Surprising Dangers of Elevated Uric Acid

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Elevated levels of uric acid are associated with gout, an excruciating form of arthritis.

More recent evidence demonstrates powerful correlations between high uric acid levels and some of the most deadly conditions of our time, including metabolic syndrome, diabetes, kidney failure, and cardiovascular disorders.1-5

In 2016-2017, a group of studies appeared linking uric acid elevations to bipolar disorder.6-9

Many people don’t realize that it is possible to have high uric acid without having gout. About 21% of Americans have elevated levels of uric acid (hyperuricemia), but only 4% suffer from gout.10

A 2016 study highlighted a natural plant extract, called Terminalia bellerica, that can effectively lower uric acid blood levels without the side effects associated with prescription drugs.11

Let’s look at how lowering uric acid blood levels is an important step not only in addressing gout, but also in helping prevent life-shortening diseases.11

Terminalia Bellerica Lowers Uric Acid

Terminalia bellerica is a tree native to lower elevations in Southeast Asia, whose fruit has been used for centuries in Indian traditional medicine to treat a variety of diseases, particularly diabetes.12

In 2011, a component of the T. bellerica fruit rind, gallic acid, was shown to promote antidiabetic activity in a study of diabetic rats.12 In that study, the extract lowered blood sugar levels, and, in a surprising finding, the animals’ pancreases showed regeneration of their insulin-producing islet cells.

Additional beneficial effects noted in that study included reductions in serum total cholesterol, triglycerides, LDL, urea, creatinine (a measure of kidney dysfunction when elevated)—and also uric acid.12

Other studies have shown that T. bellerica has protective properties against oxidative stress, which in turn are thought to directly inhibit the action of an enzyme involved in the synthesis of uric acid.11,13

Human Studies

These findings in diabetic rats led a group of Indian researchers to perform a randomized, controlled clinical trial to determine the efficacy and tolerability of a standardized extract of T. bellerica at lowering uric acid levels in humans.11

For the study, 110 people with elevated uric acid received one of the following: a placebo, 40 mg daily of the uric-acid lowering drug febuxostat, 500 mg of T. chebula extract twice daily, or either 250 mg or 500 mg of T. bellerica standardized extracts twice daily.

After 24 weeks, the uric acid levels in the placebo recipients had risen significantly compared to baseline levels. In contrast, all non-placebo groups showed a reduction in uric acid levels compared to baseline and to placebo subjects.11

The most effective dose of T. bellerica was at 500 mg twice daily, which reduced uric acid levels by nearly twice as much as the lower dose.

And while the T. bellerica treatment was only about 60% as effective as the prescription drug febuxostat at reducing uric acid levels, it achieved these results without the side effects associated with this drug,11 which include liver function abnormalities, rash, nausea, and joint pain.14

Because the other common uric acid-lowering drug, allopurinol, also carries a wide range of side effects—including a potentially life-threatening hypersensitivity syndrome15T. bellerica supplementation offers a leap forward in safely lowering high uric acid levels while reducing risks of the conditions associated with them.

WHAT YOU NEED TO KNOW

The Dangers of High Uric Acid

  • Uric acid, a byproduct of normal cell growth and turnover, builds up in our bloodstreams as we age, and is exacerbated by the modern American diet.

  • While initially associated with gout, rising uric acid levels are now associated with many dangerous, lifespan-shortening conditions including cardiovascular and kidney disease, diabetes, and metabolic syndrome.

  • While all of these conditions are proving challenging to treat using modern mainstream medicine, most are proving amenable to prevention with natural compounds.

  • Terminalia bellerica is an Asian tree whose fruit contains valuable bioactive compounds long used in Indian traditional medicine.

  • Extracts of T. bellerica have now been shown to safely and effectively reduce uric acid in humans.

  • Given the anticipated benefits of across-the-board uric acid reduction, these findings make T. bellerica extracts an essential part of any disease-preventing strategy.

Why is it Important to Lower Uric Acid Levels?

Our bodies naturally produce uric acid when we break down and recycle the molecules that constitute DNA and RNA. An enzyme called xanthine oxidase is responsible for conversion of those compounds into uric acid, which is then normally excreted in the urine.

But age-related declines in kidney function lead to impaired excretion and gradual buildup of uric acid in the blood, accounting for the elevated serum uric acid levels in up to 25% of adults.16

Making matters worse, a diet rich in red meats and sugars, especially fructose—in other words, the typical American diet—can sharply increase uric acid production, further exacerbating the problem.17,18 In fact, gout has historically been called “the disease of kings” because of its association with rich diets.19

While gout was the original disorder associated with high uric acid, more recent evidence reveals that it is associated with conditions that are far worse.

Uric acid blood levels above 8.6 mg/dL in men or 7.1 mg/dL in women are classified as hyperuricemia (although some laboratories and research groups use different limits).20,21 High uric acid levels have now been found to be significantly associated with risks for:

  • Decreasing kidney function22
  • Chronic low-level inflammation, itself a major risk factor for many chronic disorders23
  • Metabolic syndrome18,24,25
  • Type II diabetes26-28
  • A wide array of cardiovascular risks, including elevated blood pressure, heart arrhythmias, and risk of death from heart attacks and strokes.1,29-35

TABLE: Risk Elevations Associated with High Uric Acid Levels

Condition Risk Increase With Elevated Uric Acid
Kidney failure 7% per 1 mg/dL increase22
Chronic inflammation as measured by hs-CRP 52%23
Metabolic syndrome 410%25
Diabetes 18% per 1 mg/dL increase26
Unstable lipid-rich arterial plaques 143%36
Prehypertension 44%34
Atrial fibrillation (cardiac arrhythmia) 67%35
Heart muscle enlargement 96% in highest vs. lowest uric acid levels;
26% increase per 1 mg/dL elevation of uric acid31
In-Hospital death from heart attack 432%32
Major adverse cardiac event (death,
congestive heart failure, repeat heart attack, stroke)
184%33

 

The Table above shows elevations in risks associated with high uric acid levels in blood.

If recent findings are any indication, these conditions may represent only the tip of the uric acid iceberg.

For example, in 2016 and 2017, a group of Italian researchers published several papers demonstrating that elevated uric acid levels play a role in bipolar disorder,6-8 while a 2015 study related high uric acid with depression in adolescents.37

Several drugs can be effective for many cases of major depression. Yet very few drugs are helpful with bipolar disorder, a condition that’s possibly even more heartbreaking than depression.

Together, the evidence that uric acid plays a major role in so many human disorders presents an opportunity for intervention with a safe, effective, plant extract, T. bellerica.

Summary

Levels of uric acid rise with age, exacerbated by declining kidney function and our meat- and sugar-rich diets.

Formerly associated mostly with painful gout, we now know that uric acid elevations threaten millions more people with elevated risks for kidney disease, diabetes, metabolic syndrome, and a wide range of cardiovascular disorders.

Exciting research has revealed the potent uric acid-lowering effect of extracts from the fruits of the Terminalia bellerica tree, a South Asian shade tree long used in traditional medicine.

These findings suggest one more natural way to combat the risks of so many age-related disorders—and they make T. bellerica an important weapon in our arsenal against premature aging and death.

 

References

  1. Jin M, Yang F, Yang I, et al. Uric acid, hyperuricemia and vascular diseases. Front Biosci (Landmark Ed). 2012;17:656-69.
  2. Ford ES, Li C, Cook S, et al. Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents. Circulation. 2007;115(19):2526-32.
  3. Lehto S, Niskanen L, Ronnemaa T, et al. Serum uric acid is a strong predictor of stroke in patients with non-insulin-dependent diabetes mellitus. Stroke. 1998;29(3):635-9.
  4. Schretlen DJ, Inscore AB, Vannorsdall TD, et al. Serum uric acid and brain ischemia in normal elderly adults. Neurology. 2007;69(14):1418-23.
  5. Siu YP, Leung KT, Tong MK, et al. Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level. Am J Kidney Dis. 2006;47(1):51-9.
  6. Bartoli F, Crocamo C, Dakanalis A, et al. Purinergic system dysfunctions in subjects with bipolar disorder: A comparative cross-sectional study. Compr Psychiatry. 2017;73:1-6.
  7. Bartoli F, Crocamo C, Gennaro GM, et al. Exploring the association between bipolar disorder and uric acid: A mediation analysis. J Psychosom Res. 2016;84:56-9.
  8. Bartoli F, Crocamo C, Mazza MG, et al. Uric acid levels in subjects with bipolar disorder: A comparative meta-analysis. J Psychiatr Res. 2016;81:133-9.
  9. Machado-Vieira R, Salem H, Frey BN, et al. Convergent lines of evidence support the role of uric acid levels as a potential biomarker in bipolar disorder. Expert Rev Mol Diagn. 2017;17(2): 107-8.
  10. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136-41.
  11. Usharani P, Nutalapati C, Pokuri VK, et al. A randomized, double-blind, placebo-, and positive-controlled clinical pilot study to evaluate the efficacy and tolerability of standardized aqueous extracts of Terminalia chebula and Terminalia bellerica in subjects with hyperuricemia. Clin Pharmacol. 2016;8:51-9.
  12. Latha RC, Daisy P. Insulin-secretagogue, antihyperlipidemic and other protective effects of gallic acid isolated from Terminalia bellerica Roxb. in streptozotocin-induced diabetic rats. Chem Biol Interact. 2011;189(1-2):112-8.
  13. Hazra B, Sarkar R, Biswas S, et al. Comparative study of the antioxidant and reactive oxygen species scavenging properties in the extracts of the fruits of Terminalia chebula, Terminalia belerica and Emblica officinalis. BMC Complement Altern Med. 2010;10:20.
  14. Love BL, Barrons R, Veverka A, et al. Urate-lowering therapy for gout: focus on febuxostat. Pharmacotherapy. 2010;30(6):594-608.
  15. Lupton GP, Odom RB. The allopurinol hypersensitivity syndrome. J Am Acad Dermatol. 1979;1(4):365-74.
  16. Vitart V, Rudan I, Hayward C, et al. SLC2A9 is a newly identified urate transporter influencing serum urate concentration, urate excretion and gout. Nat Genet. 2008;40(4):437-42.
  17. Angelopoulos TJ, Lowndes J, Zukley L, et al. The effect of high-fructose corn syrup consumption on triglycerides and uric acid. J Nutr. 2009;139(6):1242S-5S.
  18. Cirillo P, Sato W, Reungjui S, et al. Uric acid, the metabolic syndrome, and renal disease. J Am Soc Nephrol. 2006;17(12 Suppl 3):S165-8.
  19. Giuffra V, Minozzi S, Vitiello A, et al. On the history of gout: paleopathological evidence from the Medici family of Florence. Clin Exp Rheumatol. 2017;35(2):321-6.
  20. Schlesinger N, Norquist JM, Watson DJ. Serum urate during acute gout. J Rheumatol. 2009;36(6):1287-9.
  21. Sun SZ, Flickinger BD, Williamson-Hughes PS, et al. Lack of association between dietary fructose and hyperuricemia risk in adults. Nutr Metab (Lond). 2010;7:16.
  22. Tsai CW, Lin SY, Kuo CC, et al. Serum Uric Acid and Progression of Kidney Disease: A Longitudinal Analysis and Mini-Review. PLoS One. 2017;12(1):e0170393.
  23. Raeisi A, Ostovar A, Vahdat K, et al. Association of serum uric acid with high-sensitivity C-reactive protein in postmenopausal women. Climacteric. 2017;20(1):44-8.
  24. Choi H, Kim HC, Song BM, et al. Serum uric acid concentration and metabolic syndrome among elderly Koreans: The Korean Urban Rural Elderly (KURE) study. Arch Gerontol Geriatr. 2016;64:51-8.
  25. Rubio-Guerra AF, Morales-Lopez H, Garro-Almendaro AK, et al. Circulating Levels of Uric Acid and Risk for Metabolic Syndrome. Curr Diabetes Rev. 2017;13(1):87-90.
  26. Juraschek SP, McAdams-Demarco M, Miller ER, et al. Temporal relationship between uric acid concentration and risk of diabetes in a community-based study population. Am J Epidemiol. 2014;179(6):684-91.
  27. Moleda P, Fronczyk A, Safranow K, et al. Is Uric Acid a Missing Link between Previous Gestational Diabetes Mellitus and the Development of Type 2 Diabetes at a Later Time of Life? PLoS One. 2016;11(5):e0154921.
  28. Sun HL, Pei D, Lue KH, et al. Uric Acid Levels Can Predict Metabolic Syndrome and Hypertension in Adolescents: A 10-Year Longitudinal Study. PLoS One. 2015;10(11):e0143786.
  29. Clarson LE, Hider SL, Belcher J, et al. Increased risk of vascular disease associated with gout: a retrospective, matched cohort study in the UK clinical practice research datalink. Ann Rheum Dis. 2015;74(4):642-7.
  30. Singh JA. When gout goes to the heart: does gout equal a cardiovascular disease risk factor? Ann Rheum Dis. 2015;74(4):631-4.
  31. Cuspidi C, Facchetti R, Bombelli M, et al. Uric Acid and New Onset Left Ventricular Hypertrophy: Findings From the PAMELA Population. Am J Hypertens. 2017.
  32. Gazi E, Temiz A, Altun B, et al. The association between serum uric acid level and heart failure and mortality in the early period of ST-elevation acute myocardial infarction. Turk Kardiyol Dern Ars. 2014;42(6):501-8.
  33. Kawabe M, Sato A, Hoshi T, et al. Gender differences in the association between serum uric acid and prognosis in patients with acute coronary syndrome. J Cardiol. 2016;67(2):170-6.
  34. Lotufo PA, Baena CP, Santos IS, et al. Serum Uric Acid and Prehypertension Among Adults Free of Cardiovascular Diseases and Diabetes: Baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Angiology. 2016;67(2):180-6.
  35. Tamariz L, Hernandez F, Bush A, et al. Association between serum uric acid and atrial fibrillation: a systematic review and meta-analysis. Heart Rhythm. 2014;11(7):1102-8.
  36. Ando K, Takahashi H, Watanabe T, et al. Impact of Serum Uric Acid Levels on Coronary Plaque Stability Evaluated Using Integrated Backscatter Intravascular Ultrasound in Patients with Coronary Artery Disease. J Atheroscler Thromb. 2016;23(8):932-9.
  37. Tao R, Li H. High serum uric acid level in adolescent depressive patients. J Affect Disord. 2015;174:464-6.

 

Article By:By Stephen Curtis

Article Source: http://www.lifeextension.com/Magazine/2017/7/Surprising-Facts-About-Uric-Acid/Page-01?utm_source=facebook&utm_medium=social&utm_campaign=normal

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Bone Density, Anemia Improve With Testosterone in Low-T Men

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Study Highlights

  • Snyder and colleagues:
    • Study participants were men at least 65 years old with 2 serum testosterone results of less than 275 ng/dL.
    • Men were randomly assigned to receive testosterone gel with titration to maintain serum testosterone levels commensurate with those of a young man, or placebo gel. The treatment period was 12 months.
    • The main study outcome was BMD. Participants underwent BMD testing with quantitative computed tomography and dual energy x-ray absorptiometry of the spine and hip at baseline and at 12 months.
    • 211 men participated in the trial. The mean age of participants was 72.3 years, and the baseline mean testosterone level was slightly more than 230 ng/dL.
    • vBMD increased in the testosterone group by a mean of 7.5%, compared with an increase of only 0.8% in the placebo group (P <.01).
    • Measurements of hip trabecular and peripheral vBMD were also superior in the testosterone group vs the placebo group.
    • Testosterone appeared more effective in increasing trabecular vs peripheral BMD, and in improving BMD in the spine vs the hip.
    • 19 fractures were reported during the treatment year and 1 year after the treatment period, with no evidence of a difference in fracture rates in comparing the testosterone group vs the placebo group.
  • Roy and colleagues:
    • The study was conducted as a double-blind, placebo-controlled trial among men 65 years or older. All participants had a serum testosterone level of less than 275 ng/dL.
    • Men were randomly assigned to receive testosterone gel with titration to maintain serum testosterone levels commensurate with those of a young man, or placebo gel. The treatment period was 12 months.
    • There were 788 men in the study, of whom 126 were anemic, as defined by a hemoglobin level of 12.7 g/dL or lower. Approximately half of men with anemia had no known cause for anemia.
    • The main study outcome was the effect of testosterone therapy on hemoglobin levels among men with anemia.
    • The mean age of participants was 74.8 years, and the mean serum testosterone level among men with anemia was 222 ng/dL at baseline.
    • 54% of men with unexplained anemia who were treated with testosterone experienced an increase in hemoglobin levels of 1.0 g/dL or more, compared with only 15% of men with similar anemia treated with placebo (adjusted OR, 31.5; 95% CI, 3.7-277.8).
    • 58.3% of men treated with testosterone experienced resolution of their anemia, compared with 22.2% of men treated with placebo.
    • Testosterone also raised hemoglobin levels vs placebo among men with a known cause of anemia.
    • Hemoglobin levels increased past 17.5 g/dL in 6 men without anemia at baseline.

Clinical Implications

  • A retrospective cohort study by Cheetham and colleagues finds that testosterone therapy among men with evidence of testosterone deficiency is associated with lower risks for cardiac disease and cerebrovascular disease, even among men older than 65 years and those with preexisting cardiovascular disease.
  • Two new studies demonstrate that testosterone treatment can correct anemia and improve BMD among men with low testosterone levels at baseline.
  • Implications for the Healthcare Team: The current studies further demonstrate potential benefits of testosterone therapy among men with testosterone deficiency. Testosterone therapy was also associated with a lower risk for cardiovascular events in one study. Nonetheless, clinicians should continue to perform shared decision making regarding testosterone therapy and apply this treatment only among men with established testosterone deficiency.

Article Source: http://www.medscape.org/viewarticle/876307

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Colon Cancer Screening: What You Need to Know

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Colon cancer is the second leading cause of cancer death in the United States today. It’s a serious American health problem, says Johns Hopkins gastroenterologist Francis Giardiello, M.D.

However, there are many ways you can decrease your risk or even prevent colon cancer. The single best thing you can do to prevent colon cancer is to get screened.

Giardiello breaks down what you should know about the colon cancer screening options available today.

Q. Why is colon cancer screening important?

A. Colon cancer develops from a small polyp that occurs in the lining of the colon. That small polyp slowly grows larger and larger. Once large enough, that polyp develops cancer and starts to spread.

It’s important to remember the process of polyp to cancer takes about 10 years to occur. That’s plenty of time to get a screening to catch it — and get rid of it — before it turns to cancer.

Think of a polyp as a mushroom sitting on a stalk (your intestine’s lining). If a doctor identifies it on a colonoscopy, he or she can easily put a lasso (or a loop) around the stalk and cut off the mushroom. No mushroom means no cancer.

Q. How do you screen for colon cancer?

There’s more than one way to be screened for colon cancer today.

These options include:

Colonoscopy: Before a colonoscopy, you’ll be asked to prep your bowel by drinking a liquid that helps clear out your colon. Then, doctors use a scope that has a camera attached to one end to examine inside your colon for polyps or cancer. Because the scope movement can cause discomfort, you’ll be sedated during the procedure. If a polyp is found, your doctor can remove it at the same time.

Fecal occult blood test: This test looks for blood in your stool. You place a small bowel movement sample on a provided card and send it to a lab, where it is tested for blood. If blood is detected, your doctor might recommend you get a colonoscopy for further testing.

Fecal immuno testing: This is similar to fecal occult testing, except you place the bowel movement sample in tubes. Depending on the results, you may require further testing.

Sigmoidoscopy: A sigmoidoscope is another type of scope that only looks at the bottom third of the colon, where 60 percent of cancers occur.

Barium enema: During this test, barium liquid is placed in the rectum through an enema, and then an X-ray is taken. The barium highlights any polyps or cancer for the doctor viewing the X-ray.

Virtual colonoscopy: You undergo a CT scan that takes a detailed picture of the colon.

Stool gene testing: This is a newer type of stool sample screening. Instead of testing for blood, the lab looks for certain gene changes that can indicate colon cancer.

Q. How do you know which screening is right for you?

A. Many physicians recommend most healthy people get a colonoscopy every 10 years starting at age 50 — that’s when most colon cancers start to develop. A colonoscopy is the most effective way doctors identify colon cancer.

Each type of screening has its own pros and cons. Your doctor can provide more information on screening options and recommend which is best for you based on several factors, including your:

  •  Family history
  • Overall health
  •  Personal preferences

 

Article Source: http://www.hopkinsmedicine.org/health/articles-and-answers/ask-the-expert/colon-cancer-screening-what-you-need-to-know?utm_medium=social&utm_source=Facebook&utm_campaign=Surgeryh&utm_content=RectalCancer

 

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New study demonstrates omega-3 fatty acids increase blood flow to regions of the brain associated with cognition

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According to a new study published last Thursday in the Journal of Alzheimer’s Disease, by using neuroimaging, researchers were able to demonstrate increased blood flow in regions of the brain associated with memory and learning in individuals with higher omega-3 levels.

Alzheimer’s disease and related disorders (ADRD) are a group of conditions that cause mild cognitive impairment (MCI) or dementia. These conditions affect one’s ability to function socially, personally, and professionally. It’s important to recognize that Alzheimer’s disease begins long before symptoms start, just like many other conditions. There is evidence that simple prevention strategies can reduce the risk of ADRD by as much as 50%.

This new study included 166 individuals from a psychiatric clinic in which Omega-3 Index results were available. These patients were categorized into two groups: higher EPA and DHA concentrations (>50th percentile) and lower concentrations (<50th percentile). Quantitative brain single photon emission computed tomography (SPECT) was performed on 128 regions of their brains and each individual completed computerized testing of their neurocognitive status.

SPECT can measure blood perfusion in the brain. In addition, performing various mentally stimulating cognitive tasks will show increased blood flow to specific brain regions. (Previous research has demonstrated that mentally stimulating activities reduce the risk of new-onset mild cognitive impairment even when performed later in life.) As a result, researchers identified significant relationships between the Omega-3 Index and regional perfusion on brain SPECT in areas that are involved with memory and neurocognitive testing.

This study demonstrated the positive relationships between omega-3 EPA and DHA status, brain perfusion, and cognition. This is significant because it shows a correlation between lower omega-3 fatty acid levels and reduced brain blood flow to regions important for learning, memory, depression and dementia.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Article Source: http://blog.designsforhealth.com/si-42214/new-study-demonstrates-omega-3-fatty-acids-increase-blood-flow-to-regions-of-the-brain-associated-with-cognition?

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Shift Work Throws Urologic Health Off Schedule

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Nonstandard shifts and a circadian rhythm disturbance known as shift work sleep disorder contribute to a significant increase in urinary tract symptoms and reproductive problems, according to three studies conducted at the Baylor College of Medicine in Houston.

“A 45-year-old shift worker with shift work sleep disorder might look like a 75-year-old man in terms of his lower urinary tract symptoms,” John Sigalos, a medical student and investigator on one of the studies, said here at the American Urological Association 2017 Annual Meeting.

The other studies presented demonstrate that male shift workers with shift work sleep disorder have lower testosterone levels and more hypogonadal symptoms than daytime workers, and that infertile shift workers, especially those who work rotating shifts, have significantly worse semen parameters than infertile men who work the day shift.

In the United States, approximately 15% of the labor force works late-night or rotating shifts.

Lower Urinary Tract Symptoms Study

To determine the effect of poor sleep quality and shift work on lower urinary tract symptoms, Sigalos and his colleagues retrospectively reviewed the medical records of men treated at the Baylor andrology clinic from 2014 to 2016.

All the men had completed the International Prostate Symptom Score (IPSS) to evaluate lower urinary tract symptoms, completed questionnaires about work schedules and sleep disorders, and had blood samples taken.

Of the 2487 participants, 766 (30.8%) reported working nonstandard shifts in the previous month and, of these, 36.8% were considered to be at high risk for sleep disorders.

Mean IPSS score was higher in shift workers with sleep disorders than in shift workers without, and daytime workers (7.77 vs 5.37 vs 6.84; P < .0001 between all groups).

IPSS scores were 3.1 points lower in shift workers with sleep disorders than in shift workers without, after age, comorbidities, and testosterone levels were controlled for (= .0001).

These findings suggest that poor sleep quality — rather than shift work itself — contributes to the increase in lower urinary tract symptoms. Patients at risk for shift work sleep disorder should be screened for lower urinary tract symptoms and counseled about the risk, Sigalos told Medscape Medical News.

Hypogonadism Study

The potential for hypogonadal symptoms and sexual dysfunction was examined by another group of Baylor investigators who used the same cohort of men.

On multivariable analyses that controlled for age, Charlson comorbidity score, and testosterone levels, mean scores on the quantitative Androgen Deficiency in the Aging Male (qADAM) questionnaire were 0.8 points lower in nonstandard shift workers than in daytime workers (P < .01). And mean qADAM score was 3.9 points lower in shift workers at high risk for sleep disorders than in shift workers at low risk (P < .01).

In addition, there was an independent association between high risk for shift work sleep disorder and lower testosterone levels after age, comorbidities, and history of testosterone supplementation were controlled for (P < .01).

Semen Parameters Study

The effects of shift work and sleep quality on semen parameters and reproductive hormones in men were assessed in a prospective study by Taylor Kohn, MD, and his colleagues.

The study participants — 75 infertile shift workers, 96 infertile nonshift workers, and a control group of 26 fertile men — completed questionnaires about shift work and sleep quality, and underwent semen analysis and hormone testing.

Sperm density was significantly lower in infertile shift workers than in infertile nonshift workers (P = .012), as were total motile counts (P = .019) and testosterone levels (= .026).

However, the differences in sperm motility, forward progression measures, luteinizing hormone levels, and follicle-stimulating hormone levels were not significant.

All semen parameters were significantly lower in the infertile shift workers than in the fertile control group, and luteinizing hormone and follicle-stimulating hormone levels were significantly higher. Testosterone levels were about the same in the two groups.

On linear regression that controlled for age, Charlson comorbidity index, tobacco use, and average income, there was a significant negative association between total motile count and shift work (P = .039), and a significant positive association between total motile count and previous fertility (P = .041).

In addition, total motile counts were significantly lower in men who worked rotating shifts than in those who worked fixed shifts (P < .05).

The type of job shift workers performed also made a difference. Men who performed physical labor in environments where chemical use was common (such as oil fields and refineries) had significantly lower total motile counts than physical laborers without chemical exposure, medical workers, white-collar workers, and first responders (P < .05).

Sleep satisfaction also seemed to play a role. “When assessing reported overall sleep amounts in the previous month, follicle-stimulating hormone and testosterone levels trended downward as men became more unsatisfied with the amount of sleep they were getting,” Dr Kohn reported.

Thinking Beyond the Prostate

It is important for urologists to think beyond the prostate when treating men with lower urinary tract symptoms or sexual dysfunction, said Howard Adler, MD, clinical associate professor of medicine at the Stony Brook University School of Medicine in New York.

When men present with symptoms like those reported in these studies, clinicians need to consider not only prostate-related symptoms, but also age-related changes in bladder function, renal function, and other medical conditions, such as diabetes, he told Medscape Medical News.

At Stony Brook, Dr Adler explained, he and his colleagues have begun “asking patients about sleep habits and snoring, and are sending them for sleep studies to see if they have apnea or something else, especially patients with a lot of night-time urination.”

The studies were supported by the Baylor College of Medicine. The authors and Dr Adler have disclosed no relevant financial relationships.

American Urological Association (AUA) 2017 Annual Meeting: Abstracts MP13-12 and PD13-08 presented May 12, 2017; Abstract MP91-06 presented May 16, 2017.

Written By: Neil Osterweil

Article Source: http://www.medscape.com/viewarticle/880096#vp_1

 

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Gout Patients Should Be Screened for Erectile Dysfunction

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Erectile dysfunction (ED) is common and often severe in men suffering from gout, according to the results of a cross-sectional survey of men who presented to a rheumatology clinic.

“These results strongly support the proposal to screen all men with gout for the presence of ED. Increasing awareness should in turn lead to earlier medical attention and treatment for this distressing condition,” said lead author Naomi Schlesinger, MD, chief, Division of Rheumatology, and professor of medicine at Rutgers–Robert Wood Johnson Medical School, in New Brunswick, New Jersey.

The results of the study were presented here at the European League Against Rheumatism (EULAR) Congress 2014.

The most common inflammatory arthritis in men older than 40 years, gout is caused by deposits of urate crystals in the joints and is associated with uricemia. The crystals cause inflammation, pain, and swelling, and the inflammatory component of the disease is linked to risk factors for cardiovascular disease and coronary artery disease.

The cross-sectional study included 201 men aged 18 to 89 years who presented at a rheumatology clinic between August 2010 and May 2013. Of these, 83 had gout.

Participants filled out a Sexual Health Inventory in Men (SHIM) questionnaire, which evaluates the ability to have an erection, the firmness of the erection, the ability to penetrate sufficiently for sexual intercourse, and sexual satisfaction. A score of ≤21 indicates ED; a score of ≤10 indicates severe ED.

“Men don’t usually volunteer sexual complaints,” said Dr. Schlesinger. “The gout patients in our study were generally delighted and grateful that someone finally asked them about ED.”

The mean SHIM score for all participants was 16.88. Patients with gout had a mean SHIM score of 14.38 compared with 18.53 in patients without gout (P < .0001).

A significantly greater percentage of patients with gout had ED compared with patients without gout (76% vs 52%, P = .0007). Also, significantly more men with gout had severe ED vs men without gout (43% vs 30%, P = .007).

The presence of ED was significantly more frequent in gout patients aged 65 years or older, compared with men of the same age without gout (P = .0001), and was significantly more likely to be severe (P = .0002).

A multivariate analysis adjusted for age, hypertension, low-density cholesterol level, glomerular filtration rate, obesity, and depression found that the association between gout and ED was statistically significant (P = .0096).

Silent Coronary Artery Disease

 “It is estimated that 1 in 5 men who present with ED have silent coronary artery disease. A man with ED, even with no cardiac symptoms, is a cardiac patient until proven otherwise,” said Dr. Schlesinger. “Perhaps we could say that the 3 ‘EDs’ are related: endothelial dysfunction leads to erectile dysfunction leads to early death.

“Gout patients who present with ED have an increased rate of cardiovascular risk factors and concomitant silent coronary artery disease and should be evaluated,” she added.

 Maya Buch, MD, from the Leeds Institute of Rheumatology and Musculoskeletal Medicine, at the University of Leeds, United Kingdom, praised the authors of this study for providing new information on these conditions with overlapping risk factor — gout and cardiovascular disease.
 “These patients are at risk for cardiomyopathies, and there is no literature on ED and gout. We know that patients with gout have multiple comorbidities, and it’s clear that rheumatologists need to address that,” she explained.

“I was surprised at how many patients with gout have ED. In addition to treating hyperuricemia in our patients with gout, we need to pay attention to cardiovascular risk factors. I hope that this study makes doctors more receptive to evaluating patients for ED,” she added.

Dr. Schlesinger has disclosed no relevant financial relationships. Dr. Buch has received honoraria and consulting fees from AbbVie, Bristol-Myers Squibb, and Roche-Chugai and has a research grant from Pfizer, Inc.

 European League Against Rheumatism (EULAR) Congress 2014: Abstract OP0135. Presented June 13, 2014.

Written By: Alice Goodman

Article Source: http://www.medscape.com/viewarticle/826773

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Fitness Tips for 50-Plus

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Upping your daily activity level at 50-plus is more manageable when you follow these fitness tips from a Johns Hopkins fitness expert.

One of the most important reasons to exercise at 50-plus is to keep your weight in check.

By maintaining a healthy weight, you lower your blood pressure and decrease your risk of heart disease, diabetes and arthritis, says Johns Hopkins sports medicine expert Raj Deu, M.D.

Inspired to break a sweat? Before you grab your water bottle and gear bag, keep these six fitness tips in mind.

DOs

1. Strength train.

Muscular strength declines with age, so strength training is key for maintaining strength and preventing muscle atrophy at 50-plus. “Strength training has also been shown to help with bone density,” says Deu, “and that decreases the rate at which bone breaks down, which is important for reducing the risk of fractures later in life.”

2. Get an exercise partner.

“If you work out with a friend or your spouse, you generally tend to exercise more regularly because you have that person to coax you,” says Deu. “Even owning a dog will get you out and walking.”

3. Stretch regularly.

As our bodies age, our tendons get thicker and less elastic. Stretching can counter this and help prevent injury at 50-plus. Remember to stretch slowly; do not force it by bouncing.

DON’Ts

1. Start exercising without your doctor’s blessing.

Consult your health care provider if you have underlying health risks such as a cardiovascular, metabolic or renal disease. Inactive individuals who are healthy do not need an evaluation but are recommended to start slow and progress gradually. If you have any concerns or are unsure how to start, consult your physician, says Deu.

2. Sign up for an expensive gym.

If you’re on a budget, you can get plenty of exercise at home. Great fitness tips: Moderate time spent walking, gardening and even vacuuming all count as exercise. A modest investment in dumbbells and exercise bands will also allow you to do strength training at home.

3. Focus on cardio only.

While cardiovascular exercise is important, so is stretching and strength training (see the “Dos” for details) as well as core strength and balance exercises. Deu likes tai chi, Pilates and certain kinds of yoga for working on balance and core strength at 50-plus, which will help support and protect your spine and may help prevent a future fall.

TRY IT
Sit Less, Move More

Knowing you should exercise more can feel daunting, especially when you’re just starting out. Some people don’t feel they can fit in the full amount of physical activity their doctor recommends—and they give up on moving altogether. “But those recommendations are just guidelines,” says Johns Hopkins expert Kerry Stewart, Ed.D. “It doesn’t have to be all or nothing. Try to focus on being less sedentary rather than more active. For example, you do not have to reach the goal of 10,000 steps per day in a week, but this should be the goal to reach over two to three months.”

Research shows that sitting still for long periods of time can cancel out the effects of 30 minutes of exercise. “There’s good evidence that being too sedentary, such as prolonged time in front of a TV, is perhaps as harmful to your heart health as not formally exercising at all,” Stewart says. Prolonged inactivity is linked to obesity and diabetes, even in people who are active for part of the day.

Yes, daily exercise is important, but so is regularly getting up and just moving around throughout the day, Stewart says.

Article Source: http://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/fitness-tips-for-50-plus?utm_medium=social&utm_source=Twitter&utm_campaign=Health&utm_term=FitnessTipsfor50-Plus&utm_content=HealthyAging

 

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