New way to burn off calories

A new study in the September issue of Cell Metabolism, a publication of Cell Press, points to a new method for burning off all those irresistible extra calories-by turning on an energy-draining, but otherwise futile, cycle of protein synthesis and breakdown.

Christopher Lynch of The Pennsylvania State University College of Medicine and his colleagues found that they could drive such heightened protein turnover in mice by disrupting an enzyme involved in the metabolism of some amino acids, the building blocks of proteins. The enzyme-deficient animals showed elevated blood levels of the essential amino acid leucine, an important nutrient signal, and became slimmer than normal mice despite eating more food. They also showed "remarkable" improvements in glucose and insulin tolerance, and resistance to becoming obese on a high-fat diet.

"The mice on the outside look normal, just skinnier and smaller," Lynch said. "After looking at their metabolism, we found that for the same activity, they were using more energy."

Moreover, the researchers found that the animals that ate the most food also expended the most energy. "That would be ideal for people who are overweight," Lynch said. "They could continue to eat and just waste the energy and be thin."

Abundant food supplies and a sedentary lifestyle have contributed to the current epidemic of obesity in Western nations, the researchers said. Obesity results when people consume more energy in their diet than they expend. In both short-term and relatively long-term studies, high-protein and low-fat diets have been found to increase energy expenditure, they noted, while short-term protein intake helps stave off hunger.

The effects of dietary protein are thought to be driven at least in part by leucine and perhaps other so-called branched-chain amino acids (BCAAs). Yet it has remained unclear whether leucine supplementation actually improves or worsens obesity, Lynch said.

In the current study, the researchers generated mice lacking the enzyme BCATm, critical for the first step in BCAA breakdown, which caused their leucine levels to rise by more than 10-fold. As a result of the enzyme deficiency, the animals ate more food but were lean in comparison to normal mice. The researchers traced the effect to an energy-demanding increase in protein turnover that appeared to be directly related to the amount of food the mice ate.

"Unfortunately for dieters, it appears unlikely that the tactic used by the [mutant mice] to avoid weight gain, i.e., a big increase in protein turnover, can be achieved by merely ingesting high-protein diets or leucine supplements," said Susan Fried and Malcolm Watford in an accompanying commentary. An earlier study found that eating leucine can only increase its levels to twice the normal concentration, they noted. And unlike the enzyme disruption, dietary leucine stimulates protein synthesis while it slows protein breakdown.

Nonetheless, the scientists all agree that the findings could lead to new weight-loss therapies. "It is possible that revving up protein turnover by manipulating BCATm activity through pharmacological means is worth exploring as a treatment for obesity in humans," Fried and Watford said.

http://www.cellpress.com/

Psychiatrists are the least religious of all physicians

A nationwide survey of the religious beliefs and practices of American physicians has found that the least religious of all medical specialties is psychiatry.

Among psychiatrists who have a religion, more than twice as many are Jewish and far fewer are Protestant or Catholic, the two most common religions among physicians overall.

The study, published in the September 2007 issue of Psychiatric Services, also found that religious physicians, especially Protestants, are less likely to refer patients to psychiatrists, and more likely to send them to members of the clergy or to a religious counselor.

"Something about psychiatry, perhaps its historical ties to psychoanalysis and the anti-religious views of the early analysts such as Sigmund Freud, seems to dissuade religious medical students from choosing to specialize in this field," said study author Farr Curlin, MD, assistant professor of medicine at the University of Chicago. "It also seems to discourage religious physicians from referring their patients to psychiatrists."

"Previous surveys have documented the unusual religious profile of psychiatry," he said, "but this is the first study to suggest that that profile leads many physicians to look away from psychiatrists for help in responding to patients' psychological and spiritual suffering."

"Because psychiatrists take care of patients struggling with emotional, personal and relational problems," Curlin said, "the gap between the religiousness of the average psychiatrist and her average patient may make it difficult for them to connect on a human level."

In 2003, to learn about the contribution of religious factors on physicians' clinical practices, Curlin and colleagues surveyed 1,820 practicing physicians from all specialties, including an augmented number of psychiatrists; 1,144 (63%) physicians responded, including 100 psychiatrists.

The survey contained questions about medical specialties, religion, and measures of what the researchers called intrinsic religiosity-the extent to which individuals embrace their religion as the "master motive that guides and gives meaning to their life."

Although 61 percent of all American physicians were either Protestant (39%) or Catholic (22%), only 37 percent of psychiatrists were Protestant (27%) or Catholic (10%). Twenty-nine percent were Jewish, compared to 13 percent of all physicians. Seventeen percent of psychiatrists listed their religion as "none," compared to only 10 percent of all doctors.

Curlin's survey also included this brief vignette, designed to present "ambiguous symptoms of psychological distress" as way measure the willingness of physicians to refer patients to psychiatrists.

"A patient presents to you with continued deep grieving two months after the death of his wife. If you were to refer the patient, to which of the following would you prefer to refer first" (a psychiatrist or psychologist, a clergy member or religious counselor, a health care chaplain, or other)."

Overall, 56 percent of physicians indicated they would refer such a patient to a psychiatrist or psychologist, 25 percent to a clergy member or other religious counselor, 7 percent to a health care chaplain and 12 percent to someone else.

Although Protestant physicians were only half as likely to send the patient to a psychiatrist, Jewish physicians were more likely to do so. Least likely were highly religious Protestants who attended church at least twice a month and looked to God for guidance "a great deal or quite a lot."

"Patients probably seek out, to some extent, physicians who share their views on life's big questions," Curlin said. That may be especially true in psychiatry, where communication is so essential. The mismatch in religious beliefs between psychiatrists and patients may make it difficult for patients suffering from emotional or personal problems to find physicians who share their fundamental belief systems.

http://www.uchospitals.edu/

Gastric Bypass Reduces Disease Related Deaths Among Severely Obese

A new US study shows that severely obese patients who have gastric bypass surgery have a significantly lower risk of death from cancer, coronary heart disease, and diabetes. However non-disease related deaths are likely to be higher among gastric bypass patients than those who do not have surgery, the researchers concluded.

The study is published in the 23rd August issue of the New England Journal of Medicine and was led by scientists based at the University of Utah School of Medicine and LDS Hospital.

Lead author, Dr Ted D. Adams, professor at the Division of Cardiovascular Genetics in the University of Utah School of Medicine and co-founder of the Intermountain Health and Fitness Institute of LDS Hospital in Salt Lake City, said that:

"This study helps to further define the effects of gastric bypass surgery on long-term mortality."

"Reduction in death by any cause, and disease-specific deaths such as coronary heart disease, diabetes, and cancer were significantly reduced in surgery patients compared to the non-surgical control group," he added.

But, he explained that: "rates of death not caused by disease were shown to be greater in those who underwent the weight-loss surgery when compared to controls".

The research took 14 years and involved 15,850 obese patients, 84 per cent of whom were women. Half of the participants had gastric bypass surgery to reduce weight.

The average BMI (body mass index, weight in kilos divided by the square of the height in metres) of the surgery group was 45.3 and 46.7 for the non surgery group.

The results showed that:

• Deaths due to coronary heart disease were 56 per cent lower in the group that had surgery compared to the non surgery group.
• Deaths due to cancer were 60 per cent lower in the surgery group than the non surgery group.
• Deaths due to diabetes were 92 per cent lower in the surgery group than the non surgery group.
• But, deaths due to other non disease causes such as accidents and suicide were 58 per cent higher in the surgery group than the non surgery group.

The study concluded that:

" Long-term total mortality after gastric bypass surgery was significantly reduced, particularly deaths from diabetes, heart disease, and cancer. However, the rate of death from causes other than disease was higher in the surgery group than in the control group."

The study suggests that perhaps the non disease caused deaths could be due to mood related or post traumatic stress disorders that existed pre surgery but went undiagnosed. These disorders are said to be more prevalent in obese patients.

Adams said the study showed there was a need to improve the way patients are assessed for surgery and this assessment should include psychological and psychiatric evaluation as well as follow up.

The reduction in deaths associated with disease is highly plausible because after gastric bypass obese patients usually have lower blood pressure, reduced sleep apnea, and also less severe diabetes, and in some cases the diabetes is resolved, explained Adams.

Another study carried out on Swedish patients appears in the same issue of the NEJM with similar results, although the Swedish surgery group also included banding procedures as well as surgical bypasses.

In an accompanying editorial, Dr. George Bray of Louisiana State University suggests that national guidelines for assessing the threshold for gastric bypass and other bariatric surgery should perhaps be re-examined in the light of these results.

However, another bariatric surgery specialist, Dr John Alverdy from the University of Chicago told the city's Tribune newspaper that it was unlikely things would change very much in the US as a result of these studies.

"Even though the risk-benefit ratio is in favor of the surgery and it is cost-effective, not every insurance company covers it, not every doctor believes in it, and not everyone has access to hospitals that do it," Alverdy said to the Chicago Tribune.

He said there is a belief that diet and exercise can cure obesity, and that it is the patient's fault they are obese. This makes patients reticent about seeking surgery and makes some doctors hesitant about recommending it.

This is in spite of the fact research shows that genetics and environment and not just "volition alone" play a role in the development of the disorder, said Alverdy to the newspaper.

"Long-Term Mortality after Gastric Bypass Surgery."
Adams, Ted D., Gress, Richard E., Smith, Sherman C., Halverson, R. Chad, Simper, Steven C., Rosamond, Wayne D., LaMonte, Michael J., Stroup, Antoinette M., Hunt, Steven C.
N Engl J Med 2007 357: 753-761
Volume 357:753-761; August 23, 2007; Number 8

Glaucoma: Be Cautious about water intake

In this era of fitness every- one is concerned about what he/she is eating. Everyone is calorie conscious and prefers drinking a lot of water/fluids. It is generally good for everybody, but not for a glaucoma patient.

Glaucoma or “Kala Motia” is a disease where eye pressure increases to a level that is not safe for the optic nerve. The balance between the fluid produced inside the eye and drained out from the eye is disturbed, resulting in increased pressure and damage to the optic nerve.

Glaucoma presents in different forms like open angle glaucoma, angle closure glaucoma and secondary glaucoma. Also there are various factors which affect the progression of glaucoma. In angle closure glaucoma the fluid drainage is affected.

Water therapy and different shuddhi-kriyas as per yoga are commonly practised in our country. There is a belief that taking a large quantity of water in early morning helps in bowel movement and flushes the body clean. In this water therapy the person drinks almost four-six glasses of water at a time in the morning empty stomach. This may do well for his/her digestive system, but create problems for the eye of the glaucoma patient. Many people are not aware of this.

Anything which overloads our body fluid will increase the load on the drainage system. When one drinks a large amount of water like this, it gets absorbed in the fluid spaces of the body. So, fluid in the eye is produced in excess quantity. This increases the load on the drainage system of the eye.

In angle closure glaucoma the drainage system is affected and so will lead to a rise in the eye pressure. Such intake of a large quantity of fluids in a short span will give rise to short spikes of increase in the eye pressure that may be missed on an examination by the eye specialist. So, this type of glaucoma may get presented or aggravated if one drinks a lot of water in a short span.

Every patient of glaucoma or having a family history of glaucoma should be cautious about the water therapy. In the case of such patients, if they continue the water therapy habit, glaucoma may progress in spite of the best treatment. This should not be practised in families with glaucoma. Glaucoma is a multifactorial disease and one needs to control this factor as far as possible.

The water drinking test, commonly used to detect such cases of glaucoma, is based on similar observations. During this test we check the eye pressure after drinking one litre of water in a short time.

The eye pressures are checked every half an hour for two hours. Persons with a positive water drinking test should avoid large quantities of fluid intake empty stomach in the morning.

Be careful and watch for your glass of water!

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. E-mail: msachdev@bol.net.in