NEWS UPDATE-SOLUBLE CORN FIBER (CSF) HELPS BONE RESORPTION

SOLUBLE CORN FIBER AND CALCIUM RESORPTION

The article is based on the new research from Purdue University, West Lafayette, Indiana reveals that Soluble Corn Fiber (CSF) supplementation significantly helps the bone to better absorb and utilize calcium in women at their teens and post menopause periods.
CSF is a non-digestible carbohydrate present in packed foods, such as cereals, bread, and bakery items. Also used in beverages, frozen foods, candies, carbonated and flavored water.
SCF is added to packed edibles to compensate for their loss of dietary fibers while processing.SCF is having all benefits of intact dietary fibers found in grains, legumes, veggies, and fruits plus the recent research has revealed that it improves intestinal regularities and has prebiotic properties.
Moreover SCF improves healthy blood glucose and improves bone health by increasing calcium absorption.
The research reveals that SCF a prebiotic supports the body better absorb and utilize calcium during both adolescence and post-menopause. The gut microbe flora plays an important role in this by breaking the SCF to be used by the body very easily.
Commercially the SCF is available in the brand of Promotor Dietary Fiber and labeled as Maltodextrin. The product is manufactured by Tate & Lyle Ingredients America LLC who funded the research.
The research detailed their findings that after CSF passes through the gut unlike the intact dietary fibers these soluble fibers are digested and broken down by the gut flora to short-chain fatty acids which helps in the maintenance of bone health

THE STUDY

 n the postmenopausal study, 14 healthy postmenopausal women in three groups. The first group consumed 0 grams, the second group 10 grams, and the third group 20 grams of SCF every day for 50 days. The women in the groups that received 10 grams and 20 grams - amounts that are found in supplement form - displayed bone calcium retention improvement by 4.8 percent and 7 percent, respectively.

"If projected out for a year, this would equal and counter the average rate of bone loss in a post-menopausal woman," says Weaver, an expert in mineral bioavailability, calcium metabolism, botanicals, and bone health.

In the adolescent study, 28 girls aged between 11-14 years old consumed either 0 grams, 10 grams, or 20 grams of SCF every day for 4 weeks, while maintaining their regular diet. The females in both the 10 gram and 20 gram SCF groups saw an increase in calcium absorption by around 12 percent, which would build 1.8 percent more skeleton per year.

Gastrointestinal symptoms were minimal in both studies and the same was seen in the control groups.

"Most studies looking at benefits from soluble corn fiber are trying to solve digestion problems, and we are the first to determine that this relationship of feeding certain kind of fiber can alter the gut microbiome in ways that can enhance health," Weaver said. "We found this prebiotic can help healthy people use minerals better to support bone health."

LOW CARB DIET-FREE E-BOOK

LOW CARB DIET-FREE E-BOOK

Diet plays an important role in our body health.

Carbohydrates are the best sources of energy. Carbohydrates in our food are hydrolyzed into more water-soluble and absorbable monosaccharides such as glucose and fructose. Glucose is the more common form of carbohydrate source of energy for our body. Fructose may give some energy sources but not as much as glucose.

Fructose and glucose both increase total body fats and hypertriglyceridemia and abdominal fat.

In that sense beware that fructose increases.

triglycerides level double the amount of what glucose does. 

Fructose does not need to be digested and does not need insulin to be metabolized. Most of the fructose goes into the liver. Accumulation of fructose in the liver imposes heavy load to it and may cause liver damages.

The liver processes fructose into glycerol which will increase triglyceride levels

Glucose decreased HDL level while fructose increases it.

Glucose increases insulin sensitivity but fructose decreases it.

Diet contains only fructose may cause diabetes mellitus because of the total loss of insulin sensitivity.

Fructose has a low glycemic index but this is not the only factor to decide whether a diet is healthy.

Both sugars cause diabetes and obesity.

Glucose causes more weight gain than fructose.

A low carb diet should be practiced to reduce obesity, sugar, and to lead a healthy life. To download a fresh copy of an E-Book regarding Low Carb Diet which is absolutely free for our site visitors please click here

PART-5-RHEUMATOID ARTHRITIS

SECOND LINE DRUGS-Contd.

Corticosteroids

Corticosteroids are mostly glucocorticoids used as anti-inflammatory drugs. They are cortisol analogs.

In severe progressive RA prednisone can give some benefits. Because of the seriousness of side effects corticosteroids are considered to be the drugs of last choices.

They are used in,

1.Acute flare-ups of the disease

2.As adjuncts with other slow-acting drugs

3.In elderly patients as alternatives for more toxic second-line drugs

4.In patients who cannot tolerate or who are allergic to NSAIDs.

5.In patients with a systemic attack of RA.

Administration and Dosage

Oral prednisone is 5 to 10mg may be enough to some patients

Because of the serious adverse effects dosage should be limited to possible low with care.

If pain is localized to one or few inflamed joints an intraarticular injection may be beneficial.

Side Effects

1. Immunosuppression leads to delay in wound healing

2.G.I.Bleeding

3.Myopathy

4.Cataracts

5.Hyperglycemia

6.Hypertension

7.Osteoporosis

Topical Treatments

Topical treatments are safer but less systemic. They are counter irritants and rubefacients.

Capsaicin which is a pungent hot ingredient of pepper can be used as a rubefacient to relieve RA.

Capsaicin is blocking the substance-P which transmits the pain impulses from the periphery to the brain through sensory nerves.

Capsaicin can be applied three or four times a day to get good relief.

It is available in the market by the brand Zostrix

Counter Irritants 

1.Allyl isothiocyanate

2.Methylsalicylate

3.Menthol

All the above drugs produce mild counter inflammations and thereby relieve the RA pain.

They should be applied to the skin followed by gentle massages.

PART-4-RHEUMATIC ARTHRITIS

SECOND LINE DRUGS-Contd...

5.Penicillamine:-

The mechanism of its anti-rheumatic action is due to its ability to alter the immune response of the body. Penicillamine used to treat refractory rheumatoid arthritis. Its use is now very limited with more modern medication with fewer side effects.

Chemically penicillamine is a breakdown product of penicillin.

It delays the onset of joint erosions in RA.

Absorption

Penicillamine should be given in an empty stomach as food may interfere with its potency and block its absorption. As penicillamine is a chelating agent it may chelate all polyvalent ions present in the food such as calcium, magnesium, copper, iron, and zinc. These chelates are not absorbed by the intestine.

Dosage

The initial dosage is 125 - 250 mg once daily. Then the dosage is doubled after 3 months. After the next 3 months again the dose is doubled to a maximum of 750 mg daily until to get a required therapeutic effect. Very rarely the daily dosage can be maximized to 1000 to 1500mg under strict supervision. The basic dosing moto for this drug is to go low-go slow.

Side Effects

1.Reversible side effects such as rash, fever, blood urine, proteinuria, dysgeusia(distortion of the taste sense) and aphthous ulcers(mouth ulcers)

2.Vascular complications like leukopenia, thrombocytopenia and aplastic anemia

3. Systemic Lupus Erythematosus, Good Pasteur's Syndrome, and pemphigus have occurred. All these are autoimmune diseases in which the body's own immune system wrongly attacks its own skin, kidneys, and lungs.

6.Azathioprine

 

It is an autoimmune suppressor. It is a purine analog. It is used as a last attempt if other agents are not responded (refractory RA)

The dosage is 50 to 100 mg twice daily (1mg/kg). After 6 to 8 weeks the dose can be increased by ever 4 weeks by 0.5mg/kg.to a maximum of 2.5mg/kg.daily.

The dosage should be reduced in patients with renal dysfunctions.

Side Effects

1.Gastrointestinal effects such as nausea, vomiting, stomach pain,

2.Liver damage

3.Bone marrow suppression

4.Lymphoma

7.Cyclophosphamide

 

Similar to other immunosuppressive agents this antineoplastic agent can also be used in the treatment of refractory RA. But the use is limited because of its severe toxicity when compared with other immunosuppressive agents.

The initial dose is 1.5 to 3 mg/kg of the body weight.

Side Effects

1.Bone marrow depression

2.hemorrhagic cystitis

3.steriliy

4.Alopecia

5.Bladder cancer.

Other similar drugs are chlorambucil, cyclosporine. These are also immunosuppressive agents used in neoplastic treatments with a high toxic profile. Used to treat refractory RA.

Minocycline an antibiotic that can affect the Mycoplasma organism, the organism which causes RA.

PART-3-RHEUMATOID ARTHRITIS

RHEUMATOID ARTHRITIS-Contd...

Second Line Drugs

Unlike drugs like aspirin and NSAIDs which are considered as fast-acting and first-line drugs these drugs are said to be slow-acting anti-rheumatic drugs(SAARD) or disease-modifying anti-rheumatic drugs (DMARDs).

When a patient suffers from sustained disabilities with RA only an anti-inflammatory course is not sufficient. The course of the disease should be modified to ease the disability. This is possible with second-line drugs like hydroxychloroquine, methotrexate, gold compounds, penicillamine, and sulfasalazine. These drugs are used as an adjuvant along with the anti-inflammatory treatments. 

These drugs are acting by delaying or modifying the development of the disease. Therapeutic effects may take several months. Careful monitoring of the patients must be necessary because of the serious side effects.

In general these drugs are used along with anti-inflammatory drugs. But some doctors may initiate with these drugs alone and interchange them if they found one drug is ineffective. The ineffective drug should be discontinued before changing to other drugs.Initiating a second-line drug is possible if the patient is not tolerating anti-inflammatory drugs and their prolonged may result in some possible side effects. Yet these drugs too show potential side effects.

1.Hydroxychloroquine

 

The dosage is started with 200mg twice daily (400mg/day) or 6.5mg/kg whichever is less. It is possible as per the condition the daily dose can be reduced to 200mg once daily.

The patients should be taking care of the following side effects:-

1. Nausea and epigastric pain is possible but not seriously

2. Rare effects on eyes, skin, CNS, and bonemarrow are possible on the recommended dosage

3. Hydroxychloroquine causes retinal damage and hence visual checkup is recommended every 3 to 6 months by an eye specialist.

It is highly advisable to discontinue the medicine if the first sign of the retinal damage is notified.

4. Corneal damages can be reversible but the retinopathy is irreversible.

2.Methotrexate

As methotrexate acts faster than other second-line drugs some physicians are considering it as a first-line drug yet it is somehow slower than anti-inflammatory drugs.

Methotrexate is a folic acid antagonist and is used in many neoplastic disease treatments.

The initial weekly doses are 5 to 10 mg. This can be divided as twice-daily doses but is not safer and much beneficial.

The dosage can be slowly increased to 15 to 20 mg every 3 to 6 weeks. 

Intramuscular dosage also available if the oral route is ineffective or may produce gastric trouble.I.M.dosage is once per month.

The following precautions must be taken:-

Aspirin may increase the toxicity of methotrexate by delaying its excretion. Hence aspirin should not be used with it.

Adverse Effects

1. Gastric effects like nausea, anorexia, stomach cramps, and ulcers)

2.Bone marrow suppressions

3.Liver damage

4. Hypersensitivity reactions lead to pneumonitis

5. Rarely pneumonia and chickenpox may precipitate as the drug is immunosuppressive.

6.Monitor RBC, WBC, and platelet counts.

3.Gold Compounds

 

Gold compounds are proved as very effective second-line drugs in relieving RA by delay progressions of joint erosions.

a)Gold Sodiumthiomalate i.m.injection

b)Aurothioglucose i.m.injection

A test dose of 10mg is given followed by 25mg of the initial weekly dose for two weeks.

After that the dose can be increased to 50mg per week for 20 weeks can be given.

Once there is an expected effect occur the treatment should be continued with the same 50 mg dosage with 2 weeks intervals followed by every three weeks and then to reach every month for 3 to 6 months.

The treatments should continue as a monthly therapy. Abrupt discontinue of the treatment may result in a relapse of RA which may not respond again to gold therapy.

Side Effects

1.Proteinuria

2.Blood dyscrasias

3.Rashes

4.Leucopenia

5.Thrombocytopenia

6.Aplastic anemia

7.Anaphylaxis

8.Angioneurotic edema

9.Glossitis

10.Interstitial pneumonitis

11. Gold Sodium thiomalate because of its water solubility can produce vasodilation, hypotension, and syncope. These effects do not occur with aurothioglucose which is fat-soluble.

c)Auranofin(Oral)

This drug is orally active, less effective, and less toxic.

The initial dose is 3 mg twice a day or 6 mg once a day for six months.

If no effect the dose can be increased to 3 mg three times daily or 9 mg once daily.

Still there is no effect reached auranofin should be discontinued.

Side Effects

1.Diarrhea, stomach pain usually reversible

2. Rash and stomatitis also reversible

3. Proteinuria also reversible

4.Rarely bone marrow suppression and renal toxicity.

4.Sulphasalazine

 

Sulphasalazine is a sulphonamide derivative used as an anti-RA drug widely in many countries.

It is a very effective drug

It slows the progression of joint damage

It can be given orally.

The dose is 0.5mg twice daily.

The dose is slowly increased by 0.5mg every week up to 2 to 3 gram /day in divided doses.

Side Effects

1.G.I.Distress

2.Blood dyscrasias (Rare)

3.Hepatitis (Rare)

PARTVII-FREE E-BOOK-THE BRAIN WORKSHOP

THE BRAIN WORKSHOP

The brain is the head of the department our body and is the IT head call center of our body.

Ever functions of our body are at the sole discrete decision of our brain empire.

The Central Nervous System which is branched into numerous networks spread throughout the body. Even the Autonomic Nervous System and the Somatic(skeletal muscle) Nervous System which serves as Peripheral Nervous networks too are in some way connected with the Brain Kingdom.

If the brain dies everything will stop and our eternal life starts.

PART-2-RHEUMATOID ARTHRITIS

RHEUMATOID-DIAGNOSIS AND THERAPY

 RA

Generally it is very difficult to diagnose RA at the early stages as it is mostly asymptomatic in the beginning.

RA diagnoses are based on their symptoms and laboratory findings as follows.

Diagnoses

 

1. Joint symptoms such as swelling, abnormal fluid collections in articular cavities, synovial thickening, and edema with pain on motion, indicates the presence of RA.

2. Subcutaneous nodules mostly occur in the sites exposed to external pressure such as elbow, shoulder, and wrist but also in other organs indicates the presence of RA. These nodules are rubbery, round, and firm masses can be identified with fingers.

3. A deeper diagnosis by X-radiation can indicate the presence of asymptomatic early RA by the presence of mild painless soft tissue swellings.

4. A blood test can show the presence of RA factors, heterogeneous antibodies present in most RA patients. 

5.ESR test may be high which indicates the presence of early RA.

6. The presence of normochromic, normocytic anemia may indicate the presence of RA.

Treatments

 

The treatments involve two methodological approaches such as Mechanical and Pharmacological.

Mechanical Methods

The patient should be trained with proper balanced daily exercises and rests as follows:-

1. In the beginning start with how to keep the joints in rest.

2. Start the exercise by step by step movements of the joints without straining them to strengthen the muscles.

3.when return to sleep train how to keep the joints by aligning them by the use of specially designed lightweight splints.

4. Complete immobilization should be avoided.

5. When the above methods fail a mild surgery to improve the functions and movements of hands and knees are advised.

Pharmacological Methods 

Analgesics and anti-inflammatory drugs such as aspirin and NSAIDs are beneficial. Paracetamol has not been used as it is not having any anti-inflammatory effects.

Anti-inflammatory drugs at their therapeutic dosage are riskier and the risk factors override the required therapeutic response.

Aspirin

We have already dealt with this drug in detail in another post (9-12-2015) in the same blog under the heading "Paracetamol, Aspirin and other NSAIDs".Please download it.

A piece of additional information is aspirin is the first-line drug to treat rheumatism. Aspirin is used in higher dosage to treat inflammation and it is more economical. But its risk factor overrides its benefits.

Mechanism

Aspirin is acting similar to other NSAIDs but to a lesser extent it is preventing the synthesis and release of prostaglandin.

Dose

4 to 6 gms daily

For side effects please refer to the post "Paracetamol, Aspirin, and Other NSAIDs" in this blog.

Other NSAIDs:-

They are ibuprofen, naproxen, sulindac, and piroxicam. Please refer to the following table.

Actions are similar to aspirin by inhibiting cyclooxygenase 1 and 2 and thereby inhibiting the synthesis and release of prostaglandin.

NSAIDs have the advantage over aspirin by producing the required effects in a much lower dosage than aspirin but are more expensive.

Special Precautions

1. They should be avoided in asthmatic patients as they can elevate bronchospasm. Aspirin is suitable for them.

2. Unlike aspirin NSAIDs reversibly affect the platelet function, hence safer than aspirin but still should be cautious in using them to those who have gastric bleeding.

Misoprostol is used to treat gastric hemorrhages caused by NSAIDs.(Misoprostol dosage:100 to 200 mcg four times daily along with NSAIDs treatment)

3.NSAIDs decrease the renal blood flow and renal failure may ensue in patients who already suffer from less renal flow due to CHF and Diuretic therapy. Sulindac is safer.

4.Liver failure

5.CNS effects such as drowsiness, dizziness, anxiety, tinnitus, and confusion, that disappear on continuous use. Headache is more common with indomethacin

6.Blood dyscrasias(Rare)

7. Naproxen and ibuprofen are safer than other NSAIDs in producing GI effects

Nabumetone causes lesser gastric irritation

Meclofenamate and Mefenamic acid may cause severe diarrhea

Piroxicam which has a longer duration of action may cause higher gastric bleeding. It should be avoided in elderly patients.

Indomethacin can cause more serious CNS effects than other NSAIDs.

Nonacetylated salicylates such as salsalate, choline salicylate are safer than aspirin in aspirin-sensitive patients as they do not have respiratory effects similar to aspirin.