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Aging, Neuroscience, Stanford News, Stroke, Videos

Examining the potential of creating new synapses in old or damaged brains

Examining the potential of creating new synapses in old or damaged brains

Synapses are the structures in the brain where neurons connect and communicate with each other. Between early childhood and the beginning of puberty, many of these connections are eliminated through a process called “synaptic pruning.” Stroke, Alzheimer’s disease, and traumatic brain injury can also cause the loss of synapses. But what if new synapses could be created to repair aging or damaged brains?

Stanford neurobiologist Carla Shatz, PhD, addresses this question in the above Seattle+Connect video. In the lecture, she discusses the possibility of engaging the molecular and cellular mechanisms that regular critical developmental periods to regrow synapses in old brains. Watch the video to learn how advances at the neural level around a novel receptor, called PirB, have implications for improving brain plasticity, learning, memory and neurological disorders.

Previously: Drug helps old brains learn new tricks, and heal, Cellular padding could help stem cells repair injuries and Science is like an ongoing mystery novel, says Stanford neurobiologist Carla Shatz and “Pruning synapses” and other strides in Alzheimer’s research

Ask Stanford Med, Chronic Disease, Events, Nutrition

Diabetes and nutrition: Why healthy eating is a key component of prevention and management

Diabetes and nutrition: Why healthy eating is a key component of prevention and management

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The prevalence of type 2 diabetes is expected to rise sharply over the next three decades. Recent data from the Centers for Disease Control and Prevention shows that if current trends continue, an estimated 1 in 3 adults will be diagnosed with the disorder by 2050. Eating healthy is a key component of managing diabetes and reducing one’s risk for developing the disease. But what does eating right for diabetes actually mean?

Kathleen Kenny, MD, a clinical associate professor at Stanford, and Jessica Shipley, a clinical dietitian at Stanford Hospital & Clinics, will answer this question during a talk focused on diabetes and nutrition on Dec. 4. The Stanford Health Library event will be held at the Arrillaga Alumni Center on campus, where attendees can also have their blood glucose checked. The conversation will also be webcasted for those unable to attend in person.

To promote discussion on the topic in advance of the lecture, I reached out to Kenny and asked about nutrition principles and guidelines for patients with diabetes and others interested in how healthy eating can prevent or delay onset of the disease. In the first installment of a two-part Q&A, she explains the advantages of eating a Mediterranean diet and the importance of eating fiber-rich foods.

Are there any ways to reverse or slow the progression of pre-diabetes? Are there specific diets that may be useful to help prevent or control diabetes?

One of the most common questions my diabetic patients ask is how they can reduce or eliminate diabetes medications. Others are found to be pre-diabetic on the basis of an “A1c” or an impaired fasting glucose, and want to know how to prevent diabetes. Several randomized trials have shown that healthy diet and exercise can reverse and also delay the onset of diabetes.

One of the largest trials is the often-cited Diabetes Prevention Program, which randomized more than 3,000 patients to diet/lifestyle versus metformin versus placebo. The most effective strategy was diet and lifestyle, showing a dramatic 58 precent reduction in the rate of developing diabetes. This surpassed the drug therapy with metformin. Approximately 5 percent of patients in the lifestyle group developed diabetes annually, as compared to 11 percent in the placebo arm. Notably, there was a 16 percent reduction in diabetes risk with every 1 kg reduction in weight. This seems attainable for many patients.

There was also meta-analysis last year looking at different diets for patients with known diabetes, in terms of weight loss and improving their diabetes control. In this data compilation, the Mediterranean diet had the greatest weight loss, followed by the low carbohydrate diet. In terms of A1c reduction, the Mediterranean diet had a reduction of -0.47 percent, and the low carbohydrate -0.12 percent. But all the diets studied resulted in better glycemic control. Many studies have shown that diets high in glycemic load are linked to higher diabetes risk (particularly in overweight women), and contribute to central body fat , so it is recommended that diabetics or those at risk limit their intake of high glycemic index foods both to delay and to help control their diabetes. Additionally, there are some data suggesting that adherence and success rate may be higher for low-carbohydrate diets in patients with diabetes and insulin resistance.

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Emergency Medicine, Global Health, Stanford News, Videos

Improving global emergency medicine to save lives

Improving global emergency medicine to save lives

In July 2013, Stanford physician S. V. Mahadevan, MD, and colleagues conducted a study at the largest children’s hospital in Karachi, Pakistan to understand the kinds of medical emergencies that doctors treated at the facility. “What we found was astonishing,” he says in this Stanford+Connect video. “By fourteen days 10 percent of [the 1266 children enrolled in the study] were dead.” Mahadevan saw more children die during the one week he spent in the Pakistan hospital than in his entire 22-year-career in the United States.

Despite such dire statistics, there is hope. Mahadevan, founder of Stanford Emergency Medicine International, explains in the video how important early interventions can be made in the chain of survival to save thousands of lives in low-resource countries. Watch the full lecture to learn more about his efforts to establish Nepal’s first ambulance service, India’s first paramedic training program and his ongoing work to improve emergency care in Cambodia.

Previously: Stanford undergrad uncovers importance of traditional midwives in India, Providing medical, educational and technological tools in Zimbabwe and Saving lives with low-cost, global health solutions

Aging, Neuroscience, Research

Being bilingual “provides the brain built-in exercise”

Being bilingual "provides the brain built-in exercise"

Spanish_booksWith less than two months left in 2014, many of us will soon begin the annual ritual of selecting our New Year’s resolutions. Those who are looking to boost their brain power may want to consider learning a second language in 2015: Research published today in the journal Brain and Language shows that being bilingual makes the brain more efficient at processing information.

In the study, researchers used functional magnetic resonance imaging (fMRI) technology to examine participants’ brains as they performed language comprehension tests. For example, researchers would say the word “cloud” to individuals while showing them four pictures, including one of a cloud and others of similar-sounding objects, like a clown. To complete the exercise, participants had to recognize the correct photo and ignore the irrelevant images. According to a release, study results showed:

The bilingual speakers were better at filtering out the competing words because their brains are used to controlling two languages and inhibiting the irrelevant words, the researchers found.

The fMRI scans showed that “monolinguals had more activation in the inhibitory control regions than bilinguals; they had to work much harder to perform the task,” [said lead author Viorica Marian, PhD.]

“Inhibitory control is a hallmark of cognition,” said Marian. “Whether we’re driving or performing surgery, it’s important to focus on what really matters and ignore what doesn’t.”

The fact that bilinguals are constantly practicing inhibitory control could also help explain why bilingualism appears to offer a protective advantage against Alzheimer’s and dementia, said Marian.

“That’s the exciting part,” she said. “Using another language provides the brain built-in exercise. You don’t have to go out of your way to do a puzzle because the brain is already constantly juggling two languages.”

The findings add to the growing body of scientific evidence showing that being bilingual can have profound impacts on your brain.

Previously: Study shows bilingualism may enhance attention and working memory and ¿Habla Español? How bilingualism may delay the onset of Alzheimer’s symptoms
Photo by Megan Morris

Mental Health, Public Health, Research

Survey shows nearly a quarter of U.S. workers have been diagnosed with depression in their lifetime

Survey shows nearly a quarter of U.S. workers have been diagnosed with depression in their lifetime

4369627924_ccd7f6f7ff_zDepression is a major contributor to absenteeism, reduced productivity and disability among adults in the United States. Now results from a survey examining the societal and economic burden of depression in the workplace show that almost a quarter of employees have been diagnosed with depression in their lifetime and that two in five patients have missed work, for an average of 10 day per year, because of it.

The findings underscore the importance of decreasing the stigma associated with mental-health conditions in the workplace and providing workers with support services and resources. According to a release, additional results also showed:

…64 percent of survey participants reported cognitive-related challenges, as defined by difficulty concentrating, indecisiveness and/or forgetfulness, have the most impact on their ability to perform tasks at work as normal. Presenteeism (being at work, but not engaged/productive) has been found to be exacerbated by these challenges related to thinking on the job.

Despite how depression is affecting our workforce, 58 percent of employees surveyed who have been diagnosed with depression indicate they had not told their employer of their disease. In addition, 49 percent felt telling their employer would put their job a risk and, given the economic climate, 24 percent felt it was too risky to share their diagnosis with their employer.

These figures directly contribute to the estimated $100 billion annually spent on depression costs by U.S. employers including $44 billion a year in lost productivity alone.

The survey was commissioned by Ohio-based Employers Health and conducted by market research company Ipsos MORI. Questions were asked via an online panel of 1,000 adults, aged 16-64, who have been workers or managers within the last year. Responses were weighted to ensure the sample was representative of this profile. Funding was provided by international pharmaceutical company H. Lundbeck A/S.

Previously: Anxiety shown to be important risk factor for workplace absence, Research shows working out may benefit work life and How work stress affects wellness, health-care costs
Photo by Ryan Hyde

Nutrition, Obesity, Public Health

A physician realizes that she had “officially joined our nation of fellow sugar addicts”

A physician realizes that she had "officially joined our nation of fellow sugar addicts"

sugar_11.11.14Over on CommonHealth, Terry Schraeder, MD, an internist at Mt. Auburn Hospital and a clinical assistant professor at Brown University, speaks candidly about her realization that she was consuming way too much sugar – likely more than 22 teaspoons – each day.

Her addiction started with a sugar-laden drink disguised as sparkling orange juice and spiraled into regular consumption of flavored coffees, muffins, snacks, desserts and “healthy foods” containing hidden corn syrup. In the piece, Schraeder explains that a high triglyceride level convinced her to change her eating habits:

For the past eight weeks, I have tried to limit adding sugar in any form to my food and started searching nutrition labels for sugar content. If the food lists the grams of sugar on the nutrition label (these may be natural or added), then I check the list of added ingredients to see if there is any added sugar in the form of corn syrup, sucrose, fructose, brown sugar, juice concentrate, honey, molasses, etc. If there is, I know it is “added” sugar. I try to limit my added sugar to less than 24 grams (or six teaspoons) each day.

It has not been easy but it has been well worth the effort. For the first time in years, my moods and energy are more level, the sweet cravings are gone and I feel calmer. The fat around my belly has disappeared. My teeth feel smoother and cleaner despite the same oral hygiene. The late afternoon slump and brain fog are no more. I will have my triglycerides rechecked soon.

I feel great but I am still in shock. I had no idea I was consuming too much sugar. If you had asked me, I would have denied it. For years, I have railed against fat and calories, smoking and lack of exercise. I had not considered my own sugar intake.

The piece is worth a read and may inspire you to take a closer look at your own daily sugar intake.

Previously: Study shows banning soda purchases using food stamps would reduce obesity and type-2 diabetes, What do Americans buy at the grocery store? and Mindful eating tips for the desk-bound
Photo by Moyan Brenn

Aging, Health and Fitness, Neuroscience, Public Health, Research

Neighborhood’s “walkability” helps older adults maintain physical and cognitive health

Neighborhood’s “walkability” helps older adults maintain physical and cognitive health

3275748024_c4914d4ae0_zLiving in a walkable neighborhood could be an important factor in helping older adults maintain their physical and cognitive health, according to new research from the University of Kansas.

In the small study, researchers monitored a group of adults diagnosed with mild Alzheimer’s disease and compared them to those without any cognitive impairment. Over a two-year period, individuals completed cognitive tests designed to measure attention, verbal memory and mental status. The ”walkability” of participants’ neighborhoods was determined using geographic information systems (GIS). Medical News Today reports:

Results from the study suggest that communities that are easier to walk in are linked to better physical health outcomes – such as lower body mass and blood pressure – and cognition – including better memory.

[Researchers] believe their findings could benefit older adults, health care professionals, caregivers and even architects and urban planners.

Finding also showed that environments with more complex layouts appeared to aid residents in staying mentally sharp, rather than confusing them. Researchers presented their findings over the weekend at the Gerontological Society of America’s annual meeting in Washington, DC.

Previously: Walking and aging: A historical perspective, Even old brains can stay healthy, says Stanford neurologist,  Exercise and your brain: Stanford research highlighted on NIH Director’s blog , Moderate exercise program for older adults reduces mobility disability, study shows and Creating safer neighborhoods for healthier lifestyles
Photo by Ed Yourdon

Ask Stanford Med, Chronic Disease, Events, Health and Fitness

Examining the role of exercise in managing and preventing diabetes

Examining the role of exercise in managing and preventing diabetes

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More than 29 million adults and children in the United States are living with diabetes, and it’s estimated (.pdf) that an additional 86 million Americans ages 20 years or older have prediabetes, putting them at increased risk of developing the disease.

The good news is that lifestyle modifications can be an effective method for managing or preventing diabetes. In recognition of National Diabetes Month, I reached out to Baldeep Singh, MD, a clinical professor at Stanford who focuses on chronic disease management, to discuss the importance of regular physical activity for patients diagnosed with diabetes and those working to limit their risk of developing the disease. This Thursday, Singh will explore the topic more in-depth during a Stanford Health Library event at the Arrillaga Alumni Center on campus, where attendees can also have their blood glucose checked. The discussion will also be webcasted for those unable to attend in person.

In this Q&A, Singh highlights scientific evidence showing that staying active has a beneficial effect on insulin sensitivity, and discusses the potential of exercise, in combination with other behavioral changes, to induce partial, or full, remission of type 2 diabetes.

How does regularly exercising help in preventing or delaying type 2 diabetes?

The benefit of exercise in preventing diabetes has been demonstrated in several studies. A meta-analysis of 10 studies of physical activity and type 2 diabetes reported a lower risk of developing diabetes with regular moderate physical activity, including brisk walking, compared with being sedentary

Additionally, in a subsequent prospective cohort study in men, either weight training or aerobic exercise for at least 150 minutes per week was associated with a lower risk of developing type 2 diabetes compared to those with  a control group who did no physical activity.

Why is engaging in physical activity important in managing type 2 diabetes?

In patients with type 2 diabetes, studies show that short-term exercise training improves insulin sensitivity just as it does in non-diabetics. In patients with type 2 diabetes treated with medication, exercise tends to lower blood glucose concentrations.

Exercise improves glycemic control in patients with type 2 diabetes, as illustrated by the findings of several meta-analyses of trials examining the effect of exercise on glycemic control in patients with type 2 diabetes. Exercise training reduces glycosylated hemoglobin (A1C) values by approximately 0.5 to 0.7 percentage points compared with control participants.

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Global Health, Health Costs, Health Disparities, Stanford News

Stanford undergrad works to redistribute unused medications and reduce health-care costs

Stanford undergrad works to redistribute unused medications and reduce health-care costs

1Sanchay Gupta arrived at Stanford with a strong interest in income inequality. In 2013, he spent two weeks of his summer vacation in Guatemala exploring issues of global chronic underdevelopment as part of an intensive field research internship sponsored by the Freeman Spogli Institute for International Studies. While on the trip, he shadowed Stanford doctors in ad-hoc rural clinics serving the indigenous communities and got a firsthand look at the country’s rural health-care system. He also interviewed patients about how their health status affected their family’s welfare while conducting field research.

Among the patients he interviewed was a father of nine children who made his living carrying firewood. One day the man injured himself carrying a particularly heavy load and was declared unfit for work. Seemingly overnight, the family income drastically fell below $3 a day and the father could no longer afford to see a doctor for treatment. But until he received proper medical care, there was no way that he could recover from his injury and resume supporting his family.

“It was during my time in these community settings that I witnessed how disparities in access to medical care can perpetuate inequality,” said Gupta, who was recently named one of the “15 incredibly impressive students at Stanford” by Business Insider. “As a result, I became really interested in how solving issues of inequality could break the cyclical theme of poverty.”

At the same time, Gupta was  fostering a vested interest in the fate of America’s health-care system. He had taken a few courses on U.S. health policy and strategies for health-care delivery innovation, and the experiences sparked a desire to get involved in efforts to eliminate costly inefficiencies within the health-care sector.

In looking for opportunities to get involved in helping reduce inefficiencies in health care, he learned about Supporting Initiatives to Redistribute Unused Medicine (SIRUM), a non-profit launched by Stanford students that engages with health-facility donors, converting their regulated medicine destruction process into medicine donation.

Nearly one-third of patients don’t fill first-time prescriptions and many say concerns about costs are a key reason for their non-compliance. At the same time, an estimated $5 billion of unused and unexpired prescriptions drugs are destroyed in the United States annually. To address these problems, SIRUM has developed an online platform that allows medical facilities, manufacturers, wholesalers and pharmacies to donate unused drugs instead of destroying them.

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In the News, Science, Videos

Using dance to explain science

Using dance to explain science

Circus enthusiast and University of Georgia PhD candidate Uma Nagendra used her aerial talent to create this year’s winning “Dance Your PhD” video. The contest is sponsored by Science AAAS and challenges scientists to use dance to translate their work. For the contest, Nagendra joined forces with her aerialist colleagues to produce the above video based on her research on how tornadoes can alter the dynamic of the ecosystem.

Science recently reported:

Tornadoes are destructive events, ripping up the surface of Earth, crushing buildings, and tossing automobiles in their paths. And based on some models of climate change, they are likely to become more frequent and damaging. But according to a study of forest soil ecology, tornadoes also do some good—for trees, that is. It turns out that tree seedlings get a respite from certain parasitic fungi in a tornado’s aftermath, allowing them to flourish.

For winning the BIOLOGY category and the overall prize, Nagendra receives $1000 and a free trip to Stanford University in May 2015, where her video will be screened.

Previously: “Dance Your PhD” finalists announced

Stanford Medicine Resources: