2008年12月22日 星期一

Colonoscopy prep pills carry kidney risk

由於我兩周前吃過瀉藥 檢查直腸 所以將這則列出
Colonoscopy prep pills carry kidney risk

Anyone who's ever had a colonoscopy knows the worst part is preparing for it, not the procedure itself. You have to make sure your colon is as clean as a whistle so your doctor can get an unobstructed interior view.

In the old days — the late 20th century, that is — you had to drink a gallon of a special salty liquid to cleanse your bowels in basically one sitting. So patients cheered when tasteless tablets that would accomplish the same thing became available in 2000.

But last week, the Food and Drug Administration tempered that joy by adding a "black box" warning — the sternest warning possible — to the two prescription bowel cleansers that come in tablet form. The new warning stems from reports of kidney damage in patients who took the pills, which contain sodium phosphate, in preparation for a colonoscopy.

Also, the FDA, which can require warnings only on prescription drugs, said no over-the-counter sodium phosphate products should be used for bowel-cleansing. That led C.B. Fleet Co. to announce a voluntary recall of Phospho-soda, a non-prescription laxative that in larger doses has been used for bowel-cleansing.

The FDA says prescription Visicol, approved in 2000, and its successor, OsmoPrep, approved in 2006, should be used with caution by people over 55; those who are dehydrated; those who suffer from kidney disease, acute colitis or delayed bowel emptying; and people on medicines that affect kidney function. Medicines include diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers and, maybe, ibuprofen and other non-steroidal anti-inflammatory drugs.

Indiana University gastroenterologist Douglas Rex says he's been switching older patients to fluid bowel-cleansers that don't contain sodium phosphate since the first reports of kidney problems came out in 2005. Rex serves as a scientific adviser to Salix Pharmaceuticals, maker of Visicol, OsmoPrep and MoviPrep, one of the fluid products.

No one knows how many people may have suffered damage from the sodium phosphate bowel-cleansers, because even those who've lost 75% of their kidney function feel fine, says Columbia University pathologist Glen Markowitz. Markowitz, a Salix consultant, was lead author of a 2005 report on kidney damage in 21 patients who had taken sodium phosphate bowel-cleansers. Even when detected, he says, a connection to the products could be missed.

Dallas gastroenterologist Lawrence Schiller says a patient who had an easy time with the pills wasn't thrilled to learn of the kidney issue. Schiller left future choice of prep up to her, noting: "There's a one-in-a-million chance you could end up on dialysis with (the pills)."

Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

2008年12月21日 星期日

糖尿病病患 堅果 豆子等 比全麥食品還好

對後天糖尿病病患 堅果 豆子等 比全麥食品還好 又無心臟病負作用

Recommended Diet for Diabetics May Need Changing, Study Suggests

Published: December 18, 2008

People with Type 2 diabetes on a high-fiber diet kept their blood sugar under better control when they ate foods like beans and nuts instead of the recommended whole-grain diet, researchers have found.

Beans and nuts are among foods that only modestly increase blood glucose levels; scientists describe these foods as having a low glycemic index. The new study, which lasted six months, is one of the largest and longest to assess the impact of foods with a low-glycemic index, researchers said.

Participants on the low-glycemic diet also saw significant improvements in cholesterol after six months, with increases in HDL, the so-called “good” cholesterol associated with a reduced risk of heart disease, the study found.

“That’s an important issue today, because there’s a double whammy for people who are diabetic," said Dr. David J. A. Jenkins, lead author of the report and a professor of nutritional sciences at the University of Toronto. "If they’re men, they have twice the risk of heart disease, and if they’re women, they have four times the risk. If you can hit the heart disease to which they’re particularly vulnerable, you may have something useful."

“Pharmaceuticals used to control Type 2 diabetes have not shown the expected benefits in terms of reducing cardiovascular disease,” he added.

The study was published on Tuesday in the Journal of the American Medical Association.

Some 210 patients with Type 2 diabetes were randomly assigned to a low-glycemic diet or a high-cereal, high-fiber diet.

The high-cereal high fiber diet emphasized “brown foods” such as whole-grain bread and breakfast cereal, brown rice and potatoes with the skin on. The low-glycemic diet included beans, peas, lentils, pasta, quickly boiled rice and certain breads, like pumpernickel and rye, as well as oatmeal and oat bran cereals.

Both diets are low in saturated fat and trans fat. Both groups were told to limit their consumption of white flour and to eat five servings of vegetables and three servings of fruit each day.

Participants on the low-glycemic diet saw their hemoglobin A1C levels — a measure of blood glucose levels over recent months — reduced slightly, by 0.5 percent on average, but experienced significant improvements in HDL, which increased by 1.7 milligrams per deciliter of blood on average. Those on the high-cereal diet saw smaller reductions in hemoglobin A1C and slight drops in HDL.

Dietitians who work with people who have Type 2 diabetes said earlier studies had not demonstrated the benefits of low-glycemic index foods as clearly as this report.

“We’ve been telling people to eat whole grains for a long time," said Emmy Suhl, a nutrition and diabetes educator at the Joslin Diabetes Center in Boston. "What this study shows is that it’s not enough to have whole grains. It’s these very specific low-glycemic carbohydrates that do a much better job."

But, she said, following such a diet is complicated, since the glycemic index of a food can change depending on how it is prepared and served.

“People tell us again and again that diet is the hardest part of diabetes management,” she added.

2008年12月19日 星期五

《美國醫學會期刊》研究 食用豆類堅果 有益糖尿病患 2008-12-20中國時報【黃文正/紐約時報十九日報導】  最新一期《美國醫學會期刊》刊載的一篇研究報告指出,採用高纖低脂飲食法的第二型(成年型)糖尿病患者,在控制血糖濃度方面,食用豆類和堅果類食物,會比醫界習慣推薦的全穀類飲食法,效果更佳。  研究人員表示,豆類與堅果類食物因血糖指數較低,僅會適度增加血糖濃度。研究發現,接受低血糖飲食法的參與者,在半年之後,可明顯增加體內的HDL膽固醇(高密度脂蛋白),即俗稱的「好膽固醇」,對降低罹患心臟病的風險頗有助益。  「這是非常重大的發現,因為罹患糖尿病堪稱雙重打擊,」這篇研究報告的主撰人加拿大多倫多大學營養科學系教授傑金斯說,「如果是男性患者,他再罹患心臟病的機率,是一般人的兩倍;女性更高達四倍之多。」  「截至目前,用來控制第二型糖尿病的藥物,在降低心血管疾病方面並未達到預期的效果。」他說,這項研究對容易罹患心臟病的糖尿病患者應有不小幫助。  此項研究將二百廿名第二型糖尿病患者,隨機抽樣分成兩組,一組採行低血糖飲食法,另一組採用高纖維穀物飲食法。兩組採行的飲食中,飽和脂肪和反式脂肪都很低。  高纖維穀物飲食法強調「棕色食物」,例如全麥麵包、早餐麥片、糙米和連皮的馬鈴薯。低血糖飲食法則包括豆類、豌豆、扁豆、麵糰、快煮米飯(quickly boiled rice)以及黑麵包、裸麥麵包、燕麥粥和燕麥麩等。  經過半年後,低血糖飲食法這一組,糖化血色素(hemoglobin A1c)濃度平均微降○.五%,但對促進HDL膽固醇卻成效顯著,每公合血液平均可增加一.七毫克。  至於高纖維穀物飲食法那一組,糖化血色素濃度降低較少,而HDL膽固醇甚至輕微下降。

2008年12月14日 星期日


The High Price of Cheap Eats

Published: December 11, 2008

Dollar “value meals” at fast food restaurants may not be such a bargain when you look at the potential health costs.

Many of these low-cost menu items are packed with fat, salt, cholesterol and processed meat, notes The Cancer Project, a nonprofit cancer prevention organization. The group has produced a list of what it says are the five unhealthiest items sold at the nation’s largest fast food chains.

The organization’s dieticians reviewed so-called value menus at five of the largest fast food chains in the nation, awarding points for such unhealthy characteristics as sodium, fat and low-fiber content. Jack in the Box’s junior bacon cheeseburger topped the list as the worst offender. The burger costs just one dollar but is packed with 23 grams of fat, including 8 grams of saturated fat, 55 milligrams of cholesterol and 860 milligrams of sodium and just one gram of fiber.

The Cancer Project is affiliated with the Physicians Committee for Responsible Medicine, which aggressively promotes a low-fat, vegetarian diet. The organization’s list was spurred in part by a concern that during tough economic times, more people will resort to eating inexpensive fast foods, said Krista Haynes, a dietitian with the project.

A spokeswoman for Jack in the Box said that the junior bacon cheeseburger is a “great value” but that diners may also choose from healthier options, like salads and a fruit cup. They’re more expensive, however: an entrée salad with grilled chicken strips is $4.99, and a fruit cup is $2.29.

“Our guests can also customize their order, so if you’re dining on a budget you have a lot of choices at Jack in the Box,” said Kathleen Anthony, media relations manager at Jack in the Box.

The other four menu items on the cancer group’s list were:

* In second-worst place, the 89-cent Taco Bell cheesy double beef burrito, with 460 calories, 20 grams of fat and a whopping 1,620 milligrams of sodium.

* In third-worst place was the one-dollar Burger King breakfast sausage biscuit, with 27 grams of fat, including 15 grams of saturated fat and over 1,000 milligrams of sodium.

* Fourth worst went to the one-dollar McDonald’s McDouble, which contains 19 grams of fat and 65 milligrams of cholesterol.

* Last, and least-worst, was the Wendy’s junior bacon cheeseburger, for $1.53, with 310 calories and 16 grams of fat.

Being overweight can increase the risk for diabetes and heart disease, and the American Cancer Society recommends limiting high-fat foods, which are associated with an increased risk of certain cancers, and eating plenty of fruits and vegetables.

But Alice H. Lichtenstein, director of the cardiovascular nutrition laboratory at Tufts University in Boston, questioned whether the declining economy would have much effect on people’s eating habits.

“It would be nice if they decided it was better for their budget to start preparing food at home more often," she said.