Nutrition experts at Oregon State University Linus Pauling Institute at Oregon State University have essentially “cured” laboratory mice of mild, diet-induced diabetes by boosting production of an enzyme called elongase-5. Liver function and blood sugar levels returned to normal after genetic manipulation, according to study findings published in the Journal of Lipid Research.

In the future, scientists hope to find a drug that will raise elongase-5 levels to help treat people with the form of diabetes related to lifestyle.

Research teams led by Johns Hopkins University in Baltimore and Columbia University in New York City report in the July 23 issue of Cell that bones may control how the rest of the body responds to insulin.

Data from the two studies conducted in mice indicate that bone cells called osteoblasts control release of a hormone that accelerates glucose metabolism elsewhere in the body. The discovery might pave the way to new diabetes drugs that target the key pathway, say researchers.

Research Front: Diabetes Drugs The Saturday Evening Post

Migraines matter, disrupting everyday routines at home and work when sufferers have to disengage from families, friends, or job responsibilities.

“Migraine is an extraordinarily common brain disorder,” says Robert Kaniecki, MD, director of the Headache Center, chief of the Headache Division, and assistant professor of neurology at the University of Pittsburgh. “Approximately 13 percent of American adults are affected by bouts of the disabling headache, robbing them of valuable time from work, family, home, or social activities.”

Fortunately, new and better ways to relieve and even prevent the life-disrupting attacks are on the horizon.

The first major advance in treating migraine hit the U.S. market in 1991 with FDA approval of sumatriptan (Imitrex, GlaxoSmithKline)—a revolutionary prescription drug option that not only eased migraine symptoms, but stopped the attacks.

“Over the ensuing decade, the drug class known as triptans expanded to 7 products, providing relief to millions of migraine sufferers,” explains Dr. Kaniecki. “During that same time period, two anti-epilepsy drugs, Topamax and  Depakote, were also added to the short list of daily drugs with proven benefit in reducing the frequency of migraine attacks.”

Subsequent research, however, had been disappointing—until now.

“It has been nearly 20 years since significant breakthroughs have been made in treating migraine headaches,” Dr. Kaniecki continues. “But we now seem poised for a second wave of new migraine treatments. Many are novel developments while others involve technologically innovative delivery systems for older drugs. For migraineurs who fail to respond to current drug therapies, these new options are reasons for optimism.”

Dr. Sheena Aurora, director of the Swedish Headache Center and assistant professor of neurology at the University of Washington School of Medicine concurs.

“I am excited about new migraine treatments,” Dr. Aurora told the Post. “As a practicing headache specialist, I still find patients who believe that migraine comes from stress. We make them aware that migraine is a biological disorder—they are born with a hypersensitive brain—and stress is one of many triggers. Studies confirm a genetic role in migraine and genomics and proteonomics may yield highly targeted therapies. In addition, we believe that newer trials using topiramate and botulinum toxin A in chronic migraine will pave the path for future research.”

Here are 5 promising new therapies to stop migraines in their tracks that are worth keeping an eye on:

A dissolvable powder form of diclofenac (Cambia). The nonsteroidal anti-inflammatory drug, currently available in tablets, helps reduce migraine-related inflammation and pain.

The Sumavel DosePro (Zogenix). Released in 2010, the innovative device delivers needle-free injections of sumatriptan (Imitrex) by “pushing” the drug into tissue just under the skin. Subcutaneous sumatriptan is easy to use and provides consistent and fast relief, according to Dr. Aurora. Nasal and patch delivery systems for the migraine drug are still in development. Doctors already prescribe sumatriptan tablets, shots, and intranasal solution that relieve migraines by blocking painful nerve signals and restoring swollen blood vessels back to normal size.

LEVADEX, orally inhaled dihydroergotamine (MAP Pharmaceuticals). Migraine sufferers are often unable to digest oral medicines. Now in late stages of clinical testing, LEVADEX is dispensed via an oral inhaler for fast, consistent, and sustained relief of migraine pain and other symptoms. Dihydroergotamine is presently available in nasal and injectable forms.

Calcitonin gene-related peptide (CGRP) antagonist drugs. A novel class of prescription medicines may treat migraines with fewer side effects than conventional therapies by blocking the release of CGRP, a type of protein involved in nerve and blood vessel irritation during a migraine attack. The CGRP antagonist telcagepant (Merck) is in late stages of development.

Transcranial pulse generators. These electronic devices are applied to the skull early in a migraine, sometimes shortening the attack. Surgically implanted devices may generate internal electrical signals to help treat chronic pain, Parkinson’s disease, and migraine headaches.

For a video podcast from the National Headache Foundation that explores some of these options, click here  Video – Dr. Robert Kaniecki, M.D.

Migraines in the News The Saturday Evening Post

Two recent warnings serve as important reminders for us (and our doctors) to always carefully weigh the risks as well as the benefits of taking medicines and dietary supplements.

Calcium Supplements for Bones

Controversial research linking calcium supplements to an increased risk of heart attack published in a leading British medical journal is raising eyebrows around the world.

“A paper published in the July 2010 issue of the prestigious British Medical Journal found from 11 randomized studies (around 12 000 participants) that healthy women treated with calcium supplements (without vitamin D) had about a 30% increase in the incidence of heart attacks compared with those treated with placebo,” explains heart rhythm expert Dr. Douglas Zipes. “Studies on dietary calcium intake do not show such an increase so the risk appears to be due to the calcium supplements alone. Calcium supplements reduce the risk of bone fractures by only about 10%, so the benefits of taking them may not outweigh the risks for most individuals.”

Researchers say that even a small increase might translate into large numbers of women at risk because of the widespread use of calcium supplements. Others note that the findings are not based on studies designed to prove cause and effect.

PPIs Reduce Stomach Acid

In May, the FDA reported that high doses or long-term use of popular proton pump inhibitor (PPI) medicines for chronic heartburn may increase the risk of hip, wrist, and spine fractures.

PPIs effectively reduce stomach acid to treat heartburn, gastroesophageal reflux, and ulcers—conditions that, left untreated, can have serious consequences.

As a precautionary step, however, revised labels on prescription and over-the-counter PPIs will reflect the increased risk of broken bones, say federal health experts.

Prescription PPIs are Nexium, Dexilant, Prilosec, Zegerid, Prevacid, Protonix, Aciphex, and Vimovo.

Over-the-counter PPIs are Prilosec OTC (omeprazole), Zegerid OTC (omeprazole), and Prevacid 24HR (lansoprazole).

“Because these products are used by a great number of people, it’s important for the public to be aware of this possible increased risk,” said Joyce Korvick, MD, deputy director for safety in the FDA’s Division of Gastroenterology Products, in an FDA press release.

Advice for Consumers

“Before discontinuing any medicine and supplement, individuals should first check with their provider about specific risks and benefits,” advises Dr. Zipes.

Future research will better clarify the risks associated with calcium supplements and PPIs.

In the meantime, read and follow all product labels and talk to your health care professional about any concerns you have about using dietary supplements and drugs.

Click here for more from Dr. Zipes and his new book. The Black Widows | Saturday Evening Post

Drug Alerts The Saturday Evening Post

Shingles Solutions The Saturday Evening Post

A: Doctors commonly prescribe five types of medicines that lower high blood pressure in different ways. In almost all patients, some combination of drugs (usually at least two, and sometimes more) are tolerated and are effective. As I mentioned in my March 2010 column, a new procedure involves threading a catheter into the renal artery and burning key nerves in the wall of the artery that help regulate blood pressure. Ask your cardiologist about it.

Help for Hypertension The Saturday Evening Post

Allergy Relief The Saturday Evening Post

AF occurs when the heart’s two upper chambers (the atria) quiver instead of beating effectively. In paroxysmal AF, the abnormal heart rhythm starts and stops on its own.

When drugs to control erratic heartbeats don’t work, doctors may use electric shock or thread catheters through blood vessels to zap cardiac cells with heat, a therapy called radiofrequency ablation.

The innovative therapy reported at the American College of Cardiology (ACC) 2010 Scientific Sessions utilizes freezing technology, or cryoablation, instead.

“Cryoablation could offer a straightforward and significantly simplified treatment for patients with very symptomatic and obnoxious atrial fibrillation,” says Dr. Douglas Packer, professor of Medicine at the Mayo Clinic in Rochester, Minnesota, and principal investigator of the Stop AF (Sustained Treatment of Paroxysmal Atrial Fibrillation) study.

In the pivotal trial, the Arctic Front Cardiac CryoAblation Catheter System from Medtronic kept nearly 70 percent of AF sufferers symptom-free for one year, compared to 7.3 percent of those given the usual drug therapy.

“There are 150,000 to 200,000 new cases of AF in the U.S. every year, Dr. Packer explained to Post editors. “Some will be asymptomatic and treated with blood thinners to prevent strokes. Others might be treated with anti-arrhythmic drugs. But the target population for ablation is people who don’t respond to drug therapy—and there are a lot of them.”

To date, more than 9,000 patients have been treated worldwide with the Arctic Front Cryocatheter. The treatment is not yet approved in the U.S., however.

“Seeking FDA approval for the system is the next step,” says Dr. Packer. “Data from Europe support the approach, but the FDA requires a large U.S. trial to demonstrate the device’s effectiveness and safety,” he explains. “This is the hallmark clinical trial in the U.S.”

Other ACC News on Atrial Fibrillation

Ablation therapy: Dr. Packer also reports that the CABANA pilot study of 60 patients with persistent or long-standing AF and underlying cardiovascular disease found that catheter ablation more effectively prevented recurrent AF than drug therapy. But the NIH-funded study is just getting started.

“The 4 to 5 year Cabana trial will consider longer-term issues of ablation: Does it reduce mortality, does it prevent strokes, and how much does it cost,” notes Packer.

Drug therapy: Analysis of pooled data from the EURIDIS and ADONIS trials suggest that it’s safe for doctors to prescribe dronedarone (brand name: Multaq) for their patients with atrial fibrillation within two days after discontinuing treatment with the drug amiodarone (brand name: Cordarone).

“Many doctors want to switch their AF patients from amiodarone to dronedarone,” says Dr. Peter Kowey, lead investigator and chief of the division of cardiovascular diseases at the Main Line Health System in Wynnewood, Pennsylvania. “These data will give some guidance until a randomized trial is completed.”

Atrial Fibrillation The Saturday Evening Post

Margie S.

Virginia

A swallowing study may be helpful, advises dentist Mike Brennan, at the Sjogren’s Syndrome and Salivary Disorders Center, Carolina Medical Center in Charlotte, North Carolina.

“Patients who report excess saliva are often unable to clear normal amounts from the mouth because of poor muscle control in the face and mouth or swallowing difficulties,” explains Dr. Brennan. “A swallow study may be helpful when a spit test measures less than 1 mL (about 1/4 tsp) per minute.

“Overproduction of saliva is uncommon, but when present, it is sometimes related to: prescription medications Pilocarpine (for glaucoma) and lithium (to stabilize mood); exposure to heavy metals such as iron, lead, arsenic, and mercury; and organophosphorus (acetylcholinesterase) poisoning. Excess saliva production has also been associated with gastroesophageal reflux (GERD).

“Treatment options for excess saliva are medications to decrease salivary flow, physical therapy to improve muscular control, and, in certain cases, more invasive surgical techniques involving the salivary glands. Consulting a physician, oral medicine specialist, or dentist about these options is recommended.”

Excess Saliva The Saturday Evening Post

A: Severe blockages in coronary arteries can certainly cause a heart attack. Often, such blockages can be propped open with stents, which can relieve the angina. When people have good collateral circulation (new blood vessels bypassing the blocked ones and supplying the heart with blood), then nothing further may need to be done. Imdur (isosorbide mononitrate) helps relieve angina, Taking aspirin, a statin, an ACE inhibitor, and a beta blocker may be recommended, too.

Heart Attack Risk The Saturday Evening Post

Gout: New Therapy Guidelines The Saturday Evening Post

Treating and Preventing Skin Ulcers The Saturday Evening Post

Joan,

Fort Worth, Texas

Psoriasis, an autoimmune disorder that occurs when skin cells grow too quickly, affects about 6 million Americans. Its symptoms include red, raised patches of skin that may itch, burn, and crack. Although the cure is not yet known, many cases are controlled with lotions, light therapy, and prescription medicines such as methotrexate, cyclosporine, and Soriatane (acitretin) to reduce inflammation and smooth the skin. When psoriasis covers large areas of the body, frequent (sometimes weekly) injections of immune-suppressing drugs, such as Amevive, Enbrel, Humira, or Remicade may be recommended.

Adults suffering from moderate to severe psoriasis might be candidates for Stelara, a new drug that received FDA approval in the fall of 2009. Stelara (ustekinumab), targets specific components of the immune system to block overproduction of skin cells and reduce inflammation.

“It is the first drug therapy that requires just four shots a year,” says Dr. Mark Lebwohl, chairman of the Department of Dermatology at the Mount Sinai School of Medicine in New York and Stelara study investigator. “The approved treatment schedule is two injections four weeks apart, followed by injections every 12 weeks. Four weeks after the first injection, most patients improve dramatically. Three months later, they are clear or close to clear.”

For more from Dr. Lebwohl about Stelara, visit saturdayeveningpost.com/stelara.

New Psoriasis Solution? The Saturday Evening Post

Be an active partner in your healthcare. Keep track of your medicines and conditions, advises The National Consumers League. Talk to your doctor if your insurance company contacts you about a potential switch. Find out if the new medicine has different side effects or possible interactions with other drugs, supplements, or foods, and what signs of trouble to look for. Your health is the most important factor in determining whether a switch is right for you.

Readers may send their letters to Medical Mailbox, 1100 Waterway Blvd., Indianapolis, IN 46202. Please include mailing address. Via email: medicalmailbox@satevepost.org.

Medical Mailbox supplements the advice of your healthcare provider, whom you should consult for personal medical problems.

Keep Track of Your Drugs The Saturday Evening Post

Renal experts explain that simple kidney cysts are common and benign (not cancerous). For as-yet-undiscovered reasons, people who develop these cysts often have high blood pressure, too. Simple kidney cysts are not inherited.

Most cause no symptoms and are harmless to the kidney. Treatment may be needed if a cyst becomes infected or enlarged. Nearly 30 percent of people over age 70 have at least one simple kidney cyst, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Medical Mailbox supplements the advice of your healthcare provider, whom you should consult for personal medical problems.

Are Kidney Cysts Harmful? The Saturday Evening Post