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Friday, March 29, 2013

Energy drinks: Facts behind this Fad

ENERGY DRINKS are supposed to do just what the name implies -- give you an extra burst of energy. The most popular amongst them RED BULL. They have been drawing attention recently for their potential health threat.

First lets differentiate these so called energy drinks from the other commonly used drinks.
Soft drinks are mainly water, sugar and flavoring. They don't do anything for your body; they're just supposed to taste good.
Sports drinks are designed to replenish fluids lost during activity. They typically contain water, electrolytes and sugar.
Energy drinks have added caffeine and other ingredients that their manufacturers say increase stamina and "boost" performance. They're designed for students, athletes and anyone else who wants an extra energy kick.

As it turns out, most of that "energy" comes from two main ingredients: sugar and caffeine. A typical energy drink can contain up to 80 milligrams of caffeine (about the same amount as a cup of coffee).

Energy drinks became popular in Asia long before they reached the United States.
An Austrian businessman named Dietrich Mateschitz picked up on the cash potential of energy drinks while on a business trip to Asia. Along with two Thai business partners, Mateschitz started the company Red Bull GmbH, with the idea of marketing the drink to young Europeans.
Red Bull began distributing its drink in the United States in 1997. Although Red Bull has consistently been the leader in the energy drink market, several other companies have launched their own energy drink lines. Many of them are endorsed by celebrities.

Here are some of the other ingredients you may find in popular energy drinks:

  • Taurine - Taurine is an ingredient in most energy drinks. Scientists first discovered taurine in ox bile in 1827. The name "taurine" actually references "taurus", Latin for "bull" or "ox". Urban legends have suggested that the taurine in Red Bull comes from bull semen and bull urine. While it's true that taurine could be extracted from those sources, the taurine used in Red Bull and other energy drinks is synthetically produced. Its a natural amino acid produced by the body that helps regulate heart beat and muscle contractions.
  • Ginseng
  • B-vitamins
  • Guarana seed
  • Carnitine
  • Creatine
  • Inositol
  • Ginkgo biloba
  • Glucuronolactone

Energy drinks are generally safe, but like most things, you should drink them in moderation. Because caffeine is a stimulant -- consuming a lot of it can lead to heart palpitations, anxiety and insomnia -- it also can make you feel jittery and irritable. Over time, caffeine can become addictive. It is also a diuretic -- it causes the kidneys to remove extra fluid into the urine. That leaves less fluid in the body. so drinking an energy drink while you're exercising can be particularly dangerous. The combination of the diuretic effect and sweating can severely dehydrate you.
Many people mix energy drinks with vodka or other alcohol to make a high-energy cocktail. One study found that men who combined energy drinks with alcohol felt alert and sober, even though they were actually drunk. And since both alcohol and energy drinks dehydrate you, when combined they can cause your body's fluids to drop to dangerous levels.


Red Bull may be the best selling energy drink in the United States, but it isn't so popular in other countries. In 2000, the French government decided to ban Red Bull after the brand was linked to the death of an 18-year-old Irish athlete. The teenager died after drinking four cans of Red Bull at a game. French laws dictate the maximum amount of caffeine that companies can add to products, and Red Bull exceeds that limit. Denmark and Norway have also banned the drink. Other countries, such as Canada, require the can to carry a warning label for pregnant women and children.

In the past eight years, Red Bull products have appeared in 21 of the United States Food and Drug Administration’s reports about adverse health events. The FDA said it will consider asking companies to disclose the amount of caffeine in food products, as well as imposing limitations on the products' use and warnings about possible side effects. That comes in the wake of an investigation into five deaths that could be linked with Monster Beverage's energy drinks, and 13 deaths that could be tied to 5-Hour Energy, the popular energy shots.

According to a latest meta-analysis, these Energy Drinks may temporarily Increase Systolic Blood Pressure & QT Interval.

It would be wise to conclude on this note. Energy drinks are meant to enhance the sapping energy levels. A few health concerns apart, they are relatively safe unlike the colas. However, they do have a strong potential to be misused by Gen Next.

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Wednesday, March 20, 2013

TB Serology: A boon or BAN?

Tuberculosis (TB) remains a major global healthcare issue with around 1.7 million deaths in 2009 due to TB and rising absolute number of cases each year due to the increasing global population, the emergence of drug resistance, and the detrimental effects of HIV coinfection.

The diagnosis of active TB is traditionally made using direct identification of the bacillus by smear microscopy or subsequent culture of Mycobacterium tuberculosis (M Tb). This requires appropriate specimens to examine, and time for the bacillus to grow. This can cause considerable difficulty if the infection is non-pulmonary, or if the patient does not expectorate sputum. Thus, invasive tests like surgical biopsy or bronchoscopy may have to be resorted to. Unlike in many other infections, culture of M Tb may be prolonged or difficult, hence numerous kits for the detection of antibodies to the pathogen have been marketed, as a means for rapid identification.

Serological testing can detect various classes of antibodies to the infective pathogen in the patients' serum (IgG, IgM, IgA). These antibodies are produced in response to antigenic substances or proteins on the surface of the bacterium.

Pulmonary Tuberculosis
Interferon-gamma release assays (IGRAs) are diagnostic tools for latent tuberculosis infection (LTBI). They are surrogate markers of Mycobacterium tuberculosis infection and indicate a cellular immune response to M. tuberculosis. IGRAs cannot distinguish between latent infection and active tuberculosis (TB) disease, and should not be used for diagnosis of active TB, which is a microbiological diagnosis. Clinical evaluation and additional tests (such as a chest radiograph, sputum smear, and culture) are needed to differentiate between a diagnosis of latent TB or active TB.
A positive IGRA result may not necessarily indicate active TB, and a negative IGRA result may not rule out active TB.

Because IGRAs are not affected by Bacille Calmette-Guérin (BCG) vaccination status, IGRAs are useful for evaluation of LTBI in BCG-vaccinated individuals, particularly in settings where BCG vaccination is administered after infancy or multiple (booster) BCG vaccinations are given.

QuantiFERON GOLD or TB-Gold also known as QFT-G is an interferon-γ release assay (IGRA) used in tuberculosis diagnosis. For QFT-G, the antigens include mixtures of synthetic peptides representing two M. tuberculosis proteins, ESAT-6 and CFP-10.

Findings from several systematic reviews and an independent evaluation of rapid tests suggest that serological tests for both pulmonary and extra- pulmonary TB are inaccurate. No test performs well enough to replace smear microscopy. Currently available commercial serological TB tests appear to do more harm than good because of the harm caused to patients through false-positive or false-negative tests results. Furthermore, these tests prove to be an economic burden to the country as well.

Echoing these concerns, in a recent editorial Singh and Katoch wrote, ‘Unfortunately, unethical medical practices provided major boost to these kits in recent years, without bothering much on quality of tests and implications of false-positive and false negative results...

In July 2011, WHO issued a policy stating that commercial serological tests provide inconsistent and imprecise estimates of sensitivity and specificity. There is no evidence that existing commercial serological assays improve patient outcomes, and high proportions of false-positive and false-negative results adversely impact patient safety. Overall data quality was graded as very low, with harms/risks far outweighing any potential benefits. It is, therefore, recommended that these tests should not be used in individuals suspected of active pulmonary or extra- pulmonary TB, irrespective of their HIV status.
Immediately following the WHO policy, the RNTCP published an advisory statement against the use of TB serological tests in India. More recently, an expert committee convened by the Drug Controller General of India has recommended a ban on import and sale of TB serological tests in India and this ban has been endorsed by the Indian health ministry.

Thus, the void in the diagnostics of tuberculosis which was to be filled up by these serology tests, has still remained a void. We hope that scientific research comes up soon with more reliable aids in the diagnosis of TB.

Friday, March 15, 2013

Diabetes: A new kid on the horizon?

Adding to the not so long list of anti diabetic drugs, is a new promising group -
The SGLT2 inhibitors

Amongst the orals, we have

  • Biguanides like Metformin and Thiazolidinediones like Pioglitazone which reduce the insulin resistance.

  • Sulfonylureas like Glimepiride, Gliclazide, and Glibenclamide and Glinides like Repaglinide which act on insulin secretion.

  • Alpha Glucosidase inhibitors like Acarbose, Miglitol, and Voglibose which reduce the glucose absorption from the gastrointestinal tract.

  • DPP-4 inhibitors like Sitagliptin and Saxagliptin and GLP1 agonist like Exenatide  which act by reducing Glucagon secretion.

Now we have a new group which could potentially act via the kidneys.

The kidney plays an important role in the maintenance of glucose homeostasis by reabsorbing almost all filtered glucose via sodium-glucose cotransporters (SGLTs). The SGLT2 cotransporter is the most important of these, as it mediates 90% of renal glucose reabsorption. Its expression and activity are increased in type 2 diabetes, causing increased amounts of glucose to be reabsorbed into the systemic circulation, thereby adding to the hyperglycemia derived from other pathogenic defects. The SGLT2 cotransporter has therefore been targeted as a site for intervention in the management of hyperglycemia in type 2 diabetes.

Several SGLT2 inhibitors, including dapagliflozin, canagliflozin, empagliflozin, and ipragliflozin have been developed and are currently under investigation for efficacy and safety as treatment for type 2 diabetes.

Dapagliflozin was approved by the European Commission on November 14, 2012, and on January 10, 2013, the USFDA advisory committee recommended approval for canagliflozin as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes. These agents reduce plasma glucose concentration by inhibiting SGLT2-mediated reabsorption of filtered glucose at the proximal tubule, leading to glucosuria.

Investigational study data indicate that, in patients with early or long-standing type 2 diabetes, SGLT2 inhibitors are effective in reducing fasting plasma glucose, postprandial plasma glucose, and HbA1c, promote weight loss, and have a low risk of clinically significant hypoglycemia. Because their mechanism of action is independent of insulin, SGLT2 inhibitors complement the action of other antihyperglycemic agents, including insulin and metformin.

The only worry would be the costing of the drug. Like its predecessor, the DPP-4 inhibitor, if its priced equally high, the benefits to society at large would be equally low.

Thursday, March 14, 2013

Calcium Controversy- Part 2

In my previous post I had discussed the evidence of vascular calcification and cardiovascular deaths in males taking calcium supplements unless specifically indicated. However, the importance of these supplements in post menopausal women has always been proved beyond doubt.

Now we have emerging evidence to the contrary.

A meta analysis revealed that calcium alone did not significantly reduce the risk of fractures while calcium with vitamin D did reduce the fracture risk by 12%. Vitamin D alone also does reduce incidence of fractures.

The National Institutes of Health-AARP Diet and Health Study has given new insights.

Among women, the current study suggests a neutral effect of both dietary calcium and calcium supplements on the risk for CVD. Physicians should keep in mind, however, that vitamin D and not calcium is principally responsible for preserving bone and preventing osteoporosis among women.

Take home message:

Vitamin D at a dose of at least 800 IU/day should be the primary treatment for women at average risk for osteoporosis. Until the questions regarding the long-term safety of calcium supplements in both sexes are better understood, it is reasonable to withhold calcium among women receiving preventive treatment for bone health.