Sunday, April 26, 2015

Gut microbes important for serotonin production

Serotonin is probably best known as a brain chemical that affects emotions and behavior, an imbalance of which is thought to contribute to depression. Less well-known is that scientists estimate 90% of serotonin is made in the gut, and imbalances in this peripheral serotonin have been linked to diseases ranging from irritable bowel syndrome and cardiovascular disease, to osteoporosis.

cartoon of gut
90% of serotonin is made in the gut.
Image credit: E. Hsiao/Caltech
Now, researchers from the California Institute of Technology (Caltech) in Pasadena report a study in the journal Cell that shows certain bacteria in the gut play an important role in the production of peripheral serotonin.
Senior author Elaine Hsiao, research assistant professor of biology and biological engineering at Caltech, says studies of mice and other lab animals are increasingly showing that changes in gut microbes affect behavior.
She explains that she and her colleagues were interested in finding out more about how gut microbes and the nervous system talk to each other, and:
"To start, we explored the idea that normal gut microbes could influence levels of neurotransmitters in their hosts."
In the gut, there are three types of cell we know of that produce serotonin: immune cells, nerve cells or neurons, and enterochromaffin (EC) cells.

Gut microbes appear to influence serotonin production by EC cells

For their study, Prof. Hsiao and colleagues wanted to find out which cells the gut microbes might be influencing to have an effect on serotonin levels.
In the first part of the study, they compared peripheral serotonin levels produced from these cells in two groups of mice: one with normal gut microbes and another group of germ-free mice without gut bacteria.
The team found that in the germ-free mice, their EC cells produced around 60% less serotonin than the mice with normal gut bacteria.
And when they restored bacteria colonies in the gut of the germ-free mice, their EC cells began producing normal levels of serotonin - showing the effect on the EC cells can be reversed.
In the next part of the study the team set out to find which bacteria in particular were interacting with the EC cells to make serotonin.
They introduced single species and groups of gut microbes one by one into the germ-free mice, and found that serotonin levels went up when there was a certain mix of about 20 species of spore-forming bacteria.
Introducing this particular bacterial mix into the germ-free mice increased the movement of food through their digestive tract. It also changed activity in their blood platelets, which use serotonin to boost clotting.

Bacteria control gut microbiota metabolites to influence serotonin production

Further exploration in cell cultures revealed some of the molecular mechanisms underpinning the findings. The team found several metabolic byproducts of gut bacteria are controlled by the mix of spore-forming bacteria and act on EC cells to alter serotonin production.
When the researchers increased these metabolic byproducts in germ-free mice, it increased their levels of peripheral serotonin.
Other investigations have shown bacteria can make serotonin on their own. The researchers say their study suggests a lot of the serotonin in the body relies on the interaction between bacteria and host cells.
Prof. Hsiao says a lot more research needs to be done before findings like theirs are ready for clinical use, and offers a word of caution:
"We identified a group of bacteria that, aside from increasing serotonin, likely has other effects yet to be explored. Also, there are conditions where an excess of peripheral serotonin appears to be detrimental."
She and her team now plan to find out how their findings may apply to the human brain.
Researchers are also discovering other surprising things about serotonin in the body. For example, Medical News Today recently learned how a previously unknown source of serotonin could affect antidepressant activity.
One of the main drawbacks of SSRIs (selective serotonin reuptake inhibitors - a class of antidepressants that prevent reuptake of serotonin by increasing levels of it outside cells) is that they take a while to kick in. A study led by the University of Florence found that the source of this extracellular serotonin is not what experts have assumed, and finding out more about it should help improve drugs that target serotonin.
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Study finds increased risk of type 2 diabetes with statin use

A new study published in the journal Diabetologia finds the use of statins - drugs commonly used to lower cholesterol - may significantly increase the risk of type 2 diabetes, and that this risk remains even after accounting for confounding factors, including age, smoking status and body mass index.

A box of statins
The researchers found statin therapy was associated with a 46% increased risk of type 2 diabetes, even after adjustment for confounding factors.
The link between statin use and higher risk of diabetes is not new. Back in 2013, for example, Medical News Today reported on a study published in The BMJ that found certain statins - particularly atorvastatin (Lipitor),rosuvastatin (Crestor) and simvastatin (Zocor) - raised the risk of diabetes by up to 22%.
But according to the researchers of this latest study - including Prof. Markku Laakso of the Institute of Clinical Medicine at the University of Eastern Finland and Kuopio University Hospital in Finland - such studies have had numerous limitations.
The team explains that many of these studies have included selective populations, such as those at high risk of cardiovascular disease. As a result, findings may not be applicable to the general population.
The researchers also note that these studies have often included participants whose diabetes has been self-reported or based on their fasting glucose measurements, which may underestimate the actual number of incident diabetes cases.

Increased risk 'most likely linked to statins that reduce insulin sensitivity and secretion'

For their study, Prof. Laakso and colleagues analyzed the effects of statin use on 8,749 nondiabetic Caucasian men aged 45-73 years who were part of the Finland-based Metabolic Syndrome in Men (METSIM) study.
During the 5.9-year follow-up, 625 men were diagnosed with type 2 diabetes, as determined by either an oral glucose tolerance test (OGTT), an HbA1c level of at least 6.5%, or the commencement of antidiabetic medication.
The results of the analysis revealed that men who were treated with statins were at 46% higher risk of diabetes than men who were not treated with statins.
This 46% increased diabetes risk was present even after adjusting for the men's age, body mass index (BMI), waist circumference, physical activity levels, smoking status, alcohol intake, family history of diabetes and treatment with beta-blockers and diuretic medications.
The researchers also assessed changes in insulin resistance and insulin secretion among men who were treated with statins. They found that statins led to a 24% reduction in insulin sensitivity during follow-up, as well as a 12% reduction in insulin secretion.
For two statins - simvastatin and atorvastatin - the researchers found the associated risk of type 2 diabetes was dose-dependent, as were the reductions in insulin sensitivity and insulin secretion among the men taking these statins.
After accounting for the aforementioned confounding factors, the team found high-dose simvastatin was linked to a 44% higher risk of type 2 diabetes, while a lower dose was linked to a 28% increased risk. High-dose atorvastatin was associated with a 37% increased risk of type 2 diabetes.
Of the study participants, 53% were taking atorvastatin and 29% were taking simvastatin.
Based on their results, the researchers say:
"Statin therapy was associated with a 46% increased risk of type 2 diabetes after adjustment for confounding factors, suggesting a higher risk of diabetes in the general population than previously reported.
The association of statin use with increased risk of developing diabetes is most likely directly related to statins decreasing both insulin sensitivity and secretion."
Prof. Laakso and colleagues say that while one strength of this study is its large size, the fact that all participants were male and Caucasian means the findings may not be generalizable to women or those of other ethnicities.
In February, Medical News Today reported on a study claiming - contrary to previous findings - statins may not protect against Parkinson's disease.
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Drop in abuse and overdose after opioids were made crush-resistant

After 2010, when oxycodone - a high-dose opioid painkiller sold as OxyContin - was switched by its manufacturer to a new abuse-deterrent formulation, overdose rates fell substantially, researchers have found.

Young person in a dark corner
In addition to potential misuse by people receiving the original prescription, opioid painkillers may be diverted to illicit users.
The formulation change also saw a drop in the levels of dispensing, and the lower opioid overdose and prescribing levels also correlated with the withdrawal from the market of another narcotic drug in the same year, propoxyphene.
OxyContin is an extended-release formulation to deliver its higher painkilling dose in a more controlled way, but misuse of this opioid for a quicker "high" had been possible by crushing or dissolving the medication to bypass this design. The new formulation, however, is resistant to this abuse strategy.
Propoxyphene (Darvon) was withdrawn from the US market in 2010 because of data about its cardiac side-effects. First approved for sale as an analgesic in 1957, it soon became prone to misuse - and the authors cite that, by 1977, propoxyphene was the "second-leading agent in prescription drug-induced deaths."
The authors of the study in JAMA Internal Medicine describe the reduction in dispensing following these two pharmaceutical industry changes in 2010:
"The introduction of abuse-deterrent OxyContin and withdrawal of propoxyphene at the end of 2010 were associated with sudden, substantial and sustained decreases in prescription opioid dispensing.
The estimated decrease in opioid dispensing at 2 years would be enough to supply 5 mg of oxycodone each day of the fourth quarter of 2012 to 5% of the population."

Fall in level of morphine-equivalent amounts dispensed

The researchers analyzed the prescribing of opioids to commercial health plan members across the US to reach the estimated average level of morphine-equivalent dose (MED).
For all opioids combined, between 2003 and the third quarter of 2010, the dispensing rate rose from 95 mg to 163 mg MED per plan beneficiary.
Immediately following the interventions, the dispensing rate dropped by 14.8 mg MED per member, and a downward trend then continued to buck predictions, leading to the rate in the last quarter of 2012 being estimated at 139 mg MED per member, down from the 163 mg peak.
Against the predicted trend of opioid prescriptions, this represented a 19% decrease following the 2010 changes. Further, the estimated rate of overdose also dropped - by 20%.
The prescribing data, drawn from over 31 million insured members, were analyzed by Dr. Marc Larochelle, of the Harvard Medical School and Boston University School of Medicine, and coauthors. They conclude:
"Our results have significant implications for policymakers and health care professionals grappling with the epidemic of opioid abuse and overdose. Changes imposed through regulatory mandates or voluntary company actions may be a viable approach to stemming prescription abuse."
A note of caution is made with this call, however, to reduce opioid supply without harming access to the therapeutic benefit of painkilling treatments.
The authors also warn that interventions at the supply end do not cure the present demand problem, even though it "might decrease new-onset addiction in the future."
Alongside the opioid findings, the authors found that heroin overdose, conversely, increased by 23% in the study period. The authors note:
"Regardless of the mediating mechanism, a transition from prescription opioid to heroin abuse has been well documented and further efforts are needed to improve identification and treatment of these individuals."
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9 in 10 people with mental illness report high levels of discrimination

They may have the sun, sea, Hollywood and Disneyland, but in a new study Californians report encountering high levels of discrimination due to psychological stress.

man receiving therapy
Most respondents felt that recovery from mental illness is possible - more than 70% said they are satisfied with life - and that they would seek treatment for mental illness when needed.
Behavioral scientists at the nonprofit research organization RAND worked with the California Mental Health Services Administration (CalMHSA) to conduct the California Well-Being Survey as an attempt to research and create prevention and early intervention programs to improve the mental health of Californians.
"This new report from RAND researchers highlights both the need to confront stigma, and the opportunity to promote mental health in our state with the statewide stigma reduction efforts offered by CalMHSA," says Wayne Clark, executive director of CalMHSA.
The researchers surveyed 1,066 Californians who had previously reported mild to serious psychological distress in the California Health Interview Survey, which looked at a variety of health issues.
The authors say that the new California Well-Being Survey is the first population-based survey to look at people who are either currently experiencing mental health problems - or are at risk from them - but who may not have received treatment.

Majority of respondents believe the mentally ill face high levels of prejudice

The behavioral scientists found that just 41% of respondents believed that people are caring and sympathetic toward people with mental illnesses, while a huge 81% believed that those with mental illnesses experience high levels of prejudice and discrimination.
More than two thirds of respondents stated that they would definitely or probably hide a mental health problem they were experiencing from co-workers or classmates. More than one third also said they would disguise mental health problems from family and friends.
Nearly 9 in 10 of those who reported having had a mental health problem said they experienced discrimination as a result of it - most often in intimate social relationships, but also in high levels at school or work. Health care providers and law enforcement officials were also alleged to behave in a discriminatory way by the study respondents.
However, despite reporting high levels of discrimination, more than 80% of participants in the survey said they have plans in place for them to stay or become well and continue to meet personal goals.
Overall, most participants felt that recovery from mental illness is possible - more than 70% said they are satisfied with life - and that they would seek treatment for mental illness when it is needed.
One third of people in the survey said that during the previous 12 months they had been reached by CalMHSA's early intervention efforts, and 90% reported engaging with other activities related to CalMHSA campaigns during the past year.
"This survey shows that CalMHSA's partnership of California's counties is successfully reaching the population most at risk for mental health challenges to increase support and encourage help-seeking," Clark says.
RAND's Eunice Wong, lead author of the report, says that although Californians facing a mental health challenge are displaying resilience in their own attitudes to mental health, stigma remains:
"While California residents facing mental health challenges are finding ways to cope and maintain important aspects of well-being, they are substantially burdened by self-stigma and discrimination, which may significantly undermine recovery. Our overall findings show a clear need for stigma and discrimination reduction efforts in California."
The study is part of RAND's evaluation of mental health initiatives funded by California's Proposition 63 - a tax on millionaires residing in The Golden State - that are designed to reduce stigma and discrimination around mental illness and prevent suicides.
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Scientists 'incredibly excited' by asthma treatment breakthrough

A breakthrough study has uncovered a potential root cause of asthma and a drug that reversed symptoms in lab tests. The finding brings hope to the 300 million asthma sufferers worldwide who are plagued by debilitating bouts of coughing, wheezing, shortness of breath and tightness in the chest.

little girl using inhaler
While the breakthrough will be welcomed by all asthma sufferers, it will particularly excite the 1 in 12 patients who do not respond to current treatments.
The study - led by Cardiff University in the UK - reveals for the first time that the calcium-sensing receptor (CaSR) plays a key role in causing the airway disease.
The team used human airway tissue from asthmatic and nonasthmatic people and lab mice with asthma to reach their findings.
In the journal Science Translational Medicine, they describe how manipulating CaSR with an existing class of drugs known as calcilytics reversed all symptoms.
Calcilytics block the calcium-sensing receptor and were originally developed for the treatment of osteoporosis - a condition that makes bones more likely to break - also referred to as "brittle bone disease."
One of the crucial study results is that the symptoms the drug reversed include airway narrowing, airway twitchiness and inflammation - all of which make breathing more difficult.
Daniela Riccardi, principal investigator and a professor in Cardiff's School of Biosciences, describes their findings as "incredibly exciting," because for the first time they have linked airway inflammation - which can be triggered for example by cigarette smoke and car fumes - with airway twitchiness. She adds:
"Our paper shows how these triggers release chemicals that activate CaSR in airway tissue and drive asthma symptoms like airway twitchiness, inflammation, and narrowing. Using calcilytics, nebulized directly into the lungs, we show that it is possible to deactivate CaSR and prevent all of these symptoms."
While the finding is likely to be welcomed by all asthma sufferers, it will particularly excite the 1 in 12 patients who do not respond to current treatments and who account for around 90% of health care costs associated with the disease.

Could be treating asthma patients in 5 years - huge implications for other airway diseases

Calcilytics were first developed about 15 years ago for the treatment of osteoporosis, but while they proved safe and well tolerated in trials, results have been disappointing in patients with osteoporosis.
However, the fact they have already been developed and tested gives researchers the unique opportunity to repurpose them and hugely reduce the time it usually takes to bring a new drug to market.
Once funding is secured, the team hopes to be testing the drugs on humans within the next 2 years. Prof. Riccardi concludes:
"If we can prove that calcilytics are safe when administered directly to the lung in people, then in 5 years we could be in a position to treat patients and potentially stop asthma from happening in the first place."
The researchers believe their findings about the role of CaSR in airway tissue could have important implications for other respiratory conditions such as chronic obstructive pulmonary disease (COPD), chronic bronchitis. There are currently no cure for these diseases, which predictions suggest will be the third biggest killers worldwide by 2020.
In the following video, Prof. Riccardi and colleagues talk about their findings and a patient with asthma describes her excitement about the potential implications.
Asthma UK, the Cardiff Partnership Fund and the Biotechnology and Biological Sciences Research Council (BBSRC) helped finance the study.
Last month, Medical News Today learned of another important study that uncovered new clues about overproduction of mucus in asthma and COPD in the behavior of ion channels - membrane-sited proteins that help regulate the flow of charged particles in and out of cells.
The researchers, from Washington University School of Medicine in St. Louis, believe their findings will lead to treatments for a range of diseases including asthma, COPD, cystic fibrosis and even certain cancers.
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Eating yogurt regularly does not improve health, quality of life

Yogurt is frequently lauded for its healthful properties, but a new study investigating the effects of regular yogurt consumption has suggested that it does not lead to improvements in health.

Two portions of yogurt with assorted berries.
Regular yogurt consumption has been associated with reduced risk of hypertension, cardiovascular disease and type 2 diabetes.
The study, published in the Journal of the Academy of Nutrition and Dietetics, followed 4,445 Spanish adults, analyzing the relationship between the participants' health-related quality of life and yogurt consumption for an average of 3.5 years.
"The regular consumption of yogurt was not linked to health-related quality of life," states lead author Esther López-García, of the Autonomous University of Madrid. "For future research more specific instruments must be used which may increase the probability of finding a potential benefit of this food."
Health-related quality of life is a concept that encompasses "aspects of overall quality of life that can be clearly shown to affect health - either physical or mental," as defined by the the Centers for Disease Control and Prevention (CDC). For individuals, this can involve health conditions and risks as well as socioeconomic support and status.
In Spain, where the study was conducted, the main dietary guidelines support the consumption of dairy products such as yogurt as part of a healthy, balanced diet, just as they do in many other countries.
"This is because the majority of studies have focused on the effect as a whole, but it would be interesting to evaluate the independent association between each type of product and global health indicators," suggests López-García.
Several experts have previously suggested that yogurt could influence health-related quality of life due to its high calcium content - vital for protecting the bones against debilitating disease. Other research has associated yogurt consumption with direct health benefits, such as a lower risk of type 2 diabetes.

No significant improvements in health-related quality of life for regular yogurt eaters

For the study, the researchers recruited 4,445 participants between 2008-2010 aged 18 and over. The routine yogurt consumption of the participants was recorded at the start of the study along with a validated diet history.
The health-related quality of life for the participants was then measured using surveys up until 2012, giving an average follow-up period of 3.5 years.
"In comparison with people that did not eat yogurt, those who ate this dairy product regularly did not display any significant improvement in their score on the physical component of quality of life, and although there was a slight improvement mentally, this was not statistically significant," states López-García.
Specifically, participants that consumed six or fewer servings of yogurt a week reported similar physical health survey scores compared with participants that consumed at least one serving every day. These results were similar among participants that had no diagnosed illnesses, never smoked or followed the Mediterranean diet.
Unfortunately, the researchers only assessed yogurt consumption at the start of the study. Individual levels of yogurt consumption may have changed during the follow-up period. Additionally, the researchers did not track the consumption of other food items that may have influenced their findings.
The findings of the study could be used to help evaluate any claims from the dairy industry concerning the healthful properties of yogurt. The US Department of Agriculture, for example, must review any such claims put forward by the food industry in order to allow or reject their commercial use.
Last month, Medical News Today reported on a study that set out to investigate whether there was any truth behind the proverbial claim that "an apple a day keeps the doctor away." Although regular apple consumption did not reduce the use of health care services, it did reduce reliance on prescription medications.
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Mindfulness and antidepressants offer 'similar level of protection' against depression

Mindfulness-based cognitive therapy offers a similar level of protection against relapses of depression to antidepressants, according to the results of a new trial published in The Lancet.

people in group therapy
Mindfulness-based cognitive therapy works by teaching people the skills to identify and respond constructively to thoughts and feelings linked with depression.
"Depression is a recurrent disorder. Without ongoing treatment, as many as 4 out of 5 people with depression relapse at some point," says lead author Willem Kuyken, professor of clinical psychology at the University of Oxford in the UK.
Antidepressants are currently the key maintenance treatment for preventing relapse - studies report that antidepressants reduce the likelihood of relapse by up to two thirds when taken correctly.
"However," says study co-author Prof. Richard Byng, from the Plymouth University Peninsula Schools of Medicine and Dentistry in the UK, "there are many people who, for a number of different reasons, are unable to keep on a course of medication for depression. Moreover, many people do not wish to remain on medication for indefinite periods, or cannot tolerate its side effects."
Mindfulness-based cognitive therapy (MBCT) works by teaching people who have experienced depression the skills to identify thoughts and feelings linked with depression when they encounter them. By responding constructively to these depressive thoughts, a full relapse may be avoided.
The UK-based researchers recruited 424 adults for their study who had recurrent major depression and were taking antidepressants. The participants were randomly assigned to either stay on their medication or to slowly come off their antidepressants and receive MBCT.
The 212 participants in the MBCT group attended eight group sessions that lasted for 2.5 hours each, which also involved daily homework exercises. These participants were also given the option of attending four follow-up sessions over a year-long period.

Similar outcomes reported for both groups over 2-year follow-up

The Structured Clinical Interview for DSM-IV psychiatric diagnostic interview tool was used to assess all trial participants at regular intervals over a follow-up period of 2 years.
The researchers found that 44% of the MBCT group participants and 47% of the participants on antidepressant medication relapsed over the 2-year follow-up period.
Five adverse events - including two deaths - were reported across both groups but were not considered to be related to either the interventions or the study.
Prof. Kyuken says of the study's results:
"Whilst this study doesn't show that mindfulness-based cognitive therapy works any better than maintenance antidepressant medication in reducing the rate of relapse in depression, we believe these results suggest a new choice for the millions of people with recurrent depression on repeat prescriptions."
The authors report that theirs is the largest trial of any mindfulness-based approach to date, and that the study's validity was demonstrated through high rates of treatment adherence among both intervention groups and a relatively long follow-up.
One limitation of the study was that the recruitment strategy consisted of inviting patients who were already taking maintenance antidepressants rather than recruiting patients who were discussing their options for preventing relapse with their doctor.
In a linked comment, Prof. Roger Mulder, from the University of Otago in New Zealand, writes that as MBCT is a group treatment it may also reduce treatment costs and the number of trained staff needed:
"We therefore have a promising new treatment that is reasonably cost effective and applicable to the large group of patients with recurrent depression."
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'Sugar and carbs are the obesity culprits, not lack of exercise'

Bad wing controversial questions about this established health risk. The article published in a journal from The BMJ says the problem "cannot be outrun by exercise."

woman at gym drinking juice
Commercial messages that say sugar and carbs are OK as long as you exercise are not true, say the authors.
Even the exercise done by athletes cannot counter a bad diet, say the authors, who cite evidence that while obesity has rocketed in the past 30 years, "there has been little change in physical activity levels in the western population."
Excess sugar and carbohydrates, not physical inactivity, are to blame for the obesity epidemic, says the editorial.
The review, which aims to lead the opinion of sports medicine researchers and clinicians, is written by Dr. Aseem Malhotra, a UK cardiologist and consultant to the Academy of Medical Royal Colleges in London, with Prof. Tim Noakes of the Sports Science Institute of South Africa in Cape Town, and Dr. Stephen Phinney, professor emeritus of medicine at the University of California Davis.
The healthy choice of regular physical activity is not dismissed, however, because while these experts claim it "does not promote weight loss," evidence shows that it "reduces the risk of developing cardiovascular disease, type 2 diabetes, dementia and some cancers by at least 30%."
But poor diet is a bigger risk - it "generates more disease than physical inactivity, alcohol and smoking combined." The authors support this claim with information about the global burden of disease published by The Lancet.
The editorial, published in the British Journal of Sports Medicine, continues by citing a 2013 review of the medical literature for metabolic syndrome, which asks why children are developing this cluster of cardiovascular risk factors.
That article, first-authored by Dr. Ram Weiss, a pediatrician at the Hadassah Hebrew University School of Medicine, Jerusalem, Israel, concludes that while obesity contributes to the syndrome, it is "unlikely" to be an "initiating factor."
And the present authors cite that "up to 40% of those with a normal body mass index will harbor metabolic abnormalities typically associated with obesity, which include hypertension, dyslipidemia, nonalcoholic fatty liver disease and cardiovascular disease."
Malhotra, Noakes and Phinney - who are well-known for their opinions on diet, exercise and health, having published widely through popular books and the media - add about the phenomenon in normal-weight people:
"This is little appreciated by scientists, doctors, media writers and policymakers, despite the extensive scientific literature on the vulnerability of all ages and all sizes to lifestyle-related diseases."

Food and beverage industry 'lies'

The concluding remark of the editorial reads: "It is time to wind back the harms caused by the junk food industry's public relations machinery."
As an industry example of providing "misleading" information, the authors say that Coca-Cola spent 3.3 billion US dollars on advertising in 2013, and that the company "pushes a message that 'all calories count;' they associate their products with sport, suggesting it is OK to consume their drinks as long as you exercise."
"However, science tells us this is misleading and wrong," says the article, adding:
"It is where the calories come from that is crucial. Sugar calories promote fat storage and hunger. Fat calories induce fullness or 'satiation.'"
The authors further lambast the food industry by blaming it for creating a public perception that "obesity is entirely due to lack of exercise."
Malhotra, Noakes and Phinney argue: "This false perception is rooted in the food industry's public relations machinery, which uses tactics chillingly similar to those of big tobacco."
In March, we looked at a report that similarly alleged the sugar industry "behaved like tobacco manufacturers" when it came to taking action against tooth decay.
The BMJ, the lead journal of the group publishing the present opinion piece, is positioned against commercial bias in health issues, and in February published its own investigations against the sugar industry, publishing claims that companies have attempted to influence public health policy.
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Raising awareness of the myths of autism spectrum disorder

April is National Autism Awareness Month in the US. While the cause of this disorder remains unknown, increasing general awareness can lead to earlier diagnoses, more effective interventions and improved access to services and support for individuals affected by the condition.

Girl holding up an autism sign.
Despite prevalence increasing in recent years, a number of myths and misconceptions still exist concerning ASD.
According to the Centers for Disease Control and Prevention's (CDC) Autism and Developmental Disabilities Monitoring Network, approximately 1 in 68 children have been identified with autism spectrum disorder (ASD). The disorder occurs in all ethnic, racial and socioeconomic groups.
The prevalence of ASD also appears to have increased over the past decade. The CDC report that in 2000, the disorder was identified in 1 in 150 children.
ASD is a developmental disability characterized by a certain set of behaviors often relating to how individuals communicate and interact with others. ASD is also a wide-spectrum disorder, meaning that no two people with autism will have exactly the same symptoms.
Despite a wide prevalence, however, many myths and misconceptions have arisen concerning the disorder. These misunderstandings can have unfortunate implications for both research into the disorder and people with ASD themselves.
In this Spotlight feature, we will take a look at some of the most common myths about ASD along with the actual facts. Increasing awareness of the myths of ASD can hopefully lead to improved health outcomes.

Myth no. 1: all people with ASD have a 'special gift'

In 1988, the film Rain Man was released, featuring a protagonist with ASD who had savant skills - incredible capabilities beyond the capacity of most other people. The character frequently demonstrates an exceptional ability to calculate and remember numbers.
Perhaps thanks to this well-known portrayal of ASD - Rain Man won an Academy Award for Best Film - many people believe that all people with ASD have similar savant skills to the character in the film.
According to research conducted by the National Autistic Society (NAS) in the UK, 39% of people surveyed believed that most people with ASD have special abilities. In reality, it is estimated that just 1 in 200 people with ASD have savant skills.
While it may be true that some people with ASD do have impressive capacities for working with numbers, music or retaining knowledge, many individuals do not.
Nerdy girl doing math.
In a survey conducted in the UK, 39% of participants believed that most people with ASD have special abilities.
The key fact that this myth does not account for is that ASD is a wide-spectrum disorder. Most individuals will experience completely different symptoms to others whose condition falls under the umbrella of ASD.
Although the character in Rain Man was based on a real person, he remains just a single example of ASD. "That's an extreme example," Dr. Michael Rosenthal, a pediatric neuropsychologist from the Child Mind Institute in New York City, told Parents. "Not every person on the spectrum will have a special talent like that."
While this myth cultivates a narrow perception of what ASD entails, it can also also be used as a way of debunking another common misconception about the condition: that people with ASD cannot fully integrate with and contribute to society.
The myth turns attention away from the negative perceptions of ASD and toward a more positive view. In recent years, there have been many examples of companies specifically seeking to recruit people with ASD to work for them.
In 2013, for example, the German software company SAP AG announced they were seeking to hire people with ASD as software testers, programmers and data quality assurance specialists, stating that they wanted people who "spark innovation" and "think differently."
"For so long, we've only thought of autism in terms of its deficits, but the tide is changing," says Dr. Rosenthal. "Many kids are great at math, science and technology - but they can also be great artists or musicians. We're just beginning to understand their potential."
Although an ASD diagnosis does not mean that an individual will have savant skills, it also does not mean that they are intellectually disabled or unable to have successful lives as contributing members of society.

Myth no. 2: the origins of ASD

Medical News Today asked John Rodakis, the founder of the N of One: Autism Research Foundation, what he believed the biggest myth surrounding ASD was. He told us it is that autism is primarily a genetically driven, hard-wired condition:
"The conventional view is that genes drive abnormal brain wiring, and abnormal brain wiring leads to the autistic behaviors. While there may be genetic predispositions to autism, the emerging view from the latest research is of autism as more of a syndrome that involves genes, metabolism, the immune system and the microbiome."
Many people also hold that ASD is a behavioral, emotional or mental health disorder. However, ASD should be classified as a developmental disability and neurobiological disorder.
Rodakis correctly points out that there may be genetic predispositions to ASD. The CDC report that among identical twins, if one child has ASD, the other will be affected 36-95% of the time, compared with 0-31% of the time for nonidentical twins. Parents who have one child with ASD have a 2-18% likelihood of having a second child with the condition.
ASD is also more prevalent among people with certain genetic conditions such as Down syndrome and fragile X syndrome. However, many studies are choosing to focus on the microbiome - the collection of micro-organisms that live inside and on the body - and its association with ASD.
Rodakis was prompted to investigate these connections himself following the surprising improvements in his son's autism while taking the antibiotic amoxicillin for strep throat. These improvements occurred within just 4 days of commencing the treatment.
Elsewhere, MNT recently reported on a study published in JAMA Psychiatry in which gastrointestinal (GI) symptoms such as constipation and food intolerance were reported more common and more frequently persistent in young children with ASD than in children with "typical" development or developmental delay.
The belief that ASD is a hard-wired condition can have a negative impact on what research gets done and the urgency with which it is pursued, Rodakis said. "If one's view is that autism is fundamentally a hard-wired condition, as most governmentally-sponsored research does, then one could take the view that we must accept the status quo."
"However, if one's perspective is of autism as more of a syndrome, then there is reason to believe that we can meaningfully improve the quality of life for those with severe autism," he suggested, "and like any treatable condition, we should have great urgency to do that."
At present, as stated earlier, experts have yet to work out precisely what causes ASD.

Myth no. 3: people with ASD do not feel love, emotions or have feelings

A common myth that can have a far-reaching negative impact upon people with ASD is that people with the disorder are incapable of experiencing emotions, having feelings or a capacity to love.
This myth likely stems from many examples of behavior that are associated with ASD, including the following:
A woman alone in a theater.
In one survey of young people with autism, 22% of respondents reported having no friends at all.
  • Difficulty making eye contact
  • Difficulty instinctively empathizing with others
  • Resistance to physical contact
  • Difficulty starting or maintaining a conversation
  • Difficulty expressing emotions or feelings.
Although these social difficulties can all be experienced by people with ASD, they are not necessarily experienced by every individual. Those that do experience these difficulties will also experience them by different degrees of severity.
Dr. Rosenthal states that in his experience, many children with ASD have a strong desire to make friends with people but find it difficult due to not having the necessary social skills. "They don't know what to do when a kid says 'hi' to them or wants to play a different game from the one they are interested in," he says. "They respond awkwardly."
As children with ASD grow up and become adults with ASD, these difficulties can persist and could make individuals even more isolated. "Over time, these kids stop seeking out other kids because they're failing to make those connections and it doesn't feel good," explains Dr. Rosenthal. "That's why this is such an important myth for people to understand."
The NAS state that many people with ASD feel emotions intensely and can become overwhelmed by the emotions of others around them. In addition, while ASD can make forming relationships difficult, some people with ASD have happy and successful relationships.
Sadly, a survey of young people with ASD conducted by the NAS in 2012 found 22% of participants reported having no friends at all. Further to this, 65% of participants stated that they would like to have more friends.
Early diagnosis and intervention could improve the chances of people with ASD to make friends and build relationships by helping them develop self-confidence and improving their understanding of others.
Johns Hopkins School of Education state that children and adults with ASD can learn important social skills from individualized and specialized instruction and training that they might not otherwise pick up.

Myth no. 4: there is a cure for autism

Just as experts do not yet know precisely what causes autism, neither do they know what can cure the disorder. Unfortunately, many people are unaware that this is the case; NAS research found that only 39% of people surveyed were aware that there is no cure at present.
"There are no medications that can cure ASD or treat the core symptoms," state the CDC. "However, there are medications that can help some people with ASD function better. For example, medication might help manage high energy levels, inability to focus, depression or seizures."
Some behavioral-based programs may proclaim to "cure" ASD if delivered at a certain age, and while these may have some positive effects on some children with ASD, these need to be carefully individualized to the child as all children with ASD will have their own needs and learning styles.
Similarly, a number of specialist diets have been promoted as potential cures for autism, but these have yet to be supported by strong evidence.
"A lot of parents use these treatments because they're worried and desperate," says Parents advisor Dr. Fred Volkmar, director of the Child Study Center at Yale University School of Medicine. "But we know that the placebo effect can be very pronounced in autism, so it's very hard to sort out whether you're really seeing an improvement or why."
Due to the lack of a cure for ASD at present, it is vitally important that awareness of ASD is raised and that any misconceptions are successfully dealt with. The right help and support can greatly improve the lives of people with ASD, and this can only be possible if as many people are aware of the facts as possible.
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