Measles on Upswing Despite Vaccines' Effectiveness: CDC

By Steven Reinberg

Vaccinations have prevented an estimated 732,000 deaths, 21 million hospitalizations and 322 million illnesses among U.S. children born in the last 20 years, according to a government report released Thursday.

Despite this success, measles -- a highly contagious disease -- is seeing a recurrence in the United States, the U.S. Centers for Disease Control and Prevention also reported.

As of April 18, 129 people have been diagnosed with measles in outbreaks in 13 states this year. Most of the people sickened were not vaccinated, the CDC says.

Although these outbreaks start outside the country, measles infection spreads rapidly among unvaccinated people, CDC director Dr. Tom Frieden said during an early afternoon press briefing.

"Measles is still far too common in many parts of the world," he said. "Globally, an estimated 20 million people get measles and 122,000 die from the disease each year."

Twenty years ago, the Vaccines for Children program was launched, providing free vaccines for families who can't afford to pay for them.

The program was a direct response to a measles outbreak that sickened more than 50,000 people and killed more than 100. This happened despite the availability of a measles vaccine since 1963, Frieden said.

"This was a wake-up call and it impressed upon me how infectious measles is, because a single undiagnosed case in a hospital could result in dozens of secondary cases," he explained.

The program also saves money, Frieden said. Fewer hospitalizations and more lives saved will cut nearly $295 billion in direct costs and $1.38 trillion in total societal costs, estimates indicate.

The report was published in the April 25 issue of the CDC's Morbidity and Mortality Weekly Report.

Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases, who also spoke at the news conference, said, "Measles has gotten off to an early and active start this year."

The 129 measles cases reported so far "are the most measles cases reported in the first four months of the year since 1996," she said.

In 2013, there were 189 measles cases. In 2011, 220 people had measles -- the most since 1996, according to the CDC.

"Today's measles outbreaks are too often the result of people opting out. Most of the people, 84 percent of those who were reported to have measles thus far, were not vaccinated or didn't know their vaccination status. Of the unvaccinated U.S. residents, 68 percent had personal belief exemptions," Schuchat said.

Areas with the highest number of cases include California with 58, New York City with 24 and Washington state with 13, Schuchat said. Thirty-four of all the cases were imported, involving U.S. residents who traveled overseas and foreign visitors. Half of those importations were from the Philippines, where there were about 20,000 cases and 69 deaths as of February, she said.

Schuchat noted that over the last 20 years, for measles alone, vaccination had prevented about 71 million cases and almost 9 million hospitalizations. "It's extraordinary what we are able to achieve with vaccinating, compared with not vaccinating, she said.

One expert not involved with the report said that people forget how bad measles was before there was a vaccine.

"Measles caused about 3 million cases a year in the United States before there was a vaccine in 1963," said Dr. Paul Offit, chief of the division of infectious diseases at the Children's Hospital of Philadelphia.

"It would cause 48,000 hospitalizations and about 500 deaths," Offit said. "Nobody had to be convinced to get a measles vaccine."

Now measles is reappearing because people are making a choice not to get vaccinated, Offit said. "They are choosing not to get it because they don't fear the disease," he said.

Offit thinks this may be a natural outcome of a vaccine program. The disease is conquered, the disease is forgotten, people don't get vaccinated, and the disease comes back. "This is just going to be the pattern until the sun burns out," he said.

It will take more measles hospitalizations and maybe a death or two to convince people not to opt out of vaccinating their children, Offit said. "It has to get to a level of consciousness that you realize that not getting vaccinated means it might be you or your child who gets hospitalized or dies," he said.

According to the CDC, the side effects of the vaccine are minor -- including pain and redness at the injection site, headache, fatigue or a vague feeling of discomfort -- all of which go away quickly.

Because measles is so contagious, the CDC recommends people of all ages keep up to date with their vaccinations. The agency recommends two doses of MMR (measles, mumps and rubella) vaccine for everyone, starting at age 12 months. In addition, infants aged 6 through 11 months should receive one dose of MMR vaccine before traveling out of the country, the agency says.

SOURCES: April 24, 2014, press briefing with Tom Frieden, M.D., M.P.H., director, U.S. Centers for Disease Control and Prevention, and Anne Schuchat, M.D., director, National Center for Immunization and Respiratory Diseases; Paul Offit, M.D., chief, division of infectious diseases, Children's Hospital of Philadelphia; April 25, 2014, Morbidity and Mortality Weekly Report

What to eat to lower your cholesterol

High cholesterol levels are slowly killing off the population. The increasing prevalence and risk of hypertension and heart disease in Americans are ringing the alarm bells in the country's health sector. Health officials are desperately trying to find ways to combat the rise and make people aware of the eating lifestyle and exercise lifestyle that they are imbibing.

The truth about cholesterol

Although cholesterol is mainly the culprit in the increase in high blood pressure in the body, not all cholesterol that we take in is essentially bad. In fact, small amounts of cholesterol is being used by the body in the production of bile salts and in the transformation of Vitamin D. Cholesterol also plays a role in the balancing of hormones especially in women.

There are two kinds of cholesterol, the good and the bad as the lay people will like to clal them. The bad cholesterol or the LDL is the kind that is often found in saturated fats and trans fatty acids. These are taken into the body through foods that are pre-packed and prepared such as potato chips, canned goods, etc.

LDL cholesterol adheres to the walls of the arteries. High levels of LDL can form plaques in the arterial walls that may eventually cause clogging in the passageway of the blood. This slows down the blood flow, which in turn makes it hard for the heart to pump. This scenario describes the initial stages of hypertension and coronary heart problems.

What to eat

The good cholesterol HDL on the other hand lower the levels of LDL in the body by helping transport the LDL to the liver where it is excreted. HDL cholesterol can be found in fishes as well as in nuts.

Other foods that can lower the cholesterol levels are fruits and vegetables. These foods do not contain that much cholesterol so whatever you have, you will not be adding to its levels.

Another great thing about veggies and fruits is the fact that they are great sources of fibers that the body also need to combat the increase in LDL cholesterol. Berries, fruits that are citrus and carrots are just some of the fruits that you can count on.

Another food that can dramatically reduce the levels of cholesterol in the body is the soya. Fiber-rich food, soya as well as almonds and plant sterols figure in a landmark study conducted by University of Toronto that reduced the cholesterol levels of the participants by as much as 20 percent. Eating oats, olive oil and barley are also great ways to lower LDL.

Another great source of cholesterol are foods that are really oily. To lower one's LDL, one must consciously avoid foods that are deep-fried. If you have to eat fried foods, make sure that the oil that you use is made out of vegetable.

Never use butter as this is rich in saturated fats. Instead, use margarine as a substitute. Try to also steam, braise, boil or bake your food. You will find that they are tastier and healthier.

Not just the food

There are many factors that contribute to the rise of cholesterol levels in the body. In addition to one's eating lifestyle, there is the age, the gender, the family history and of course the amount of physical activity that the person does.

Exercise is fairly important in keeping LDL cholesterol at bay. What is more, it strengthens the body's resistance as well as improves blood circulation.

With Foods with Vitamin D so Easy to Find, do you still Need Supplements?

If I just told you that they invented a new kind of treatment that could help strengthen your bones, keep heart disease and kidney disease at bay, and to boot, help with your blood pressure, wouldn't you pay a lot for it? There have been medical research reports out recently, that there is such a remedy already - and it is a well known micronutrient that you find in some varieties of milk, and fish, and also in exposure to the sun - of course you know what it is - it is vitamin D. But as wonderful as vitamin D is, and as plentiful as foods with vitamin D are, about one out of every two people in America is somewhat deficient, and about 10% of all children are quite deeply deficient. Doctors are now taking to routinely prescribing vitamin D tests to patients; apparently there has been about 50% more tests done this year for vitamin D levels, than the year before.

When doctors find some kind of deficiency, usually, they decide that a changed diet would be too slow to be effective. They offer supplements instead and America is now knocking back vitamin D supplements worth a quarter of a trillion dollars a year. This may not really be a good idea; the science behind it as shaky at best, and doctors seem to be letting the idea run away with them. There haven't been any real randomized trials done in research yet, and no one really knows what the ideal level is supposed to be either. As an example of the kind of simple and unsophisticated level we are at in understanding vitamin D, doctors only believe that you need to have a certain high level of vitamin D because that is what they see in healthy people. And yet, that could just be circumstantial evidence. What if it were just that healthy people happen to have high levels of vitamin D by accident, and not that the vitamin D were actually responsible? They do happen to come together, vitamin D levels and good health, but who says that there is a cause-and-effect relationship?

They are trying in-depth clinical studies now to find the foods with vitamin D that should help the most; one study includes 20,000 elderly people, men and women, to see how fish oil supplements that contain vitamin D and omega-3 should help. So what exactly is it that vitamin D does around the body? Basically, vitamin D is supposed to be the signaling juice around the body. It helps cells turn on or turn off as they are needed to. About one gram of fish oil a day should probably do the trick. This is probably overkill too; but it does help older women with osteoporosis, protect themselves from fragile bones that are prone to fracture. In fact, I should probably have my mother put aside her revulsion for fish oil, and have her protect herself. They've also found that this kind of a high dose of fish oil can even help protect against breast cancer.

If doses go any higher than that, they can often do some harm too. In men for example, very high levels of vitamin D in the system, can dispose you to diabetes. And it is easy when you read health advice in a piece of this kind, to get really carried away.

Liquid Vitamins Versus Chewable Vitamins

Nearly 50% of Americans residing in the United States use some type of vitamin or vitamin supplement ever day. Even though they may take vitamins, most are unaware of the fact that nearly 90% of the nutrients and minerals found in the vitamin isn’t properly absorbed by the body, which means they are virtually watered down and most of their benefits proven to be not effective.

Almost all individuals who take vitamins use the pill form. Pills were once thought of to be the best, simply because they were the only vitamin sources. These days, liquid vitamins are much more effective, and people are starting to realize it. Although many use pills or chewable vitamins, they aren’t getting near the benefit they think they are.

Vitamins and supplements are very popular, especially for those who have active lifestyles and find it difficult to consume the necessary vitamins and minerals they need from the proper meals. Therefore, those with busy lifestyles turn to vitamins and supplements to give their bodies what it needs to carry out day to day activities. Even though you should never replace food with vitamins, vitamins can help you to get the nutrients and minerals you need on a daily basis.

The main reason why liquid vitamins are more effective than pills and tablets is due to the nature of their liquid base. With the vitamins being liquid, they are easier for the body to digest and easily absorbed into the digestive tract as well. Chewable tablets and pills will pass through the body in hard form, making them hard to digest. Liquid is always digested when it passes through, so it will go through your body quicker and take effect faster.

Due to the body having to work less to break down and absorb liquid vitamins, they will pass through the body much faster. The nutrients and minerals contained in liquid vitamins will reach vital areas faster through the bloodstream, and they are easier to use by the most important organs in your body that need them the most. Liquid is also easy to swallow as well, as you can add the liquid vitamin to your favorite juice or just take it right out of the bottle if you prefer.

With pills or chewable vitamins, the majority of the nutrients and minerals that are contained in the vitamins aren’t normally broken down in the digestive system. With these types of vitamins being in hard form, they are harder for the body to pass at the most crucial moments, where the body needs to have nutrients and minerals. Unless you completely chew up the vitamin, it can stay in hard form until it passes through when you go to the bathroom. If this happens, you are normally just wasting the vitamin as it doesn’t have a chance to get into the bloodstream.

Liquid vitamins have proven themselves to be the best way to get the minerals and nutrients your body needs. As more and more people discover the benefits of liquid vitamins and how easy they are to digest, they make the switch. Liquid is far superior to tablets and pills, simply because it tastes better, it’s easier to digest, and it travels through the body faster. You can find many different flavors and types of vitamin supplements at your local nutrition store, or get online and order what you need there. Either way you go - you’ll find liquid vitamins to be the ideal way to get the nutrients you need for you body on a daily basis.

Diets for High Cholesterol Can Save Your Life

Being health conscious is more important now than ever before. When you neglect your body by eating high fat foods and not exercising you run the risk of a whole host of health issues, including obesity and heart disease. Many people don’t pay any attention to what they eat until their doctor tells them their cholesterol level is too high. In most cases, if it’s only moderately high the physician will suggest one of the diets for high cholesterol. If it’s alarmingly high, medication may also be prescribed to lower it quickly.

One reason people are a little standoffish about the medications used to lower your bad cholesterol is because some of them are allegedly causing liver damage. This is why your doctor may simply tell you to change the way you eat. A diet to lower cholesterol can be really effective if the person is serious and sticks to it. Although you’ll have to change the way you view food, and give up certain foods, the benefits are well worth it.

Common sense plays a big part in healthy meal planning. If you’re trying to get in better shape, there are many fatty foods that you need to avoid. Diets for high cholesterol suggest staying away from things like red meat and heavy cream sauces. Eggs are also another source of cholesterol so be sure to limit the number you eat each week. If you want bacon with those eggs, your best bet is to opt for the turkey or chicken variety.

Whole grain foods are something you’ll need to get used to when you want to follow a meal plan like this. They have a positive impact on cholesterol in a short period of time. It’s easy to make the change to whole grains and many of the diets for high cholesterol suggest eating whole grain cereals and making sandwiches from seven grain bread. If you haven’t yet tried these products you’ll be pleasantly surprised by how good they actually taste.

Fruits and vegetables are really the staple of any diet that is designed for optimum health. You should really try and add at least one serving to each of your meals and turn to this food group when you are searching for a snack too. Fruit flavored yogurt is also found in many diets for high cholesterol but do be careful to avoid any that are sweetened with sugar.

Drink a lot of water each day. This is a good rule of thumb for everyone. If you get tired of plain water, try adding a little juice of lemon or lime to it. That brightens it up and gives it a cool, refreshing flavor. Red wine is the alcohol of choice included in some heart healthy diets but it does need to be consumed in moderation.

Once you adjust your palate and become accustomed to your new way of eating, you’ll never want to switch back to the French fries and burgers that used to sustain you. In addition to having a safe cholesterol level, you’ll also be slim and trim.

A study finds that HIV-Infected Men at Increased Risk for Heart Disease

NIH-supported research also identifies predictors of heart disease risk in this group

The buildup of soft plaque in arteries that nourish the heart is more common and extensive in HIV-infected men than HIV-uninfected men, independent of established cardiovascular disease risk factors, according to a new study by National Institutes of Health grantees. The findings suggest that HIV-infected men are at greater risk for a heart attack than their HIV-uninfected peers, the researchers write in Annals of Internal Medicine.

In addition, blockage in a coronary artery was most common among HIV-infected men whose immune health had declined the most over the course of their infection and who had taken anti-HIV drugs the longest, the scientists found, placing these men at even higher risk for a heart attack.
“These findings from the largest study of its kind tell us that men with HIV infection are at increased risk for the development of coronary artery disease and should discuss with a care provider the potential need for cardiovascular risk factor screening and appropriate risk reduction strategies,” said Gary H. Gibbons, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), part of NIH.

“Thanks to effective treatments, many people with HIV infection are living into their 50s and well beyond and are dying of non-AIDS-related causes—frequently, heart disease,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), also part of NIH. “Consequently, the prevention and treatment of non-infectious chronic diseases in people with HIV infection has become an increasingly important focus of our research.”

NIAID and NHLBI funded the study with additional support from the National Center for Advancing Translational Sciences, part of NIH.

Past studies of the association between heart disease and HIV infection have reached inconsistent conclusions. To help clarify whether an association exists, the current investigation drew participants from the Multicenter AIDS Cohort Study (MACS), a study of HIV/AIDS in gay and bisexual men established by NIAID nearly 30 years ago.

“One advantage of the MACS is that it includes HIV-uninfected men who are similar to the HIV-infected men in the study in their sexual orientation, lifestyle, socioeconomic status and risk behavior, which makes for a good comparison group,” said Wendy S. Post, M.D., who led the study. Dr. Post is a professor of medicine and epidemiology at the Johns Hopkins School of Medicine and the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Another advantage was the MACS’ size, with nearly 7,000 men cumulatively enrolled, 1,001 of whom participated in the new study. The participants included 618 men who were HIV-infected and 383 who were not. All were 40 to 70 years of age, weighed less than 200 pounds, and had had no prior surgery to restore blood flow to the coronary arteries.

Dr. Post and colleagues investigated whether the prevalence and extent of plaque buildup in coronary arteries, a condition called coronary atherosclerosis, is greater in HIV-infected men than HIV-uninfected men and whether that plaque is soft or hard. Coronary atherosclerosis, especially soft plaque, is more likely to be a precursor of heart attack than hard plaque.

The scientists found coronary atherosclerosis due to soft plaque in 63 percent of the HIV-infected men and 53 percent of the HIV-uninfected men. After adjusting for cardiovascular disease risk factors, including high blood pressure, diabetes, high cholesterol, high body mass index and smoking, the presence of soft plaque and the cumulative size of individual soft plaques were significantly greater in men with HIV infection.

In addition, by examining a subgroup of HIV-infected men, the scientists discovered two predictors of advanced atherosclerosis in this population. The first predictor deals with white blood cells called CD4+ T cells, which are the primary target of HIV and whose level, or count, is a measure of immune health. The researchers found that for every 100 cells per cubic millimeter decrease in a man’s lowest CD4+ T cell count, his risk of coronary artery blockage rose by 20 percent. The scientists also found that for every year a man had taken anti-HIV drugs, his risk of coronary artery blockage rose by 9 percent.

Because the investigators examined coronary artery plaque at a single point in time, further research is needed to determine whether coronary artery plaque in HIV-infected men is less likely to harden over time, or whether these men simply develop greater amounts of soft plaque, according to Dr. Post. In addition, she said, studies on therapies and behavioral changes to reduce risk for cardiovascular disease in men and women infected with HIV are needed to determine how best to prevent progression of atherosclerosis in this population.

The study was funded by NIH through grant numbers RO1-HL-095129, UL1-RR-025005, UO1-AI-35042, UL1-RR-025005, UM1-AI-35043, UO1-AI-35039, UO1-AI-35040, and UO1-AI-35041. The National Cancer Institute co-funds the MACS.

For more information about HIV/AIDS, please visit http://aids.gov .

NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

Food to Consume To Lower Cholesterol

There is a saying that goes. "We are what we eat." This is so true as the food being consumed may affect the cholesterol levels inside the person’s system. This makes this makes the person prone to high blood pressure or heart disease through age, which could leave the patient, paralyzed or dead.

The only thing to do before it is too late is to make some changes in the individual's diet. While many of the good stuff that people love to eat have high concentrations of LDL better known as bad cholesterol, this can all change by consuming those that have HDL or good cholesterol. Here are a few examples.

A good way to start a healthy diet is to have a breakfast. Instead of eating bread, the individual can consume oatmeal instead. Studies have shown this can lower the cholesterol in the body by more than 20% after just two weeks of use. This figure can go down some more if this becomes a habit before going to work.

It is tough to just have oatmeal in the morning. Sometimes, the individual can have a fruit. An example could be an apple.

Studies have shown that people who eat at least 2 full apples a day or drink 12 ounces of apple juice are able to reduce the chances of heart diseases by 50%. This can be purchased at the supermarket and eaten during anytime of the day such as dessert after a light meal or as a snack.

During lunch or dinner, the person must have some vegetables in the meal. Those who order can have fish or poultry instead of eating red meat. Such dishes are not high in saturated fats, which are healthier.

Those who love to cook at home can try mixing some healthy things ingredients in the meal. One example is garlic that has natural properties that can declog the arteries and again lower the odds of succumbing to heart disease.

Having a can of pork and beans is also good for the diet. This is because it contains soluble fibers that can combat the bad cholesterol in the person's body. There are not that many people who will do this but those who are able to eat even a half an onion daily will be able to increase the HDL and lower the LDL.

People are often told that fats are not good for the diet. This isn’t entirely true because this comes in many forms. There are fats that are healthy such as unsaturated ones and omega 3 fatty acids.

Monosaturated and Polysaturated ones are also effective since these are usually found in cooking oils. This means food preparation also plays a big factor in reducing lowering one’s cholesterol levels.

The individual should read the label at the supermarket and read the ingredients to find out if this is healthy for cooking.

Being a bit overweight or noticing a lot of bulges in the body is one way of knowing that the person is potentially at risk for succumbing to disease to high levels of cholesterol in the system.

If the individual is unable to make a proper dietary plan, a specialist can help make one so all the person has to do is follow it.

Higher Dose of IVF Drug May Be Needed for Obese Women

Obese women undergoing in vitro fertilization (IVF) might need a stronger dose of a certain medication to improve their chances of getting pregnant, new research suggests.

In IVF, sperm is mixed with an egg outside a woman's body and the resulting embryo is then transferred into the uterus. Harvesting as many eggs as possible helps improve the chances that IVF will be successful.

During egg collection, women are given a medication called GnRH antagonist to prevent ovulation from starting too early and ruining the egg harvest, explained the authors of the study published March 20 in the Journal of Clinical Endocrinology & Metabolism.

"If the GnRH antagonist clears from a woman's body too quickly, there is a risk that the brain will signal the body to discharge the eggs from the ovaries too early," Dr. Nanette Santoro, of the University of Colorado at Denver, said in a news release from the Endocrine Society.

"We were surprised to find obese women were more likely to experience this, and it may be one reason why overweight and obese women have a higher rate of unsuccessful IVF cycles than normal-weight women do," she explained.

Santoro and colleagues gave GnRH antagonist to 10 obese and 10 normal-weight women and monitored them for 14 hours. The drug was cleared from the obese women faster than from the normal-weight women.

The researchers also found that during the monitoring period, half of the obese women had a rebound of a hormone that causes the body to release eggs.

"Our findings indicate obese women may need a different or increased dosing regimen to improve fertility treatment outcomes," Santoro said. "Given the cost of IVF and stress of infertility, it is important to maximize each woman's chances of conceiving a child."

Foods that are High in Vitamin K

Vitamin A, vitamin B, vitamin C…there’s a whole alphabet of vitamins out there, and we don’t always know what each of them does but we do know that vitamins are good for us. One of these important vitamins is vitamin K, which helps blood clotting and bone formation. It’s important that our blood clots when we’re injured or else we could bleed to death, which is a possible consequence of hemophilia, a condition made famous by the royal Romonov family of Russia. Whenever the skin breaks, like from a cut, blood comes out of it and it eventually results in a scab. This scab is a result of blood clotting—after you get a cut, blood cells come together in a clot to prevent more blood coming out and keep out germs. Under the scab, your immune system is working to heal the skin. Now that you know how important scabs are, you might refrain from picking them the next time you injure yourself!

Vitamin K promotes this healing process, so it’s important that we get enough of it in our diet. A healthy diet includes foods high in vitamin K that aid the blood clotting process. Without enough vitamin K in our bodies we can become endangered from even minor injuries, because as little as it seems it’s essential to our health for that scab to form and stop the bleeding. Vitamin K also makes our bones strong, so a vitamin K deficiency can weaken them.

Foods high in vitamin K are many green leafy vegetables. Vegetables high in vitamin K include spinach, broccoli, okra, kale, brussels sprouts, collard greens, mustard greens, alfalfa, turnip greens, beet greens, chards, and kelp. But vegetables aren’t the only foods that have a lot of vitamin K in them. You can also get vitamin K from spices: basil, coriander, parsley, sage, thyme (but not rosemary), and miscellaneous foods high in vitamin K like bread crumbs, fish oil, plums and soy beans.

However, there are cases in which eating foods high in Vitamin K can actually be detrimental. People who are at risk for excessive blood clotting should stay away from vitamin K because it’ll make blood clot even more. It will also work against blood thinners that people might be taking to reduce their clots. It might seem counterintuitive to cut a lot of vitamin K rich vegetables out of your diet, but by talking with your doctor you can figure out a balanced diet to monitor your blood clotting levels.

Diet to lower Triglyceride and Cholesterol

When people undergo a blood test, there are four things that the doctor will review carefully before revealing the results to the patient. These are namely the LDL, HDL, triglyceride level and total cholesterol.

If any of these are way above the normal range, the doctor will make some recommendations before it is too late. The most common advice given is to make changes in the diet. This is because the numbers that come out can improve dramatically by changing the food being eaten.

People are well aware of what LDL and HDL is which is basically the good and bad cholesterol in the bloodstream. There isn’t that much said about a triglyceride and is often referred to just as a type of fat.

So what happens when there is too much triglyceride in the body? When a patient has too much of this in the blood, this puts the person at a greater risk of succumbing to heart disease.

The food being eaten can make this go up or down even if the individual is not allowed to eat for at least 14 hours before the checkup. The normal range should fall between 10 and 250 mgs./dl, which unfortunately a lot of people exceed.

Studies show that many patients who have high triglyceride levels also have high total cholesterol levels. It is a good thing that it is possible to kill two birds with one stone by having a dietitian prepare a simple diet plan.

The basic plan involves eating foods that are low in fat. Breakfast for example can be whole grain breads with a little touch of egg whites. The person should stop drinking coffee and replace this with unsweetened tea. Those who prefer milk should use non-fat or try some fresh juice instead.

Breakfast may have been light so the individual can have chicken without skin or the choice of lean cut meats such as flank, round, rump or sirloin served with some vegetables on the side.

Drinking bottled water is much healthier than ordering a can of diet soda because this still has certain properties that are not good for someone who is trying to cut down on cholesterol intake.

Those who want to get a quick bite as a snack can have fruit or vegetables strips. The person won’t find this in the store so getting up a little earlier in the morning or preparing this the night before is a good idea so the plastic container can be put into the bag before going to work.

Dinner must also be light because the body will soon rest and will not burn that much calories when one is sleeping. Steamed fish will do well or a little pasta. The individual can have a glass of red wine with the meal to help it go down into the belly.

The practice of this healthy habit must not only be done when eating home cooked meals. This should also be done when dining out with friends because a slight disruption in the plan can have certain consequences to someone who is trying to make some lifestyle changes.

Living a healthy life free from high levels of triglyceride and cholesterol can be achieved. It just takes a little determination and discipline to make this happen.

An Overview of the B5 Vitamin

The B5 vitamin is also known as Pantothenic Acid. The B5 vitamin is the most prolific of all the vitamins and is found in every type of food. In fact, it is impossible for a person to consume less B5 vitamin than they need. That means that there is no little possibility that a person can have a B5 vitamin deficiency. For this reason, there is actually no recommended daily amount that health professionals can state as everyone obtains more than enough from their normal food consumption. However, even though there is no need to calculate a recommended daily allowance it does not mean that the B5 vitamin is not vital for a healthy body and mind. In fact, the B5 vitamin is essential for turning food into energy amongst other functions. The B5 vitamin is responsible for taking the fats and carbohydrates into energy.

Some B5 vitamin can be found in almost every food whether it is animal or vegetable. Obviously there are some sources of the B5 vitamin that are better than others but a balanced diet will provide more than enough. The foods with the highest B5 vitamin content are organ meats, salmon, eggs, beans, milk, and whole grains. It is worth noting that the B5 vitamin is lost when grains are milled into flour and tends not to beaded back in. Therefore, processed grain foods such as bread, pasta, rice, breakfast cereal, and baked goods are not good sources of the B5 vitamin.

The B5 vitamin is the most effective when it is combined with other B vitamins especially thiamin or B1, riboflavin or B2, niacin or B3, pyridoxine or B6, and biotin. Along with these other B vitamins, the B5 vitamin is an integral part in a number of processes. The most important of these is the production of energy from food that is consumed and this is known as the Kreb’s cycle. The B5 vitamin is also required for releasing energy from fats.

Interestingly, the B5 vitamin is also considered to be helpful in reducing stress. This is chiefly due to the fact that during periods of stress, the body produces more of certain hormones such as adrenalin and these require the B5 vitamin. There are many theories as to the benefits of the B5 vitamin but there is no need for the majority of people to actively seek out foods that are high in B5 as they are likely to be consuming far more than is needed already. There are no adverse effects to consuming too much B5 vitamin.

Tanzeum Approved for Type 2 Diabetes

Tanzeum (albiglutide) has been approved by the U.S. Food and Drug Administration to help control blood sugar in adults with type 2 diabetes.

Some 24 million people in the United States have type 2 diabetes, which is more than 90 percent of all diabetes cases, the agency said Tuesday in a news release. People with the disease are at increased risk of heart problems, blindness, nerve damage and kidney damage.

Tanzeum is a glucagon-like peptide-1 receptor agonist, a hormone that helps regulate blood sugar. The injectable drug's safety and effectiveness -- in combination with diet and exercise -- were evaluated in a clinical trial of more than 2,000 people. The drug can be used as a standalone therapy or in combination with other diabetes drugs such as metformin, glimepiride (Amaryl), pioglitazone (Actos) or insulin, the FDA said.

The most common side effects of Tanzeum's use were diarrhea, nausea and injection-site reactions. The drug's label will include a boxed warning that it may increase the risk of thyroid tumors, although a scientific link between the drug and such tumors hasn't been established, the agency said.

The FDA is requiring several post-approval studies to evaluate the drug's possible link to thyroid tumors, its effectiveness among children and any risks to the cardiovascular system. It is not to be used by people with type 1 diabetes, the agency added.

Tanzeum is produced by GlaxoSmithKline, in Wilmington, Del.

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UN's safe drinking water target was never really met

By Fred Pearce

Put the champagne away. Hundreds of millions of people do not, after all, have access to safe drinking water. The new millennium's first great "mission accomplished" for public health turns out to have been a figment of the United Nations's imagination.

In 2012, the World Health Organization (WHO) declared that a UN Millennium Development Goal – to "halve the proportion of people without access to safe drinking water" between 1990 and 2015 – had been met. UN secretary-general Ban Ki-Moon hailed "a great achievement for the people of the world".

But now the WHO's official journal has admitted that the claim does not stand up.

The problem is that we don't have global data on the cleanliness of drinking water, say Joe Brown of the Georgia Institute of Technology in Atlanta and his colleagues. So the WHO redefined the health goal as an engineering goal: to halve those without access to "improved" water supplies.

Unclear water In practice, that encouraged governments to meet the targets by delivering the same dirty water in new pipes. People receiving dirty river water one hour a day down a pipe were counted as having water that was as safe as a householder in London or New York.

"It is quite unreasonable to assume that 'improved' equals 'safe'," says Brown. "The WHO has been silent about this."

New Scientist reported at the time that some public health professionals did not believe that the UN had met its goal. An earlier study had estimated that 50,000 African boreholes, pumps and wells were lying derelict.

Since 2012, evidence has accumulated that many piped water supplies installed to meet the target are unsafe. For instance, Mark Sobsey of the University of North Carolina in Chapel Hill reported last year that, in the Dominican Republic, "47 per cent of improved drinking water sources were of high to very-high risk water quality, and therefore unsafe for drinking" (The American Journal of Tropical Medicine and Hygiene, DOI: 10.4269/ajtmh.13-0380).

Still off target As many as 1.8 billion people, a quarter of the world's population, may lack access to safe water, more than double the 783 million estimated by the WHO. Sobsey has estimated that the world is still 700 million off meeting the UN goal.

"We are well aware of the issues raised in the new paper," says Bruce Gordon, the WHO's head of water and sanitation for health. "The Millennium Development Goal targets as measured by improved sources have been met, but many more [people] are likely to lack access to reliable safe water."

The WHO hopes to do better monitoring in future, using new low-cost kits for rapid assessment of water quality.

Journal reference: Bulletin of the World Health Organization, DOI: 10.2471/BLT.13.119594

A Guide to the E Vitamin

The vitamin E is extremely important for a variety of functions in the body. A healthy heart needs plenty of the vitamin E as it has been shown to actually prevent heart disease. The vitamin E can also help contain any existing heart disease and stop it from getting worse.

Vitamin E is also vital in protecting the cell membranes from the harmful free radicals that are present in the body. Without  vitamin E, amongst others, the cell membranes would be damaged and this could lead to serious health problems, including cancer. The reason that the vitamin E is so effective against free radicals is that it is fat soluble so it can be absorbed into the cell membranes. The  vitamin E is therefore essential for the immune system.

The recommended daily amount of the vitamin E that a person requires depends on their body weight. This is connected to the fact that the more fat a diet contains then the more of the vitamin E that is needed. However, the only foods that really contain any reasonable amount of the vitamin E are vegetable oils, seeds, wheat germ, and nuts. It is for this reason that most people should take some form of vitamin E supplement.

A deficiency of the vitamin E does not affect a person immediately. In fact, it can take months for the effects of insufficient vitamin E to be detected. After years of vitamin E deficiency there may be some detectable damage to the nerves of the spinal cord or retina of the eye but this is very rare. Most people obtain enough vitamin E from a normal diet but it is essential that the food that a person eats contains a little fat to help with the absorption of the vitamin  E.

There are a few medical conditions that may lead to a deficiency of the e vitamin and may require the person to take vitamin E supplements. Cystic fibrosis causes a person to be unable to digest fats well which leads to less of the vitamin E being absorbed. Crohn’s disease causes to lower absorption rates of the vitamin E and a supplement may be necessary. Some forms of liver disease can also lead to problems absorbing the   vitamin E, especially through the intestine. Of course, as fat is required to help absorb sufficient amounts of the e vitamin, anyone on an extremely low-fat diet will need to discuss their options for increasing the amount of vitamin E that their body needs.

Exercise, Diet May Help ' Pre-Diabetics ' Dodge Heart Disease Death

By Steven Reinberg

For people with high blood sugar at risk of type 2 diabetes, losing weight and exercising may lessen their chances of dying from heart disease or other conditions, a new long-term study suggests.

People enrolled in the study on diabetes prevention in China followed a diet and exercise program for six years, then were followed by researchers for another 23 years.

Over that time, there was a significant reduction in their risk of death from cardiovascular diseases--such as coronary heart disease and stroke--and death from other causes, the researchers found.

"This reduction in mortality appears to be due in part to the delay in the onset of diabetes resulting from the lifestyle interventions," said lead researcher Dr. Guangwei Li, of the department of endocrinology at the China-Japan Friendship Hospital, in Beijing.

For the study, Li's group randomly assigned 438 patients to the diet and exercise program, and another 138 patients to maintain their regular lifestyle.

Diets were designed to produce weight loss in obese or overweight participants, and to reduce carbs and alcohol intake in people of normal weight, the study authors explained.

The exercise segment of the program focused on increasing how much physical activity participants did during their leisure time.

After more than two decades of follow-up, the incidence of death from cardiovascular disease among those in the diet and exercise program was about 12 percent, compared with nearly 20 percent among those who did not change their lifestyles, the study found.

Moreover, the incidence of death from any cause was about 28 percent among those in the lifestyle-change group versus over 38 percent among the others, the researchers added.

Previous research has shown that for people with type 2 diabetes, the risk of dying from heart conditions and stroke is more than twice that of people without diabetes, Li noted.

"These [new] findings provide yet further justification to implement lifestyle interventions in people with high blood sugar, as clinical and public health measures to control the long-term consequences of diabetes," Li said.

The report was published April 3 in the online edition of The Lancet Diabetes & Endocrinology.

Dr. David Katz, director of the Yale University Prevention Research Center, said that "lifestyle is the best medicine has been established by an impressively consistent array of research findings spanning populations and decades."

Careful attention to eating well, being active, controlling weight and avoiding tobacco has been shown to reduce the lifetime risk of all major chronic disease by 80 percent, he said.

"This study shows first, that an intervention focused particularly on diabetes prevention has generalized benefits," Katz said. "This is not very surprising, since the causal and protective factors for all of the prevalent chronic diseases are interrelated. The same diet and activity pattern that helps prevent diabetes does the same for cardiovascular disease, "he added.

"Second, and more surprising, this study suggests that a robust lifestyle intervention program of sufficient duration is a gift that keeps on giving, conferring benefit for years after it concludes," Katz said. "This offers important promise with regard to the cost-effectiveness of such interventions."

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DNA nanobots deliver drugs in living cockroaches

By Sarah Spickernell

Nano-sized entities made of DNA that are able to perform the same kind of logic operations as a silicon-based computer have been introduced into a living animal.

The DNA computers – known as origami robots because they work by folding and unfolding strands of DNA – travel around the insect's body and interact with each other, as well as the insect's cells. When they uncurl, they can dispense drugs carried in their folds.

"DNA nanorobots could potentially carry out complex programs that could one day be used to diagnose or treat diseases with unprecedented sophistication," says Daniel Levner, a bioengineer at the Wyss Institute at Harvard University.

Levner and his colleagues at Bar Ilan University in Ramat-Gan, Israel, made the nanobots by exploiting the binding properties of DNA. When it meets a certain kind of protein, DNA unravels into two complementary strands. By creating particular sequences, the strands can be made to unravel on contact with specific molecules – say, those on a diseased cell. When the molecule unravels, out drops the package wrapped inside.

A bug's life The team has now injected various kinds of nanobots into cockroaches. Because the nanobots are labelled with fluorescent markers, the researchers can follow them and analyse how different robot combinations affect where substances are delivered. The team says the accuracy of delivery and control of the nanobots is equivalent to a computer system.

"This is the first time that biological therapy has been able to match how a computer processor works," says co-author Ido Bachelet of the Institute of Nanotechnology and Advanced Materials at Bar Ilan University.

"Unlike electronic devices, which are suitable for our watches, our cars or phones, we can use these robots in life domains, like a living cockroach," says Ángel Goñi Moreno of the National Center for Biotechnology in Madrid, Spain. "This opens the door for environmental or health applications."

DNA has already been used for storing large amounts of information and circuits for amplifying chemical signals, but these applications are rudimentary compared with the potential benefits of the origami robots.

Commodore cockroach The number of nanobots in the study – more than in previous experiments – makes it particularly promising, says Bachelet. "The higher the number of robots present, the more complex the decisions and actions that can be achieved. If you reach a certain threshold of capability, you can perform any kind of computation. In this case, we have gone past that threshold," he says.

The team says it should be possible to scale up the computing power in the cockroach to that of an 8-bit computer, equivalent to a Commodore 64 or Atari 800 from the 1980s. Goni-Moreno agrees that this is feasible. "The mechanism seems easy to scale up so the complexity of the computations will soon become higher," he says.

An obvious benefit of this technology would be cancer treatments, because these must be cell-specific and current treatments are not well-targeted. But a treatment like this in mammals must overcome the immune response triggered when a foreign object enters the body.

Bachelet is confident that the team can enhance the robots' stability so that they can survive in mammals. "There is no reason why preliminary trials on humans can't start within five years," he says.

Journal reference: Nature Nanotechnology, DOI: 10.1038/nnano.2014.58

All About Vitamin A

Vitamin A was first discovered back in 1912, by a Polish biochemist named Casimir Funk. He came up with the word vitamine, which was later given the name vitamin. Funk was the first to discover vitamins as we know them today, although vitamin A was actually the first one discovered, hence the letter “A” in the title of the vitamin.

You can find vitamin A in natural foods such as oranges and yellow fruits. It can also be found in vegetables as well, such as spinach and fats. When found in vegetables, vitamin A is water soluble, coming in the form of beta carotene. The beta carotene form of vitamin A can be eliminated from your body through natural processes, making it an excellent way to get vitamin A.

Vitamin A is required by the body on an every day basis to maintain healthy skin and keep your eyesight on track. There are many people who say that carrots provide enough vitamin A to prevent you from getting night blindness. The fact is, ancient Egyptian doctors prescribed liver in their time, which they said contained enough vitamin A to combat night blindness. Vitamin A is also known as an antioxidant, which makes it ideal to prevent cancer and anti aging. Along with these benefits, it also helps with your immune system as well.

To get the proper absorption of vitamin A, you’ll need to consume fat. Those of you who happen to be on a low fat or restricted diet, simply may not be getting the right amounts of vitamin A from your supplements that you may think. To get the proper absorption of vitamin A in your diet, you’ll need to consume a high enough level of protein. Protein combines with vitamin A to make it stronger, and help it move through your body.

On a normal day, you should be consuming around 5,000 international units (IU) of vitamin A. Depending on your health and your age, you may need to consume more or less. The safest form of vitamin A is beta carotene as mentioned above, and it can be taken in much larger doses. No matter what age you may be, you can feel safe to consume high amounts of vitamin A in the form of beta carotene.

If you don’t consume enough vitamin A in your diet, you’ll end up with a deficiency. A deficiency is never a good thing, as it normally results in skin problems, increased infections, and even night blindness as well. A prolonged deficiency in vitamin A can put you at a risk for cancer as well, and you’ll also miss out on any effects of anti aging that the vitamin might have. Although you should begin taking it immediately if you have a deficiency, the effects wouldn’t be the same as they would be if you stayed up to date with the right amount on a daily basis.

On the other hand, if you are getting too much vitamin A, you’ll put yourself at risk for pain in your joints, abdomen, and your bones. Even though too much or not enough can cause you serious side effects, you should always get the right amount in your diet. Vitamin A is very important, and should always be included in your diet. You can find it in many foods, or take supplements that include the well needed vitamin. If you are going to take supplements, you should make sure that they provide the right amounts - with no side effects.

Vitamins : What are they and their discoveries

Vitamins are organic substances that are necessary for normal health and growth in both animals and humans. If a vitamin is absent from the diet, or we don't properly absorb it, a specific deficiency disease may develop. Even worse, our entire body may start a decline that, over a period of years, may develop into a very serious disease such as, diabetes, cancer, heart disease, etc. That there is a relationship between what we eat and specific disease was first noted by the Englishman William Fletcher in 1905 while researching the causes of the disease beriberi. He observed that the disease was prevented by eating unpolished rather than polished rice. He concluded that the husk of rice must have special nutrients, which we know today as vitamins. Even before this discovery, fruits and vegetables were known to prevent and cure many diseases. Even though what we now know as "vitamins" were unknown, many of their benefits were well recognized. Even today English sailors are known as "Limeys" because, when limes were added to their diets, they no longer suffered from scurvy. While vitamins prevent and cure some specific diseases, they also are necessary for virtually every function within our bodies. Because of heavy advertising, we associate Vitamin C with preventing/fighting colds. In truth, Vitamin C does not prevent or fight a cold. It bolsters and strengthens our immune system which attacks the cold germs. Vitamin C performs many other important functions within the body.

A major function is synthesis of hydroxyproline, an important component of collagen and, thereby, all connective tissues. Vitamin C is essential for growth of cartilage, bone and teeth, and for wound healing. It contributes to the structure of bones, muscles, and blood vessels. Vitamin C helps support the immune system, aids amino acid metabolism and iron absorption. Another vitamin - B6 - does not have a reputation as grand as Vitamin C yet it is as essential to good health. Vitamin B6 cannot claim dramatic and immediate "cures" for diseases like scurvy, beriberi, or colds like other vitamins, but it is known as the master vitamin in processing amino acids. It is estimated that 50% of Americans are deficient in Vitamin B6. The same is true for virtually every vitamin. Without a proper supply of vitamins, the body develops disease. Some diseases, such as beriberi and scurvy, show up quickly and dramatically. Other diseases, such as heart disease and cancer, take years to develop. They go undetected for many years until it may be too late. Because the body is a "closed system", vitamins, like every other nutrient, must come from the food we consume. The principal sources of vitamins are the fruits and vegetables we consume. In 1936 the US Government released a report that clearly and emphatically stated that the soils used to grow our food products are so depleted of minerals that: "We know that vitamins are complex chemical substances which are indispensable to nutrition, and that each of them is of importance for normal function of some special structure in the body. Disorder and disease result from any vitamin deficiency. It is not commonly realized, however, that vitamins control the body's appropriation of minerals, and in the absence of minerals they have no function to perform. Lacking vitamins, the system can make some use of minerals, but lacking minerals, vitamins are useless." Things have not improved in 70 years. In fact, they have gotten much worse. An entire industry has come into existence because of this fact.

Vitamins are consumed by 43% of Americans, yet we continue to suffer and die from preventable diseases that were unknown 50 years ago. Research scientists have long recommended that nutritional supplements are absolutely essential to our health and wellbeing. This is especially true when we consider our long term health. And now the American Medical Association, in a significant break from its earlier position that vitamins only produce colored urine, agrees that every American needs to take nutritional supplements. Not only are vitamins missing from the fruits and vegetables we consume, but antioxidants, minerals, enzymes, amino acids, essential fatty acids, and fiber are also missing. Nutritional supplements that provide only one, or a limited number of components, can provide a false feeling of wellbeing. It is unrealistic to believe that the food we eat is lacking only one element needed by our body. When the body lacks one component it probably lacks many, even most, simply because the source of the components is deficient. Adding only one component to the diet not only ignores the fact that the basic diet is deficient but gives a false sense of security that we are correcting a health problem.

Sunlight and Weight

If you're looking for a new way to stay fit and lean, new research suggests simply starting your day with a bit of morning sun.


A small new study reveals that just 20 to 30 minutes of morning sunlight may help protect against excess poundage. 54 men and women enrolled in the 1-week experiment during which participants kept food

Getting The Right Amount Of Vitamins

If you eat healthy and balanced meals each and every day, you will get all of the necessary vitamins and minerals your body needs to function. Even though we all have different dietary needs, we all need vitamins in order to live healthy lives and prevent diseases. Vitamins have been around for hundreds of years, providing us with a way to live our lives in a healthy manner.

Although there are many different vitamins out there, you’ll need a certain amount of each one to keep your body healthy. There are many different classifications of vitamins, including A, B, C, D and E. These vitamins are extremely important, with each one serving a unique purpose for both your body and your health.

When it comes to the type of vitamins, B vitamins are the most diverse. This is a very important vitamin, one that was discovered by mixing several chemicals together. With the B vitamin being so diverse, scientists understand the complex well enough to isolate the vitamin into eight different variations of the B vitamin family. These variations include B1, B2, B3, B5, B6, B7, B9, and B12.

As with other vitamin classes, a deficiency in the B vitamin can result in several different conditions such as weight loss, weakness, stress, diarrhea, dementia, anemia, and other things. A deficiency in B vitamins isn’t good for anyone, as the entire family contributes to your body. If you have a deficiency of any of the variation of this vitamin, you should always do something about it just as fast as you can.

As a whole, the B vitamin family will work to give you healthier skin, a faster metabolism, and an overall better immune system. They can also help you to fight back against depression and stress as well, which is something we could all use. No matter how you look at it, this family of vitamins could greatly improve life as you know it. Although other vitamins are essential to your diet as well, the B family is among the most important. All of these vitamins should be included in your daily diet, as they greatly improve your body and your health.

Even though you may be on a healthy diet, you may not be getting what you need of the B vitamin family. If this happens to be the case, you should look into vitamin supplements that will give you the doses of the B vitamins you need. Although you may not realize it, going without B vitamins can be very bad on your body and your health. If you make the smart choice and get yourself some B vitamin supplements - you’ll know that you are getting exactly what you need to live a healthy life.

The Role Of Vitamin B3 (Niacin)

Vitamin B3 (Niacin) is an essential vitamin for your body. It is just one of the eight water soluble types of B vitamins. Nearly all of the vitamin B classes will help the body convert carbohydrates into sugar or glucose, which can then be burned to produce energy. Also known as complex B vitamins, B3 niacin are essential in helping the body break down protein and fat.

Complex B vitamins also play an important role with maintaining muscle tone within the digestive tract, along with the health of the skin, nervous system, live, eyes, hair, and mouth. Even though a lot of people associate creative with the aspect of muscles and muscle tone, vitamin B3 niacin is as equally important - if not more important.

B3 niacin is also important with getting harmful or toxic chemicals out of the body. It can also help the body produce different sex and stress related hormones within the adrenal glands, among other parts of the body. The vitamin is also useful for helping with sexual dysfunction as well. This can be great news for those who have problems with pleasing their mate.

Also very effective with improving circulation, B3 niacin can also help to reduce cholesterol levels found in the blood. Even though vitamin B3 niacin is great as a stand alone supplement, it should also consumed with foods that contain protein, due to the fact that the body is able to convert the amino acid known as tryptophan into niacin.

The higher doses of B3 niacin, which are available only through prescription, have been proven to prevent and also improve a variety of different symptoms and ailments. Due to the high risk of toxicity, individuals should always consult with a doctor first, before they decide to start higher doses of B3 niacin.

There are also niacin skin care products that are being developed as well, which contain anti-aging products, helping to treat acne and also aid in the prevention of skin cancer. A lot of dermatologists expect that these products will become really popular over the next several years. Even though they are still in development stages, research has proven them to be very effective when compared to the other types of products.

The best sources for vitamin B3 niacin include beef, pork, turkey, beets, veal, fish, chicken, salmon, tuna, and peanuts. You can also get supplements that contain B3 niacin as well, which can give your body the amounts it needs. This is a very important vitamin, as it does a lot more for the body than most think. By consuming foods that contain it or taking the proper supplements - you’ll get the amount of B vitamins that your body needs on a daily basis.

Vitamins And Your Health

These days, we all know that taking vitamins is an easy way to start pursuing a healthy and disease free way of life. In the past, vitamins were used with diets, although they weren’t near as sophisticated as they are today. The vitamins of today are far more sophisticated and geared towards certain aspects of your body and your health.

Even though some people may not realize it, food doesn’t give you all of the vitamins and nutrients your body needs. Although you may be following a healthy diet, you won’t receive everything your body needs to carry out daily functions. You can buy high quality food if you wish, although it isn’t the preferred way to fix this type of situation. No matter what you choose to eat, you still won’t get the vitamins and nutrients you need.

If you have any type of restrictions with your diet, it can be even more difficult to get the vitamins and nutrients you need. Those who suffer from food allergies especially, find it even harder to get the right amount of vitamins. Even if you have a small appetite, you can be at a major disadvantage to getting everything your body needs. Smaller appetites get full a lot quicker, making it harder to eat the foods you need on a daily basis.

No matter how you look at it, you won’t get everything your body needs from food. To get the vitamins, minerals, and nutrients you need, you’ll need to use supplements and vitamins. Vitamin supplements are the easiest way to give your body what it needs. You can use vitamins and supplements in your normal diet, although you’ll need to choose them accordingly with what you need and what your diet consists of.

Even though there are many vitamins that you can benefit from, one of the most important is B12, which can raise your energy levels and help with your immune system. Some other vitamins you’ll need to include in your normal diet are vitamin A, C, D, and E. These vitamins are very important to your body, as they help with many different functions. Vitamins C and E are among the most important, as they help with your skin, hair growth, and the way your body functions.

To ensure that your body remains at it’s best, you should make sure that you get the right amount of vitamins with your diet. You can find vitamin supplements locally or on the Internet, with hundreds to choose from. You should also include selenium and colostrum in your daily diet as well, as these two vitamins will help you with your health. If you take the right vitamins with your diet - you’ll find that your health and energy will always will remain at their top levels of performance.

Targeted Radiation Might Help Fight Advanced Breast Cancer

A minimally invasive treatment that delivers radiation directly to tumors may slow progression of breast cancer that has spread to the liver, a new study suggests.

The treatment is called yttrium 90 (Y-90) radioembolization. Doctors insert a catheter through a tiny cut in the groin and guide it into the artery that supplies the liver. Radiation-emitting micro beads are then sent through the catheter and float out to kill small blood vessels that feed the tumor.

Researchers led by Dr. Robert Lewandowski, an associate professor of radiology at Northwestern University Feinberg School of Medicine in Chicago, looked at the outcomes of 75 patients. The women ranged in age from 26 to 82, and had chemotherapy-resistant breast cancer that had spread to the liver ("metastatic" disease). Their liver tumors were too large or too numerous to be treated with other methods, the authors noted.

Y-90 radioembolization therapy stabilized 98.5 percent of the treated liver tumors, according to the study, which was to be presented Monday in San Diego at the annual meeting of the Society of Interventional Radiology.

In addition, 24 of the women experienced a more than 30 percent shrinkage in tumor size after treatment, which caused few side effects.

"Although this is not a cure, Y-90 radioembolization can shrink liver tumors, relieve painful symptoms, improve the quality of life and potentially extend survival," Lewandowski said in a society news release.

"While patient selection is important, the therapy is not limited by tumor size, shape, location or number, and it can ease the severity of disease in patients who cannot be treated effectively with other approaches," he added.

Two breast cancer experts were cautiously optimistic about the findings.

According to Dr. Neelima Denduluri, "while these results appear promising, this is a very small retrospective study," meaning that it fell short of the "gold standard" type of prospective trial that tracks patients going forward over time. "Randomized controlled prospective studies addressing this issue are necessary before radioembolization can be incorporated routinely," she believes.

For now, "in women that cannot receive systemic therapy due to toxicities [side effects], are not eligible for clinical trials that utilize new agents, or have exhausted conventional chemotherapy options, radioembolization may be a choice," said Denduluri, a medical oncologist with Virginia Cancer Specialists in Arlington, Va., a US Oncology Network affiliate.

Dr. Stephanie Bernik is chief of surgical oncology at Lenox Hill Hospital in New York City. She said that while this type of therapy has been used to fight liver tumors, "the ability to use this therapy in treatment of metastatic breast cancer to the liver offers some hope to patients with the disease."

Bernik stressed that, right now, the treatment can only extend survival for women with advanced breast cancer, it is not a cure. However, "as the technique is modified and perfected, it is hoped the [treatment] can help achieve remission in women with advanced disease."

Each year in the United States, about 117,000 patients are diagnosed with breast cancer that has spread to the liver. Chemotherapy is the standard treatment in such cases, but is not effective in, or suitable for, all patients.

Experts note that studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

SOURCES: Neelima Denduluri, M.D., medical oncologist, Virginia Cancer Specialists, Arlington, Va., a US Oncology Network affiliate; Stephanie Bernik, M.D., chief of surgical oncology, Lenox Hill Hospital, New York City; Society of Interventional Radiology, news release, March 24, 2014

The Morning Light May Help You Stay Slim

Spending time in the bright morning light may help you slim down, new research suggests.

The small study found that people exposed to more light earlier, rather than later, in the day tended to be leaner than their peers.

TV, Computer Time Tied to Heavier, Less Happy Kids

Kids who spend more time plunked in front of screens may become unhappier, new research suggests. Meanwhile, mothers who devote the most effort to monitoring their kids' exposure to computers and TVs could prevent them from putting on extra pounds.

The findings in a pair of new studies aren't definitive, and there's still intense debate about exactly how TV, video games and computer use affect children.

Still, "parents who read these studies should be heartened that they can make a difference in the health and well-being of their children," said Diane Gilbert-Diamond, an assistant professor of community and family medicine with the Geisel School of Medicine at Dartmouth.

"They can reduce the amount of TV and other media that they allow their children to view, and encourage their children to engage in more active play," said Gilbert-Diamond, who was not involved with the new research.

Both studies appeared online March 17 in JAMA Pediatrics.

Previous studies have suggested that TV watching, especially in high amounts, may not be good for kids, another expert noted. "The amount is most related to things like physical health and school performance, whereas content is most related to behaviors such as aggression," said Douglas Gentile, an associate professor of psychology at Iowa State University.

However, it's difficult for researchers to figure out the exact role, if any, that television and other types of technology -- such as video games -- play in encouraging obesity or violence.

For example, kids may turn to more television-watching because they don't like exercising. In that case, the TV might not be at fault if they put on extra pounds. Along those lines, kids prone to aggression may be drawn to violent programs, making the shows less responsible for their actions.

In one new study, an international team of researchers tracked about 3,600 European children aged 2 to 6 years who took part in a health research project over a three-year period. The investigators found evidence that kids who were exposed to more screen time -- especially television -- were more likely to suffer declines in what the study called "well-being." They were also more likely to have more emotional problems and family dysfunction.

While the study shows that screen time potentially makes a difference in children's lives, the precise extent of the effect would only be available through a complicated statistical analysis.

In the other study, researchers tracked 213 children and most of their parents in the U.S. Northwest from 1998 to 2012. The study authors focused on the kids at ages 5, 7 and 9.

The researchers found that kids were thinner if their mothers -- but not their fathers -- more closely monitored their screen time. Over the ages of 5, 7 and 9 years, 22 percent of the kids on average were overweight and 19 percent were obese.

When it came to avoiding overweight in children, monitoring of screen time appeared to be especially important when compared to other parental duties, such as monitoring kids to protect them from problems like drug use and crime. Keeping an eye on computer, video game and TV time "was what really mattered in understanding children's weight development," said study lead author Stacey Tiberio, a research associate with the Oregon Social Learning Center.

What's next for research? Tiberio said it's important to understand why monitoring by mothers may matter. And there are questions about issues such as food commercials (could they make kids want to eat more?) and being in front of a screen (could it disrupt when kids are hungry and what they do about it?).

Gilbert-Diamond, the Dartmouth professor, said researchers need to better understand the connection between media use, such as TV watching, and the well-being of children. It's possible that kids who are unhappier may be drawn to screens, an alternative to the theory that screen time causes unhappiness, she said.

Iowa State's Gentile called for careful monitoring of the technology that kids soak up. More involvement "can have long-lasting and profound effects on children's health and well-being," he said.

SOURCES: Diane Gilbert-Diamond, Sc.D., assistant professor, department of community and family medicine, Geisel School of Medicine at Dartmouth, Lebanon, N.H.; Stacey Tiberio, Ph.D., research associate, Oregon Social Learning Center, Eugene, OR; Douglas Gentile, Ph.D., associate professor, psychology, Iowa State University, Ames, IA; March 17, 2014, JAMA Pediatrics, online

Study finds that Underweight is even deadlier than Overweight

It's said you can never be too rich or too thin, but new research suggests otherwise. People who are clinically underweight face an even higher risk for dying than obese individuals, the study shows.

Compared to normal-weight folks, the excessively thin have nearly twice the risk of death, researchers concluded after reviewing more than 50 prior studies.

Obesity has occupied center stage under the public health spotlight, but "we have [an] obligation to ensure that we avoid creating an epidemic of underweight adults and fetuses who are otherwise at the correct weight," said study leader Dr. Joel Ray, a physician-researcher at St. Michael's Hospital in Toronto.

The findings appear in the March 28 issue of the Journal of Epidemiology and Public Health.

Studies included in the analysis followed people for five years or more and focused on associations between BMI (body-mass index, a key indicator of healthy weight) and fatalities related to any cause.

Ray's team also looked at how death rates related to weight patterns among newborns and stillborns.

Underweight patients of all ages (those with a BMI of 18.5 or under) were found to face a 1.8 times greater risk for dying than patients with a normal BMI (between 18.5 and 25.9), the study found.

By contrast, obese patients (those with a BMI between 30 and 34.9) face a 1.2 greater risk for dying than normal-size patients. Severely obese patients -- those with a BMI of 35 or more -- faced a 1.3 times greater risk.

Ray said it's important to keep a healthy body size in mind when attempting to tackle the obesity epidemic.

"BMI reflects not only body fat, but also muscle mass. If we want to continue to use BMI in health care and public health initiatives, we must realize that a robust and healthy individual is someone who has a reasonable amount of body fat and also sufficient bone and muscle," Ray said in a hospital news release. "If our focus is more on the ills of excess body fat, then we need to replace BMI with a proper measure, like waist circumference."

Typical factors linked to a higher risk for being underweight included malnourishment, drug or alcohol use, smoking, poverty and mental health issues.

Vegetables in Childhood May Benefit Breast Health

Girls who ate the most fruits and vegetables rich in carotenoids were less likely to get benign breast disease, a new study suggests.

Carotenoids are a group of pigments that typically produce an orange, red or dark green color. They are believed to have antioxidant properties that may guard against disease.

Benign breast disease describes a variety of noncancerous conditions of the breast; some forms raise the risk of breast cancer.

"There have been a number of studies about carotenoids and breast cancer," said lead researcher Caroline Boeke, a postdoctoral fellow at Channing Division of Network Medicine at Brigham and Women's Hospital and Harvard School of Public Health, in Boston.

While the studies have produced mixed results, she said, overall they suggest a protective effect of the carotenoids. So her team decided to analyze the intake of these vegetables by girls enrolled in an ongoing study that began in 1996.

For her study, Boeke and her colleagues looked at food reports from 1996 through 1998 and then evaluated reports in 2005, 2007 and 2010 from girls who got a diagnosis of benign breast disease from a doctor after having a biopsy.

In all, Boeke studied nearly 6,600 girls, and 122 reported a diagnosis of benign breast disease.

When she looked at carotenoid intake, she found high intakes were protective. "The odds of benign breast disease in those who consumed the most beta carotene were about half that of those who consumed the least," she said.

Girls in the highest intake group ate two to three servings of carotenoid-rich foods weekly, she said.

The study is published in the May issue of Pediatrics.

"It's an observational study, so we can't say for sure the carotenoids cause the lower risk," Boeke noted. "We can only say there's an association."

She did take into account other factors that might affect the risk of benign breast disease, such as alcohol intake, physical activity, family history and body mass index (a measure of body fat using height and weight).

Why might the fruits and vegetables help? It's not known for sure, but Boeke said it may be due partly to their antioxidant properties. Carotenoids absorb harmful substances known as free radicals which can harm cells.

The study looked only at food intake, not supplements, and Boeke said she would not recommend supplements since other research has found some harmful effects with supplement use.

Other foods that are rich in carotenoids include yams, melons, spinach and kale.

The most common kind of benign breast disease in teens and young women is a noncancerous tumor known as a fibroadenoma, according to Boeke.

The period of time between the start of a girl's period and the first birth is a sensitive one for the breasts, as they are very vulnerable to environmental exposures, according to background information in the study.

Not many lifestyle habits have been shown to protect against benign breast disease, said Dr. Joanne Mortimer, director of women's cancer programs and co-director of the breast cancer program at the City of Hope Comprehensive Cancer Center, in Duarte, Calif.

The study has limitations, she said, including the self-report by the girls of a benign breast disease diagnosis by a doctor and the food questionnaires, which are always subject to error since it's difficult to remember exactly what was eaten.

SOURCES: Caroline Boeke, Sc.D., postdoctoral fellow, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard School of Public Health, Boston; Joanne Mortimer, M.D., director, women's cancer programs, and co-director, breast cancer program, City of Hope Comprehensive Cancer Center, Duarte, Calif.; May 2014 Pediatrics

Genes May Influence Weight Gain from Fried Foods

Genetics help determine whether a frequent diet of fried food will make you fat, according to a new Harvard study.

Eating fried food more than four times a week had twice as big an effect on body size for people at high genetic risk of obesity compared with people at low risk, researchers found after analyzing data from three U.S. trials.

Moreover, the more pro-obesity genes you carry, the bigger you'll get chowing down on fried chicken and such, the researcher said.

Such findings help explain why Americans' overall bad health habits don't affect everyone equally, said Claude Bouchard, chairman of genetics and nutrition at the Human Genomics Laboratory of Pennington Biomedical Research Center, in Baton Rouge, La.

"Our dietary habits and our lack of physical activity is driving the obesity epidemic, but the force of the behavioral driver is not the same in everyone," Bouchard said.

"We also have a biology driver, and that driver for some people is very minor," he said. "For others, it's a powerful agent enhancing the risk of behavior."

Other studies have noted similar interactions between these genetic risks and other environmental risk factors for obesity, including physical activity and total calorie intake, Bouchard said. People who are more sedentary or eat more are more likely to gain weight if they carry these genetic risks.

In the future, genetic testing could help reveal who is at higher risk of obesity, so they can take preventive measures, Bouchard said.

"It's not a sentence for obesity, but rather an increased susceptibility to obesity," he said. "Your peers can afford to have an extra serving or be sedentary and they will be OK, but for you it won't happen. That's important to know."

The findings, published March 19 in the journal BMJ, are based on an analysis of more than 37,000 men and women who participated in three U.S. health trials.

For each person, the researchers looked at a panel of 32 known genetic variants associated with obesity. They tracked fried food consumption using questionnaires and looked at each person's body-mass index (BMI), a measurement of body fat based on height and weight.

People with genetic risk scores in the top third tended to have a BMI that was 1 unit higher in women and 0.7 units higher in men if they ate fried food four or more times a week, compared with people at the same risk who ate such food less than once a week.

But for participants with the lowest genetic risk, little differences was seen between those who ate the most fried food versus very little -- just half a unit in women and 0.4 units in men.

A BMI of 25 or more is considered overweight, while a BMI of 30 or more is considered obese.

The research team also found that a person's overall risk of obesity from fried foods increases exponentially with every 10 genetic variants, or alleles, that predispose them to obesity.

Those who eat less than one serving a week have a 61 percent increased risk of obesity for every 10 risk genes, but that person's risk rises to 112 percent with one to three servings of fried food a week.

"If you have people who have 30, 35, 40 risk alleles, their total risk on average would be much, much larger," Bouchard said.

The researchers don't have the biological evidence to say why these genes inflate the body's reaction to fried foods, said senior author Lu Qi, an assistant professor of nutrition at the Harvard School of Public Health. He said, however, that they believe it may stem from the way some genes are tied to the body's energy balance.

"It's likely through the interplay between the genetic factors and the dietary factors in managing energy balance," he said.

SOURCE: Lu Qi, assistant professor, nutrition, Harvard School of Public Health, Boston; Claude Bouchard, John W. Barton Sr. Chair in Genetics and Nutrition, Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, La.; March 19, 2014, BMJ

Weight-Loss Surgery Might Help Mild Knee Pain

Small, early study of obese patients found improvement similar to knee replacement.

Weight-loss surgery reduces knee pain in obese people, and the results are similar to those seen in patients who have a knee replacement, according to a small new study.

The study included 20 obese patients who had weight-loss surgery and 40 patients who had total knee replacement due to arthritis.

One year after their procedure, the patients who had weight-loss surgery reported significant improvements in knee pain. Their results were comparable to the patients who had a knee replacement, according to the study, which was presented Friday at the annual meeting of the American Academy of Orthopaedic Surgeons, in New Orleans.

Compared to the knee-replacement patients, the weight-loss patients showed much greater improvement in knee function six months after surgery, according to an academy news release. After one year, however, the difference was much smaller.

Weight-loss patients who had knee arthritis reported less improvement in knee pain and function after surgery than those without arthritis.

Doctors should consider weight-loss surgery for obese patients who have knee problems but do not have advanced arthritis in the knee, the researchers concluded.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

SOURCE: American Academy of Orthopaedic Surgeons, news release, March 14, 2014

Why is it so Hard to Kick the Smoking Habit

Brain scans showed nicotine withdrawal weakens parts of the brain tied to ability to control cravings
Nicotine withdrawal triggers changes to the brain that help explain why smokers have such a tough time quitting, a new study suggests.

Up to 80 percent of smokers who try to quit eventually start smoking again. This latest finding might lead to new ways to identify smokers who are at high risk for failure when they try to quit, the researchers said. The study might also lead to more intensive treatment to help smokers quit for good.

The researchers used fMRIs to scan the brains of 37 smokers, aged 19 to 61, immediately after they smoked and again after they had been smoke-free for 24 hours and were experiencing nicotine withdrawal.

The researchers discovered that nicotine withdrawal weakens brain connections associated with the ability to control cravings for cigarettes, according to the study, which was published in this week's issue of the journal JAMA Psychiatry.

Specifically, they have trouble shifting from an inward-focused brain network to one that helps them have more control over their desire for cigarettes and focus on quitting smoking, the researchers said.

"Symptoms of withdrawal are related to changes in smokers' brains, as they adjust to being off of nicotine," study co-leader Caryn Lerman, head of the Brain and Behavior Change Program at the University of Pennsylvania, said in a university news release. "This study validates those experiences as having a biological basis."

"The next step will be to identify in advance those smokers who will have more difficultly quitting and target [them with] more intensive treatments, based on brain activity and network connectivity," she added.

Fatty acid Metabolism : Regulation of Fatty Acid Oxidation (Part 2)

Fatty acyl CoA formed has two fates one, it can undergo β oxidation and the other is it is converted to Tg and phospholipid in the cytosol.

Malonyl CoA (first intermediate in the cytosolic biosynthesis of long-chain fatty acids from acetyl-CoA) inhibit the carnitine acyltransferase I ensures that FA oxidation is inhibited when liver is amply supplied with glucose as fuel and is actively making Tg from excess glucose.

When NADH/[NAD⁺] ratio is high (energy sufficiency), β-hydroxyacyl-CoA dehydrogenase is inhibited; in addition, high concentrations of acetyl-CoA inhibit thiolase.

During vigorous muscle exercise or during fasting [ATP/AMP] ratio decreases, this activates Protein Kinase (AMPK) which phosphorylates and deactivates acetyl-CoA Carboxylase; this lowers the concentration of malonyl-CoA, relieving the inhibition of fatty acyl-carnitine transport to mitochondria and allow β oxidation to replenish the supply of ATP.

Transcription factors turn on the synthesis of proteins for lipid catabolism

PPAR or PPAR_α (Peroxisome proliferator-activated receptors) these are transcription factors. During increase demand for energy from fat catabolism, during fast between meals, long starvation. They turn on genes essential for fatty acid oxidation.

In fetus the principle fuels are glucose and lactate, but in the neonatal heart, fatty acids are the main fuel, so during transition from fetus to neonate, its activation, activates the genes essential for fatty acid metabolism.

Endurance training increases PPARα expression in muscle, leading to increase levels of fatty acid oxidizing enzymes.

Glucagon, in low blood glucose, can act through cAMP and the transcription factor CREB to turn on genes for lipid catabolism.

β Oxidation in Peroxisomes

One difference between the Peroxisomal and mitochondrial pathways is in the chemistry of the first step. In peroxisomes, the flavoprotein acyl-CoA oxidase that introduces double bond directly passes electrons to O₂ producing H₂O₂ and this is cleaved by catalase. But in mitochondria electron are transferred to ETC, producing ATP and water. In peroxisomes energy is released as heat. Another difference is mitochondrial NADH is regenerated but in peroxisomes NADH cannot be regenerated. The Peroxisomal system is active on very long chain fatty acids as hexacosanoic acid and on branched chain fatty acids like phytanic acid and pristanic acid. Peroxisomal beta oxidation shortens the side chain of cholesterol in bile acid formation. Peroxisomes also take part in the synthesis of glycerolipids, cholesterol; and dolichol. They do not contain carnitine palmitoyltransferase.

The inability to oxidize these compounds is responsible for several serious human diseases. Individuals with Zellweger syndrome are unable to make peroxisomes.

In mammals, high concentration of fats in the diet results in increased synthesis of enzymes of Peroxisomal beta oxidation in the liver also the hypolipidemic drug like clofibrate. Liver peroxisomes do not contain the enzymes of CAC and cannot catalyze the oxidation of acetyl-CoA to CO₂.

α- and ῳ-oxidation

This occurs in some vertebrates and other species. α-oxidation removes the one carbon from carboxyl end and seen in brain tissue. It does not require CoA and does not generate energy. This occurs when beta position is occupied by methyl group e.g. in phytanic acid which cannot undergo beta oxidation.

ῳ-oxidation is brought about by cytochrome P450 and electron donor NADPH in ER of liver and kidney. In mammalian this is minor but when beta oxidation is defective this comes into play. This is also a type of mixed function oxidase reaction. The –CH₃ is converted to –CH₂OH that is oxidized to –COOH, forming dicarboxylic acid. This is beta oxidized to adipic (C₆) and suberic (C₈) acids, and excreted in urine.

Ketone body formation

Ketone bodies are acetoacetate, D(-)-3hydroxybutyrate (β-hydroxybutyrate) and acetone (spontaneous decarboxylation of acetoacetate. They are produced in the liver.

The ratio of 3-hydroxybutyrate/acetoacetate in blood varies between 1:1 and 10:1 in blood.

Formation, utilization, and excretion of ketone bodies. Solid arrow indicates the main pathway.

Enzymes for ketogenesis are located in mitochondria. C₂ units formed in β-oxidation condense to form acetoacetate. This may occur by inhibition of thiolase. Acetoacetyl-CoA is the starting material for ketogenesis which may arise by β-oxidation or by condensation of 2 acetyl-CoA. 3-hydroxybutyrate is the predominant ketone body present in the blood and urine in ketosis.

Utilization of ketone bodies

In the liver cytosol it is a precursor of cholesterol synthesis. Before utilization, Acetoacetate is activated as Acetoacetyl-CoA involving succinyl-CoA and the enzyme succinyl-CoA-acetoacetate CoA transferase.

Ketone bodies are oxidized in extrahepatic tissue. If the blood level is raised, oxidation increases until, until a concentration is approximately 12 mmol/L, where they saturate the oxidative machinery. Ketonemia is the increased production of ketone bodies and decreased utilization in extrahepatic tissues.

Regulation of ketogenesis

1. Control in adipose tissue: Free fatty acids produced by lipolysis of TAG in adipose tissue are the precursors of ketone bodies in the liver. The liver both in fed and in fasting condition can extract 30% of FFA passing through it.

2. Carnitine palmitoyltransferase-I (CPT-1): Regulates the entry of long chain fatty acyl groups into mitochondria prior to β-oxidation. Its activity is low in fed state, leading to depression of fatty acid oxidation, and high in starvation, allowing fatty acid oxidation to increase. During fed state Malonyl-CoA formed inhibits CPT-1, so fatty acids entering liver are esterified as acylglycerols and transported out of liver as VLDL. As the concentration of FFA increases with starvation, acetyl-CoA carboxylase is inhibited by acyl-CoA, and malonyl-CoA decreases, releasing the inhibition of CPT-1 and thus more FFA are oxidized. These events are reinforced in starvation by decrease in the [insulin]/ [glucagon] ratio. This cause inhibition of acetyl-CoA carboxylase in liver by covalent phosphorylation. Thus, β-oxidation is controlled by CPT-1 gateway into the mitochondria, and those not oxidized is esterified.

3. Regulation of partition of acetyl-CoA between the ketogenic pathway and pathway of oxidation to CO₂. The partition of acetyl-CoA between the ketogenic pathway and the pathway of oxidation to CO2 is so regulated that the total free energy captured in ATP which results from the oxidation of free fatty acids remains constant. Here the complete oxidation of 1 mol of palmitate involves a net production of 129 mol of ATP via β-oxidation and CO2 production in the citric acid cycle, whereas only 33 mol of ATP are produced when acetoacetate is the end product and only 21 mol when 3-hydroxybutyrate is the end product. Thus, ketogenesis may be regarded as a mechanism that allows the liver to oxidize increasing quantities of fatty acids within the constraints of a tightly coupled system of oxidative phosphorylation without increasing its total energy expenditure. Also increased [NADH]/ [NAD⁺] ratio caused by β-oxidation caused the decrease in the concentration of oxaloacetate; this can impair the ability of the CAC to metabolize acetyl-CoA.

Regulation of ketogenesis

Regulation of long-chain fatty acid oxidation in the liver

CLINICAL ASPECTS

a) Carnitine deficiency: Particularly in newborn and especially in preterm infants owing to inadequate biosynthesis or renal leakage. There are episodic periods of hypoglycemia owing to reduced gluconeogenesis resulting from impaired fatty acid oxidation in the presence of raised plasma FFA, leading to lipid accumulation with muscular weakness. Treatment is by oral supplementation of carnitine.

b) Inherited carnitine palmitoyltransferase-I deficiency: Affects only the liver, resulting in reduced fatty acid oxidation and ketogenesis with hypoglycemia.

c) Carnitine palmitoyltransferase-II deficiency: Affects skeletal muscles (weakness and necrosis with myoglobinuria) and more severely the liver.

d) Acute fatty liver of pregnancy: Deficiency of long-chain 3-hydroxyacyl-CoA dehydrogenase.

e) Jamaican vomiting sickness: Caused by eating the unripe fruit of the akee tree, which contains a toxin hypoglycin that inactivates medium and short-chain acyl-CoA dehydrogenase.

f) Dicarboxylic aciduria: Excretion of C₆-C₁₀ omega dicarboxylic acids and by non-ketotic hypoglycemia. Caused by lack of mitochondrial medium-chain acyl-CoA dehydrogenase.

g) Refsum’s disease: Rare neurological disorder caused by accumulation of phytanic acid, formed from phytol, a constituent of chlorophyll, this occurs due to defect in α-oxidation.

h) Zellweger’s (cerebrohepatorenal) syndrome: There is inherited absence of peroxisomes in all tissues. They accumulate C₂₆ –C₃₈ polyenoic acids in brain tissue, they also have impaired bile acid and ether lipid synthesis.

i) Ketoacidosis: This occurs during starvation, due to depletion of carbohydrate coupled with mobilization of FFA, this process is exaggerated during diabetes mellitus. This also occurs in high fat diet and severe exercise in the postabsorptive state.

Fatty acid contains a long hydrocarbon chain and a terminal carboxylate group. Fatty acids have four major physiological roles.

1. Stored as triacylglycerols (neutral fats) – used as energy reserve

2. FA are building blocks of phospholipids and glycolipids – component of biological membrane.

3. FA covalently attaches protein and modifies them and targets them to membrane locations. E.g. attachment of soluble proteins to membrane by attaching to palmitoyl group, farnesyl group and glycosylphosphatidylinositol group.

4. Fatty acid derivatives serve as hormones and intracellular messengers.

FATTY ACID SYNTHESIS AND DEGRADATION MIRROR EACH OTHER CHEMICALLY BUT DIFFER MECHANISTICALLY.

Triacylglycerols are highly concentrated stores of metabolic energy because they are reduced and anhydrous. The yield from the complete oxidation of fatty acids is about 9 kcal g-1 (38 kJ g-1), in contrast with about 4 kcal g-1 (17 kJ g-1) for carbohydrates and proteins. The basis of this large difference in caloric yield is that fatty acids are much more reduced. Furthermore, triacylglycerols are nonpolar, and so they are stored in a nearly anhydrous form, whereas much more polar proteins and carbohydrates are more highly hydrated. In fact, 1 g of dry glycogen binds about 2 g of water. Consequently, a gram of nearly anhydrous fat stores more than six times as much energy as a gram of hydrated glycogen, which is likely the reason that triacylglycerols rather than glycogen were selected in evolution as the major energy reservoir. Consider a typical 70-kg man, who has fuel reserves of 100,000 kcal (420,000 kJ) in triacylglycerols, 25,000 kcal (100,000 kJ) in protein (mostly in muscle), 600 kcal (2500 kJ) in glycogen, and 40 kcal (170 kJ) in glucose. Triacylglycerols constitute about 11 kg of his total body weight. If this amount of energy were stored in glycogen, his total body weight would be 55 kg greater. The glycogen and glucose stores provide enough energy to sustain biological function for about 24 hours, whereas the triacylglycerol stores allow survival for several weeks.

FFA, monoacylglycerol transported to intestine and absorbed into plasma membrane

In mucosal cells TAG and MAG are resynthesized and packaged into chylomicrons along with apo-B48.

Chylomicrons released into blood via lymph

Action of lipoprotein lipase in adipose tissue and muscle tissue breaks TAG into fatty acids

TAG resynthesized and stored or used as energy

Difference between Fatty acid synthesis and Degradation.

1.Synthesis takes place in the cytosol, in contrast with degradation, which takes place

primarily in the mitochondrial matrix.

2. Intermediates in fatty acid synthesis are covalently linked to the sulfhydryl groups of an

acyl carrier protein (ACP), whereas intermediates in fatty acid breakdown are covalently

attached to the sulfhydryl group of coenzyme A.

3. The enzymes of fatty acid synthesis in higher organisms are joined in a single polypeptide

chain called fatty acid synthase. In contrast, the degradative enzymes do not seem to be

associated.

4. The growing fatty acid chain is elongated by the sequential addition of two-carbon units

derived from acetyl CoA. The activated donor of two carbon units in the elongation step is

malonyl ACP. The elongation reaction is driven by the release of CO2.

5. The reductant in fatty acid synthesis is NADPH, whereas the oxidants in fatty acid

degradation are NAD+ and FAD.

6. Elongation by the fatty acid synthase complex stops on formation of palmitate (C16).

Further elongation and the insertion of double bonds are carried out by other enzyme

systems.