For The Doctor of The Future

Wednesday, August 31, 2011

Preserving Your Patients Eye Health

Eye Preservation

July 8, 2011By Steve Myers

Top Ingredients 
  • Lutein and Zeaxanthin, the main macular pigments, limit macular degeneration and are linked to reduced incidence of cataract. 
  • Anti-inflammatory omega-3s DHA and EPA positively impact glaucoma and dry eye, improving tear production and maintaining corneal epithelial integrity. 
  • Flavonoid-rich herbal products—black currants, bilberry, pine bark extract and curcumin, for example—address inflammatory and oxidative factors in eye health. 

Blindness is scarier than heart disease, according to respondents of the “Eye on Eyesight" survey, which was conducted by Surge Research for the nonprofit Choice Magazine Listening. While nearly twice the number of respondents aged 50 to 64 years said they feared losing their eyesight more than than they feared heart disease, 79 percent of adults said losing their eyesight is the third biggest fear after their own death and the death of a loved one.

Forgoing the connection between death and heart disease, the importance of eyesight to quality of life is apparent. Sight endows us with not just aesthetic rewards, but it also provides us valuable information and tools for our interactions with the world and other beings.

The National Federation of the Blind (NFB) estimated 1.75 million people in the United States are legally blind—central visual acuity of 20/200 or less in the better eye with the best possible correction, or a visual field of 20 degrees or less. However, NFB further noted as many as 10 million Americans are blind or visually impaired—including some 5.5 million seniors—with 75,000 additional people joining the ranks of blind or visually impaired each year. Given just 1 percent of Americans are born blind, the majority of blindness occurs later in life due to deterioration caused by diseases such as age-related macular degeneration (AMD), glaucoma and diabetes.

To see is to process light. The cornea layer of the eye focuses light through the pupil, lens and vitreous fluid to the retina. An ultra-sensitive layer of photoreceptor cells, the retina absorbs the incoming light and converts it to nerve signals. The optic nerve attached at the back of the eye carries these signals to the brain for further processing and use of the information.

Among the neuronal photoreceptor cells in the retina are the rods and cones. Found more on the periphery of the retina, the rods number in the hundreds of millions and are adept at black and white vision in dimmer environments. There are far fewer cones, about 7 million, which dominate the central retina and handle colors and brighter environments. High-resolution central vision, however, is handled by the macula, a yellow-pigmented area near the center of the retina. Its yellow color comes from its content of the xanthophyll carotenoids lutein and zeaxanthin, and is responsible for the macula’s ability to filter blue and ultraviolet (UV) light.

Lutein and zeaxanthin are derived from the diet, found in abundance in dark, leafy greens such as spinach, kale and collards, and moderately plentiful in vegetables such as bell peppers, corn and broccoli. There is mounting evidence that increased consumption of lutein and zeaxanthin improves the macular pigment optical density (MPOD), indicating an important role in preserving vision and supporting retinal function.1 DSM researchers found the xanthophylls increased MPOD in different areas of the macula: lutein appears to be predominant in the fovea, while zeaxanthin covers a wider retinal area.2

Zeaxanthin has been shown to improve human color vision, visual acuity and vision in low-light conditions in healthy adults.3 Subjects took regular supplements of zeaxanthin, lutein, a combination of the two or placebo. Those who took lutein and zeaxanthin showed significant improvements in visual acuity and color vision.

These yellow carotenoids take a multifaceted approach to eye health, absorbing potentially harmful bands of spectral light, protecting against oxidative stress and damage, and helping to stymie inflammation.

To bring physician only line of these supplements to your practice click here to schedule an appointment with a product specialist.

Sunday, August 28, 2011

Consumer Information Should I check with my doctor or healthcare provider before using a supplement?

Below is a link directly to the FDA site online with the answer to the question every patient should know before their next visit to the doctor.

Consumer Information Should I check with my doctor or healthcare provider before using a supplement?

Health Professional Information 

Doctors, are you prepared to answer with knowledge the questions your patients are going to start asking about prevention, weight management and supplementation?

For 12 CME Credits on the following contact i-Medical for a list of courses and locations for 2011.
1-866-356-iMED (4633)

Course Objectives:

Session: Nutrition Principles for the Clinician Objectives: 
At the end of this session you should be able to:
Understand how poor dietary trends have lead to alarming prevalence rates of diabetes, cardiovascular disease, cancer and other chronic diseases.
The current state of the American diet. 
Role and importance of the macronutrients, micronutrients and minerals. 
The structure and function of proteins, lipids and carbohydrates. 
The significance of glycemic index/glycemic load for optimal nutrition. 
The types, role and therapeutic applications of dietary fiber. 
The nature, composition and role of fats and oils. 
The impact, advantages and disadvantages of various food pyramids. 
What constitutes the fundamentals of healthy eating. 
Appreciate and recognize the role and responsibility of society for promoting good
Understand how to respond to the nutritional needs of our nation. 
Learn the challenges for modifying the nation's poor nutritional behaviors.

Session: Pathophysiology and Nutrition I Objectives: 
At the end of this session you should be able to:
Understand the different types, sources and nature of oxidants or free radicals. 
Learn the role and impact of oxidant stress on health. 
Explain how oxidant stress may play a role in the pathophysiology of cardiovascular
disease, cancer, aging, retinopathy and other diseases. 
Know the biomarkers for evaluating oxidant stress. 
Learn the importance and functions of antioxidants. 
Know the various bioflavonoids, antioxidant vitamins and minerals. 
Appreciate the recent medical literature on the bioflavonoids including: in vitro studies,
animal models and clinical trials. 
Know the principles and significance of the ORAC assay. 
Appreciate the natural food sources that are high in ORAC.

Session: Pathophysiology and Nutrition II Objectives: 
At the end of this session you should be able to:
Appreciate the role of inflammation in chronic diseases such as: cardiovascular, asthma, arthritis, inflammatory bowel disease, rhino-sinusitis.
Know the key cell types, cytokines, eicosonoids and adhesion molecules involved in the inflammatory process
Learn the importance of biomarkers in inflammation 
Understand the omega-3 and omega-6 fatty acid metabolic pathways
Know the consequences of an overproduction of omega-6 with a concomitant underproduction of omega-3 fatty acids.
Appreciate the AHA guidelines for the use of omega-3. 
Understand the role of Vitamins B-6, B-12 and folate in homocysteine metabolism. 
Know the importance of homocysteine in inflammation and cardiovascular disease.

Session: Metabolism and Nutrition Objectives: At the end of this session you should be able to:
Understand the importance, role and effects of insulin resistance in contributing to abnormal carbohydrate metabolism.
Learn the pathways towards developing insulin resistance. 
Describe the spectrum and features of abnormal carbohydrate metabolism including:
early, late insulin resistance, metabolic syndrome and Type II diabetes. 
Learn the essentials of an effective weight management system including: nutritional
interventions, patient education, training and follow up. 
Review the importance of low glycemic index foods for weight control 
Understand the role of calcium and vitamin D in normal bone metabolism.

Session: Nutrigenetics and Clinical Applications Objectives: 
At the end of this session you should be able to:
Know the fundamental principles of genetic testing with respect to its applications to nutritional requirements.
Explain the concept of genetic nucleotide polymorphism (gene SNP) and provide some examples.
Appreciate the applications of gene SNP to areas such as: heart health, antioxidant/detoxification mechanisms, Vitamin B metabolism, bone health, diseases of inflammation and insulin sensitivity.
Learn how to interpret and explain a gene SNP report to your patients. 
Appreciate the future role and direction of nutrigenetics.

Session: Nutrition Interventions Part I and II Objectives: 
At the end of this session you should be able to:
Know the fundamentals of nutrition supplement and bioavailability and delivery 
Learn what nutritional modalities are needed for: optimal health and health
maintenance, bone and joint health, immune health, anti-inflammation, digestive health,
vision and cognitive health female and male health 
Describe the benefits and define the role for key nutritional ingredients including:
glucosamine, omega-3 fish oils, calcium, bioflavonoids (i.e. lutein, lycopene, oligomeric proanthocyanidins, polyphenols), fat and water soluble vitamins, minerals, fiber and some common herbs.

Session: Educating and Motivating Patients Objectives: 
At the end of this session you should be able to:
Learn how to educate and motivate patients to improve compliance. 
Understand how to use audio, DVDs and printed materials to implement an effective
nutrition patient education program into your practice. 
Know how to navigate and effectively use the Natural Comprehensive Medicine Database. 
Learn the importance of literature searches and databases.

Session: Quality Control and Regulatory Issues in the Nutraceutical Industry Objectives: 
At the end of this session you should be able to:
Understand the regulatory issues of the nutrition supplemental industry such as DSHEA. 
Know the difference between a structure/function claim vs. a disease claim. 
Provide examples of structure/function claims for a particular supplement. 
Learn the essentials of risk management when using nutritional interventions.
Review the fundamentals of HIPPA. 
Know how to report adverse reactions for nutritional supplements. 
Appreciate the quality control measures that are important when evaluating a nutritional

Penn Medicine News: One Shot of Gene Therapy and Children with Congenital Blindness Can Now See

Lab Tests and Patient Education... Do we need a lab result facelift?

Recently I watched a video from TEDMED on redesigning medical data.  Thomas Geotz talked about a clinical study done in the Dental field on prevention.  Interestingly, the study showed that fear didn't motivate patients to brush and floss.  It was the patients intention that mattered most.  Clearly, patients that are educated to the power they have to create the outcome that they desire yielded the best clinical results for interaction.  Yet still we try to scare patients into being responsible for their health, keeping them in the dark as to how their bodies work and their interracial part in their long-term health and quality of life.  Telling them what to do, but not why or how to do it.  Common sense you say?  I say it's not that common for people to have sense that they haven't been taught to have.

Wired magazine did an article about how difficult it is for patients to understand their medical test results and how it would be great if our results could be summarized and shared with patients in a manner that educates them as to their current health standing, what would be ideal and some suggested actions that would help patients achieve their goal to be healthy.

The article and video created a lot of feedback from opposing sides and I was shocked and interested to hear the arguments from both sides.

Since I work with doctors, patients and testing facilities I do recognize all sides of the story as having some great points.  With that being said Obesity is clearly a major issue in this country, as are the diseases that are related to this condition.  80-85% of which are preventable with lifestyle changes.

We have to find a way to communicate with the patients that will enact a change in lifestyle.  If that can be achieved by doing a better job educating them, without putting the doctor out of business because they don't have time in their schedules today do to the cost of providing healthcare, then I think that warrants additional research and effort.  I am always interested in finding methods that could improve patient care and patient outcomes.  With EMR and electronic lab results becoming more common, culminating those results and providing them in a fashion that would educate the patient shouldn't be too difficult.  Who's up for the challenge.  Post below if you have feedback, criticism or solutions.  We always love the latter.

Below is a link to the TEDMED Video by  Thomas Goetz: It's time to redesign medical data

TEDMED Video:Thomas Goetz

Here is the Wired Magazines Redesigned Blood Test Result and a link to the article the magazine wrote.  Congrats on the National Magazine Award nomination for this article!

Wired Magazine Article: The Blood Test Gets a Makeover

Heather C Montgomery, CEO i-Medical Solutions

NEWS from MIT on viral infection drug

New drug could cure nearly any viral infection

Researchers at MIT’s Lincoln Lab have developed technology that may someday cure the common cold, influenza and other ailments.
CAMBRIDGE, Mass. — Most bacterial infections can be treated with antibiotics such as penicillin, discovered decades ago. However, such drugs are useless against viral infections, including influenza, the common cold, and deadly hemorrhagic fevers such as Ebola.

Now, in a development that could transform how viral infections are treated, a team of researchers at MIT’s Lincoln Laboratory has designed a drug that can identify cells that have been infected by any type of virus, then kill those cells to terminate the infection.

In a paper published July 27 in the journal PLoS One, the researchers tested their drug against 15 viruses, and found it was effective against all of them — including rhinoviruses that cause the common cold, H1N1 influenza, a stomach virus, a polio virus, dengue fever and several other types of hemorrhagic fever.

The drug works by targeting a type of RNA produced only in cells that have been infected by viruses. “In theory, it should work against all viruses,” says Todd Rider, a senior staff scientist in Lincoln Laboratory’s Chemical, Biological, and Nanoscale Technologies Group who invented the new technology.

Because the technology is so broad-spectrum, it could potentially also be used to combat outbreaks of new viruses, such as the 2003 SARS (severe acute respiratory syndrome) outbreak, Rider says.

Other members of the research team are Lincoln Lab staff members Scott Wick, Christina Zook, Tara Boettcher, Jennifer Pancoast and Benjamin Zusman.

Few antivirals available

Rider had the idea to try developing a broad-spectrum antiviral therapy about 11 years ago, after inventing CANARY (Cellular Analysis and Notification of Antigen Risks and Yields), a biosensor that can rapidly identify pathogens. “If you detect a pathogenic bacterium in the environment, there is probably an antibiotic that could be used to treat someone exposed to that, but I realized there are very few treatments out there for viruses,” he says.

There are a handful of drugs that combat specific viruses, such as the protease inhibitors used to control HIV infection, but these are relatively few in number and susceptible to viral resistance. 

Rider drew inspiration for his therapeutic agents, dubbed DRACOs (Double-stranded RNA Activated Caspase Oligomerizers), from living cells’ own defense systems.

When viruses infect a cell, they take over its cellular machinery for their own purpose — that is, creating more copies of the virus. During this process, the viruses create long strings of double-stranded RNA (dsRNA), which is not found in human or other animal cells.

As part of their natural defenses against viral infection, human cells have proteins that latch onto dsRNA, setting off a cascade of reactions that prevents the virus from replicating itself. However, many viruses can outsmart that system by blocking one of the steps further down the cascade.

Rider had the idea to combine a dsRNA-binding protein with another protein that induces cells to undergo apoptosis (programmed cell suicide) — launched, for example, when a cell determines it is en route to becoming cancerous. Therefore, when one end of the DRACO binds to dsRNA, it signals the other end of the DRACO to initiate cell suicide.

Combining those two elements is a “great idea” and a very novel approach, says Karla Kirkegaard, professor of microbiology and immunology at Stanford University. “Viruses are pretty good at developing resistance to things we try against them, but in this case, it’s hard to think of a simple pathway to drug resistance,” she says.

Each DRACO also includes a “delivery tag,” taken from naturally occurring proteins, that allows it to cross cell membranes and enter any human or animal cell. However, if no dsRNA is present, DRACO leaves the cell unharmed.

Most of the tests reported in this study were done in human and animal cells cultured in the lab, but the researchers also tested DRACO in mice infected with the H1N1 influenza virus. When mice were treated with DRACO, they were completely cured of the infection. The tests also showed that DRACO itself is not toxic to mice.

The researchers are now testing DRACO against more viruses in mice and beginning to get promising results. Rider says he hopes to license the technology for trials in larger animals and for eventual human clinical trials.

This work is funded by a grant from the National Institute of Allergy and Infectious Diseases and the New England Regional Center of Excellence for Biodefense and Emerging Infectious Diseases, with previous funding from the Defense Advanced Research Projects Agency, Defense Threat Reduction Agency, and Director of Defense Research & Engineering (now the Assistant Secretary of Defense for Research and Engineering).

Written by: Anne Trafton, MIT News Office