The UK’s National Health Service NHS) has a published treatment algorithm for the use of disease-modifying therapies, but is it any good? What medications should you use if you are newly diagnosed or if the first treatment fails? I give my perspective as an American neurologist.
With low or no-carbohydrate diets rising in popularity in recent times, the humble potato is now regularly overlooked in favour of other vegetables.
In fact, research literature has previously indicated potatoes may have a detrimental effect on health, such as possibly increasing the likelihood of developing Type 2 diabetes.
However, new Edith Cowan University (ECU) research has shown while spuds may not have all the same benefits as some other vegetables — such as lowering risk of Type 2 diabetes — health issues associated with potatoes may actually be due to how people are preparing them and what they’re eating them with.
More than 54,000 people reported their dietary intake for the long-term Danish Diet, Cancer and Health study.
A recent analysis of this study led by Dr Nicola Bondonno from ECU’s Nutrition and Health Innovation Research Institute, found people who consumed the most vegetables were 21 per cent less likely to develop Type 2 diabetes than those who consumed the least amount of vegetables.
PhD candidate Pratik Pokharel carried out work on the analysis and said while potatoes didn’t have the same impact on Type 2 diabetes, they also didn’t have any negative effect.
“In previous studies, potatoes have been positively linked to incidence of diabetes, regardless of how they’re prepared — but we found that’s not true,” Mr Pokharel said.
“In Denmark, people consume potatoes prepared in many different ways; in our study, we could distinguish between the different preparation methods.
“When we separated boiled potatoes from mashed potatoes, fries or crisps, boiled potatoes were no longer associated with a higher risk of diabetes: they had a null effect.
Mr Pokharel said underlying dietary patterns were the key.
“In our study, people who ate the most potatoes also consumed more butter, red meat and soft drink — foods known to increase your risk of Type 2 diabetes,” he said.
“When you account for that, boiled potatoes are no longer associated with diabetes. It’s only fries and mashed potatoes, the latter likely because it is usually made with butter, cream and the like.”
Eat your vegies
Mr Pokharel said findings from the study indicate vegetables could play a key role in reducing Type 2 diabetes, as people who ate a lot of leafy greens and cruciferous vegies such as spinach, lettuce, broccoli and cauliflower had a significantly lower risk of developing the condition.
He said the relationship between vegetables and diabetes should be incorporated into public dietary guidelines — as should the benefits of eating potatoes.
“The finding that vegetables lower diabetes risk is crucial for public health recommendations, and we shouldn’t ignore it,” he said.
“Regarding potatoes, we can’t say they have a benefit in terms of type 2 diabetes, but they also aren’t bad if prepared in a healthy way.
“We should separate potatoes and other vegetables in regard to messaging about disease prevention but replacing refined grains such as white rice and pasta with potatoes can improve your diet quality because of fibre and other nutrients found in potatoes.”
Putting it into practice in the kitchen
Mr Pokharel said people should be advised to increase their vegetable intake — and they could include potatoes, so long as they left out some of the unhealthy extras such as butter, cream and oil.
“Potatoes have fibre and nutrients, which are good for you,” he said.
“People talk about carbs being bad, but it’s more about the type of carbs you’re having; compared to something like white rice, boiled potatoes are a good quality of carbohydrate.
“But just take care how you prepare them: don’t eat fries, or mash with extras in it all the time.
“Just boil them and eat them like other greens or other foods — and you don’t need to have it with red meat all the time.”
An overview of Menzies Institute for Medical Research’s TAURUS.2 study which will measure the effects of magnetic brain stimulation (MBS) on multiple sclerosis (MS). MBS can non-invasively activate nerve cells in the human brain and can be used to change nerve cell activity. MBS is currently used to treat depression but has only been used for MS in the research setting to date. In this video for potential study participants we talk about the TAURUS.2 study aims, how magnetic brain stimulation works, what’s involved and who is eligible to participate in this phase 2 clinical trial.
Exposure to traffic related air pollution is associated with an increased likelihood of having multiple long-term physical and mental health conditions according to a new study of more than 364,000 people in England.
Led by researchers from Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, this is the largest study worldwide to examine whether air pollution exposure is linked with the occurrence of multiple long-term health conditions.
Multimorbidity is defined as having two or more physical or mental health conditions and affects 27 per cent of adults in UK primary care. It increases the use of healthcare services and the costs of primary and secondary care, but its association with air pollution has not been studied in the UK until now.
Published in Frontiers in Public Health the study showed that high levels of traffic-related air pollution – fine particulate matter 2.5 (PM2.5) and nitrogen dioxide (NO2) – were associated with an increased risk of having at least two long term health conditions. The strongest associations were observed for co-occurring neurological, respiratory, cardiovascular and common mental health conditions such as depression and anxiety.
This research was funded by National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre and NIHR Applied Research Collaboration (ARC) South London.
Dr Amy Ronaldson, Research Associate at Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London and first author on the study said: “People with more than one long-term health condition have a lower quality of life and greater dependence on the healthcare system. Our NIHR funded research has indicated that those people that live in areas of higher traffic-related air pollution are at greater risk of having multiple health conditions. The study does not prove that air pollution causes multimorbidity, but it does warrant further research in this area. It could be that simple measures to reduce traffic levels could potentially improve lives and lessen the pressure on our healthcare systems.”
Researchers analysed data from UK Biobank – a large-scale biomedical database and research resource containing anonymised genetic, lifestyle and health information from half a million UK participants. aged between 40 and 69 years. Participants were assessed for 36 physical and five mental health chronic conditions. Multimorbidity was defined as having two or more of these conditions.
Physical and mental health data from UK Biobank in 2010 were linked with the estimated concentration of air pollution at the residential address of the participants.
The study found that those participants exposed to higher concentrations (above 10µg/m3) of fine particulate matter had a 21 per cent increased risk of two or more co-occurring conditions compared to those exposed to concentrations below 10µg/m3.
For participants exposed to above 30µg/m3 of NO2 the research showed a 20 per cent increased risk of having two or more co-occurring conditions compared to those participants that were exposed to concentrations of NO2 below 20µg/m3.
Amongst those with multiple conditions, increased exposure to both PM2.5 and NO2 was linked to a greater severity of the co-occurring conditions.
Dr Ioannis Bakolis, Reader at IoPPN, King’s College London and senior author on the study said: “How air pollution affects multiple organs and systems at the same time is not yet fully understood, but there is some evidence that mechanisms such as inflammation, oxidative stress and immune activation could be triggered by air particulates, which can cause damage to the brain, heart, blood, lungs and gut.
“Our study suggests that it could be through shared mechanisms that air pollution negatively impacts several body systems and increases the likelihood of people developing multiple long term health conditions. More research is needed to understand just how air pollution affects the different bodily systems, but it may be that tackling air pollution could help prevent and alleviate the debilitating impact of multiple long-term health conditions.”
Researchers identified several patterns in the associations: the strongest links were primarily between conditions relating to the respiratory system (asthma, chronic obstructive pulmonary disease) as well as the cardiovascular system (atrial fibrillation, coronary heart disease, heart failure) but also to neurological and common mental conditions (stroke, substance abuse, depression, anxiety).
The study, ‘Associations between air pollution and multimorbidity in the UK Biobank: A cross-sectional study’ was published in Frontiers in Public Health.
A medication used to treat MS also has a beneficial effect on the composition of the intestinal flora, according to researchers from the University of Basel and the University Hospital Basel. Conversely, the gut flora also plays a role in which side effects occur during treatment with the medication.
Few previous studies have examined the effects of MS treatments on intestinal flora and on the role their composition plays with regard to efficacy and side effects. A team of researchers at the University of Basel and the University Hospital Basel has now examined these questions in a group of 20 MS patients being treated with dimethyl fumarate. The team led by Professor Anne-Katrin Pröbstel, senior physician in Neurology and research group leader, and Professor Adrian Egli, who recently moved to the University of Zurich, published their findings in the journal Gut Microbes.
The medication, which is sold under the brand name Tecfidera, reduces the number of MS flare-ups by interfering with the metabolic processes of certain immune cells. However, the therapy is also associated with side effects, including hot flashes and gastrointestinal complaints, and in some cases lymphopenia, a lack of lymphocytes such as B cells and T cells in the blood. This can lead to severe complications.
More “good” bacteria
In their study, the researchers examined stool and blood samples from participants before and during the first twelve months of the treatment. Their focus was on the composition of the gut microbiome. Pröbstel and her team also measured the number of lymphocytes in the blood in order to identify patients who were experiencing lymphopenia as a side effect.
After only three months of treatment, the research team was already able to identify changes to the gut microbiome: “We were able to show that the gut bacteria of patients receiving the medication started to become more like the composition seen in healthy individuals,” Pröbstel explained. Treatment with dimethyl fumarate reduced the proportion of pro-inflammatory types of bacteria, which have been associated with MS, and supported the growth of “good” bacteria.
Furthermore, the researchers were able to draw a connection between the composition of the gut microbiome and the development of lymphopenia: The presence of Akkermansia muciniphila bacteria combined with the lack of Prevotella copri bacteria emerged as a risk factor for this side effect. The authors therefore suspect that P. copri may protect against lymphopenia.
Interaction between therapy and gut flora
“Our data suggest that immunomodulatory therapies affect not only immune cells, but also positively influence the gut microbiome,” Pröbstel explains. The connection between gut bacteria and clinical side effects of the treatment may eventually enable early identification of patients at risk of developing lymphopenia. Microbiologist Egli continues: “In the future, this relatively new field of microbiology may help us better understand the effects and side effects of many medications with regard to gut bacteria, and to personalize treatment accordingly.”
“What we have so far is only a pilot study with a relatively small number of participants,” she cautioned. Larger-scale studies are needed to confirm the results and explore the potential for supporting MS therapies via gut flora and for predicting side effects in advance.
The research team from the Departments of Neurology, Biomedicine, Clinical Research, and the Research Center for Clinical Neuroimmunology at the University of Basel and the University Hospital Basel received funding for the study from the University Hospital of Basel’s Propatient Foundation, the Goldschmidt-Jacobson Foundation, Biogen, the National Multiple Sclerosis Society and the Swiss National Science Foundation.