationship with appetite mechanisms, as evidence by its use with chemotherapy patients who need to eat. The theory is that the metabolic effects are mediated by a complex mix of cannabinoid type 1 and type 2 receptor interactions, since type 1 receptor antagonists like rimonabant improve insulin resistance in humans, and type 1 knockout mice also show resistance to diet-induced obesity. Does marijuana smoking protect against diabetes? Wisely, the researchers don’t go that far, on the basis of this one uncontrolled study. The researchers’ conclusions neatly hedge the bets, suggesting that with recent trends in the direction of marijuana legalization, “physicians will increasingly encounter patients who use marijuana and should therefore be aware of the effects it can have on common disease processes, such as diabetes mellitus.” As it happens, the findings aren’t entirely new. Anecdotal reports abound. Back in 2010, on the Diabetes Daily support board, there was a long discussion of marijuana’s effect on blood glucose levels in diabetics. And there are several mouse models showing the same effects. In a prepared statement, lead investigator Murray A. Mittleman of Beth Israel Deaconess Medical Center in Boston conceded that previous epidemiological studies have found “lower prevalence rates of obesity and diabetes mellitus in marijuana users compared to people who have never used marijuana, suggesting a relationship between cannabinoids and peripheral metabolic processes.” However, he believes that “ours is the first study to investigate the relationship between marijuana use and fasting insulin, glucose, and insulin resistance.” Perhaps so. A 2011 study in the American Journal of Epidemiology concluded that “the prevalence of obesity is lower in cannabis users than in nonusers.” And the British Medical Journal featured a finding in 2012 by Los Angeles researchers that marijuana use was “independently associated with a lower prevalence of diabetes mellitus.” But the online patient guide for marijuana offered by Mayo Clinic says without equivocation that “cannabis may lower blood sugar. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar.” In fact, Mayo Clinic advises that patients may want to monitor their blood glucose levels if they smoke medical marijuana. Regarding the current study, the editor-in-chief of the American Journal of Medicine said in a statement that there is a need for “a great deal more basic and clinical research into the short- and long-term effects of marijuana in a variety of clinical settings such as cancer, diabetes, and frailty of the elderly.” Editor Joseph S. Alpert also called on the National Institutes of Health (NIH) and the Drug Enforcement Administration (DEA) to collaborate in “developing policies to implement solid scientific investigations that would lead to information assisting physicians in the proper use and prescription of THC in its synthetic or herbal form.” Penner E.A., Buettner H. & Mittleman M.A. (2013). The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults, The American Journal of Medicine, DOI: 10.1016/j.amjmed.2013.03.002 Photo Credit: http://www.herbalmission.org/...

Penner Elizabeth A., Buettner Hannah, & Mittleman Murray A. (2013) The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults. The American Journal of Medicine. DOI: 10.1016/j.amjmed.2013.03.002

Video Tip of the Week: Canary Database for sentinels of human health

2013-05-22T09:32:39Z

Recently we attended the Medical Library Association conference (#MLAnet13). Librarians are working so hard to wrangle information into usable forms, and to generate new connections among data types to reveal new information and leads for further studies. I ♥ librarians. In one of the sessions I attended on Medical Informatics, I heard several great talks. One [...]...

Rabinowitz, P., Scotch, M., & Conti, L. (2010) Animals as Sentinels: Using Comparative Medicine To Move Beyond the Laboratory. ILAR Journal, 51(3), 262-267. DOI: 10.1093/ilar.51.3.262

Rabinowitz, P., Gordon, Z., Holmes, R., Taylor, B., Wilcox, M., Chudnov, D., Nadkarni, P., & Dein, F. (2005) Animals as Sentinels of Human Environmental Health Hazards: An Evidence-Based Analysis. EcoHealth, 2(1), 26-37. DOI: 10.1007/s10393-004-0151-1

Rabinowitz, P., Cullen, M., & Lake, H. (1999) Wildlife as sentinels for human health hazards: a review of study designs. Journal of Environmental Medicine, 1(4), 217-223. DOI: 10.1002/jem.33

How Pain Works, Part III – Nociception

2013-05-21T15:39:53Z

There is actually no such thing as a "pain sensor" or "pain fiber" - but there is the fascinating system of nociception! An important concept in understanding pain....

Basbaum AI, Bautista DM, Scherrer G, & Julius D. (2009) Cellular and molecular mechanisms of pain. Cell, 139(2), 267-84. PMID: 19837031

CrossFit Woman: How Hormone Replacement Therapy May Protect You From Depression.

2013-05-21T13:35:33Z

CrossFit Woman, Depression, Female Hormones and Anti-Depressants A CrossFit woman usually take good care of herself. We do CrossFit. We lift weights. Eat well. Get lots of exercise. All theseThe post CrossFit Woman: How Hormone Replacement Therapy May Protect You From Depression. appeared first on WODMasters Stiff Competition....

Michopoulos V, Berga SL, & Wilson ME. (2011) Estradiol and progesterone modify the effects of the serotonin reuptake transporter polymorphism on serotonergic responsivity to citalopram. Experimental and clinical psychopharmacology, 19(6), 401-8. PMID: 21843009

Bright Lights, Cold Bodies - The Near-Death Experience Explained

2013-05-21T08:53:47Z

Last February, Dr. Sam Parnia, an intensive care physician who has been researching near-death experiences for the past 15 years, published his new book ‘Erasing death: The Science That is Rewriting the Boundaries Between Life and Death’. Following the release of that book, Dr. Parnia was interviewed on National Public Radio in the US. It wasn’t so much this interview that sparked my interest, as much as the comments that followed. “It’s hard to believe that this guy is actually a doctor based on the junk he presents here,” commenter ‘Joe MARTYN’ says. And another user, ‘Steven Kay’, adds: “Oh, please.. Not this guy again. Why not interview the last person who claims to have seen the Virgin Mary?” To be fair, many other commenters did appreciate the interview and the work that Dr. Parnia had done. But still, the virulent dismissiveness related to this subject baffled me. Why is research on near-death experiences received with such hostility?...

van Lommel P, van Wees R, Meyers V, & Elfferich I. (2001) Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands. Lancet, 358(9298), 2039-45. PMID: 11755611

Epilepsy Service Organization in Countries with Limited Resources

2013-05-20T13:23:31Z

tumblr: bellapaige88On average, 9.5/1000 population has epilepsy in Low and Middle Income Countries (LAMIC). A research which has resulted in the global campaign against epilepsy has shown, the gap between treatment need and the treatment provision worldwide is approximately 70% [1]. This large ‘treatment gap’, i.e., lack of appropriate treatment for a large number of patients with epilepsy, due to a number of causes including inability to identify cases, inability to deliver adequate treatment, people’s attitudes and perception, availability of anti-epileptic drugs and finally, health policies of individual countries and the priority given to epilepsy. [2]The first step towards narrowing the treatment gap is improving diagnosis. Clinical investigations that help in the diagnosis of epilepsy include electroencephalography (EEG), neuro-imaging techniques such as computed axial tomograpy (CT) and magentic resonance imaging (MRI). Simple blood tests, including haematological, liver and kidney function profiles can reveal treatable causes of epilepsy, such as parasitic infections. Neuropsychological evaluation identifies areas of function and dysfunction. Long term video monitoring can greatly improve the diagnosis of epilepsy. Therapeutic drug monitoring can ensure that patients are receiving optimal doses of medication and can help greatly in avoiding toxicity. However, the availability of investigative procedures varies greatly, from 82.4% for EEG, 70.5% for CT, 45% for therapeutic drug monitoring to only 20.6 % for MRI, 21.7% for long-term video monitoring and in LAMICs. Special investigations of brain function such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) are not available in most LAMIC centres.Epilepsy services in low and middle income countries are almost non-existent and service organization is a challenge. Epilepsy services should be community based and it is important to integrate these services into the primary health care structure to ensure sustainability. The Indian model is one such example, where epilepsy care has been incorporated into programmes for poverty alleviation [3]. Public-private partnerships and non-governmental organizations (NGO) are also important components of the Indian model. [4]The ultimate goal of all workers in the epilepsy field is to improve the quality of the life of people with epilepsy and their families. The prime manner in which this is aimed for is by the provision of good medical care.Wang WZ, Wu JZ, Wang DS, Dai XY, Yang B, Wang TP, Yuan CL, Scott RA, Prilipko LL, de Boer HM, & Sander JW (2003). The prevalence and treatment gap in epilepsy in China: an ILAE/IBE/WHO study. Neurology, 60 (9), 1544-5 PMID: 12743252Mbuba CK, Ngugi AK, Newton CR, & Carter JA (2008). The epilepsy treatment gap in developing countries: a systematic review of the magnitude, causes, and intervention strategies. Epilepsia, 49 (9), 1491-503 PMID: 18557778 Pal, D., Das, T., & Sengupta, S. (2000). ...

Mbuba CK, Ngugi AK, Newton CR, & Carter JA. (2008) The epilepsy treatment gap in developing countries: a systematic review of the magnitude, causes, and intervention strategies. Epilepsia, 49(9), 1491-503. PMID: 18557778

Pal, D., Das, T., & Sengupta, S. (2000) Case-control and qualitative study of attrition in a community epilepsy programme in rural India. Seizure, 9(2), 119-123. DOI: 10.1053/seiz.1999.0357

Mani KS, Rangan G, Srinivas HV, Srindharan VS, & Subbakrishna DK. (2001) Epilepsy control with phenobarbital or phenytoin in rural south India: the Yelandur study. Lancet, 357(9265), 1316-20. PMID: 11343735

Wang WZ, Wu JZ, Wang DS, Dai XY, Yang B, Wang TP, Yuan CL, Scott RA, Prilipko LL, de Boer HM.... (2003) The prevalence and treatment gap in epilepsy in China: an ILAE/IBE/WHO study. Neurology, 60(9), 1544-5. PMID: 12743252

Sugary Drinks May Increase Risk of Kidney Stones

2013-05-20T13:10:39Z

Staying hydrated is good advice for men who’ve had kidney stones before, but sugar-sweetened sodas and fruit punch may not be the best choice of fluids....

Ferraro, P., Taylor, E., Gambaro, G., & Curhan, G. (2013) Soda and Other Beverages and the Risk of Kidney Stones. Clinical Journal of the American Society of Nephrology. DOI: 10.2215/CJN.11661112

Cancer increases the chances of bankruptcy - a new study on Americans

2013-05-20T12:25:56Z

Main Points: Researchers have found that the cancer patients in America are more than two times more likely to go bankrupt than the healthy people. I think this is the case not only in America but everywhere in the world. Published in: Health Affairs Study Further: Researchers collected data in Washington State from about 400,000 adults and found that the patients of cancer have more chances of bankruptcy, i.e. 2.65 times more chances, even if they have the health insurance as the high cost of cancer treatment is really high. “Younger cancer patients had 2–5 times higher rates of bankruptcy than cancer patients age sixty-five or older, which indicates that Medicare and Social Security may mitigate bankruptcy risk for the older group,” Researchers wrote. “People who have fewer assets, less income and less generous insurance because of entry-level jobs or no insurance are more vulnerable to severe financial distress,” lead author, Dr. Scott Ramsey, said in a statement. These financial crises could be solved by the help from the governments and employers. “The findings suggest that employers and governments may have a policy role to play in creating programs and incentives that could help people cover expenses in the first year following a cancer diagnosis,” Researchers wrote. Source: Think Progress, NBC News Reference: Ramsey, S., Blough, D., Kirchhoff, A., Kreizenbeck, K., Fedorenko, C., Snell, K., Newcomb, P., Hollingworth, W., & Overstreet, K. (2013). Washington State Cancer Patients Found To Be At Greater Risk For Bankruptcy Than People Without A Cancer Diagnosis Health Affairs DOI: 10.1377/hlthaff.2012.1263...

Ramsey, S., Blough, D., Kirchhoff, A., Kreizenbeck, K., Fedorenko, C., Snell, K., Newcomb, P., Hollingworth, W., & Overstreet, K. (2013) Washington State Cancer Patients Found To Be At Greater Risk For Bankruptcy Than People Without A Cancer Diagnosis. Health Affairs. DOI: 10.1377/hlthaff.2012.1263

Epidemiology of Childhood Brain Disorders: ADHD and Autism

2013-05-20T11:55:27Z

The U.S. Centers for Disease Control has published a comprehensive summary of the epidemiology of childhood brain disorders in the most recent Morbidity and Mortality Weekly Report.This report produced some sensationalized headlines that up to 20% of children suffer from a mental disorder. However, I was more interested in looking at the prevalence estimates for some of the individual disorders from the report.The report collates data collected from a variety of surveys and data sets including the NHANES, NHIS and the National Survey of Children's Health (NSCH). These surveys typically use parental report to estimate prevalence ratesFor the purposes of this post, I will focus on two childhood brain disorders: attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).The key findings from the report in ADHD include:7.6% of parents reported their child between 3-17 years had received a diagnosis of ADHD in the NHIS8.9% of parents reported their child received a diagnosis of ADHD in the NSCH study9.6% to 12.3% of boys had received a diagnosis of ADHD3.8% to 5.4% of girls had received a diagnosis of ADHDA diagnosis of ADHD was more with older age, in children with health insurance and higher income groupsA diagnosis of ADHD was not related to parental education level The key findings from the report for autism and autism spectrum disorder include:.8% to 1.1% of parents reported their child between 3-17 years had received a diagnosis of autism1.8% of parents reported their child had received a diagnosis of ASDSurveys consisted noted a male predominance with boys having an estimated 3.5 to 4.5 times higher rate of autism and ASD diagnosisAgain having health insurance increased the rate of autism or ASD diagnosis by around two foldAutism and ASD prevalence rates were somewhat higher in the Northeast region of the U.S. and in white, non-Hispanic childrenIn contrast to ADHD, ASD rates were similar across parental income categoriesThe report notes in the discussion section: "Substantial but not insurmountable challenges to surveillance of mental disorders in children exists." They note current methods focus on parental reports and are biased by variability in access to health and mental health providers. The also note the imperfect diagnostic approach to childhood mental disorders and the need for more consistent diagnostic approaches.This report is a good comprehensive summary of what we know about these childhood brain disorders in the United States. Readers with more interest in this topic can access the free full text report in the citation below. In the next two posts, I will summarize key findings in the conduct disorder and affective disorder categories.Photo of clown fish from the Oklahoma Aquarium is from the author's files.Perou R, Bitsko RH, Blumberg SJ, Pastor P, Ghandour RM, Gfroerer JC, Hedden SL, Crosby AE, Visser SN, Schieve LA, Parks SE, Hall JE, Brody D, Simile CM, Thompson WW, Baio J, Avenevoli S, Kogan MD, Huang LN, & Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia (2013). Mental health surveillance among children - United States, 2005-2011. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), 62 (2), 1-35 PMID: 23677130...

Perou R, Bitsko RH, Blumberg SJ, Pastor P, Ghandour RM, Gfroerer JC, Hedden SL, Crosby AE, Visser SN, Schieve LA.... (2013) Mental health surveillance among children - United States, 2005-2011. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), 62(2), 1-35. PMID: 23677130

CrossFit Nutrition: Saturated Fat May Speed Cell Demise

2013-05-20T11:24:48Z

CrossFit Nutrition: Cell Health and Telomeres. CrossFit Nutrition: you can only be as healthy as your cells. One marker of cell health is telomere length. Telomeres cap the ends ofThe post CrossFit Nutrition: Saturated Fat and Cell Health appeared first on WODMasters Stiff Competition....

Song Y, You NC, Song Y, Kang MK, Hou L, Wallace R, Eaton CB, Tinker LF, & Liu S. (2013) Intake of Small-to-Medium-Chain Saturated Fatty Acids Is Associated with Peripheral Leukocyte Telomere Length in Postmenopausal Women. The Journal of nutrition. PMID: 23616516