Immunology Breakthrough Has Big Implications

In May, the Wall Street Journal published an article that describes a new breakthrough in the field of immunology. The breakthrough is that antibodies work inside of cells as well as outside of them.  This discovery has huge implications for antiviral treatments and gene therapy treatments.  Included below is the full text from the article.

It isn’t often that an entire field of medical science gets turned on its head. But it is becoming clear that immunology is undergoing a big rethink thanks to the discovery that antibodies, which combat viruses, work not just outside cells but inside them as well. The star of this new view is a protein molecule called TRIM21.

 

Dissident researchers have sparked a big rethink in the science of fighting infection. Yarek Waszul

Until recently, the conventional wisdom was that the body fights off infection in two separate ways. First is the adaptive immune system, which works outside the cell. It generates antibodies to intercept specific invaders, locking onto them like a tracking missile and preventing them from entering the cell. A second line of defense, the innate immune system, operates within the cell; it is like an expansive air-defense network, blasting away at all invaders.

Three years ago work by Leo James, William McEwan and their colleagues at the Laboratory of Molecular Biology in Cambridge revealed that this understanding was incomplete. They found that the neutralization of adenoviruses (common viruses causing colds and other infections) by antibodies was happening mainly inside the cell, not outside, and by an unexpected mechanism.

Their announcement—a challenge to the entire field of immunology—elicited a predictable immune reaction of its own from the establishment. Sure enough, leading journals rejected the Cambridge group’s paper, sometimes without even reviewing it, while key funding agencies turned down the group’s grant applications.

Gradually, though, the authors have won the argument. New papers from the group have pinned down what is going on. They describe a potent detection mechanism that links the antibodies outside a cell with its innate immunity, somewhat dissolving the distinction between the two.

Dr. James’s team has shown that if an adenovirus enters the cell with antibodies attached, those antibodies will attract TRIM21 molecules, which pull the virus into a disposal system and send danger signals to put the whole cell in a state of antiviral alert. This explains the hitherto baffling finding that just one or two antibody molecules can neutralize a virus 1,000 times their size.

The significance of the group’s finding is just sinking in. It gives medicine a whole new angle on infection, and it just might crack the hitherto almost insuperable problem of how to cure viral infections, rather than just prevent them by vaccination. Though treatments do exist for viruses such as HIV, they are neither as common nor as effective as antibiotics for bacterial infections. No effective remedy exists, for example, for the many kinds of common cold, whatever your grandmother says.

Perhaps the new knowledge that TRIM21 and other molecules like it are key antiviral defenders will lead to a true antiviral therapy, though if it was as easy as turning up the volume of TRIM21, then cells would surely be doing it. And it’s worth noting that some viruses (including HIV) use a tactic for getting into cells that allows them to evade TRIM21.

The discovery may aid vaccine design and begins to explain why gene therapy has often run into trouble. Such therapy uses adenoviruses to carry new genes into cells, but frequently this provokes a strong native-immune response. TRIM21 possibly plays a part in this. Finally, there is a chance that TRIM21 will help to explain autoimmune diseases, in which the body attacks itself. TRIM21 itself is a target of autoantibodies in autoimmune conditions such as lupus.

In short, we will be hearing more from this molecule.

 

Matt Ridley

May 24, 2013

Wall Street Journal

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Negative News for Multivitamins: Are There Reasons to Question Conclusions from the Media?

My readers know that in my view, nutrition is everything when it comes to general health and wellness (well nearly everything).  Globally there is population evidence suggesting that people who eat a diet emphasizing vegetables and fruits (and thus high density micronutrient/antioxidant food sources) have lower incidences of virtually any disease you wish to look for.  We know that vitamins are essential to proper cellular function and energy metabolism- that’s why we call them essential vitamins. Without them, chemical cellular activities necessary for life cannot run.

We know also that eating protein throughout the day results in faster metabolism and lower central obesity.  Clearly nutrition and lifestyle are critical to health. So why do the media and a large part of the medical community want to toss out conversations and studies looking at the role of nutrition and supplements on our health?  I think it is because it is very hard to control for broad variables like multivitamins and food sources. Doctors are not well versed in nutrition- I recall being told dogmatically in medical school that “vitamins are a waste of money” with very little support of that dogmatic statement.  This thinking hasn’t really changed. It is easy to attack things you are ignorant of.

 Those that want to tout the benefits of supplements have plenty of water to carry as well. Scientists that have done vitamin studies do a poor job controlling for the supplements used.  Good study design is critical for decent science. The supplement industry fails to do good studies and this is convenient for the industry (and equally convenient for the doctors to stay dogmatic). I say it is high time some folks put their money where their mouths are.  Meanwhile we consumers have to do our best to eat optimally if we are interested in staying well.  The decision to supplement is personal. Based upon the current literature no one should anticipate their insurance carrier paying for vitamins.

The media blitz that preceded two publications in the Annals of Internal Medicine (December 17th 2013 volume 159 Number 12) highlights how the medical community at large enjoys pooh-poohing supplementation of vitamins for diseases.  In fact, the editorial provided in the same journal was titled: Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.  Below I provide an analysis of the two trials from a doctor’s perspective.

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Tasty Guilt Free Dessert

Lemon Peel Ricotta Crème Recipe – South Beach Diet

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This healthy dessert recipe comes from Dr. Agatston’s famous book, The South Beach Diet.  His diet has been scientifically validated to help with metabolic syndrome, diabetes and pre-diabetes.  His diet is also cholesterol/lipid friendly and I highly recommend it as a diet appropriate for most folks.

You can go with even lower fat ricotta cheese to achieve less calories and less saturated fat. Also you can use other flavorings to provide more variety to this “pudding” type dessert.  I have found you can make them ahead of time and keep them in a ramekin (custard dish) so they are easily available for an after dinner snack. Flavorings to consider: chocolate, almond extract, lime peel, banana, berries.  If you use real fruit you won’t need to add the artificial sweetener.  Having a pre-made handy dessert in the fridge will keep you from being tempted to eat something less healthy.  Storing them in the refrigerator also allows the flavoring to “stew” a bit and enhance the flavor experience (cover them though to prevent staleness).

Fast and easy to make, this is sort of a pudding made with ricotta cheese, grated lemon peel, vanilla, and sugar substitute. Good for a snack or dessert for those following the South Beach Diet.

Prep Time: 5 minutes

Cook Time: 15 minutes

Total Time: 20 minutes

Ingredients:

  • 1/2 c part-skim ricotta cheese
  • 1/4 tsp grated lemon peel
  • 1/4 tsp vanilla extract
  • 1 pkg sugar substitute

Preparation:

Mix together the ricotta cheese, lemon peel, vanilla extract, and sugar substitute. Serve chilled.

Yield: 1 serving

Per Serving: 178 cal, 14 g pro, 7 g carb, 10 g fat, 6 g sat. fat, 38 mg chol, 0 g fiber, 155 mg sodium

Recipe from: The South Beach Diet : The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss by Arthur S. Agatston M.D. (Ballantine Books)

Copyright 2003 by Arthur S. Agatston M.D.

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Weight Loss Recently Shown to Improve Symptoms and the Frequency of Atrial Fibrillation.

This recent article which was well executed, shows that in obese subjects with atrial fibrillation (a common problem which is associated with significant risk for stroke),  weight loss results in less burden of symptoms and severity of symptoms. There were a few important points born out in this study from Australia.

The premise of the study was that it is firstly observed that obesity is a risk factor for atrial fibrillation. Obesity is defined as a body mass index of 30 or higher. BMI is readily calculated from a person’s weight and height. The question asked was whether weight reduction can reduce the burden of atrial fibrillation. Both groups in the study were counseled on weight loss and had routine medical care as well as medical optimization equally.

Point one. The intervention group used meal replacements to achieve rapid and initial weight loss. Meal replacement for weight Imagemanagement works. I have been aware of this on a personal and as a provider basis for years. Those of us with weight issues need to think of Purina For People. I recommend Pharmanex’s TR 90 program and formulated nutrition/protein supplementation from Pure Encapsulations and Pharmanex’s line of morning shakes as a strategy for weight loss and weight control.

Point two: It worked superiorly. At the beginning the groups had BMI’s averaging above 32. At the end of 15 months the intervention group’s average BMI was 27.2 while the control group had a BMI of 32.5 (better than in the beginning of the trial but barely). At the beginning of the trial the average weight in the intervention group was 217.8 lbs and at 15 months they were at 176 lbs.

Point three: All risk factors improved statistically. HDL cholesterol improved (the good stuff), inflammation, and blood pressure improved.

Point four: The heart remodeled (left atrial enlargement improved, and left ventricular septal thickness improved) favorably with the larger amount of weight loss. This translated to less atrial fibrillation.

Point five: Intervention involved intense supervision and health system support. Wouldn’t it just make more sense to not get so overweight to begin with?

Point six: There was less blood pressure medication use in the intervention group but not for the control group.

Point seven: There were a lot of newly diagnosed sleep apnea patients and treatment in both groups. This did not go down at the end of the treatment study but rather went up 4-5 fold in both groups (with 2 less cases in the intervention group). If you have or had obesity and atrial fibrillation, perhaps you should be screened for sleep apnea.

For those readers who are patients as well, remember that I have been offering a special and tailored approach to health and wellness for years. Nutrition and dietitian services combined with my lipidology certification offers me a unique skill set to help folks minimize risk for cardiovascular disease. Invest in yourself and your health so that you can receive dividends of benefits with lower insurance risk, lower overall healthcare expenditures and personal health and satisfaction.

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Statin Use For The Prevention of Cardiovascular Disease

A review of statin use for the prevention of cardiovascular disease shows very positive support for the use of statin medication. My readers know that I am very much in favor of lifestyle changes to lower cardiovascular risk and this is always the preferred first strategy. This just published article validates the safety and net benefit of medication in the event a person’s risk is not optimal. Contrary to much lay literature the science on this is very strong. Read the study abstract for complete information. I felt as a bottom line comment to the readers an excerpt from the article is very important to note.

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Click to enlarge

 

“The incidence of cancers, myalgia, rhabdomyolysis, liver enzyme elevation, renal dysfunction, or arthritis did not differ between the groups, although not all trials reported fully on these outcomes. Rates of adverse events (17%) and stopping treatment (12%) were similar in statin and placebo/control groups.”

 

Bottom line here: A large and mature body of literature (and my clinical experience) supports all-cause mortality benefit from the use of statin therapy for persons at risk for heart attack, large vessel atherosclerosis and stroke. If all-cause mortality is reduced, this by definition means subjects using medication are not trading a heart attack for fatal liver disease (a myth), or cancer induced by the medication. If you need it, you should feel comfortable taking it.

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Curried Sweet Potato Soup

Sweet potato, not only is just sweet to your taste buds but also good for your cardiovascular health. This starchy root vegetable is rich source of flavonoid antioxidants, vitamins, minerals, and dietary fiber that are essential for optimal health.

currysoup

Curry is a mixture of several spices, mainly turmeric. Curry powder has many antioxidants and anti-inflammatory compounds. Curcumin is one of the main substances that gives turmeric its health benefits. Curcumin supports colon health,brain function, and helps the cardiovascular system.

This recipe combines sweet potato and curry in a delicious soup.

Ingredients

  • 4 1/2 Cups vegetable broth
  • 1 Cup dried onion
  • 2 teaspoons curry powder
  • 5 Cups chopped sweet potato
  • 1 Cup water
  • 1 Cup + 6 Tablespoons non dairy or 0-1% dairy fat yogurt

Directions
Use vegetable peeler or knife to remove skin from sweet potatoes. Chop sweet potatoes into small pieces. Put potatoes in pot with vegetable broth, dried onion, and curry powder. Cook over medium-high heat until potatoes are tender. Once potatoes are tender, puree sweet potato mixture with the water and yogurt . I puree it in my food processor or blender (depending upon my mood) in small portions, then transfer the portions back to my large pot for further simmering. You could also blend it in the pot with a hand blender, but the consistency wouldn’t be as smooth. This could be enjoyed as a cold soup as well. It is such an easy and affordable recipe! Top with more yogurt and or parsley (totally optional).

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Medicare Advantage Crisis is Here

PPACA (Patient Protection and Affordable Care Act) has ramifications across the entire health insurance market. Besides the 10-15 million private insurance end of contract notices, now the Medicare beneficiaries are seeing the beginning of the 700 plus billion in cuts from the program.  This real life situation is starting to play out not only across the country but right here in our back yards.  Posted below is an article from the AMA about how Medicare Advantage has changed it’s lack of transparency.

AMA Logo for website

Following the article is a brief commentary in response. I continue to press the issue that price-fixing by the government via Medicare is the root cause of market disruption for physician access in this country.  It is my view that doctors are being compelled to come to work for whatever price CMS/the Federal government decides. The doctors are not engaged in negotiating these terms and the law regarding participation are a legal form of extortion.  Besides price-fixing the program the government continues to saddle the doctors with additional expensive regulatory costs that affect the overhead of the practice and the doctors productivity. I ask the AMA to take this coercion issue to the courts. Continue reading

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The Healthcare.gov Insurance Exchange Debacle

The Healthcare.gov Insurance Exchange Debacle

As the reality of higher premiums and more restricted access continue to rear their heads as Obamacare takes full effect January 1st, it will be prudent to revisit some alternatives to solving the healthcare access debate.

Here are 8 real world, workable contributions to make health care more affordable while at the same time allowing more choice and individual responsibility. Let’s ask to unleash the creativity of American ‘know-how’ to help get the goals accomplished, not seek central, bureaucratic ineptitude (the law itself and the exchange as hard evidence) to be tolerated any further.

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Obamacaid

Reposted from the Wall Street Journal, October 9, 2013

ObamaCare’s website appears to have been built by Mitt Romney‘s “Project Orca” digital team, and perhaps tens of people have managed to sign up so far. “Fully enrolled, I can’t tell you. I don’t know,” Health and Human Services Secretary Kathleen Sebelius conceded Monday. But Democrats do have one lament about implementation: Some states are opting out of the Medicaid expansion.

Medicaid, the joint state-federal safety net intended for the poor, already covers more than one of five Americans and pays for two of five U.S. births. And that’s before ObamaCare dumps up to 20 million new dependents onto its rolls. Liberals are still somehow evoking Little Nell and the blacking factory because 26 Governors or legislatures or both are so far declining to expand. Their hysterics would benefit from a fact or two.

First note the Perils-of-Pauline Medicaid moment is the result of a 7-2 Supreme Court majority, which ruled that the Affordable Care Act’s expansion mandate was coercion exceeding the Constitution’s limits on federal spending powers. This was the first such holding in the history of the Republic and the rebuke ought to embarrass Democrats, if they’re still familiar with that sensation.

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Reminder From A Recent European Meeting Highlights Heart Failure As A Major Cause Of Mortality and Morbidity In Diabetic Patients

Reminder From A Recent European Meeting Highlights Heart Failure As A Major Cause Of Mortality and Morbidity In Diabetic Patients.

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