Category Archives: Better Health Through Science

WHY ARE YOU EATING GLUTEN-FREE?

                  Gluten Intolerance: What is it?

 Gluten is a protein found in grains that 99% of the population eat without health risks unless when eaten in excess causing weight gain. Many of the good foods we eat everyday and with every meal contain gluten. Bread, pasta, cereals and many processed foods, even cold-cuts and salad dressings contain the culprit. Some candies contain gluten, too. So, to follow a gluten-free diet is not easy. Most people would not want to follow this restrictive diet for life unless it had proven value.

Symptoms of gluten intolerance include bloating, upset stomach, abdominal pain, weight loss and diarrhea. True gluten intolerance is an autoimmune disease in which the body mounts an inappropriate immune response against its own cells. The disease runs in families. It is sometimes becomes active after surgery, pregnancy, infections or severe emotional stress.

Nutrients including protein, carbohydrates, fats, vitamins and minerals are absorbed into the body via tiny projections in the small intestine called villi. In people affected by gluten intolerance or celiac disease (also known as gluten sensitive enteropathy or sprue), inflammation and damage to the villi occurs when they eat foods containing wheat, rye and barley. The damaged villi cannot absorb nutrients so gluten intolerant people become malnourished and lose weight.

Affected people may also develop lactose intolerance, vitamin deficiency, neuropathy with loss of sensation in feet and hands, skin problems and oral ulcers. Many other symptoms are attributable to the malabsorption: iron deficiency anemia, osteoporosis, fatigue, depression, menstrual irregularity and infertility.

To make a definitive diagnosis, a very sensitive blood test to detect the autoantibodies reacting against the intestine can be done. The autoantibodies are known as: Anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). If you are not eating gluten when you are evaluated, the test will be negative even if the disease is present. In fact, the test must be done before you quit eating gluten because without the stimulus from the abnormal protein, antibodies decrease and return to normal within three-six months. People who have an accurate but negative test and still find they are symptomatic when they eat gluten are said to be gluten-sensitive.

Gluten intolerance can develop at any time. Right now it seems to be a fad to go “gluten-free.” A gluten-free diet is healthy, but there is no scientific evidence that a gluten-free diet is any healthier than a diet containing gluten grains, unless of course, you are gluten-intolerant or actually have the autoimmune disease. A gluten-free diet eliminates wheat, barley, rye and oats, while including corn, nuts, potatoes, rice, soy and wild rice.

Find more information from the Celiac Disease Foundation at: www.celiac.org

Betty Kuffel, MD

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BREAST CANCER

 

OCTOBER 2012

BREAST CANCER AWARENESS MONTH

 

One in eight women develops breast cancer. More than half are over age 50.

 Early detection correlates with better long-term health and cure.

The founding goal for Breast Cancer Awareness Month focused on educating women about the importance of obtaining mammograms for early diagnosis. The campaign began in 1985 as a partnership between the American Cancer Society and the drug division of Imperial Chemical Industries (now AstraZeneca). Awareness and evaluations have improved since its inception. Many supportive organizations have partnered to raise money for breast cancer research and help women obtain life-saving diagnosis and treatment.

Doing self breast exams can identify abnormalities and trigger life-saving interventions by a physician. Breast cancer experts may not agree on the frequency of mammograms, but women in high-risk categories typically start having mammograms by age 40 and continue annually. Nearly 75% of all women who develop breast cancer, have zero risk factors.

Recognized risk factors are: cancer in one breast increases your risk for additional unrelated or same type cancer in the other breast, family history, (familial breast cancer genes increase a woman’s risk to 85% chance of developing breast cancer, ovarian, pancreatic and other cancers over a lifetime). Other slight increased risk occurs in women who: give birth to their first child at age 35 or older; have early onset menses (before age 12); are overweight; experience late menopause (over age 55); consume alcohol daily. There are additional factors. For more information consult reliable websites such as: www.webmd.com/breast-cancer/guide

Most abnormalities found on mammograms are not breast cancer. Calcifications are usually non-cancerous and are related to aging. However, tiny specs appearing in clusters called “microcalcifications” raise concerns for cancer.

Mammograms often detect fluid-filled sacs called cysts. Sometimes an ultrasound of the breast is required to further evaluate the abnormality.  An ultrasound exam using noninvasive sound waves helps determine whether a lump is a solid mass requiring a possible biopsy or a benign cyst requiring no further treatment.

Breast cancer is not generic – there are many unique cell types, some more aggressive than others. Breast tissue consists primarily of lobules which produce milk and ducts that carry milk to the nipple. Fatty tissue enhances size, but the functional part of the breast is two fold: lobules and ducts. Most cancer originates in these two sites. Each cancer cell carries different protein markers on the cell surface. It is from these markers, called receptors that specific cancer types are identified and appropriate treatment of cancer determined. For more details on breast cancer see: www.cancer.org/cancer/breastcancer/detailedguide/

Breast cancer is a complex disease. There are many different cell types and treatment protocols available. Information on treatment plans and outcomes are shared by physicians internationally. Your local cancer specialist has current detailed information to provide the best treatments. Additional diagnostic methods are used including a breast MRI.

On a personal note, after having annual mammograms for years and a few weeks before my next scheduled mammogram,  I felt a lump. A needle biopsy revealed a high grade cell type: negative progesterone and negative estrogen receptors plus positive HER-2 receptors.  Approximately 200,000 new breast cancer cases are found each year; 25% of these are HER-2 + (Human Epidermal Growth Factor-2). This is an aggressive, fast growing form of breast cancer. I believe a self breast exam plus mammography, resulting in early detection, may have saved my life. Time will tell. There is a monoclonal antibody drug targeted specifically to HER-2 cell receptors. In fact there are two similar drugs now available. Following a double mastectomy, I opted for aggressive chemo therapy and a year of Herceptin, (a monoclonal antibody drug).

The over-all survival rate for women with breast cancer is 90%, a big improvement from a rate of 63% – 50 years ago. If the cancer is identified and treated before it spreads to the lymph nodes, survival at 5 years is 98%. Even if it has spread to local lymph nodes the survival rate at 5 years  is 84%. Knowing the incidence of breast cancer and the potential for long-term survival, if it is treated early, I encourage all women to do self breast exams, discuss any findings with a physician and obtain regular mammograms.
Betty Kuffel, MD

Helping Your Heart and Your Memory

Resveratrol: Its Beneficial Effects

Would you like to make a simple healthful change to benefit your heart? Resveratrol elevates HDL levels, the good cholesterol. Having a high HDL doesn’t mean you are protected against developing heart disease, but those with high HDLs appear to have reduced risk for coronary artery disease. Two human studies have also shown resveratrol can boost insulin activity in Type II diabetics and reduce harmful blood vessel disease leading to diabetic blindness. Another effect is the reduction in fat cell production of inflammatory compounds that contribute to heart disease and tissue damage associated with diabetes.

This natural product, obtainable in most pharmacies and health food stores, stimulates a family of sirtuin proteins in the body that are gene regulators. Metabolic and biological aging processes are affected by sirtuins, especially the protein SIRT1. Researchers at Howard Hughes Medical Institute found SIRT1 plays a roll in decreasing aging and aids learning and memory. Most of us could benefit from that!

Another protein resveratrol stimulates is CREB, which  strengthens connections between neurons. The CREB activity is increased by SIRT1.  There won’t be an SIRT1 pill coming soon, but understanding this relationship shows promise in understanding and reversing degenerative processes causing memory loss. Resveratrol in your diet may help your memory.

Diets rich in resveratrol protect the heart, increase fat burning and reduce weight gain—and in mice, extend lifespan. The compound is found in grapes, grape products, wine, peanuts and some plants. A trade product containing resveratrol called Reversitol comes in both pill and liquid forms. It tastes like grape juice and is easily tolerated as a food supplement.

Betty Kuffel, MD

INNOVATIONS IN CANCER TREATMENT

Understanding Cancer: Targeted Treatments

Cancers develop from multiple causes including genetic factors, infection, environmental toxin exposure and lifestyle factors such as tobacco use. Some are very slow growing while others grow and spread rapidly. No cure-all for cancer is likely in the near future. A strong immune system efficiently suppresses cellular and precancerous changes. With age and reduced immunity and sometimes for unknown reasons, abnormal cells grow and spread by direct extension to surrounding tissues, and metastasize throughout the body via blood and lymph. Each year treatments improve and many more of them are targeted at mutations and cell surface markers.

Two heritable disorders are mutations in the human genes that belong to a class of genes that are tumor suppressors, the BRCA1 and BRCA2 genes. The normal genes help stabilize DNA and prevent uncontrolled cell growth. Mutations block the stabilization and lead to early breast and ovarian cancer.

BRCA= BReast CAncer Susceptibility gene 1 and 2, affect both men and women. Men who carry this gene are also at risk for breast, and possibly pancreatic, testicular and early prostate cancer.

Other harmful mutations in the BRCA 2 gene increase risk of many other cancers including melanoma skin cancer.

Knowing you carry the BRCA gene can allow you to make decisions before the cancer develops. In women without the abnormal gene, the lifetime risk of developing breast cancer is 12% or 120/1000. In women with the harmful BRCA1 or BRCA2 mutation, they have a 60% chance or 600/1000, of developing the cancers. Many affected women make the decision to have both breasts and ovaries removed before cancer develops. This may sound drastic, but it is life saving.

An example of targeted treatment based on cell surface receptors is the Human Epidermal Growth Factor Receptor 2 (HER2) an abnormal protein found on breast cancer cells. The abnormal cancerous cell growth is triggered by an excess of HER2 due to a gene mutation and is found in other cancers, not just breast. This form of breast cancer tends to be more aggressive than other types. It is also less responsive to hormonal treatment.

Luckily there are two very specific drugs that target HER2, killing the abnormal cells but not the normal ones. These are Herceptin (Trastuzumab) and Tykerb (Lapatinib). Both may be used in combination with other chemo therapy drugs. They are not without side effects as both can cause heart toxicity and allergic reactions.

Other examples of innovations in the treatment of cancer patients are a vaccine that targets a particularly aggressive brain tumor (glioblastoma). This new treatment significantly prolongs life.  Another is melanoma skin cancer.  40-60% of them contain a mutation that encodes BRAF gene. The BRAF mutation is associated with features of high risk aggressive melanoma. This gene makes a protein (B-Raf) which is involved with directing cell growth. Inhibitors have been developed to target the abnormality; one year ago Vemurafenib was released to treat late-stage melanoma.

Betty Kuffel, MD

LEARNING ABOUT VIRUSES

 

VIRUS OVERVIEW AND UPDATE

 

Severe Acute Respiratory Syndrome (SARS)

There is a new strain of the potentially deadly virus related to SARS. The initial fear was we’d be facing an aggressive form like the outbreak in China that killed one in ten victims and infected about 8,000. The World Health Organization reports this new form is not as easily spread from person to person. Like the SARS outbreak which began in China in 2002, it is related to a common cold virus of the coronavirus family. Only one person has died. One person is critically ill. Both are from the Middle East where this new form was first identified.

Influenza A (H3N2v) Variant Virus Outbreaks

The H1N1 virus, found in pigs (2010) and humans (2011) has now surface as a new variant which has infected humans resulting in one death. The variant is transmitted from pigs to humans by droplet contact. Most infected developed only mild symptoms. Any one who is under age 5, over 65, or are pregnant, have diabetes, heart disease or weakened immune systems are at high risk of serious complications. They must have no contact with pigs. There is no risk with eating cooked pork. The seasonal flu vaccine will not protect you from this disease. See a doctor early if you suspect this infection as antiviral drugs may help.  http://www.cdc.gov/flu/swineflu/h3n2v-outbreak.htm

Viruses in Health and Disease

We have all had numerous viral illnesses with little evidence of persistence. Yet, after mapping the human genome, scientists found viruses incorporated into human genes. In fact, 8% of the human genome consists of endogenous (embedded segments) of virus sequences we pass on to our offspring. Many of these are retroviruses, based on RNA. To be functional, RNA viruses must insert themselves into a DNA-based genome which contains reverse transcriptase. The enzyme allows the RNA virus to reproduce itself using the cell’s machinery.

We have known for years that cancers arise from viruses. The Human T-cell Lymphotropic Virus (HTLV) was the first human retrovirus discovered. This virus affects T lymphocytes, white cells responsible for fighting infection. HTLV-1 and HTLV-2 are involved in numerous disease processes including leukemia, lymphoma, skin and neurologic disorders.

The Human Papilloma Virus (HPV) causes a variety of aggressive cancers: cervical, penile, oral and throat. Prevention of HPV-based cancers is now possible with an immunization. (HPV Vaccination) For guidelines: www.cdc.gov/vaccines/vpd-vac/hpv/

 

A recent discovery by researchers at the University of Texas broadens understanding of the viruses embedded in our genes. They found human genomes and those of other mammals contain Bornavirus DNA. This is an RNA virus which activates viral factories within the cell nucleus establishing persistent infection, and has been passed in mammals throughout evolution. Researchers looked at more than 200 genomes and found Bornavirus sequences in them. Why do you care?

First of all, Bornavirus infects a large number of animals internationally from birds to primates. It causes a severe and usually fatal form of encephalitis with striking behavior changes in horses, but is also seen in cattle, sheep, cats and canines. Changes in horses include: staggering, agitation and depressed behavior. Transmitted by contact with secretions, there is an incubation period from weeks to months.

Viral infections caused by influenza, cytomegalovirus (CMV) and herpes simplex virus (HSV) may be involved with psychiatric disorders but no clear causation has been reported. Bornavirus antibodies and viral RNA have been found in humans with psychiatric disorders but there is no proven direct causal link between Bornavirus infection and mental problems. Genetic and environmental factors both interact in the expression of psychiatric illness including schizophrenia and mood disorders. Research is ongoing and is a field to watch.

Information on this virus, its diagnosis and correlation with evidence for possible infection in humans causing mental disorders is discussed in detail in the following source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC164222/ from Clinical Microbiology Reviews.

There is much we do not know about how latent viruses may affect our health. Maybe they will never surface and will lie dormant in our genes over a lifetime. Many people are all too aware of Varicella Zoster Virus. This one lies dormant after having chicken pox as a child. Anyone who has had chicken pox and recovered may develop this painful blistering skin rash that follows nerves along one side of the body. One out of three people develop shingles. The best treatment is prevention and an immunization is available, even at local pharmacies. There are medications that help and you should see a doctor if you develop shingles. Zostavax® immunization is recommended by the CDC for those over age 60.  Guidelines at the CDC:

http://www.cdc.gov/vaccines/vpd-vac/shingles/vacc-need-know.htm#get-vaccine

Studies show viruses change the way genes turn on and off in embryonic stem cells. As more research information surfaces, studies using new molecular mechanisms to turn cell functions on and off are designed. Cancer treatment studies are now targeting the on-off switches which could stop rapid growth of abnormal cells and halt cancer growth.

Betty Kuffel, MD

BEAT THE FLU SEASON: IMMUNIZE NOW

Prevent Influenza: B and A including H1N1, H3N2

Influenza is always around, but the typical “flu season” in the US extends from October to May. It takes about two weeks for your body to generate antibodies against the flu following an immunization, so now is the time to immunize yourself and your family. Vaccines are available at many convenient locations, even in pharmacies, so there are no long lines.

We may have forgotten the scare and severity of the H1N1 (swine) flu illness in the past, but recent illnesses and a death from swine flu contracted by people attending fairs and touching pigs has brought the disease back into focus. Treatment may not be effective, so it is best to avoid the disease altogether. You can do that by arming yourself against the H1N1 viral illness and other seasonal flu types by an immunization which covers a variety of influenza strains.

An annual immunization is recommended because flu viruses change. The vaccine is re-formulated based on the observed changes. Just because you had the “flu” once, doesn’t mean you are immune. Natural immune responses decline over time. The inclusion of a viral strain in the vaccine is based on research and anticipated spread of illness type. This year the vaccine protects against three different flu types: influenza A (H3N2 virus, influenza A (H1N1) and influenza B viruses.

You have a number of immunization options:

“Flu shot”-an inactivated vaccine containing a killed virus is given with a needle and is for healthy adults, children older than 6 months and for people with chronic medical conditions

  • Regular: 6 months and older
  • HD (high dose): for people age 65 and older
  • Intradermal: for ages 18-64

Nasal-Spray: Made from weakened viruses which do not cause the flu. Approved for healthy people ages 2-49 that are not pregnant.

At the website listed below there are immunization guidelines. People who have severe egg allergies and anyone who has had a severe reaction to the vaccine in the past should not be re-immunized. Others who are ill and feverish, and those who have had a paralytic illness called GBS (Guillain-Barré Syndrome) should discuss the situation with a physician. Children younger than 6 months of age are not approved for flu immunization.

General immunization recommendations include: People with lung conditions such as asthma and COPD; Diabetics and people 65 years and older; Pregnant women; Those associated with the above examples including caregivers and household contacts.

If you develop influenza, what are the symptoms?

  • Sudden onset of a high fever
  • Headache, cough, sore throat, runny nose, aches and tiredness
  • Diarrhea and vomiting can occur but are less common and more often in children

What to do: Although the above symptoms might be flu, other illnesses have similar symptoms. If you are concerned, especially if you have asthma, diabetes, chronic lung disease or have been diagnosed with congestive heart failure, you should discuss your symptoms with your doctor. There are some medications that help, in fact, some specifically treat viral infections. These antiviral drugs may make you feel better faster and help prevent complications, but must be started within two days to have benefit.

There are actions to decrease your risk of infection, such as:

  • Avoid people who are coughing or other flu symptoms
  • Be sure to wash your hands
  • Don’t shake hands with people
  • Use alcohol based wipes or sanitizer solutions frequently

It takes about two weeks for your body to produce antibody protection after you receive the vaccine. The best protection is to GET YOUR IMMUNIZATION NOW!

You have two options:

  • The shot—when this vaccine containing a killed virus is injected, your body begins building antibodies against the illness. Generally healthy people, those with chronic disease and children over 6 months of age are approved for this method
  • The nasal spray—this vaccine is made from live but weakened viruses that do not cause the flu. The body senses it’s presence on the nasal mucus membrane and mounts an antibody response. This is approved for healthy people between the ages of 2-49. It is not used in pregnant women.

NOTE: You cannot get influenza from the vaccine. But vaccine effectiveness varies and flu viruses are constantly changing.

Possible Side effects: Soreness, redness and swelling at the site of the injection, low grade fever and aches, runny nose, wheezing, headache, vomiting, muscle aches, fever, sore throat, cough.

For more information: www.cdc.gov/flu/protect/keyfacts.htm and Influenza Vaccine Safety at the same site.

For questions related to your personal health issues, consult your physician.

Betty Kuffel, MD

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