Monday, March 30, 2020
Digestion

According to a new study analyzing the data of thousands of people, an excessive intake of a certain kind of amino acid — present in protein-rich foods — is associated with a higher cardiometabolic risk.

person slicing meat
A new study in humans adds to the evidence that protein-rich foods, such as meat, may have a negative effect on heart health.

Many people follow diets that are high in protein, which can help with weight loss and building muscle mass.

However, increasingly, researchers are starting to question whether protein-rich foods provide enough benefits to offset the potential risks.

For the most part, various recent studies have suggested that high protein foods may affect the health of the heart and the cardiovascular system.

For example, a study in animal models that Medical News Today covered last week found that diets that are high in protein may be directly responsible for cardiovascular problems, such as atherosclerosis.

Now, hot on its heels, a new study in humans points out a link between eating foods with a high sulfur amino acid content — typically high protein foods — and an increased cardiometabolic risk.

The research — the findings of which appear in EClinicalMedicine — comes from Pennsylvania (Penn) State University in State College.

Proteins comprise tiny compounds called amino acids, which vary in their components. Some contain atoms of the element sulfur, which gives them their name: sulfur amino acids.

Cardiometabolic risk and diet

Two sulfur amino acids occur in protein-rich food. These are methionine, an essential amino acid, and cysteine, a semi-essential amino acid.

The human body needs these amino acids to function well, and it must obtain them from a food source. The body cannot synthesize essential amino acids, and it cannot make enough of the semi-essential ones.

However, as with many other nutrients, if they are present in excessive quantities, amino acids can end up doing more harm than good.

This is what Penn State researchers noticed when they looked at the diets and health status of 11,576 individuals, whose data they accessed via the third National Health and Nutrition Examination Survey (NHANES III), which the Centers for Disease Control and Prevention (CDC) conducted.

The researchers came up with a composite cardiometabolic disease risk score assessing each participant’s risk of developing cardiometabolic problems, such as heart disease, stroke, and diabetes.

To do this, they measured the levels of tell-tale biomarkers — including cholesterol, triglycerides, glucose (sugar), and insulin — in the participants’ blood following a 10–16 hour fast.

“These biomarkers are indicative of an individual’s risk for disease, just as high cholesterol levels are a risk factor for cardiovascular disease,” explains study co-author Prof. John Richie.

“Many of these levels can be impacted by a person’s longer-term dietary habits leading up to the test,” Prof. Richie adds.

The researchers also analyzed information about the participants’ dietary habits, which included nutrient intake calculations. They excluded from the study any individuals who reported having an overly low intake of sulfur amino acids.

‘First epidemiologic evidence’

The team’s final analysis, which accounted for body weight measurements, revealed that the participants had an average intake of sulfur amino acids that was almost 2.5 times higher than the estimated average requirement of 15 milligrams per kilogram of body weight per day.

“Many people in the U.S. consume a diet rich in meat and dairy products, and the estimated average requirement is only expected to meet the needs of half of healthy individuals,” points out study co-author Xiang Gao.

“Therefore, it is not surprising that many are surpassing the average requirement when considering these foods contain higher amounts of sulfur amino acids,” says Gao.

Moreover, the investigators found that participants with higher sulfur amino acid intakes also tended to have higher composite cardiometabolic risk scores.

This association remained in place even after the researchers accounted for confounding factors, including age, biological sex, and a history of health conditions such as hypertension and diabetes.

As for the source of the sulfur amino acids, the team said that they were present in almost all foods, excluding grains, fruit, and vegetables.

“Meats and other high protein foods are generally higher in sulfur amino acid content,” notes lead author Zhen Dong, Ph.D.

“People who eat lots of plant-based products like fruits and vegetables will consume lower amounts of sulfur amino acids. These results support some of the beneficial health effects observed in those who eat vegan or other plant-based diets,” Dong adds.

The researchers caution that the current findings are, so far, only observational, pointing to an association rather than verifying causality.

“A longitudinal study would allow us to analyze whether people who eat a certain way do end up developing the diseases these biomarkers indicate a risk for,” notes Prof. Richie.

Nevertheless, he stresses that the recent study shows that researchers should pay more attention to the possible risks associated with dietary amino acids.

“For decades, it has been understood that diets restricting sulfur amino acids were beneficial for longevity in animals. This study provides the first epidemiologic evidence that excessive dietary intake of sulfur amino acids may be related to chronic disease outcomes in humans.”

– Prof. John Richie

New research uses high quality data to find that the type 2 diabetes drug rosiglitazone raises the risk of adverse cardiovascular events by 33%.

Rosiglitazone is a drug originally developed to treat type 2 diabetes. The United States Food and Drug Administration (FDA) approved it in 1999 under the name Avandia.

Although Europe suspended the drug due to concerns about its adverse effects on heart health, and the United States restricted its use, the research on its safety has so far yielded mixed results.

Now, a new study, appearing in the journal The BMJ has used more reliable data to investigate the effects of this drug on cardiovascular health.

Joshua D. Wallach, who is an assistant professor in the Department of Environmental Health Sciences at Yale School of Public Health in New Haven, CT, is the lead author of the new paper.

The need for more accurate data

The FDA approved rosiglitazone in 1999, a year ahead of Europe, note Wallach and colleagues in their paper.

Regulatory bodies warned about its potential effects on heart failure as early as 2006, and a meta-analysis of several trials pointed to a 43% higher risk of heart attack in 2007.

As a result, by 2010, the drug was pulled off European markets because it raised the risk of heart attack and stroke.

In the U.S., the drug is still available, although it features warnings on its packaging, and the FDA restricted its availability in 2010-2011.

The fact that the drug is still available is primarily due to the mixed results yielded by the investigation into the drug’s cardiovascular effects.

However, the new research suggests that these mixed results are due to the poor quality of the data that these previous studies used.

Namely, these previous papers did not have access to “individual patient data (IPD),” that is, raw data, such as the medical records of patients, instead of summary-level data, which are the final results of clinical trials, for example.

Studying rosiglitazone and heart health

To rectify this methodological problem, Wallach and colleagues set out to analyze over 130 clinical trials; the researchers had access to IPD for 33 of these trials. This totaled 48,000 adult patient data, of which researchers had IPD for 21,156.

The clinical trials were randomized, controlled, phase II-IV trials that had studied and compared the effects of rosiglitazone with any other control for at least 24 weeks.

“The control group was defined as patients who received any drug regimen other than rosiglitazone, including placebo,” explain the researchers.

The team examined the outcomes of “acute myocardial infarction, heart failure, cardiovascular-related death, and noncardiovascular-related death” in their analysis of trials for which they had IPD.

For the other trials, the researchers examined myocardial infarction and cardiovascular-related death only, using summary-level data.

A 33% higher risk of cardiovascular disease

The analysis revealed a 33% higher risk of heart attack, heart failure, cardiovascular deaths, and noncardiovascular-related deaths combined for people who were taking the drug compared with people who were taking another control substance, including placebo.

Wallach and colleagues conclude:

“The results suggest that rosiglitazone is associated with an increased cardiovascular risk, especially for heart failure events.”

The findings also serve to emphasize the importance of using raw data to accurately assess the safety of a drug, say the authors.

“Our study suggests that when evaluating drug safety and performing meta-analyses focused on safety, IPD might be necessary to accurately classify all adverse events,” they write.

“By including this data in research, patients, clinicians, and researchers would be able to make more informed decisions about the safety of interventions.”

“Our study highlights the need for independent evidence assessment to promote transparency and ensure confidence in approved therapeutics, and postmarket surveillance that tracks known and unknown risks and benefits.”

Experts know that processed red meats are likely to raise the risk of cardiovascular disease and death. But are unprocessed meats, fish, and poultry less harmful? New research investigates.

Several studies have established a link between consuming processed meat — such as bacon, hot dogs, sausages, and other similar meats — and an increased risk of cardiovascular disease (CVD) and death.

The higher amount of saturated fats in these foods, along with a higher level of salt and preservatives, might explain these associations. Newer research has suggested that even a low amount of these foods is enough to jeopardize health.

But what about other meats, such as unprocessed red meat, poultry, or fish? Do these foods affect cardiovascular risk and longevity in the same way?

Here, the research is more mixed. The results of several studies vary partly because the methods were different and partly because the existing prospective cohort studies had their limitations.

So, to fill this gap in the research, a group of scientists led by Victor W. Zhong, Ph.D., of Cornell University in Ithaca, New York, set out to conduct a new meta-analysis of 6 existing studies.

The pooled analysis appears in the journal JAMA Internal Medicine.

Studying intake of meat, poultry, and fish

Zhong and the team looked at prospective cohort studies that had been carried out across the United States, totaling 29,682 U.S. adults who did not have CVD at baseline.

Of the participants, 44% were men, and almost 31% were non-white.

Researchers had recorded the participants’ dietary data between 1985–2002 and clinically followed them for 30 years, until August 31, 2016.

Over a median follow-up period of 19 years, 6,963 adverse cardiovascular events and 8,875 all-cause deaths occurred.

Of the cardiovascular events, 38.6% were cases of coronary heart disease, 25% were stroke events, and 34.0% involved heart failure.

To define what constitutes 1 serving of meat and assess the participants’ diet, the researchers used the Willett Food Frequency Questionnaire.

“1 serving was equivalent to 4 [ounces] of unprocessed red meat or poultry or 3 [ounces] of fish. For processed meat, 1 serving consisted of 2 slices of bacon, 2 small links of sausage, or 1 hot dog,” explain the authors.

The median consumption in terms of servings of meat, poultry, and fish per week was 1.5 for processed meat, 3 for unprocessed red meat, 2 for poultry, and 1.6 for fish.

“Compared with participants with lower total intake of these four food types, participants with higher total intake,” write the authors, were more likely to:

  • be younger and male
  • be non-Hispanic black
  • be smokers, have diabetes, a higher body mass index (BMI), higher non-high-density lipoprotein (HDL) cholesterol levels, and consume more alcohol
  • have lower HDL cholesterol levels and eat a lower diet quality diet
  • have a higher incidence of CVD and death from any cause

The main outcome that the scientists looked for was the relative risk of CVD and all-cause mortality over the 30 years between people who consumed these different foods, as well as the difference in absolute risk over the same period.

They calculated the risks for each additional intake of 2 servings per week.

Up to 7% higher relative risk of death, CVD

Zhong and the team summarize the findings: the “intake of processed meat, unprocessed red meat, or poultry was significantly associated with incident cardiovascular disease, but fish intake was not.”

More specifically, the increased relative risks of CVD and all-cause mortality ranged from about 3% to 7%. “The increased absolute risks were less than 2% over the 30 years of follow-up,” add the authors.

More in-depth detail shows that for every 2 additional servings of processed meat per week, the relative risk of all-cause mortality rose by 3% compared with those who did not eat processed meat.

The same was true for each additional 2 servings of unprocessed meat.

The relative risk of CVD rose by 7% for every 2 servings of processed meat per week. For unprocessed red meat, this risk was 3%.

An increase of 2 weekly servings of poultry correlated with a 4% higher relative risk, whereas fish was not associated with CVD risk.

“People who consume more servings per week would have greater risks,” add the researchers.

Study of ‘critical public health’ importance

The authors deem the findings of “critical public health” importance. They also note that more research is necessary to strengthen the findings.

As it stands, the current study has some limitations, such as the self-reported nature of dietary data. This may have resulted in over or underestimation of the association.

Secondly, the scientists did not have any data on the method of food preparation. Whether the meat was fried or non-fried may have impacted the health outcomes.

Thirdly, the study only used one dietary measurement at the beginning of the study, but the dietary habits of the participants may have changed over time.

Finally, residual confounding, the observational nature of the study, and the fact that the data may only be limited to U.S. adults are further shortcomings of this research. Still, Zhong and team conclude:

“The findings of this study appear to have critical public health implications given that dietary behaviors are modifiable, and most people consume these four food types on a daily or weekly basis.”

A new trial suggests that people who eat walnuts every day may have better gut health and a lower risk of heart disease.

Nuts can be a great source of nutrients and a very healthful “pick-me-up” snack.

Walnuts, in particular, are high in protein, fat, and they are also a source of calcium and iron.

Given walnuts’ nutritional potential, some researchers have been looking at whether these nuts might actually help prevent specific health issues.

In 2019, researchers from Pennsylvania State University in State College found that individuals who replaced saturated fats with walnuts — a source of unsaturated fats — experienced cardiovascular benefits, particularly improvements in blood pressure.

The investigators explain that walnuts contain alpha-linolenic acid, which is a type of omega-3 fatty acid that is present in plants.

Following up from that research, the team — which includes assistant research professor Kristina Petersen and Prof. Penny Kris-Etherton — have recently conducted another study to find out more about walnuts’ benefits to health.

The new study — whose findings appear in the Journal of Nutrition — suggests that incorporating walnuts into a healthful diet may benefit the gut and thus lead to better heart health.

“There’s a lot of work being done on gut health and how it affects overall health,” notes Prof. Kris-Etherton.

“So, in addition to looking at factors like lipids and lipoproteins, we wanted to look at gut health. We also wanted to see if changes in gut health with walnut consumption were related to improvements in risk factors for heart disease,” she says.

‘A small change to improve your diet’

The researchers conducted a randomized, controlled trial involving 42 participants with overweight or obesity aged 30–65.

They wanted to see if — and how — adding walnuts to a person’s diet might influence gut health.

To begin with, the research team asked the participants to follow a standard Western diet for 2 weeks.

Then, at the end of this period, the researchers randomly split the study participants into three groups. One group followed a diet that included whole walnuts, the second group ate a diet that included alpha-linolenic acid but in the same quantity that the walnuts would contain. The third group followed a walnut-free diet in which the researchers replaced alpha-linolenic acid with oleic acid.

The participants followed their assigned diet for 6 weeks and then switched diets until each person had followed all three eating plans.

The researchers collected fecal samples from all participants at the end of each diet regimen period. This allowed them to analyze any changes regarding the bacterial populations present in the gastrointestinal tract.

Prof. Kris-Etherton, Petersen, and their colleagues found that individuals who ate 3 ounces (oz) of walnuts as part of an otherwise healthful diet experienced improvements in heart health. The scientists say that these changes were likely mediated by improvements in gut health, as suggested by changes in gut bacteria.

“The walnut diet enriched a number of gut bacteria that have been associated with health benefits in the past,” explains Petersen.

“One of those is Roseburia, which has been associated with protection of the gut lining,” she adds. “We also saw enrichment in Eubacteria eligens and Butyricicoccus.”

The researchers explain that E. eligens has associations with a variety of different aspects of irregular blood pressure. They add that an increase in the population of this bacterium may thus suggest a lower cardiovascular risk.

They also note that an increase in Lachnospiraceae has links with lower blood pressure, total cholesterol, and “bad” cholesterol measurements.

The study did not find any significant associations between any changes in gut bacteria following the walnut-free diets and risk factors for heart disease.

“Replacing your usual snack — especially if it’s an unhealthful snack — with walnuts is a small change you can make to improve your diet,” notes Petersen.

“Substantial evidence shows that small improvements in diet greatly benefit health. Eating 2 to 3 oz of walnuts a day as part of a healthful diet could be a good way to improve gut health and reduce the risk of heart disease.”

– Kristina Petersen

Just how healthful are walnuts?

The authors of the current study explain that walnuts may bring different health benefits due to the variety of nutrients that they contain.

Co-author Regina Lamendella, who is an associate professor of Biology, emphasizes that “[f]oods like whole walnuts provide a diverse array of substrates — like fatty acids, fiber, and bioactive compounds — for our gut microbiomes to feed on.”

She continues, “this can help generate beneficial metabolites and other products for our bodies.”

Going forward, the research team wants to find out whether whole walnuts might influence other measurements that determine a person’s health, too.

“The study gives us clues that nuts may change gut health, and now we’re interested in expanding that and looking into how it may affect blood sugar levels,” says Prof. Kris-Etherton.

Yet, while nutritious and healthful, do walnuts really have a significant impact on our well-being? The researchers who conducted this study suggest they might.

However, they do disclose that their trial received some funding from the California Walnut Commission, which represents the walnut growers of California. As other research suggests, studies funded by stakeholders often raise issues about trust among the general public.

Other researchers have also concluded that walnuts are “optimal healthful foods.” There are few reports of health risks associated with walnuts for people who do not have a nut allergy or gastrointestinal problems.

For now, the research into how much of a difference walnuts can make for a person’s health continues.

Tap water may be the cause of one in 20 cases of bladder cancer in Europe each year, a major study suggests. Researchers have linked drinking, showering and bathing in the water to more than 6,500 cases of the disease in 26 countries across the continent.

They estimate 1,356 bladder cancer diagnoses in Britain since 2005 were caused by contaminated water, making up a fifth of all cases in the European Union (EU).

Long-term exposure to a group of chemicals called trihalomethanes (THMs) is thought to be the cause. The chemicals, shown to be carcinogenic in animal studies, are formed as an unintended byproduct when water is disinfected with chlorine at supply plants.

As well as being drunk, steam given off in the shower can allow tap water to seep into people’s pores, and so too can prolonged periods in the bath. Earlier research has found an association between THMs and bladder cancer, but this is the first to estimate the scale of the problem. Some 10,000 people are diagnosed with bladder cancer each year in the United Kingdom (UK), making it the tenth most common form of the disease.

The latest study estimates nine per cent of them are caused by exposure to water contaminated with THMs.The findings are published in the journal Environmental Health Perspectives. Scientists from the Barcelona Institute for Global Health (ISGlobal) set out to analyse the presence of the chemicals in drinking water in all 28 EU states between 2005 and 2018.

They did this by sending questionnaires to bodies responsible for the national water quality. Data was obtained for 26 countries – all except Bulgaria and Romania. The scientists probed levels of THMs in water at the tap, in the distribution network and at water treatment plants.

To make estimates as accurate as possible, the researchers also used other sources including open data online, reports and scientific literature. The findings revealed considerable differences between countries. Average THM levels were above legal levels in nine countries – Britain (24.2ug/l) , Spain, Portugal, Poland, Cyprus, Estonia, Hungary, Ireland and Italy.

The European Union has said the maximum limit is 11.7 micrograms per litre (ug/L). The European Union has said the maximum limit of THMs in water should be 11.7 micrograms per litre (ug/L). Researchers estimated the number of attributable bladder cancer cases using incidence rates and levels of THMs.

Analysis suggested Cyprus had highest percentage, with a quarter of diagnoses linked to the chemicals. Joint second-wort were Ireland and Malta, where one in six bladder cancer patients (17 per cent) are thought to have developed it from exposure to tap water.

Spain (11 per cent) and Greece (10 per cent) were not much better. At the opposite extreme was Denmark, where less than 0.1 per cent of cases were caused by THM water contamination. In Holland it was just 0.1 per cent of cases and Germany 0.2 per cent. THMs could be blamed for 0.4 per cent of cases in Austria and Lithuania. In total, the researchers estimated that 6,561 bladder cancer cases per year are attributable to THM exposure in the European Union.

The study authors say if the 13 countries with the highest averages were to reduce their THM levels to the EU average, 2,868 annual bladder cancer cases could be avoided.

Chloroform is the most infamous type of THM, which the World Health Organisation (WHO) describes as ‘probably carcinogenic to humans’.Co-study author Manolis Kogevinas, a researcher from ISGlobal, said: “Over the past 20 years, major efforts have been made to reduce trihalomethanes levels in several countries of the European Union, including Spain.

“However, the current levels in certain countries could still lead to considerable bladder cancer burden, which could be prevented by optimising water treatment, disinfection and distribution practices and other measures.”

A spokesperson for Britain’s Department for Environment, Food and Rural Affairs said: “This Government takes the safety of our drinking water extremely seriously, and have a robust monitoring regime in place which tests for a wide range of chemicals, including trihalomethanes, to ensure the public can have absolute faith in the water coming from their taps.

“The latest figures from 2018 found only four samples out of 11,900 exceeded the legal limits, and firm action was taken in each of these four cases.”

A study in September last year discovered 22 carcinogenic substances in water across the United States (U.S.).Despite the fact that most of the water systems they tested were within federal limits on each of these toxins, the scientists estimated that their cumulative effects could be dire over the course of Americans’ lifetimes.

Exposure to arsenic, products of disinfectant chemicals and traces of radioactive chemicals like uranium and radium had the most substantial effects on cancer risks. Over 1.7 million new cases of cancer are diagnosed in the US each year. In the same time period, over 600,000 people die of the disease.

Better prevention strategies, earlier detection and better treatments – like the immunotherapies that are revolutionizing the disease’s future – have driven cancer mortality down dramatically. Yet the disease’s elimination is no where in sight. In part, this is because its roots are many, and difficult to control.

Rather than being triggered by any one thing, genetics, what you eat, where you live, how you eat and, of course, the water you drink all play roles in raising or lowering cancer risks.

Some chemicals, like arsenic are nearly impossible to keep out of water in certain places. For example, in some areas of Illinois, the soil is rich in arsenic, a toxic, carcinogenic heavy metal, linked to liver and bladder cancers.

Arsenic seeps into the ground water, and winds up in our bodies. It also leaks into the water supply from many types of manufacturing plants.US water systems treat drinking water with chlorine – a non-carcinogenic cleaning chemical – in an attempt to reduce or eliminate the metal.

The medical term form dry mouth is “xerostomia.” Xerostomia can be an uncomfortable condition that can affect a person’s sense of taste and may increase their risk of developing dental cavities.

Some people may experience dry mouth at night. This may be due to natural variations in how much saliva the body makes, but certain medical conditions can also cause it.

This article outlines the various causes of dry mouth at night and their associated treatment options. It also provides a list of home remedies for dry mouth.

Causes of dry mouth at night

The following are some potential causes of dry mouth at night.

Natural variation in saliva production

According to an article in the journal Compendium, a person’s salivary glands typically produce less saliva at night. As a result, some people may notice that their mouths feel drier in the evening.

Treatment:

A doctor may prescribe special mouthwashes that can moisten the mouth and reduce sensations of dry mouth before bedtime.

People should also consider keeping a glass of water by their bedside. If a person wakes up with a dry mouth, drinking some water will help moisten the mouth.

Dehydration

According to the Oral Cancer Foundation, an estimated 20% of older adults struggle with dry mouth. In older adults, this condition usually occurs as a result of dehydration or as a side effect of certain medications.

Older adults who wear dentures may find that they no longer fit properly as a result of dry mouth. Without adequate saliva, dentures can rub against the gums, causing sore spots.

Treatment:

A person who experiences dry mouth should visit their doctor or dentist who will help determine the cause of the condition.

If dry mouth is due to the medications a person is taking, the doctor or dentist may recommend changing the dosage or switching to a different drug.

In some cases, people may receive medications to improve the function of the salivary glands.

Medication side effects

The U.S. Department of Health and Human Services state that more than 400 medicines can reduce the body’s ability to produce saliva. People who take their medications at nighttime may notice their dry mouth symptoms worsening at night.

Some medications that can cause dry mouth include:

  • blood pressure lowering drugs, or antihypertensives
  • antihistamines
  • antidepressants
  • diuretics
  • some medications used to control Parkinson’s disease
  • chemotherapy
  • radiation therapy

Treatment:

A person should see their doctor if they suspect that their medication is causing dry mouth. However, people should not stop taking their medications unless they have their doctor’s approval to do so.

A doctor may suggest lowering the dosage of the medication or taking the drug earlier in the day. Sometimes, a doctor may suggest changing to a different medicine that does not cause dry mouth.

The doctor may also recommend the following:

  • taking medications with plenty of water
  • sipping on water at nighttime
  • chewing on gum to encourage saliva production
  • using a humidifier to release moisture into the air and alleviate sensations of dry mouth

Mouth breathing

Some people wake up during the night and notice that they have an extremely dry mouth. This can be a sign that they have been breathing through their mouth while asleep. Some possible causes of this behavior include:

  • a narrowing or blockage of the nasal passages
  • an acute illness, such as an upper respiratory infection or a cold
  • allergies
  • obstructive sleep apnea, which may result in repeated gasping, snorting, or snoring episodes

Treatment:

The treatment for nighttime mouth breathing depends on the underlying cause. We outline the potential causes and their associated treatment options below.

Infections

Antibiotics can help to treat a bacterial infection, while decongestants may help to alleviate any associated sinus congestion.

Allergies

Antihistamines can help to treat allergies, while corticosteroids may also help to relieve any associated nasal inflammation and stuffiness.

Sleep apnea

People who experience sleep apnea may require a continuous positive airway pressure (CPAP) device. The CPAP is a mask that fits over the mouth or nose and blows air into the airways to keep them open during sleep.

Although the treatment is effective against sleep apnea, the constant stream of air can actually worsen symptoms of a dry mouth. A person should talk to their doctor or dentist who can adjust the mask or recommend a machine that does not dry out the mouth.

Narrowed nasal passages

In some cases, people who have severe difficulty breathing through their nose may require surgery to widen the nasal passages. This will help to promote airflow through the nasal passages, preventing the need for mouth breathing.

Sjogren’s syndrome

Sjogren’s syndrome is an autoimmune disorder in which the body attacks its tear glands and saliva-producing glands. As a result, a person who has Sjogren’s syndrome will typically experience sensations of dry mouth. This symptom may worsen at nighttime when the salivary glands naturally produce less saliva.

People with Sjogren’s syndrome may experience the following symptoms as a result of dry mouth:

  • difficulty swallowing food without a drink
  • pain in the mouth
  • speech problems at night

They may also experience dryness in their eyes, nose, throat, or vagina.

Treatment:

Doctors may prescribe medications to reduce dry mouth and encourage saliva production. Examples include pilocarpine (Salagen) and cevimeline (Evoxac).

A doctor will also encourage people with Sjogren’s syndrome to drink water frequently, and chew sugar-free gum to stimulate saliva production.

Home remedies for dry mouth

Regardless of the underlying cause of dry mouth at night, the following home remedies can help reduce sensations of dry mouth:

  • avoiding caffeinated drinks at night
  • avoiding smoking and use of tobacco products, which can dry out the mouth
  • chewing sugarless gum or sucking sugar-free lozenges or hard candies to stimulate saliva production.
  • sipping cool water frequently throughout the day

To reduce the risk of dental cavities associated with dry mouth, people should maintain good oral hygiene. This involves flossing daily and brushing the teeth twice a day using fluoride toothpaste.

People who have a very dry mouth may require more frequent dental check-ups. This is to ensure that they have not developed cavities.

When to see a doctor

Dry mouth at night is rarely a medical emergency. However, in some cases, it may indicate a need for medical treatment.

People should see a doctor if they experience any of the following:

  • dry mouth that is affecting their sleep at night
  • dry mouth that causes pain and discomfort
  • increased incidence of dental cavities without any change in dental routine

Summary

Dry mouth at night can occur as a result of a normal nighttime decrease in saliva production.

However, dry mouth at night can also be a symptom of an acute illness or an underlying medical condition.

People should see a doctor if their dry mouth causes pain or discomfort or affects their sleep and overall sense of well-being. A doctor will work to diagnose the cause of dry mouth and will recommend appropriate treatments.

Anxiety commonly causes a change in appetite. Some people with anxiety tend to overeat or consume a lot of unhealthful foods. Others, however, lose their desire to eat when they feel stressed and anxious.

Anxiety is a mental health condition that affects 40 million adults in the United States each year. Changes in appetite are one of many possible symptoms.

Keep reading to learn more about the link between anxiety and a loss of appetite, some potential remedies and treatments for the problem, and some other common causes of appetite loss.

Anxiety and appetite loss

When someone starts to feel stressed or anxious, their body begins to release stress hormones. These hormones activate the sympathetic nervous system and trigger the body’s fight-or-flight response.

The fight-or-flight response is an instinctive reaction that attempts to keep people safe from potential threats. It physically prepares the body to either stay and fight a threat or run away to safety.

This sudden surge of stress hormones has several physical effects. For example, research suggests that one of the hormones — corticotropin-releasing factor (CRF) — affects the digestive system and may lead to the suppression of appetite.

Another hormone, cortisol, increases gastric acid secretion to speed the digestion of food so that the person can fight or flee more efficiently.

Other digestive effects of the fight-or-flight response can include:

  • constipation
  • diarrhea
  • indigestion
  • nausea

This response can cause additional physical symptoms, such as an increase in breathing rate, heart rate, and blood pressure. It also causes muscle tension, pale or flushed skin, and shakiness.

Some of these physical symptoms can be so uncomfortable that people have no desire to eat. Feeling constipated, for example, can make the thought of eating seem very unappetizing.

Overeating vs. appetite loss

People who have persistent anxiety or an anxiety disorder are more likely to have long-term heightened levels of CRF hormones in their system. As a result, these individuals may be more likely to experience a prolonged loss of appetite.

On the other hand, people who experience anxiety less frequently may be more likely to seek comfort from food and overeat. However, everyone reacts differently to anxiety and stress, whether it is chronic or short-term.

In fact, the same person may react differently to mild anxiety and high anxiety. Mild stress may, for example, cause a person to overeat. If that person experiences severe anxiety, however, they may lose their appetite. Another person may respond in the opposite way.

Men and women may also react differently to anxiety in terms of their food choices and consumption.

One study indicates that women may eat more calories when anxious. The study also links higher anxiety with a higher body mass index (BMI) in women but not in men.

Remedies and treatment

Individuals who experience a loss of appetite due to anxiety should take steps to address the issue. Long-term appetite loss can lead to health problems. Potential remedies and treatments include:

1. Understanding anxiety

Simply realizing that sources of stress can trigger physical sensations can go some way toward reducing anxiety and its symptoms.

2. Addressing sources of anxiety

Identifying and dealing with anxiety triggers can sometimes help people regain their appetite. Where possible, individuals should work to eliminate or reduce stressors.

If this proves challenging, a person may wish to consider working with a therapist who can help them manage anxiety triggers.

3. Practicing stress management

Several techniques can effectively reduce or control anxiety symptoms, including appetite loss. Examples include:

  • deep breathing exercises
  • guided imagery practice
  • meditation
  • mindfulness
  • progressive muscle relaxation

4. Choosing nutritious, easily digestible foods

If people cannot eat much, they should ensure that what they do eat is nutrient-rich. Some good choices include:

  • soups containing a protein source and a variety of vegetables
  • meal-replacement shakes
  • smoothies containing fruits, green leafy vegetables, fat, and protein

It is also a good idea to opt for easily digestible foods that will not further upset the digestive system. Examples include rice, white potato, steamed vegetables, and lean proteins.

People with symptoms of anxiety may also find it beneficial to avoid foods that are high in fat, salt, or sugar, as well as high-fiber foods, which can be difficult to digest.

It can also help to limit the consumption of drinks containing caffeine and alcohol, as these often cause digestive problems.

5. Eating regularly

Getting into a regular eating pattern can help the body and brain regulate hunger cues.

Even if someone can only manage a few bites at each mealtime, this will be better than nothing. Over time, they can increase the amount that they eat at each sitting.

6. Making other healthful lifestyle choices

When a person is anxious, they may find it difficult to exercise or sleep. However, both sleep and physical activity can reduce anxiety and increase appetite.

Individuals should try to get enough sleep each night by setting a regular sleep schedule.

They should also aim to exercise most days. Even short bursts of gentle exercise can be helpful. People who are new to exercise can start small and increase the duration and intensity of activities over time.

When to see a doctor

People should see a doctor if their appetite loss persists for 2 weeks or more, or if they lose weight rapidly. A doctor can check for an underlying physical condition that may be causing symptoms.

If the loss of appetite is purely a result of stress, a doctor can suggest ways to manage the anxiety, including therapy and lifestyle changes.

They may also prescribe medication to those with chronic or severe anxiety.

Other causes of appetite loss

Anxiety is not the only cause of appetite loss. Other possible causes include:

  • Depression: As with anxiety, feeling depressed can cause a loss of appetite in some people but lead others to overeat.
  • Gastroenteritis: Also known as a stomach bug, gastroenteritis can cause vomiting, diarrhea, and loss of appetite.
  • Medication: Some medications, including antibiotics and certain pain relievers, can reduce appetite. They can also cause side effects that include diarrhea or constipation.
  • Intense exercise: Some people, especially endurance athletes, experience gastrointestinal symptoms such as nausea, vomiting, and intestinal cramping after periods of intense activity, which may result in a loss of appetite.
  • Pregnancy: Some pregnant women may lose their appetite due to morning sickness or because of pressure on the stomach.
  • Illness: Certain medical conditions, such as diabetes or cancer, can lead to a reduction in appetite.
  • Aging: Appetite loss is common among older adults, possibly due to a loss of taste and smell or because of illness or medication use.

Summary

Anxiety can cause a loss of appetite or an increase in appetite. These effects are primarily due to hormonal changes in the body, but some people may also avoid eating as a result of the physical sensations of anxiety.

Individuals who experience chronic or severe anxiety should see their doctor.

Sometimes, there may be other reasons for appetite loss that also require treatment.

Once a person addresses the anxiety, their appetite will typically return. Without treatment, long-term appetite loss and chronic anxiety can have serious health consequences.

Previous research has suggested that there is a link between depression and tea drinking. Now, a new study is investigating this relationship further.

Depression is common among older adults, with 7% of those over the age of 60 years reporting “major depressive disorder.”

Accordingly, research is underway to identify possible causes, which include genetic predisposition, socioeconomic status, and relationships with family, living partners, and the community at large.

A study by researchers from the National University of Singapore (NUS) and Fudan University in Shanghai raises another possibility. It finds a statistically significant link between regular tea drinking and lower levels of depression in seniors.

While the researchers have not yet established a causal relationship between tea and mental health, their findings — which appear in BMC Geriatrics — show a strong association.

Reading the tea leaves

Tea is popular among older adults, and various researchers have recently been investigating the potential beneficial effects of the beverage.

A separate study from the NUS that appeared in Aging last June, for example, found that tea may have properties that help brain areas maintain healthy cognitive function.

“Our study offers the first evidence of the positive contribution of tea drinking to brain structure and suggests a protective effect on age-related decline in brain organization.”

Junhua Li, lead author

That earlier paper also cites research showing that tea and its ingredients — catechin, L-theanine, and caffeine — can produce positive effects on mood, cognitive ability, cardiovascular health, cancer prevention, and mortality.

However, defining the exact role of tea in preventing depression is difficult, especially due to the social context in which people often consume it. Particularly in countries such as China, social interaction may itself account for some or even all of the drink’s benefits.

Feng Qiushi and Shen Ke led the new study, which tracks this covariate and others, including gender, education, and residence, as well as marital and pension status.

The team also factored in lifestyle habits and health details, including smoking, drinking alcohol, daily activities, level of cognitive function, and degree of social engagement.

In addition, the authors write, “The study has major methodological strength,” citing a few of its attributes.

Firstly, they note, it could more accurately track an individual’s tea-drinking history because “instead of examining tea-drinking habit [only] at the time of survey or in the preceding month/year, we combined the information on frequency and consistency of tea consumption at age 60 and at the time of assessment.”

Once the researchers had classified each person as one of four types of tea drinker according to how often they drank the beverage, they concluded:

“[O]nly consistent daily drinkers, those who had drunk tea almost every day since age 60, could significantly benefit in mental health.”

13,000 study participants

The researchers analyzed the data of 13,000 individuals who took part in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 2005 and 2014.

They discovered a virtually universal link between tea drinking and lower reports of depression.

Other factors seemed to reduce depression as well, including living in an urban setting and being educated, married, financially comfortable, in better health, and socially engaged.

The data also suggested that the benefits of tea drinking are strongest for males aged 65 to 79 years. Feng Qiushi suggests an explanation: “It is likely that the benefit of tea drinking is more evident for the early stage of health deterioration. More studies are surely needed in regard to this issue.”

Looking at the connection the other way around, tea drinkers appeared to share certain characteristics.

Higher proportions of tea drinkers were older, male, and urban residents. In addition, they were more likely to be educated, married, and receiving pensions.

Tea drinkers also exhibited higher cognitive and physical function and were more socially involved. On the other hand, they were also more likely to drink alcohol and smoke.

Qiushi previously published the results of the effect of tea drinking on a different population, Singaporeans, finding a similar link to lower rates of depression. The new study, while more detailed, supports this earlier work.

Currently exploring new CLHLS data regarding tea drinking, Qiushi wishes to understand more about what tea can do, saying, “This new round of data collection has distinguished different types of tea, such as green tea, black tea, and oolong tea so that we could see which type of tea really works for alleviating depressive symptoms.”

Adnexal masses are lumps that occur in the adnexa of the uterus, which includes the uterus, ovaries, and fallopian tubes. They have several possible causes, which can be gynecological or nongynecological.

An adnexal mass could be:

  • an ovarian cyst
  • an ectopic pregnancy
  • a benign tumor
  • a malignant tumor

A family doctor can usually manage benign masses. However, prepubescent and postmenopausal individuals will need to see a gynecologist or oncologist.

Malignant adnexal masses require treatment from a specialist.

In this article, we discuss the characteristics of adnexal masses. We also review how doctors diagnose and treat adnexal them.

Symptoms

People report different symptoms, depending on the cause of the adnexal mass.

People with an adnexal mass may report:

  • severe lower abdominal or pelvic pain that is usually on one side
  • abnormal bleeding from the uterus
  • pain during sexual intercourse
  • worsening pain during a period
  • painful periods
  • abnormally heavy bleeding during periods
  • abdominal symptoms, including a feeling of fullness, bloating, constipation, difficulty eating, increased abdominal size, indigestion, nausea, and vomiting
  • urinary urgency, frequency, or incontinence
  • weight loss
  • lack of energy
  • fatigue
  • fever
  • vaginal discharge

Different causes of adnexal masses may have similar symptoms, so doctors usually conduct further investigations to determine the exact cause.

Once the doctor has worked out the cause of the adnexal mass, they can recommend treatment and management.

Causes

Adnexal masses include a variety of different conditions that range in severity from benign growths to malignant tumors.

The cause of adnexal masses could be gynecological or nongynecological.

Some of the causes of adnexal masses include:

  • Ectopic pregnancy: A pregnancy where the fertilized egg implants somewhere outside the uterus.
  • Endometrioma: A benign cyst on the ovary that contains thick, old blood that appears brown.
  • Leiomyoma: A benign gynecological tumor, also known as a fibroid.
  • Ovarian cancer: These tumors of the ovary may be ovarian epithelial cancers that begin in the cells on the surface of the ovary or malignant germ cell cancers that begin in the eggs.
  • Pelvic inflammatory disease: Inflammation of the upper genital tract, which includes the uterus, fallopian tubes, and ovaries. It occurs due to an infection.
  • Tubo-ovarian abscess: An infectious adnexal mass that forms because of pelvic inflammatory disease.
  • Ovarian torsion: A gynecological emergency involving a complete or partial rotation of the tissue that supports the ovary, which cuts off blood flow to the ovary.

Diagnosis

A doctor may diagnose an adnexal mass by:

  • taking a complete medical history
  • asking questions about symptoms
  • conducting a physical examination
  • obtaining blood samples

Most of the time, people will need a transvaginal ultrasound to allow doctors to evaluate the characteristics of an adnexal mass.

Females who have had a positive pregnancy test result and report abdominal or pelvic pain and vaginal bleeding might have an ectopic pregnancy. An ovarian torsion causes sudden, severe pain with nausea and vomiting. Immediate medical attention is necessary to treat both an ectopic pregnancy and ovarian torsion.

People with pelvic inflammatory disease or a tubo-ovarian abscess may experience gradual pelvic pain with nausea and vaginal bleeding.

Early ovarian cancer may sometimes present with nonspecific symptoms. Sometimes, doctors may only detect cancer when the tumor has become malignant.

Malignant tumors may have one or several of the following characteristics:

  • a solid component of the tumor
  • parts of the tumor have thick divisions larger than 2–3 centimeters separating them
  • they are present on both sides of the reproductive tract
  • the presence of fluid filled lumps

Treatment

A doctor will choose the most appropriate treatment depending on the cause of the adnexal mass. Women with an ectopic pregnancy will have to end their pregnancy. A doctor may choose one of the following procedures:

  • the administration of a single or two-dose intramuscular methotrexate
  • laparoscopic surgery
  • a salpingostomy or salpingectomy, which are surgical procedures involving the fallopian tubes

Doctors have not yet determined the optimal management of an endometrioma, according to a study that featured in Obstetrical & Gynecological Survey.

Currently, the possible treatments for an endometrioma include:

  • watchful waiting
  • medical therapy
  • surgical intervention
  • inducing ovulation and using assisted reproductive technology in females with infertility

People with pelvic inflammatory disease will require courses of intravenous antibiotics, which may include:

  • cefotetan (Cefotan)
  • cefoxitin (Mefoxin)
  • clindamycin (Cleocin)

Some people can receive treatment outside of the hospital setting with oral doxycycline (Vibramycin) and intramuscular ceftriaxone (Rocephin) or another third generation cephalosporin antibiotic. In some cases, doctors will need to add oral metronidazole (Flagyl).

In the past, tubo-ovarian abscesses required surgical removal of the uterus, ovaries, and fallopian tubes. However, doctors can now prescribe broad-spectrum antibiotics. A person with a ruptured tubo-ovarian abscess may still require surgery.

Ovarian torsion is a gynecological emergency. The only treatment is surgery to prevent severe damage to the ovaries and fallopian tubes.

People with leiomyomas or fibroids may receive hormonal treatments or nonsteroidal anti-inflammatory drugs to control the symptoms. Once a person stops taking medication, the symptoms may return, and the fibroids may continue to grow. Surgery is the most successful treatment for fibroids.

The treatment options for ovarian cancer include surgery, chemotherapy, and targeted therapy. Oncologists will consider the following factors before recommending a treatment plan:

  • the type of ovarian cancer and how much cancer is present
  • the stage and grade of the cancer
  • whether the person has a buildup of fluid in the abdomen causing swelling
  • whether surgery can remove the whole tumor
  • genetic changes
  • the person’s age and general health status
  • whether it is a new diagnosis, or if cancer has come back

Risk factors

Risk factors depend on the cause of the adnexal mass. Females with ovarian masses have an increased risk of developing ovarian torsion. More than 80% of females with ovarian torsion have masses of 5 cm or larger.

Doctors diagnose fibroids in about 70% of white females and more than 80% of black females by the age of 50 years. Other factors may increase a person’s risk of developing fibroids, such as:

  • starting periods early in life
  • using oral contraceptives before 16 years of age
  • an increase in body mass index (BMI)

Ovarian cancer can run in families. People with a family history of ovarian cancer may have an increased risk of developing ovarian cancer. Other risk factors include:

  • inherited genetic changes
  • hereditary nonpolyposis colorectal cancer
  • endometriosis
  • postmenopausal hormonal therapy
  • obesity
  • tall height

The likelihood of developing cancer also tends to increase with age.

Summary

Adnexal masses are lumps that doctors may find in the adnexal of the uterus, which is the part of the body that houses the uterus, ovaries, and fallopian tubes. Not all masses are cancerous, and they do not all require treatment.

Different types of adnexal mass can share many of the same symptoms. As a result, doctors need to collect a full medical history and data from physical examinations, blood tests, and medical imaging, including transvaginal ultrasounds.

Doctors need to pinpoint the location and cause of an adnexal mass to determine the appropriate management and treatment.

New research in pigs finds that sugar intake alters the reward-processing circuitry of the brain in a similar way to addictive drugs.

Whenever we learn something new or experience something pleasurable, our brain’s reward system becomes activated. With the help of natural brain chemicals, several brain areas communicate with each other to help us learn and repeat behaviors that improve our knowledge and well-being.

Relying heavily on the neurotransmitter dopamine, the reward system helps explain several quintessential human experiences, such as falling in love, sexual pleasure, and enjoying time with friends.

However, certain substances, such as drugs, hijack the brain’s reward system, “artificially” activating it. Telling the brain to repeat pleasure-seeking behavior constantly is the mechanism behind addiction.

But is sugar such a substance? And if so, does it help explain sugary food cravings?

A United States scientist named Theron Randolph coined the term “food addiction” in the 1950s to describe the compulsive consumption of certain foods, such as milk, eggs, and potatoes.

Since then, the studies exploring this concept have yielded mixed results, and some experts argue that speaking of food addiction is a bit of a stretch.

New research helps shed some light on the matter, as Michael Winterdahl, associate professor at the Department of Clinical Medicine at Aarhus University in Denmark, and his colleagues examined the effect of sugar intake on the reward circuitry in the brains of pigs.

The researchers published their findings in the journal Scientific Reports.

‘Major changes’ after 12 days

The scientists analyzed the effects of sugar intake on seven female Göttingen minipigs, using complex PET imaging techniques with opioid receptor agonists and dopamine receptor antagonists to examine the animals’ brain reward systems.

The team gave the minipigs access to a sucrose solution for 1 hour on 12 consecutive days and then retook the scans 24 hours after the last sugar dose.

In a subgroup of five minipigs, the team applied an additional PET scanning session after the first exposure to sugar.

“After just 12 days of sugar intake, we could see major changes in the brain’s dopamine and opioid systems,” reports Winterdahl.

“In fact, the opioid system, which is that part of the brain’s chemistry that is associated with well-being and pleasure, was already activated after the very first intake,” adds the study’s lead author.

Specifically, there were alterations in the “striatum, nucleus accumbens, thalamus, amygdala, cingulate cortex, and prefrontal cortex” after the sugar intake.

Why sugar may be addictive after all

The findings, conclude the researchers, imply that “foods high in sucrose influence brain reward circuitry in ways similar to those observed when addictive drugs are consumed.”

The lead researcher explains that the findings contradicted his initial expectations. “There is no doubt that sugar has several physiological effects, and there are many reasons why it is not healthy.”

“But I have been in doubt of the effects sugar has on our brain and behavior, [and] I had hoped to be able to kill a myth.” He continues by emphasizing the addictive aspects of sugar intake.

“If sugar can change the brain’s reward system after only 12 days, as we saw in the case of the pigs, you can imagine that natural stimuli, such as learning or social interaction, are pushed into the background and replaced by sugar and/or other ‘artificial’ stimuli.”

Michael Winterdahl

“We’re all looking for the rush from dopamine, and if something gives us a better or bigger kick, then that’s what we choose,” he explains.

Are pig models relevant?

The researchers also explain their choice of minipigs as a model in which to study the effects of sugar on the brain.

They say that previous studies have used rats, but even if these rodents do have a penchant for sugar, their homeostatic mechanisms — which help regulate weight gain and metabolism — “differ significantly from those of humans.”

“It would, of course, be ideal if the studies could be done in humans themselves, but humans are hard to control, and dopamine levels can be modulated by a number of different factors,” explains Winterdahl.

“They are influenced by what we eat, whether we play games on our phones, or if we enter a new romantic relationship in the middle of the trial, with potential for great variation in the data.”

“The pig is a good alternative because its brain is more complex than a rodent and […] large enough for imaging deep brain structures using human brain scanners.”